By Dr. Egilius L.H. Spierings

I have spent almost fifty years studying and treating headaches. In that time, I have seen thousands of patients walk into my office with the same question. They ask, “Doctor, do I have a brain tumor?” or “Why won’t these headaches go away?” Usually, they have already tried everything. They have taken pills that did not work. They have consulted numerous doctors who administered treatments haphazardly. Many of them came to me in desperation.

For more educational resources about headache diagnosis and treatment, visit my book’s website: http://www.help4headache.com/

What I have learned is the truth. Headaches are incredibly common, and most people will never know why they have them because they never get a proper explanation. My patients deserve better. You deserve better. That is why I am writing this article.

How Common Are Headaches Really?

Let me start with some facts. About half of all people get headaches at least once a month. One out of every seven people gets headaches every single week. About one out of every twenty people gets headaches every single day. That is a lot of suffering.

The good news is that most people who get headaches can treat them with over-the-counter medications. Aspirin, ibuprofen, acetaminophen, and naproxen work just fine for them. But here is the problem. If you are reading this article, you probably are not one of those lucky people. You probably have headaches that do not go away with simple pain medication. That makes you one of about one in five people who experience intense headaches.

The Fear That Haunts Everyone

The first thing every patient asks me about is brain tumors. I understand this fear. It is rational. If your head hurts in a way that does not feel normal, the first thing you think is that something serious is wrong. You think about cancer. You think about tumors. You think about your skull opening up.

Let me tell you something that might help you sleep better at night. Brain tumors from headaches alone are actually quite rare. I mean, really rare. We see far more people with severe headaches than we see people who actually have tumors. If you are worried, we have imaging technology now that is amazing. We can look at your brain with CT scans or MRI machines. Your doctor can order these easily. They are covered by insurance. There is no reason to worry for weeks without answers.

Why Doctors Get Your Diagnosis Wrong

Here is something that has surprised me ever since I  became a doctor. A lot of doctors do not actually know what migraine is. They hear the word ‘migraine’, and they think it just means annoying headaches. That is wrong. Migraine is a specific condition. It is genetic. It runs in families. And if you have it, your body responds differently from people who do not have it.

Patients often approach me, claiming that their doctors have diagnosed them with tension headaches. They tell me their doctor said it was stress. Other patients say their doctor told them it was their sinuses. But here is what I have learned from treating thousands of people. Bad tension headaches do not exist. Bad sinus headaches do not exist. Bad hangover headaches do not exist. What does exist is migraine triggered by tension, by sinus problems, or by alcohol.

This distinction is important. Why? Because if you have a migraine, you need another type of medication than someone with regular headaches. You need medication developed specifically for migraine. You need something stronger. If your doctor does not understand this difference, you will keep taking the wrong medications and keep suffering.

How do you know if you have a migraine? Ask your parents. Ask your grandparents. Ask your siblings. Do they get headaches that do not go away with a couple of aspirin? Migraines run in families. If your family members have the same problem, you probably have migraine too.

The Medications That Actually Work

I have treated thousands of people with migraines. I have prescribed more triptans than almost any other doctor in the country. Let me tell you what I have learned about what actually works.

For acute migraine, when the headache hits, you need medication that is specifically designed for migraine. Over-the-counter pain medication is not going to cut it. You need a triptan like sumatriptan, or you need a newer medication called a gepant. Triptans come in many forms. Tablets. Injections. Nasal sprays. Some work faster than others. Some last longer than others.

The key is taking the medication early. Do not wait for the pain to get terrible. Do not give it an hour to go away on its own. When you feel a migraine starting, take your medication right away. This is when it works best.

In the last few years, we have had preventive medications that target CGRP directly. Erenumab, eptinezumab, fremanezumab, and galcanezumab. These are given as injections. They work by blocking CGRP before it can bring about a migraine. They have been transformative for many patients.

The key is that there is no universal solution. What works for your neighbour, might not work for you. That is okay. A good doctor will work with you to find what does work.

What You Need to Do Every Single Day

Medicine is only part of the answer. How you live matters too. I have seen patients completely change their lives by doing these things.

Sleep is number one. I cannot stress this point enough. You need regular sleep. You need enough sleep. If you are only getting five or six hours, that is not enough. You need eight to nine hours. And your sleep needs to be at the same time every night. Your body likes routine when you have migraine. Going to bed at midnight one night and three in the morning the next night will trigger a migraine.

Eat regularly. Skipping meals is a common migraine trigger. Your blood sugar crashes. Your body does not like that. Eat something every few hours. It does not have to be big. Just eat regularly.

Exercise helps. Not crazy exercise that exhausts you. That can trigger a migraine. But regular, moderate exercise that you enjoy and is relaxing. Walking. Swimming. Cycling. Something that gets your blood moving and distracts your mind.

Manage your stress. Stress is a trigger. So is stress relief. Interesting, right? Sometimes, when you finally relax after a stressful week, that is when the migraine hits. We call that a letdown migraine. Know that this can happen and prepare for it.

Keep your caffeine use steady. If you usually drink coffee, keep drinking it but not too much. If you do not drink coffee, do not suddenly start. Caffeine changes can trigger migraine.

Get your environment right. Too much light can trigger a migraine. Too much noise can trigger a migraine. If you are light sensitive, you need sunglasses. You might need a quiet space.

These sound simple, but they are powerful. I have had patients who did nothing but fix their sleep, and their migraine was cut in half.

Face Pain is Different from Headache

I spend a lot of my time treating face pain. This is different from a headache. People often come to me confused about what they have.

One condition is trigeminal neuralgia. This is nerve pain in the face. It feels like electric shocks, like stabbing. It comes and goes. Traditional treatments like carbamazepine help some, but many people have bad side effects. Dizziness. Drowsiness. Falling. For older patients, this can be dangerous.

Another type of face pain comes from muscles. Your jaw has muscles. Your temple has muscles. These can get tight and cause pain. Sometimes we use botulinum toxin, the same one used for wrinkles, to relax these muscles. This can work really well.

Sometimes face pain comes from your sinuses or from your nose. A spur from a deviated septum can stick into the side of your nose and cause pain. This usually needs surgery to fix.

Sometimes a tooth causes face pain. You may think you have sinus pain or migraine, but it is actually a tooth problem. You need dental work, not migraine medication.

The point is, face pain is complex. You need a doctor who understands all the different causes and can figure out which one you have.

Why We Cannot Cure Headaches, But We Can Manage Them

I want to be honest with you about something. We cannot cure migraine. Migraines are genetic. It runs in your family. It is part of how your body responds to stress and strain. There is no surgery to fix it. No medication cures it permanently.

But that does not mean you have to suffer. We can manage it. We can reduce how often they happen. We can make them less intense. We can shorten them. For many people, we can reduce their migraine headaches by half or more.

I once had a patient tell me that a doctor promised to cure her migraine. When I heard that, I knew something was wrong. Promises like that usually mean something else is going on. Such promises often to indicate that someone is trying to deceive you.

When Something More Serious Is Happening

I need to mention a few things that are actually serious and require immediate attention.

A sudden, severe headache is an emergency. Get to the hospital. The cause could be a bleed around your brain.

If you get a new type of headache that is very different from your normal headaches, get checked out. See a doctor if your headaches worsen over time. See a doctor if the pattern of your headaches changes.

If your headache is accompanied by fever, stiff neck, confusion, or new vision changes, get checked out.

If you weaken one side of your body, can’t speak clearly, or have a drooping face, get checked out.

These things could mean strokes, infections, or other serious problems. Do not ignore them.

The Bottom Line

I have been doing this work for fifty years. I have read thousands of research papers. I have treated thousands of patients. I have trained in multiple countries. I have learned that headaches are incredibly complex yet incredibly manageable.

The key is getting the right diagnosis. The key is finding a doctor who takes time to listen and to examine you properly. The key is understanding that your headaches might be related to other health problems. The key is sticking with treatment long enough to see if it works. The key is being willing to try different approaches.

You do not have to suffer. I know from experience that the right treatment can change your life.

If you have been struggling with headaches, I encourage you to seek help from a headache specialist. Bring your family history. Bring a list of what triggers your headaches. Bring a list of what you have already tried. Be willing to work with your doctor. You might be surprised at how much better you can feel.

If you want a deeper understanding of headache diagnosis, migraine science, and treatment strategies, you can explore my book HEADACHES Why You Have Them – What You Can Do About Them on Amazon here.

Your headaches are real. Your pain is real. You deserve answers. You deserve relief. And that relief is possible.

Disclaimer: This article is for informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.