AARP Smart Guide to Headache Management

AVOIDING COMMON TRIGGERS

7. Nosh if you need to

A mild headache could be a sign of hunger on its own, but “peaks and valleys” in your glucose levels can also bring on other kinds of headache, Starling says. Especially if you have a high metabolism, eating nutrient-dense snacks such as nuts, raisins or yogurt between meals can help keep your blood sugar steady, says Susan Broner, M.D., director of the Weill Cornell Medicine Headache Program and an assistant professor of clinical neurology at Weill Cornell Medicine.

8. Beware the open bar

Red wine can cause headaches in some people, while other alcoholic drinks — or, obviously, too much to drink — can have the same effect on others. If you notice that you tend to get headaches after drinking alcohol, switching to mocktails or alternating alcoholic drinks with non-alcoholic drinks or water could help.

9. Moderate your caffeine intake

Starling suggests thinking of caffeine like medicine. After all, many over-the-counter headache remedies, including Anacin, contain it. Too much caffeine can cause a headache, but a single cup of coffee when you feel a migraine or tension-type headache coming on could potentially ease your symptoms. “It’s a double-edged sword,” says Starling, who gets migraines herself. If you have a daily coffee habit, you might also experience withdrawal headaches on the mornings you go without. These are simply remedied by having your morning cup. Or, you can prevent them by gradually cutting back.

10. Know your daily meds

Some drugs — including those that are used to lower blood pressure — can cause headaches as a side effect. And if you take more than one daily medication, an interaction between two or more could also cause trouble. “One piece of advice I give everybody who comes to me is, assemble all of your medications and doses,” Levin says. “Then we’ll have a look and see if there’s something there that can be adjusted.”

11. Watch the weather

Changes in temperature or barometric pressure, especially related to storms, can kick off mild or severe headaches, research shows. Knowing the forecast can help you take steps to lower your risk. When Starling hears there’s a big change coming, she says, “I start taking better care of myself. I make sure I hydrate, I eat really consistently and get good sleep.”

12. Keep a diary

Documenting your headaches, including when they occur, what they feel like and what led up to them, can help you — or your doctor — identify triggers to avoid. Did you eat something unusual? Where on your head does it hurt? What, if anything, helps relieve the pain? Keeping track of such details can reveal patterns that point to the source of the problem.

HANDLING UNDERLYING CONDITIONS

13. Treat sleep apnea

If you get headaches in the morning and have symptoms of sleep apnea, such as loud snoring or daytime drowsiness, ask your primary care physician whether you should get tested. Your doc may refer you to a specialist to be evaluated — and prescribed a CPAP machine or other treatment, if necessary. Although neurologists are still not sure of the mechanism, they know that treating sleep apnea may reduce headaches, according to the Journal of Headache and Pain.

14. Address neck issues

Neck pain caused by a pinched nerve, a slipped disk, arthritis or other common conditions can lead to cervicogenic headaches — throbbing, often one-sided head pain. The good news is that exercises to stretch and strengthen the neck may help. “Everybody’s neck is different, so you might want to see a specialist to learn the exercise you need,” says Hsinlin Thomas Cheng, M.D., director of the headache and neuropathic pain unit at Massachusetts General Hospital and an assistant professor of neurology at Harvard Medical School. Changes in daily posture can also help reduce these headaches, Levin adds. If you ride a bike, for example, he recommends extending the stem to avoid being too hunched over.

15. Cushion tooth grinding

“If your brain clenches your jaw all night long when you sleep, you’re going to wake up in the morning with a lot of neck issues,” says Cheng — and that means a potential for cervicogenic headaches. Your dentist can tell you whether your teeth show signs of nocturnal clenching or grinding, also called bruxism. If they do, a custom-made mouth guard to wear at night might reduce your pain.

16. Keep your sinuses clear

Painful pounding around the eyes, especially when accompanied by a stuffy nose or a cough, could indicate sinus inflammation. Treating this inflammation with decongestants might eliminate your headache. It isn’t always easy to distinguish between sinus headache and migraine, though, so if over-the-counter decongestants don’t help, talk to your primary care doc about next steps — whether that means an antibiotic for sinus infection or a referral to a headache specialist.

17. Root out root causes

As you age, your risk of getting secondary headaches — that is, headaches that are symptoms of other disorders — increases. While not all causes of secondary headaches are serious, some are: brain lesions, cerebrovascular disease and metabolic disorders can all cause secondary headaches. Symptoms to watch out for include these:

• A progressive headache that gets worse day after day;
• A headache triggered by coughing, sneezing or exercising;
• A headache that’s worse when you’re lying down than standing up, or vice versa; or
• A headache accompanied by swelling of the eye.

If you develop any unfamiliar kind of headache after the age of 50, even a mild one, you should consult a doctor, especially if you’re immunocompromised, Broner says. “If people have previous headaches, but they start to become more frequent, they change, or they are accompanied by new symptoms, that needs to be evaluated too,” she adds. Bear in mind that it’s possible to have more than one kind of headache at a time.

WHEN A HEADACHE HITS

18. Take deep breaths

Sometimes, something as simple as controlling your own breathing can help mitigate a headache. “Practicing relaxation techniques and mindfulness can actually treat the individual attack,” Starling says. She recommends box breathing: inhale deeply for a count of four, hold for a count of four, and exhale slowly for a count of four. This can help engage your “rest and digest” (parasympathetic) nervous system and disengage your “fight or flight” (sympathetic) nervous system. Biofeedback — a therapy where you learn to control body processes such as heart rate — can also help. If you don’t know where to start, Starling says, you can try meditation apps like Headspace, Calm or Juva.

19. Quiet the noise

Dimming the lights and turning down the radio and other sounds can help make a headache, especially a migraine, go away more quickly, Levin says. “When you’re in the midst of a migraine, there’s a very heightened sensitivity to all sensations: visual, hearing, noise, smell, movement,” he explains. “It’s almost like with a thermostat or the volume on TV. It gets turned up somewhere in the brain.”

20. Get the right painkiller

There are plenty of over-the-counter medications that can help with headaches, Starling says. Ibuprofen and naproxen are especially good options for migraine attacks, while acetaminophen and Excedrin — a mix of acetaminophen, aspirin and caffeine — may help more with non-migraine headaches. But if you take such drugs more than twice a week, you could be contributing to your own headaches by triggering a rebound. In that case, your doctor has other options, including triptan medications, which activate serotonin receptors; CGRP antagonists (or “gepants”), which block the action of a protein that can trigger migraines; neuromodulation, a therapy designed to modify the way your nerves carry information to and from the brain; or Botox injections.

21. Stay alert to signs of infection

An unexplained headache combined with a fever or chills could indicate a serious infection. If you have these symptoms, see a doctor as soon as possible, Levin says, whether at urgent care or at the emergency room.

22. Protect your brain at all costs

Some headaches are red flags that could indicate a life-threatening emergency. These include:

• A headache combined with neurological symptoms such as numbness, weakness, vision problems, speech problems, lethargy or confusion, any of which could indicate a stroke;
• A headache that develops after you’ve hit your head and is accompanied by neck stiffness, nausea, vomiting, drowsiness or vision impairment, which are potential signs of a brain bleed; or
• A sudden, intense “thunderclap” headache, which could be caused by an aneurysm.

If you have a new headache accompanied by any concerning symptoms, don’t wait to see whether they resolve. Call an ambulance or head to the ER as soon as possible.