Headaches and Migraines

I’m seeing my doctor for frequent headaches. What is likely to happen at the appointment?

DEAR DOCTOR K: I've made an appointment to see a doctor because of my frequent headaches. What is likely to happen at the appointment?

DEAR READER: If your headaches are severe, occur often, or are unresponsive to nonprescription pain relievers, it makes sense to see your doctor. He or she will try to determine the causes of your headaches and design a treatment plan. Your appointment is likely to begin with a series of questions about your headaches.

What’s the best way to treat sinus headaches?

DEAR DOCTOR K: I've had terrible allergies this year, and they have caused repeated, severe sinus headaches. What's the best way to treat sinus headaches?

DEAR READER: The sinuses are air-filled spaces above, between and beneath your eyes, flanking your nose. Both the nose and sinuses are lined with a thin membrane that swells and produces mucus in response to irritation. Normally, the mucus from the sinuses drains through small openings, known as ostia, into the nose. The stuff you blow out when your nose is congested is usually mucus produced by the membranes that are in your sinuses and in your nose.

What can I do to prevent migraines?

DEAR DOCTOR K: I suffer from excruciating migraine headaches. What can I do to prevent them?

DEAR READER: Migraines are severe, throbbing, often debilitating headaches. They can be accompanied by nausea or vomiting. It's no wonder that anyone who suffers from migraines would do anything to avoid them. Migraines can be triggered by certain activities, foods, smells or emotions. Common migraine triggers include:

Can Botox injections help treat chronic migraines?

DEAR DOCTOR K: I suffer from chronic migraine headaches. My doctor mentioned Botox injections as a possible treatment. Can you tell me more?

DEAR READER: I'll bet you were surprised when you told your doctor you needed treatment for your migraines, and he or she said, "You need Botox!" After all, what does removing wrinkles have to do with headaches? Botox can do much more than remove wrinkles. Botox -- short for botulinum toxin -- is a substance made by the bacteria responsible for botulism.

How can I prevent tension headaches?

DEAR DOCTOR K: I get tension headaches fairly often. What's the best way to treat and prevent them?

DEAR READER: Tension headaches are the most common type of headache. The pain -- usually a dull tightness or pressure -- may envelop your entire head, or it may strike only your forehead or the back or top of your head. (I've put an illustration showing where tension headaches usually strike below.)

What will help my sinus headaches?

DEAR DOCTOR K: I'm a woman in my 30s who has suffered from sinus headaches for years. Allergy medications haven't helped. What else can I try?

DEAR READER: Seasonal allergies can cause sinus congestion, sneezing and a runny nose. But when you experience pain and pressure in your head, it may be time to consider other causes. That's because sinus problems do not usually cause headaches. At least, they don't cause what most people refer to when they use the term "headache." Most people with sinus congestion refer to "head congestion," not headache.

I get migraines regularly — should I have a brain scan?

DEAR DOCTOR K: I regularly get terrible migraine headaches. My doctor has prescribed medication, but I still think I should have a brain scan to make sure there's nothing more serious going on.

DEAR READER: Severe headaches cause both misery and fear. Obviously, the fear is that something serious, like a brain tumor, may be causing the headache. Still, the pain of even a severe headache rarely comes from something catastrophic like a tumor.

What pain relievers are safe to take for tension headaches if you have cirrhosis of the liver?

DEAR DOCTOR K: I have cirrhosis of the liver. I also get tension headaches. What pain reliever can I take for my tension headaches?

DEAR READER: One of the liver's many jobs is detoxification -- ridding the blood of toxins. Cirrhosis, a liver disease, interferes with the liver's ability to detoxify substances in the blood. Your liver sees medications as toxins. When your liver is compromised, medications that are normally considered "safe" may no longer be safe for you.

What can I do to prevent my painful cluster headaches?

DEAR DOCTOR K: I get excruciatingly painful cluster headaches. What can I do to treat, or better yet, prevent them?

DEAR READER: Cluster headaches are rare. Only about one adult in a thousand suffers from them. But they are among the most painful of all headaches. We doctors have theories about what causes cluster headaches, but the fact is that we don't really know. They do run in families: There is an inherited, genetic component.

What could be causing my chronic headaches?

DEAR DOCTOR K: I've had a headache every day for six months, despite taking painkillers every day. What could be causing the headaches? And what can I do to stop them?

DEAR READER: Most people who suffer from frequent headaches don't have them every day. If your headaches have literally been with you "every day for six months," and this is something new for you, consult your doctor. While your headaches still could be one of the two most common causes of headaches -- migraine headaches or tension headaches -- they also could point to something more serious.