Salt Lake City VA Headache Center of Excellence

Please Note: This is not a substitute for, or an effort to provide, complete medical care.

Headache disorders are characterized by repeated headache attacks and are among the most common disorders. There are two general types of headache: primary headaches and secondary headaches. Primary headaches are headaches that happen more than once and have unknown causes. Secondary headaches are headaches that are traced to a specific cause (like a head or neck injury), certain medications/substances, or body disorders. There are many types of headaches. We will focus on the most common.

What are the types of headaches?

The most common type of primary headaches are tension-type headache, migraine, and cluster headache. Three of the major secondary headaches are medication overuse headache, post-traumatic headache, and cervicogenic headache. These headache types can either be episodic or chronic. Headaches that occur 1 – 14 days per month are referred to as “episodic.” If headaches occur 15 or more days per month, they are called “chronic.”

Your treatment may depend on how frequently you experience a headache. All headache types can be improved by having a healthy lifestyle, exercising, and not smoking.

Tension-type headache

Tension-type headache is the most common primary headache. Patients with tension-type headache often start getting them during their teenage years. Tension-type headache is usually not very severe and does not get in the way of everyday activity. It is also slightly more common in women than men, may be associated with neck pain, and can feel like pressure or tightness, often like a band around the head (sometimes spreading into or from the neck).

Episodic tension-type headache is very common. Attacks usually last a few hours but can occur for several days. Chronic tension-type headache is not very common. Chronic tension-type headache can feel endless and is much more painful than episodic tension-type headache. Tension-type headache usually responds well to over-the-counter pain medications.

Migraine

Migraine usually begins during puberty and is more common in women. It is caused by the release of chemicals in the brain and around the brain’s blood vessels that cause inflammation and pain. Migraine may occur every week or even more often. Some patients experience migraine their whole life. Migraines are generally moderate to severe in intensity and may feel like throbbing on one side of the head.

Migraines can be worsened by physical activity and can last a few hours or several days. In addition to headache, patients with migraine often experience nausea and sensitivity to light and sound. Prescription medications are available to treat migraine when over-the-counter pain medications do not work.

Cluster headache

Cluster headache is very rare and affects men more often than women. It typically occurs in people over the age of 20. A cluster headache is typically a short but intense headache that can occur many times in one day. It can cause severe pain focused around one eye, a runny or blocked nose on the side of the headache, or eyelid droopings during headache (even though it appears normal other times). Cluster headache also has episodic and chronic forms.

Contact Your Primary Care Provider for a Consult

Neurology Headache Clinic: Our Headache Clinic provides consultation, full evaluation, and treatment of all headache types.

Before your visit, you may be asked to fill out a pre-visit questionnaire or keep a headache diary. A neurologist will do a comprehensive medical history and physical examination. Together we will develop a treatment plan tailored to your individual needs. We will communicate the plan with your primary care provider and refer you to additional specialty clinics/providers when appropriate.

Whole Health Consult: Wellbeing, Integrative Health, Pain and Self- Management Classes.

www.va.gov/wholehealth/

VHA Pain Management: Living with chronic pain is challenging. It often feels like you just need the right medication or treatment to take the pain away. But often that’s not enough, especially with chronic pain. There are many other approaches to managing chronic pain, and better relief is often found when medications and invasive interventions are combined with or even replaced by active rehabilitation and education approaches, and behavioral-psychological treatments.

www.va.gov/painmanagement/

There are many different types of treatments for headache including pills, injections, and non-medication interventions. It is important to share with your healthcare provider how headache affects your life and the life of those around you. Your healthcare provider may ask you to write down when your headaches happen in a “diary” to help understand the headache disorder better. This may help you to work with your healthcare team to develop goals for your headache treatment. A combination of medication and non-medication treatments may be the most effective for you. Work with your healthcare team to create a treatment plan that is personalized to fit your needs, preferences, and circumstances.

Source: VA DoD Headache Clinical Practice Guideline (Version 1.0 2020)

Devices

Video: How to Use the CEFALY Migraine Treatment Device

Video: ThermaZone

Video: The cutting-edge treatments for migraines l GMA

Website: gammaCore for Veterans

Websites

University of Utah Headache School: Educational videos produced by University providers, plus, especially good free yoga and meditation videos.

University of Utah Headache Guide

Danielle Byron Henry Migraine Foundation: Support and access to treatment for those living with migraine disease, especially young adults and children. Free yoga, mindfulness videos, plus a monthly newsletter.

Dawn C. Buse, PhD Migraine Website: Great articles, podcasts, links to resources and free guided imagery/relaxation.

CHAMP: Vast selection of resources and information for Headache and Migraine Sufferers.

• Lifestyle Management for Migraine with Dr. Amaal Starling - (1 hour 14 min video)
• Living Well with Migraine with Dawn Buse, M.D. - (1 hour 12 min video)
• New Medicines and Devices for Migraine Care - (7 min 22 sec video)

Articles

How Yoga Can Help With Headaches

Links

Suicide Hotline

National Suicide Prevention Lifeline or 1-800-273-TALK (8255)

Post Traumatic Stress Disorder (PTSD)

Veteran’s Affairs National Center for PTSD

Classes

Seeds for Success in Migraine Class (42 min): Dr. Amaal Starling of the Mayo Clinic offers lifestyle counseling centered around the mnemonic SEEDS: sleep, exercise, eat, diary, and stress. Each factor is discussed along with best-practice recommendations.

Mobile Phone Apps (iOS and Android)

Headache Calendars and Diaries

Migraine Monitor

Migraine Buddy

Health Storylines

Improving Headache Control and Sleep

Breath2Relax - Teaches diaphragmatic breathing to help reduce stress.

Virtual Hope Box - Contains simple tools to help with coping, relaxation, distraction and positive thinking.

Mindfulness Coach - Practice mindfulness to improve anxiety/depression and coping with chronic pain.

Calm - For sleep, meditation, relaxation.

Insight Timer - Practice meditation.

How To

How to Find a Headache Specialist Neurologist or Healthcare Professional

American Migraine Foundation (American Headache Society)

Migraine Research Foundation

How To Find a Psychologist (Cognitive Behavioral Therapy) or a Psychiatrist

American Psychological Association

Clinics and Consults

MusculoSkeletal (MSK) Clinic: Treatment of headaches starting from the neck utilizing trigger point injections, Botox, and Battlefield Acupuncture. Assessment for massage and chiropractic treatments. Referrals for Cefaly and Gammacore devices, traction, physical therapy, and others.

Physical Therapy: Utilizing Exercises, Dry Needling, Manual Therapy, Low Level Laser Therapy, Traction and Self=Management Techniques (Foam Roller, Posture, TheraCane, Suboccipital Release).

Nutrition Consult: Evaluate and treat for dietary headache triggers.

Optometry Consult: Evaluate for glasses or tinted lenses to treat pain from light sensitivity.

Sleep Study Consult: Evaluate and treat for sleep disorders that may impact headache management.

Dental Consult: Multidisciplinary approach, including Botox and mouth guards, for patients who have tension headaches and pain associated with temporomandibular disorder (TMD). Modify pain causing habits with education, massage of muscles, physical therapy, cognitive behavioral therapy, and stress reduction exercises/stretching.