Treatment for Headaches Isn’t Given Much Thought

How to treat headaches isn't given much thought. There’s an alarming trend toward costly imaging tests and medications for headaches. Here’s what you should know.

Are you worried you have a brain tumor or another illness causing your head to ache? Some 45 million Americans each year see their doctors over a headache. Almost 21 percent of women and 10 percent of men get migraines or severe headaches. Many of those visits lead to expensive tests that are unnecessary and of little help, according to a Harvard Medical School study drawing on data from 1999 to 2010. You may be one of them, so think about the overall result.

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What you can do

Many people can cut the frequency of their headaches if they adopt habits that are good for all of us: it helps to quit smoking, cut back on alcohol and caffeine, eat and sleep on a regular schedule, and exercise several times a week. Diet counts: This infographic from the American Headache Society has tips on diet for migraine sufferers.

The first step is to look for triggers for your pain. Identifying what sets you off — from changes in the weather to dehydration and perfume — is an area that needs more research and consensus, but you can keep careful records and figure out your own.   

Overtreatment is a risk

Meanwhile, doctors tend to go high-tech. “I was particularly alarmed about the overall trend of more imaging tests, medications, and referrals alongside less counseling,” said John N. Mafi, MD, lead author of the Harvard study. Mafi is now an internist at UCLA and connected to the RAND research organization.

“These findings seem to reflect a larger trend in the U.S. healthcare system beyond just headache: over-hurried doctors seem to be spending less time connecting with their patients and more time ordering tests and treatments.”

In a separate survey, for example, doctors said that more than a fifth of American medical care was unnecessary, including 22 percent of prescriptions and 25 percent of tests. The report was prepared by researchers at several top institutions and published in the journal PLoS One.

Sometimes, just taking a complete medical history can lead a doctor to treat an underlying cause for headache, said Kathryn Boling, MD, a family medicine specialist at Mercy Medical Center in Lutherville, MD

“Some headaches are the result of tension in the neck and shoulders, some start due to sinus and allergy symptoms, and some are migraine headaches,” she said. “Some headaches are actually rebound headaches caused by daily or near-daily use of OTC (over-the-counter) headache medications.”

The solution depends on the kind of headache you have. For tension headaches, you may need to learn stress reduction techniques, often breathing exercises. Treating allergies and promoting sinus drainage can curb sinus headaches, Boling noted. You might be able to eliminate chronic daily headaches if you stop relying on OTC drugs.

Do you need a CT scan?

It’s easy to worry that a brain tumor or other illnesses is causing your headaches. But “a CT scan or an MRI rarely shows why the headache occurs. And they do not help you ease the pain,” observes the Choosing Wisely website sponsored by the American Board of Internal Medicine.

Boling agrees. “In the face of a normal neurologic exam, a chronic headache history and no red flags, further testing in the form of imaging should not be necessary,” she said.

Red flags that might require brain imaging could include:

• Acute onset of headaches
• Rapid increase in intensity and frequency of chronic headaches
• Being awakened from sleep by headaches
• An abnormal neurological exam
• Head pain that is sudden or explosive
• A headache brought on by exertion
• A headache accompanied by fever, a seizure, vomiting, loss of coordination, or a change in vision, speech, or alertness

In the Harvard study, the authors’ analysis of more than 9,300 visits for headache from across the country found that referrals for imaging had nearly doubled in a decade, though more than half may have been inappropriate. Prescriptions also jumped.

At the same time, doctor counseling — which you should be getting in most cases anyway, rather than expensive tests and powerful drugs — decreased.

According to Stanford University’s Headache Clinic, lifestyle modification is often the most important, beneficial piece of a strategy that will work for you.

“The goal is to maintain consistent sleep, eating, and exercise patterns,” the clinic advises. “These three behaviors influence changes in your body's hormonal cycles. By maintaining consistency in these cycles, your body is better able to anticipate and adapt without spiraling out of control and into migraine.”

If that advice sounds familiar, the reason is that it forms the foundation of good health in general. You’ll hear it in connection with preventing diabetes, cardiovascular disease, and other serious health problems.

Mafi believes that, often, a very conservative approach to treatment will make most normal headaches go away. He urges that you listen more to your body and pay close attention to the triggers.

You may have a misconception that fancy tests and referrals amount to better care, but Mafi says simple lifestyle counseling will often be more effective.

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