Chronic Headaches Are a Pain

Doctors’ Notes

Real stories by real family physicians

If headache pain is getting in the way of your daily activities, it’s time to see your family doctor.

by Dr. Jennifer Hanna

About the Author
Dr. Jennifer Hanna
Jennifer M. Hanna, DO, is a family physician who practices at the outpatient family medicine office and resident clinic at Ascension Macomb-Oakland Hospital in Warren, Michigan. She also teaches medical students and trains residents as a core faculty physician in the department of family medicine.

Different types of headaches have different causes and different symptoms. By examining my patients, reviewing their symptoms, and taking time to learn about their lifestyle habits, I can identify what type of headache they have. This helps me recommend ways to manage their symptoms and prevent future headaches.

Some of my patients have frequent headaches that make it hard to function in daily life. My patient Wanda (not her real name) came in for an office visit because she had been having headache and neck pain nearly every day for the past month. She said the pain would start at the back of her head and wrap around to the front. Sometimes, it hurt so much that she had to stay home from work.

Wanda said that over-the-counter (OTC) pain relievers had helped at first. But they seemed to be less effective lately. When I asked which OTC medicine she was taking, she listed the brand names of several different types of pain relievers. She was taking one or more of them multiple times per day.

I gave Wanda an exam and ruled out serious health problems that can cause headaches. It’s also very important for me to ask questions about a patient’s daily habits. I learned that Wanda works for a tech company. She spends a lot of time sitting at her desk and using a computer. She told me she often feels overwhelmed by her heavy workload and multiple deadlines. In addition to her full-time job, she takes care of her family, does volunteer work, and has a number of other responsibilities.

Next, I asked Wanda about her sleep habits. She told me she often stays up late to work and has not been getting enough sleep. To help her stay alert during the day, she typically has at least 3 cups of coffee, as well as energy drinks. Because her schedule is so busy, she eats out frequently and doesn’t exercise on a regular basis.

For most of my patients who have headache pain, I can make a diagnosis based on a physical exam and information about their health, symptoms, and lifestyle habits. Typically, it’s not necessary to do an imaging test, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).

In rare cases, I may order additional testing to help me make a diagnosis. This could include lab tests to check my patient’s blood or chemical levels, or an imaging test. These tests are not helpful in diagnosing the most common types of headaches, including migraines and tension headaches. But they might be necessary if I find something that isn’t normal during the exam, the diagnosis isn’t clear, or my patient’s headaches are unusual.

After talking to Wanda, I was able to determine that she was experiencing tension headaches. Like most patients I see for headache pain, Wanda didn’t need to any additional testing. A number of factors she described were likely triggering her tension headaches. She was inactive during the day and had a high stress level. She also was not eating or sleeping well and was consuming too much caffeine. Her overuse of different OTC pain relievers that contain similar active ingredients was probably also causing headache pain.

Together, Wanda and I created a plan to gradually lower her caffeine intake and reduce her use of OTC pain medicines. I advised her to avoid caffeine in the afternoon and evening so that she would sleep better at night. We also talked about the benefits of taking quick breaks during the day to avoid sitting for long periods. Wanda said she was willing to try preparing some of her meals ahead of time so that she didn’t eat out as often.

I explained that her headache pain probably wouldn’t resolve quickly. But, if she was patient and put in the effort, she should start to feel better. I asked her to return to my office in a few weeks for a follow-up appointment.

Four weeks later, Wanda returned to my office. She told me she had not missed any days of work in the past month. She had followed our plan and dramatically decreased her caffeine intake. Also, she was no longer taking OTC pain relievers every day. Because she wasn’t dealing with daily headaches and neck pain, Wanda had more energy overall. She had even started a walking program! Although she wasn’t feeling 100% better, she was definitely heading in the right direction.

Quick Tip

It’s important to know what triggers your headaches, especially if you have them often. Keep a headache journal to track the time and pattern of your headaches, as well as how they feel. This information can help you and your family doctor determine what’s causing your headaches and how to treat them.