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Though headaches may be common, they should not be ignored or dismissed. Headaches sometimes signal more dangerous conditions — including some, such as a stroke, that must be addressed immediately. They can also be a symptom of covid-19, appearing in about a third of diagnosed patients in the United States. And even though most headaches do not require medical attention, there’s no need to just grit your teeth and get through it.
Here is expert advice that can help you prevent and treat headaches more effectively and more safely.
There are about 200 types of headaches, says Juliette Preston, assistant professor of neurology at the OHSU School of Medicine and medical director of the university’s headache center.
Two of the most common types are tension and migraine. Most tension headaches are mild to moderate, usually with pain on both sides of the head, and without any other major symptoms. According to an Italian study published in 2008, about a third of older adults experience at least one over the course of a year.
Migraines, on the other hand, generally involve moderate to severe head pain as well as an array of other symptoms, such as sensitivity to light or sound, nausea and temporary problems with cognition, says Niushen Zhang, a clinical assistant professor of neurology at Stanford University. Migraines can occur in men and women but are more frequent in women, often worsening during menopause and subsiding soon after.
If, however, you’re 50 and older and experience what seems like your very first migraine, the probability that it is truly a migraine is relatively low. There may be another condition at work.
Similar symptoms can also point to what’s known as a hypnic headache, which is rare but occurs most often in older adults. Its defining symptom? It wakes people from sleep at around the same time each night, which is why it’s known as the “alarm clock headache.”
Preventing frequent aches
Hypnic headaches are generally easier to manage than migraines. A little bit of caffeine before bed — about 40 to 60 mg in a tablet, or about a half-cup of brewed coffee — usually prevents them without keeping people up at night, Preston says. But don’t try this without talking to your doctor first. Just be sure to mention the time of your headaches so that they are not mistaken for migraines.
Even for migraines and recurring tension headaches, however, don’t reach for the meds right away. There is evidence that lifestyle changes can help prevent headaches, especially migraines. “Twenty minutes a day of aerobic exercise actually decreases migraine frequency and severity,” Zhang says.
For many headache types, keeping consistent mealtimes, bedtimes and wake times can help, as can making sure you’re staying hydrated by drinking plenty of water. For migraines, a neurologist can also help you identify possible triggers, such as dehydration.
In one classic study of people who experience migraines, most subjects reported at least one external factor that seemed to trigger their head pain. The most common triggers were stress, hormonal changes, fasting, weather and sleep disturbances.
In the past, trying to avoid all potential triggers was a popular strategy. But newer research suggests that many triggers can be hard to identify and impossible to avoid. And other studies have suggested that simply adhering to a healthy lifestyle — which would naturally include avoiding things such as toxic odors, hunger, dehydration, lack of sleep, etc. — may actually be more effective than trying to avoid all potential triggers, such as stress and noise.
Your doctor can also help connect you with other treatment options if basic interventions are not helping. For instance, there is strong evidence that physical therapy can help prevent tension-type headaches from returning. Acupuncture may help prevent frequent headaches, Zhang says. And research has also suggested that biofeedback — which typically uses electrical sensors on your body to make you aware of and help you control physiological processes — may reduce chronic pain, including from headaches.
Serious stress can also cause recurrent headaches. In those cases, cognitive behavioral therapy, or CBT, can help as well. Ask your doctor for a referral to a therapist who practices it.
Using meds properly
You should take medications with caution, especially if you get headaches regularly. But over-the-counter (OTC) or prescription medications can help ease the discomfort of both tension and migraine headaches.
Older adults are more sensitive to the effects of medications, Preston says. For pain relievers such as ibuprofen (Advil and generic), naproxen (Aleve and generic) and aspirin, side effects can include dizziness, cognitive issues and increased risk of gastrointestinal bleeding. So you should keep your use to a minimum. Acetaminophen (Tylenol and generic) is potentially safer for older adults but also may be somewhat less effective for headaches, according to UpToDate, a tool for doctors.
Be sure to follow dosing directions on the package. But if you are taking OTC pain meds regularly, that’s not enough: You should also check with your primary care doctor and consider setting up an appointment with a neurologist to discuss your intake of these meds in more depth. In general, Zhang says, to protect yourself from what’s known as a medication overuse headache, avoid taking pain relievers such as ibuprofen and naproxen more than 15 days per month. For some medications, however, you’ll need to keep that number far lower, she cautions, which is why checking with your provider is important.
For people who get consistent headaches and can’t tolerate OTC meds, doctors may also consider certain prescription pills, Preston says.
When to get emergency help
Occasionally, a headache requires immediate attention. When someone 50 and older experiences a type of headache that is different from one they have had before — even when it’s a dull pain rather than explosive — that “is usually a red flag to us,” Preston says.
And if it is accompanied by a change in hearing, prompts a feeling of weakness or numbness, or gets worse when you change positions — say, when you lie flat, stand up, exert yourself, or bear down — that’s a sign to visit the emergency room.
“If it feels different, if it just doesn’t feel right,” trust your own judgment, Zhang says.
A doctor will try to rule out the most severe conditions that could be causing an odd-feeling headache, including aneurysm, stroke and other blood-vessel abnormalities; tumor; and an inflammatory disorder called giant cell arteritis, among other concerns.
But while it’s important to be cautious, keep in mind that a new headache is sometimes just that: a headache.
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