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Headaches: When to Call the Doctor

By: TRANG M. PHAM, M.D.

Headaches are our most common form of pain and a major reason for trips to the doctor. While most headaches are just a temporary nuisance, sometimes they can warn you about a serious health problem that needs immediate attention.

Causes of headaches

Headaches happen when nerve endings in your body react to triggers and send pain messages to your brain. Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck can play a role in headaches.

A primary headache is caused by problems with pain-sensitive nerves in your head and is not a symptom of another medical problem. Primary headaches can be triggered by lifestyle factors, such as stress, alcohol (especially red wine), certain foods (such as processed meats with nitrates), poor sleep and poor posture.

A secondary headache is related to medical conditions that trigger pain-sensitive areas in the neck and head, including a neck injury, eye problems, and infections in your jaw, teeth, or sinuses. More serious causes of secondary headaches can be brain tumors, aneurysms, and meningitis.

Types of headaches

There are many types of headaches, but three of the most common are tension, cluster, and migraines.

Tension headaches are the most common kind and are often brought on by stress and tight muscles. Symptoms include:

  • Gradual start
  • Head usually hurts on both sides
  • Pain is dull or feels like a band or vice around the head
  • Pain may involve the back part of the head or neck
  • Pain is mild to moderate
  • Typically, does not cause nausea, vomiting or sensitivity to light

Cluster headaches usually occur in a series that may last weeks or months. They are more common in men than women and may be caused by alcohol use, smoking cigarettes, bright light, exercise/exertion, hot weather or water, and foods with nitrates, such as bacon or lunch meat. Symptoms of cluster headaches include:

  • Severe pain on one side of the head, usually behind one eye
  • The eye that is affected may be red and watery with a droopy lid and small pupil
  • Swelling of the eyelid
  • Runny nose or congestion
  • Swelling of the forehead

Migraines mostly affect women. The average migraine lasts from four hours to three days, but severe attacks can last longer, badly impacting your work, family, and social life. In addition to headache pain, migraines can include:

  • Nausea and vomiting
  • Lightheadedness
  • Sensitivity to light and other visual symptoms, such as flashing spots, wavy lines, and blurred vision

Treatment depends on the headache

Effective treatment depends on what type of headache you have. It may include:

  • Avoiding known triggers, such as certain foods and beverages
  • Stress management
  • Changing eating habits
  • Exercise
  • Resting in a quiet, dark place
  • Over-the-counter medications or prescriptions from your healthcare provider

Migraine and cluster headaches may need specific medicine management:

  • Preventive medicines: Prescribed by your healthcare provider and taken daily to reduce the onset of headaches.
  • Abortive medicine: Prescribed by your healthcare provider and acting on specific nerves and blood vessels in the head to stop a headache in progress.
  • Rescue medicines: Over-the-counter pain relievers to stop the headache.

When you should call your doctor

Most headaches can be treated with over-the-counter medicine and will go away on their own. But there are times when they can be a symptom of serious medical conditions, such as a blood clot, aneurysm or tumor in the brain, concussion, encephalitis, meningitis, or stroke. Call your healthcare provider immediately if you experience a sudden, severe headache with:

  • Fever
  • Nausea
  • Vomiting
  • Convulsions
  • Shortness of breath
  • Confusion
  • Muscular weakness
  • Double vision
  • Change in level of consciousness

If headaches are an unpleasant part of your life, contact your MPCP healthcare provider to discuss what can be done to help you feel better.

 

Trang Pham, M.D.Dr. Pham is a MPCP partner and cares for patients in the Pasadena office. She holds her medical degree from Jefferson Medical College and is certified by the American Board of Family Medicine.

Not Just a Headache: The painful facts about migraines

By: TRANG M. PHAM, M.D.

More than one in 10 Americans suffer from migraines, but unless you experience them yourself you may have no idea how painful and crippling they can be. Here’s what migraines are and what can be done about them.

Migraine is more than just a bad headache

The cause of migraines is not well understood, but researchers believe they are a neurological disorder caused by brain chemistry imbalance. They cause intense pain (called an attack) that can be throbbing or pounding. But unlike headaches, they often come with other symptoms like sensitivity to light and sound, as well as nausea and auras.

Migraines can be with or without auras

Migraines occur with auras 25%-30% of the time, but they often happen without them. Auras come in many forms, including:

  • Flashing spots
  • Wavy lines
  • Blurred vision
  • Unusual smells
  • Ringing in the ears
  • Tingling sensations in your face or hands

Migraines can happen often and last a long time

Unlike headaches, which are usually short in duration, the average migraine lasts from four hours to three days — but severe attacks can last weeks, badly impacting a person’s work, family and social life. Some unfortunate people get migraines on 15 or more days per month, a condition called chronic migraine.

Anyone can get migraines

Migraines are more common in women (18%) than men (6%), but children also get them. They happen more in boys than girls, but that seems to switch in the teen years. Migraines seem to peak between the ages of 30 and 49.

Migraines are a serious medical condition

Besides the pain, research indicates a link between migraine and serious health issues, including heart disease, stroke and even suicide:

  • Migraine can increase the risk of heart disease, including heart attacks and angina.
  • It can also raise the risk of stroke, coronary events, and other related deaths by 50%.
  • Suicide attempts are three times more likely among those who have migraines compared to those with no history of migraines.

There are effective treatment options

A cure for migraines is still to come, but there are treatment options that can reduce their frequency and severity. For example, a healthcare provider skilled in migraine management can help you identify and manage factors that may trigger attacks, such as:

  • Stress
  • Hormonal changes in women, including those from oral birth control or hormone replacement therapy
  • Alcohol
  • Bright lights and glare from the sun
  • Loud noises
  • Not getting enough sleep or poor sleeping patterns

Your healthcare provider may also prescribe several types of medicine:

  • Pain-relieving medications – Once a migraine attack begins, you take these to reduce its severity.
  • Preventive medications – You take these to reduce the number of migraines and their severity. You may use them on a daily basis.
  • BOTOX® injections: BOTOX is the only FDA-approved, preventive treatment that is injected by a healthcare provider. MPCP offers BOTOX injections for adults with chronic migraines – they can prevent up to nine headache days a month. Talk to your provider to see if you are eligible, or click here to learn more.

Your healthcare provider can diagnose migraines

If you suspect migraines, no lab or imaging tests are needed to confirm it. Your MPCP provider can make the diagnosis with a medical history and physical exam. In some cases, they may refer you to a migraine specialist.

 

Trang Pham, M.D.Dr. Pham is a Maryland Primary Care Physicians, LLC partner and is certified by the American Board of Family Medicine. She earned her medical degree from Jefferson Medical College and sees patients in the Pasadena office.

Can Botox for Migraines Help Me?

I began offering BOTOX® injections for chronic migraines at our Pasadena practice in December 2015. Since then I have treated a number of patients who have noticed significant improvement. One patient was having migraines almost on a daily basis, and 1 month after beginning treatment, has had only 2 mild headaches. Another patient I’ve been treating went from having 20 severe migraine headaches per month to 14 (8 mild and 6 moderate), and has not had to take prescription pain medications since her first Botox treatment.

BOTOX® is the only FDA-approved, preventative treatment that is injected by a doctor every 12 weeks for adults with Chronic Migraine (15 or more headache days a month, each lasting 4 hours or more). BOTOX® prevents up to 9 headache days a month (vs. up to 7 for placebo). BOTOX® therapy is not approved for adults with migraine who have 14 or fewer headache days a month.

Most insurances will cover BOTOX® as long as you meet the criteria for chronic migraine (see above) and have tried at least 2 chronic medications, such as beta blockers or other blood pressure medications, Topiramate, anti-depressants, etc. Even if you have experienced some improvement with these medications, you may still qualify for BOTOX®.

The most common side effect of BOTOX® is neck pain. Other side effects which may occur include dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems, such as double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes. Serious and/or immediate allergic reactions may include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint.

If you suffer from chronic migraines and want to see if this course of treatment might be right for you, you should discuss this option with your primary care provider. For more information please call our office at 410.255.2700, or visit the Pasadena office page.

 

Trang Pham, M.D.Dr. Pham is a Maryland Primary Care Physicians, LLC partner, is certified by the American Board of Family Medicine, and has been performing cosmetic BOTOX® injections since 2008.

Be Kind to Yourself

New research on the mind-body connection

Are you your own worst critic? Do you treat friends and family better than you treat yourself? If you answered “yes” to these questions, you’re not alone. In fact, many of us find it easy to be supportive of others, but we are hard on ourselves for not measuring up in some way.

However, new scientific research is broadening the concept of how important the mind-body connection is to our health. Researchers at Wake Forest University and other institutions are looking at the psychological area of “self-compassion.” The research suggests that actually giving ourselves a break and accepting our imperfections may be the first step to better health. People who score high on tests of self-compassion have less stress and anxiety, and tend to be more optimistic. Data suggests that self-compassion can even influence how much we eat and may help some people lose weight, or stick to an exercise plan over time.

But “cutting ourselves slack” is often thought of as being undisciplined or self-indulgent, right? Researchers counter this much-held thought by saying that a cycle of self-criticism or negativity actually leaves us feeling less motivated to change.

“We don’t understand exactly how optimistic thinking translates to better health, but we see examples of it every day,” says Trang Pham, M.D. of MPCP Pasadena. “We know that thoughts and mood affect brain chemistry and immune function, so this is part of the answer. We also know that people who have a sense of control or optimism recover faster or deal better with disease or injury.”

Doctors aren’t saying to give up the daily practices that go with a healthy lifestyle- eating right, exercise, taking medications if needed – but to try to include positive thinking or self-compassion as much as possible. “Changing habits is hard, and this goes for our thought patterns as well,” says Dr. Pham. “But, as primary care doctors we know that making small changes can have a huge impact on health.”

Try some of the following tips to help influence positive thinking:

  • Monitor negative self-talk. If the thoughts that run through your head during the day are mostly negative, try to switch that around. For example, instead of thinking “I’ve never done this before,” try, “Here’s a chance to learn something new.”
  • Identify small changes. To become more optimistic, identify parts of your life that you typically think negatively about- work, your daily commute, relationships, parenting- and pick one area to approach in a more positive way. Either come up with a better idea to control/improve the situation, or realize that you may just need to change your attitude about it.
  • Surround yourself with positive people. Research shows that our relationships play a key role in our outlook and health, so keep ties with those who are supportive and add some fun to your life.
  • Act positive. Many experts ascribe to the “fake it til you make it” concept of becoming more optimistic. If you actually act happy, or force yourself to smile more often or try to find the humor in a situation, it becomes more natural over time.

With actual practice you can change your self-compassion. You may even improve the lives of those around you in the process!

Trang Pham, M.D.
Dr. Trang Pham, an MPCP partner who practices in our Pasadena office, is certified by the American Board of Family Medicine. She received her medical degree from Jefferson Medical College and completed a residency program in Family Practice at University of Maryland Medical Center.