Headaches are extraordinarily common, number seven on the list of reasons why people see their doctor. It is estimated that 45 million people suffer from chronic head pain. That doesn’t begin to include those who have occasional headaches. Yet for all that, the exact causes of head pain are not all that clear.

According to Joel Saper, MD, director of the Michigan Head Pain and Neurological Institute, the brain itself doesn’t feel pain. That’s why neurosurgeons can operate on the brain tissue while a patient is wide awake. So, a headache isn’t exactly the result of pain in the brain. We perceive head pain that may originate from the scalp, the skull, or the coverings of the brain. Muscles and nerves in the neck can also create discomfort that is perceived as a headache.

An occasional mild headache does not usually pose a serious problem. But a more severe headache, even if it occurs only once in a while, or a chronic headache, even if it is not extremely painful, deserves medical evaluation. Popping a couple of aspirin or acetaminophen pills just isn’t a good idea when the headache occurs several times a week. In fact, Dr. Saper says that using such over-the-counter (OTC) analgesics too frequently can actually cause the headaches you’re trying to treat. It takes an experienced headache doctor to help someone out of such a vicious cycle.

“I have suffered from headaches all my life. For the past 30 years, I’ve taken from 25 to 35 aspirins daily, in addition to sinus medication. My doctor doesn’t know about these large doses, but regular checkups reveal no damage to my liver or kidneys

The trouble is that many physicians are not aware of how serious this problem can be. John Edmeads, MD, editorializing in the journal Headache, noted that “the daily use (or, more accurately, abuse) of analgesics actually worsened and perpetuated headaches.” He bemoaned the fact that so few physicians “know that chronic analgesic abuse causes chronic headaches.”328

The diagnostic dilemma for doctors is that they must distinguish between headaches brought on by overuse of pain relievers, headaches caused by some other medical condition, and headaches caused by a change in brain chemistry. If the headache is a consequence of an underlying condition like the flu, it will go away when the infection runs it course. Celiac disease is one condition that can cause recurrent headaches, among many other symptoms, although the underlying issue is actually a reaction to gluten in the small intestine. The treatment is to avoid any foods that contain gluten (wheat, barley, and rye).

Headaches are extremely common. Occasional uncomplicated (“garden-variety”) headaches respond well to self-treatment with OTC analgesics. Severe or recurrent headaches deserve medical attention. A number of approaches have been developed to treat migraines, so it should be possible for most sufferers to get relief.

Anyone who is using a headache medicine of any type more than 2 days a week on a regular basis is flirting with the danger of converting a frequent headache into a chronic headache. This holds true whether the drug is an OTC pain reliever or a prescription migraine medication. In such a situation, the help of a headache specialist may be needed to break the vicious cycle and help find a headache management plan that works.

  • Consider phasing off caffeine intake gradually to avoid caffeine withdrawal headaches.
  • Try relaxation techniques for a tension headache.
  • If you regularly take headache medicine more than 2 days a week, see a headache specialist for help. Such frequent use of medication can cause rebound headaches that become chronic.
  • Keep a headache diary to discover your migraine triggers. Include details on exercise, sleep, diet, and weather.
  • Experiment with riboflavin, magnesium, feverfew, or butterbur for natural ways to prevent migraine.
  • Acupuncture may help reduce the frequency of migraines.
  • Sip hot, spicy soup to stop a migraine that has just begun.
  • For best results, treat a migraine as early as possible. Don’t wait to see if it will really turn into a headache.
  • For mild to moderate migraines, try OTC treatment.
  • Try a prescription triptan drug for moderate to severe migraines.
  • Use prescription Topamax to prevent frequent migraines.
  • Prevent menstrual migraines by taking NSAIDs for several days before the expected onset of menses.
  • See a doctor if you experience a headache during sex or upon exertion. Serious problems need to be ruled out.
  • Take an NSAID before making love to prevent benign sex headache.

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  1. Angela

    I’ve had headaches ever since I was 6years old and still have them doctors don’t know what it is. I’ve tried everything out of the book. I am 25 years of age don’t have much money am on SSI. So can you help me?

  2. C. L.

    I don’t have migraines, but have frequent headaches on the front side of head and temples. The triggers are many: weather changes, changes in my body temperature, foods with tyramine, etc. Nothing, natural, OTC or prescription makes a dent. Any other ideas?

  3. bfalkner

    I have a heart condition and take the blood thinner Plavix. I have headaches often and do not know what otc medications I can take that will not interfere with the Plavix. I have tried Tylenol but it does not do anything for me? Any advice you can give me will be appreciated.

  4. smallfutures

    I have suffered with migraines since the birth of my son sixteen years ago. They have gotten worse with each year it seems. Within the last five years I would say I have had to take prescription medication for my migraines and not just OTC medications anymore. I had to change my career so that I had medical insurance to cover me for the migraines alone. I have had tests performed and everything has come back fine, yet when the weather changes or I walk into a room where someone has smoked or wears perfume then I am completely done for and will have a migraine hands down. I know my food triggers and stay away from them. This has helped a great deal with weight loss but it can be challenging when it comes to mealtime.
    I take Topomax as a preventative 300mg per day and an extra 25mg around time of menses. I also have triptans for when I have a migraine come on and medication to take to offset any “breakthrough” headaches. I just want to stop taking so much medicine. I am afraid that I am taking too much medication and don’t want to end up down the road a few years and someone come back and say “I’m sorry we didn’t know”
    I saw on a talk show that feverfew was recommended and I thought I would give that a try but can it be taken with topomax?
    Thanks for listening!!

  5. Marcus

    I used to use Excedrin all the time for headaches – it works fantastically. I started reducing the amount I took though when my doctor told me that using it too often can actually give you more headaches. Besides that, I’ve found that lots of times when I get headaches it just means I’m dehydrated. Drinking a few glasses of water helps a lot of the time.

  6. J.B.

    I use 400mg riboflavin and 500mg magnesium along with daily topamax to control migraines. Last year I was able to reduce the dose of topamax from 100mg to 75mg per day. I normally have a menstrual migraine and maybe one more a month or less. The remainder of my headaches are mild or moderate. I am a high school teacher – so these are probably due to stress and tension.
    My question is: How much and what kind of feverfew or butterbur is recommended? Also, which NSAIDs are recommended to take before menses to prevent the menstrual migraine? My other headaches also tend to happen sometimes due to low pressure fronts with the weather. Thanks for all your help and advice. JB

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