There are many types of headaches, each lasting between 30 minutes and a week. If your symptoms are new or you've never had a headache like this before, you may need to visit the emergency department.
Dr. Nick Colovos, Assistant Professor Emory School of Medicine Department of Emergency Medicine and Interim Chief Quality Officer for the Physician Group Practices, discusses different types of headaches and evaluation to diagnose and treat headaches.
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Headaches & Migraines: Know Where to Go
Featuring:
Learn more about Nick Colovos, MD, MBA
Nick Colovos, MD, MBA
Nick Colovos, MD, MBA is an Assistant Professor Emory School of Medicine Department of Emergency Medicine Interim Chief Quality Officer for the Physician Group Practices.Learn more about Nick Colovos, MD, MBA
Transcription:
Bill Klaproth (Host): A headache is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck and here to talk with us about headaches and migraines and know where to go is Dr. Nick Colovos, assistant professor at Emory School of Medicine, Department of Emergency Medicine Interim Chief Quality Officer for the physician group practices at Emory Health Care. Dr. Colovos, thank you for your time. So what are the most common types of headaches that you treat?
Dr. Nick Colovos (Guest): Well there’s a number of them out there. I think the most common headache that we see people experiencing is that of a tension headache and that can often be a headache that’s brought on by stress or muscle strain or anxiety, typically starting in the back of the head and the neck area and causing some discomfort, and these types of headaches as well as others can last anywhere from 30 minutes to a week.
Bill: So we hear a lot about migraines. What is the main difference between migraines and tension type headaches you were just talking about?
Dr. Colovos: Yeah I think the migraine headache is often described as a very intense or more severe type of headache. It can have symptoms that bring on with it, nausea. It can have pain behind one eye or one ear. It can have pain to the temple region of the head. Some people will describe seeing spots or flashing lights in front of their eyes. They can have some light sensitivity associated with it, and there are even circumstances where people will have temporary vision loss associated with migraine headaches.
Bill: Now if someone is experiencing those symptoms, is that cause for going to the ER or Urgent Care or seeing the doctor?
Dr. Colovos: Most people that are experiencing the symptoms of a migraine have a knowledge because they’ve seen it before, they’ve had it before and what typically patients should consider, if this is your typical migraine and it’s not something that’s causing debilitation. It’s not something that came on suddenly. It’s not presenting with unusual symptoms, they could typically see their primary care doctor for this. They could also see an Urgent Care facility for that type of headache and often those patients are recommended if they don’t have follow up to follow up with neurology because they have an exceptional way of managing a lot of these patients.
Bill: So if there’s someone who doesn’t have normal migraines and you were just mentioning someone would know themselves and this is typically what happens when I have a migraine, for someone where these symptoms are new, when is it time to see the doctor?
Dr. Colovos: Yeah the biggest concern we have is when somebody has a headache and they come to the emergency department or they tell their doctor, I’ve never had a headache like this before. This is the worst headache of my life. It came on suddenly. It’s causing maybe some nausea or vomiting. Those patients should go to the emergency department, and they’re going to require that visit because those unusual symptoms we’re going to want to pursue a little bit further. The things that we worry about are going to be things like an aneurysm, a bleed inside of one’s brain, or an infection like meningitis. So anybody that presents with a severe headache that started suddenly, it’s different from prior headaches, or is an absolute new type of presentation, that would be, those would be the reasons to go to the emergency department to be evaluated because you’re going to need the advanced studies that are available there.
Bill: What about someone that may have a chronic headache, maybe not to the level of a migraine, but a long period of time, say weeks, of a constant headache or headache every other day, it’s always there, what about someone with those types of symptoms?
Dr. Colovos: Yeah I think with those patients the first step would be is making sure that they’re following up with their primary care physician, getting an appointment with them so that that headache can be evaluated, looked at, and make a determination if there’s something more significant going on. You know it’s important to know that ER physicians, emergency medicine physicians, we’re not specialists in headaches and migraine and our goal is basically to rule out any serious life threatening problem and to reduce the pain and discomfort that a patient is having; however, they’re probably going to warrant additional evaluation and that’s where both their primary care physician in conjunction with specialist such as neurologists, may help to facilitate that patient’s headache and their discomfort.
Bill: How about a headache that doesn’t go away with aspirin? Is that typically a sign of a problem or not?
Dr. Colovos: It doesn’t necessarily indicate that there’s a problem. When we take things like aspirin or ibuprofen, those medications are typically used for the treatment of both migraines as well as tension headaches. They relieve inflammation and relief of that inflammation can cause relief of the symptoms. The fact that we’re not seeing improvement with those medications is not too uncommon, but it doesn’t necessarily mean that there’s something more serious going on.
Bill: So how about headaches that originate from neck problems, are those diagnosed and treated differently?
Dr. Colovos: The headaches that are associated with neck problems, the first step is we’ve got to figure out if you’ve never had a headache like this before, maybe you were involved in a motor vehicle accident, and you got that whiplash of your neck that caused the muscles in your neck to spasm and tighten up and that causes that type of tension headache. So part of it is the evaluation by your primary care physician to determine was this a headache related to some other mechanism. Now if it’s not and it’s a typical tension headache, which is one of the most common types of headache, then using some medications can potentially help to relieve that, even potentially some physical therapy and stretching exercises may help as well. Not unusual for folks to be seen by the primary care physician or urgent care for those types of headaches.
Bill: So you just mentioned medications and physical therapy. How are headaches usually treated?
Dr. Colovos: Typically most headaches are treated with the use of anti-inflammatory medications. We kind of stay away from some of the narcotic or opioid type medications in the treatment of acute headaches. We really have found the data out there supports the use of what they call NSAIDs or nonsteroidal anti-inflammatory drugs and those medications such as Naprosyn and ibuprofen are usually a typical way of treating them.
Bill: And when it comes to headaches, what are the main types of headaches that you treat at Emory?
Dr. Colovos: Well we see a number of them. As mentioned earlier, we’ll see tension headaches, which are fairly common. We’ll see cluster headaches on some patients, where they’re severely painful headaches that usually occur on one side of the head and they come in cycles, almost like a headache attack. We’ll see sinus headaches, which can often be just in the frontal – just above our eyes or just below our eyes and that can often be seen in the time of flu and cold season where folks are getting the stuffy nose, the cough, and congestion, and that facial pressure, and then one of the ones that we really worry about in the emergency department are what are described as the thunderclap headache. That’s a headache that’s very severe in nature that usually develops within 60 seconds or less and patients will often describe it as the worse headache of their life. That is a true medical emergency. That’s a 911 call and get to your closest emergency department because those headaches have life threatening consequences and we need to make sure that that is not what’s happening very quickly.
Bill: Oh man I can’t even imagine what that would feel like and I hope I never do. So if someone is experiencing that severe type of headache and they’re headed to the ER, are there certain things a person should bring or a family member should bring to help speed up the process of being seen?
Dr. Colovos: Yeah I think the most important thing when anybody is traveling or coming to the emergency department is 1) notify your primary care physician, I like to do that, maybe we can’t depending on the time of day and night and what not, but when coming to the ER if you can bring your medical records, that is invaluable. You can always get a copy of your records from your primary care physician, keep a copy with you in your car or your glovebox so that it’s always available and that would be a real help to the folks in the emergency department. A list of your medications and allergies is also a key to bringing those things to the local ER that you visit.
Bill: And Dr. Colovos, if you could wrap it up for us, what else do we need to know about headaches and where to go?
Dr. Colovos: Well the chief thing to understand about headaches is they’re pretty common. Tension headache is probably the most common, migraines follow a close second. The challenge with these is knowing where to go and when to go. If it is a headache that is just mild in discomfort, not the worst of your life, you’re treating it at home with some ibuprofen or aspirin or Tylenol type products and you’re not getting relief, following up with your primary care physician or the local urgent care would be a good move. However, if it is a headache that comes on suddenly and it’s severe in nature and it’s causing you to have visual deficits and it’s causing you to have nausea or vomiting and it’s a headache that you never experienced before or has changed in nature from prior headaches, those would be reasons to go to your local emergency department and my advice is to call 911 and have them transport you there.
Bill: Great information, you have helped us today Dr. Colovos. Thank you so much for your time, and for more information, please visit emoryhealthcare.org, that’s emoryhealthcare.org. You’re listening to advancing your health with Emory Health Care. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): A headache is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck and here to talk with us about headaches and migraines and know where to go is Dr. Nick Colovos, assistant professor at Emory School of Medicine, Department of Emergency Medicine Interim Chief Quality Officer for the physician group practices at Emory Health Care. Dr. Colovos, thank you for your time. So what are the most common types of headaches that you treat?
Dr. Nick Colovos (Guest): Well there’s a number of them out there. I think the most common headache that we see people experiencing is that of a tension headache and that can often be a headache that’s brought on by stress or muscle strain or anxiety, typically starting in the back of the head and the neck area and causing some discomfort, and these types of headaches as well as others can last anywhere from 30 minutes to a week.
Bill: So we hear a lot about migraines. What is the main difference between migraines and tension type headaches you were just talking about?
Dr. Colovos: Yeah I think the migraine headache is often described as a very intense or more severe type of headache. It can have symptoms that bring on with it, nausea. It can have pain behind one eye or one ear. It can have pain to the temple region of the head. Some people will describe seeing spots or flashing lights in front of their eyes. They can have some light sensitivity associated with it, and there are even circumstances where people will have temporary vision loss associated with migraine headaches.
Bill: Now if someone is experiencing those symptoms, is that cause for going to the ER or Urgent Care or seeing the doctor?
Dr. Colovos: Most people that are experiencing the symptoms of a migraine have a knowledge because they’ve seen it before, they’ve had it before and what typically patients should consider, if this is your typical migraine and it’s not something that’s causing debilitation. It’s not something that came on suddenly. It’s not presenting with unusual symptoms, they could typically see their primary care doctor for this. They could also see an Urgent Care facility for that type of headache and often those patients are recommended if they don’t have follow up to follow up with neurology because they have an exceptional way of managing a lot of these patients.
Bill: So if there’s someone who doesn’t have normal migraines and you were just mentioning someone would know themselves and this is typically what happens when I have a migraine, for someone where these symptoms are new, when is it time to see the doctor?
Dr. Colovos: Yeah the biggest concern we have is when somebody has a headache and they come to the emergency department or they tell their doctor, I’ve never had a headache like this before. This is the worst headache of my life. It came on suddenly. It’s causing maybe some nausea or vomiting. Those patients should go to the emergency department, and they’re going to require that visit because those unusual symptoms we’re going to want to pursue a little bit further. The things that we worry about are going to be things like an aneurysm, a bleed inside of one’s brain, or an infection like meningitis. So anybody that presents with a severe headache that started suddenly, it’s different from prior headaches, or is an absolute new type of presentation, that would be, those would be the reasons to go to the emergency department to be evaluated because you’re going to need the advanced studies that are available there.
Bill: What about someone that may have a chronic headache, maybe not to the level of a migraine, but a long period of time, say weeks, of a constant headache or headache every other day, it’s always there, what about someone with those types of symptoms?
Dr. Colovos: Yeah I think with those patients the first step would be is making sure that they’re following up with their primary care physician, getting an appointment with them so that that headache can be evaluated, looked at, and make a determination if there’s something more significant going on. You know it’s important to know that ER physicians, emergency medicine physicians, we’re not specialists in headaches and migraine and our goal is basically to rule out any serious life threatening problem and to reduce the pain and discomfort that a patient is having; however, they’re probably going to warrant additional evaluation and that’s where both their primary care physician in conjunction with specialist such as neurologists, may help to facilitate that patient’s headache and their discomfort.
Bill: How about a headache that doesn’t go away with aspirin? Is that typically a sign of a problem or not?
Dr. Colovos: It doesn’t necessarily indicate that there’s a problem. When we take things like aspirin or ibuprofen, those medications are typically used for the treatment of both migraines as well as tension headaches. They relieve inflammation and relief of that inflammation can cause relief of the symptoms. The fact that we’re not seeing improvement with those medications is not too uncommon, but it doesn’t necessarily mean that there’s something more serious going on.
Bill: So how about headaches that originate from neck problems, are those diagnosed and treated differently?
Dr. Colovos: The headaches that are associated with neck problems, the first step is we’ve got to figure out if you’ve never had a headache like this before, maybe you were involved in a motor vehicle accident, and you got that whiplash of your neck that caused the muscles in your neck to spasm and tighten up and that causes that type of tension headache. So part of it is the evaluation by your primary care physician to determine was this a headache related to some other mechanism. Now if it’s not and it’s a typical tension headache, which is one of the most common types of headache, then using some medications can potentially help to relieve that, even potentially some physical therapy and stretching exercises may help as well. Not unusual for folks to be seen by the primary care physician or urgent care for those types of headaches.
Bill: So you just mentioned medications and physical therapy. How are headaches usually treated?
Dr. Colovos: Typically most headaches are treated with the use of anti-inflammatory medications. We kind of stay away from some of the narcotic or opioid type medications in the treatment of acute headaches. We really have found the data out there supports the use of what they call NSAIDs or nonsteroidal anti-inflammatory drugs and those medications such as Naprosyn and ibuprofen are usually a typical way of treating them.
Bill: And when it comes to headaches, what are the main types of headaches that you treat at Emory?
Dr. Colovos: Well we see a number of them. As mentioned earlier, we’ll see tension headaches, which are fairly common. We’ll see cluster headaches on some patients, where they’re severely painful headaches that usually occur on one side of the head and they come in cycles, almost like a headache attack. We’ll see sinus headaches, which can often be just in the frontal – just above our eyes or just below our eyes and that can often be seen in the time of flu and cold season where folks are getting the stuffy nose, the cough, and congestion, and that facial pressure, and then one of the ones that we really worry about in the emergency department are what are described as the thunderclap headache. That’s a headache that’s very severe in nature that usually develops within 60 seconds or less and patients will often describe it as the worse headache of their life. That is a true medical emergency. That’s a 911 call and get to your closest emergency department because those headaches have life threatening consequences and we need to make sure that that is not what’s happening very quickly.
Bill: Oh man I can’t even imagine what that would feel like and I hope I never do. So if someone is experiencing that severe type of headache and they’re headed to the ER, are there certain things a person should bring or a family member should bring to help speed up the process of being seen?
Dr. Colovos: Yeah I think the most important thing when anybody is traveling or coming to the emergency department is 1) notify your primary care physician, I like to do that, maybe we can’t depending on the time of day and night and what not, but when coming to the ER if you can bring your medical records, that is invaluable. You can always get a copy of your records from your primary care physician, keep a copy with you in your car or your glovebox so that it’s always available and that would be a real help to the folks in the emergency department. A list of your medications and allergies is also a key to bringing those things to the local ER that you visit.
Bill: And Dr. Colovos, if you could wrap it up for us, what else do we need to know about headaches and where to go?
Dr. Colovos: Well the chief thing to understand about headaches is they’re pretty common. Tension headache is probably the most common, migraines follow a close second. The challenge with these is knowing where to go and when to go. If it is a headache that is just mild in discomfort, not the worst of your life, you’re treating it at home with some ibuprofen or aspirin or Tylenol type products and you’re not getting relief, following up with your primary care physician or the local urgent care would be a good move. However, if it is a headache that comes on suddenly and it’s severe in nature and it’s causing you to have visual deficits and it’s causing you to have nausea or vomiting and it’s a headache that you never experienced before or has changed in nature from prior headaches, those would be reasons to go to your local emergency department and my advice is to call 911 and have them transport you there.
Bill: Great information, you have helped us today Dr. Colovos. Thank you so much for your time, and for more information, please visit emoryhealthcare.org, that’s emoryhealthcare.org. You’re listening to advancing your health with Emory Health Care. I’m Bill Klaproth, thanks for listening.