Interviewer: We're talking with Dr. Kirtly Parker Jones, she's the expert on all things women. Dr. Jones, is it common for women to come into your office and ask the question, "I've got a headache. Is it normal?" That's a normal question, right?
Dr. Jones: It's a pretty common question. So first of all, in someone's lifetime, pretty much everybody's going to have a headache. Trying to find out what type of headaches they are, how to predict them, and how to treat them is something everybody should know. So let's talk about this headache.
Interviewer: Yeah, so let's play a little game here then.
Dr. Jones: Let's play a little game.
Interviewer: Let's play like detective here.
Dr. Jones: Yeah, okay.
Interviewer: So I'm going to use myself as the guinea pig. I'm just going to make things up because, you know...
Dr. Jones: Okay, stop, stop, stop. No, if I let you talk about your headache, talking to women about their headaches tells me the story of their life, and their kids, and oh by the way, their son's getting married, and I can see already tension building up so this could be stressful. But if I get to talk and I want patients to have two minutes to talk about their headaches, then I want to ask questions. So...
Interviewer: Okay, yeah. Give me questions then.
Dr. Jones: You're going to get your two minutes. I'm going to ask you.
Interviewer: Okay, okay. So we're going to switch this around then.
Dr. Jones: Right, so...
Interviewer: Okay. All right.
Dr. Jones: First of all, how often do you have your headaches?
Interviewer: Every week.
Dr. Jones: Every week. About once a week?
Interviewer: Yeah, more or less.
Dr. Jones: Okay, once a week.
Interviewer: Once, twice a week.
Diagnosing Headaches in Women: Types and Frequency
Dr. Jones: Okay. Once or twice a week. So when you get to more than twice a week, it's almost called a chronic headache, but once or twice a week is very common. People have it more than twice a week. That's only about 5% of people, but a lot of people have headaches. About 80% of people will have a headache called tension headache, and for women, about 17% to 20% of women will have migraines. Now, women often think because the headache is bad it must be a migraine because migraine headaches are...
Interviewer: It sounds bad.
Dr. Jones: Notorious. Yes, got this name migraine. There's the whole cultural thing around migraines, but what you have may not be a migraine headache. So can you describe your headache to me? Where is it?
Interviewer: So it's about once, twice a week. Maybe the left side, just one side of the, I guess the brain, of the mind, my head headaches, right? It's on one side. It doesn't really travel anywhere else...
Dr. Jones: Okay, one side.
Interviewer: But it's throbbing. It's just kind of...
Dr. Jones: One side throbbing. So that gives me two important cues it's probably a migraine type of headache. It's one-sided and it's throbbing. Now, does anything bother you? When you have this headache do anything, sorts of things bother you?
Interviewer: Let's say for the sake of this, let's say no.
Dr. Jones: No. So many people with migraines, but not everyone would say, "The lights are too bright," so they're photophobic. They really don't like lights and they'll go into a dark room and it feels better when they don't have bright light, but not everyone. Some people get nauseated and throw up. Some people actually have some symptoms around their jaw or their neck that feel like part of their neck or jaw feels funny or is tight. Now, can you tell when your headache is coming? Do you see any sparkles, or do you see anything before your headache starts?
Interviewer: Let's say that I feel it coming.
Dr. Jones: You feel it coming?
Dr. Jones: You've got some twinkles in your eyes?
Migraine Headaches: Symptoms and Triggers
Dr. Jones: So it turns out that about 15% of people have migraine, and I think you have migraine, have what we call classic migraine. And classic migraine is usually marked by an aura. An aura is a visual sign that something's going to happen, and it's often one side of your visual field. You can see either jagged lines or twinkly lines that start small and then grow a little bit bigger and then get smaller. The aura often precedes the headache, so that's a classic migraine.
So it's unilateral, one-sided, throbbing often, sometimes with nausea and photophobia. And for about 15% of people with classic migraine, they have an aura, a visual disturbance. And the headache usually lasts anywhere from a couple of hours to a day, not longer than a day, usually. How long does yours last?
Interviewer: That sounds painful.
Dr. Jones: How long does yours last?
Interviewer: Let's say half a day. Let's go...
Dr. Jones: Half a day?
Interviewer: Let's say half a day.
Dr. Jones: And how much does this bother you? How much does this get in your way?
Interviewer: When it happens, I don't want to do anything else but just lay in my bed and hope it goes away.
Dr. Jones: Okay. Have you taken anything for it?
Interviewer: Advil, Tylenol.
Dr. Jones: And does it help a little?
Interviewer: Ibuprofen... Let's say yes.
Dr. Jones: Okay. So there's no...
Interviewer: Or let's say I would like to think it does.
Dr. Jones: Okay. If it's going to last for half a day, then anything is eventually going to work because it's going to go away.
Interviewer: You like to think it helps.
Dr. Jones: What you want is something that makes it go away right now.
Treating Migraine Headaches: Medications and Prevention
Dr. Jones: So in terms of treatment of migraine, it's certainly some people do well. Some Tylenol or ibuprofen can help some. There is a new category of drugs, new meaning for the last 15 plus years or even longer called Triptans, and these actually, if you take them as soon as that little twinkly eye thing is going on, or as soon as you think it's coming...
Interviewer: The aura's coming?
Dr. Jones: If you take them, they can decrease or block the headache part. So they have been very, very successful in treating migraine. If you take it at the beginning... So if you're having headaches a couple of times a week and it's like this, and you have to...
Interviewer: Like I know it's coming.
Dr. Jones: Go to a doctor. You have to go to a doctor to get this prescription, you need to carry it with you in every purse you've got because if you have to run home or drive home especially if you're not feeling all that well, which isn't that great, to go get it so you have to carry it with you.
Interviewer: Let's back up a little bit and let's talk just briefly about if there are no signs or symptoms. Like we talked about, "Yeah, I can see it, I can feel it coming." What about the ones that are just sudden?
Dr. Jones: For people who don't have an aura, the Triptans still work very well. It can shorten the course, intensity, and duration of that migraine. So as soon as you start feeling the headache, that unilateral throbbing, happens a couple of times a week, then taking it as soon as you begin to feel it will also shorten the course. So people with aura just have a little bit more warning before the headache starts.
Interviewer: So this is normal? So like once, twice a week for about half a day a day, that's normal?
Dr. Jones: Well, normal. About 17% of women plus are going to have migraine in their lifetime.
Interviewer: Do you know why? What's causing this?
Dr. Jones: We don't know exactly why. We used to think, in the old days, that it was vasospasm that for some reason in the brain, the blood vessels would go become tight and then they would expand and that would hurt when they got expanded. That no longer is really the understanding that we have. So we're not exactly sure. The mechanisms are difficult, but Triptans seems to work pretty well. When you have a headache ibuprofen can work.
What you really want to stay away from is taking ibuprofen all the time, or taking narcotics for these headaches because people can develop rebound headaches. So rebound headache is when you get a headache after the stuff you've been taking for the headache stops, and then you get a more headache. So the goal is to try to take something.
Now, I asked what your triggers were. Triggers are things that you say, I think that I am... This is happening when I have my headache."
Interviewer: I mean, I can't think of any triggers, but...
Dr. Jones: Okay. Well, let me tell you some of the triggers.
Interviewer: Let's be fun here and let's have you tell me some triggers.
Dr. Jones: I'm going to tell you some triggers. So it turns out that there are some well-known triggers, and one is they fall into categories of change in habit. So if you usually sleep X number of hours a night, or you usually get up at a certain time and now you're changing that, you're not getting...
Interviewer: Change your behavior.
Dr. Jones: Your behavior. So you have changed your behavior and you're getting more sleep, you're getting up later than you normally do, and morning migraine is common. So you're getting up too late or you're getting up at a time that you aren't used to those. So not enough sleep or a change in sleep habits, not enough food or a change in food habits, a weekend headache, vacation headache. So you're stressed, stressed, stressed, stressed, and all of a sudden you're letting down and you're sleeping more or you're eating differently, so vacation headaches or change.
Interviewer: There's such a thing as vacation headaches?
Dr. Jones: Yeah.
Interviewer: There is the headache that's caused by vacation?
Dr. Jones: Yeah.
Dr. Jones: So you're changing. So migraine is often associated with when you've changed a habit. Caffeine withdrawal has its own kind of headache, but people drink much more coffee than they used to, or less can trigger their migraines, although it can trigger different kinds of headaches too.
Interviewer: So that reminds me of what I like to call the hangover headache.
Dr. Jones: Well, so that's a hangover. If you're drinking, now let's talk about what you're doing the night before twice a week. Twice a week you'll go out with the girls or the boys or whoever you're going out with and you drink way too much. So hangover headache is not a migraine. It is associated, we believe, with dehydration. So it turns out that when you drink a lot, you tend to pee a lot more and you get a little dehydrated.
So people say, "Before you go to bed if you drank too much, you should drink a horde of water and take two aspirin." Another is to get yourself tanked up and then take some aspirin before you go to bed. So in general, I'd say that if these two headaches a week are preceded by a night time of drinking too much, then even if it is migraine, you're drinking too much. So hangover headache. So there you go. That's a hangover headache.
What Causes Tension Headaches?
Now, there's another kind of headache that doesn't sound like you have, but 80% of people have this headache, and it's called tension headache. Now, when you say the word "tension headache," it makes you think that you're tense. But in fact, what's tense are the muscles around your scalp. So you have a thin layer of muscles all around your scalp and your forehead, in the back of your head, and across the top of your head. These headaches are bilateral. When people explain it to me they often cup their hands over the front of their head or the back of their head. These are very well treated with ibuprofen and drugs like that and sometimes Botox treatment.
Dr. Jones: It's like Botox has been used for migraines as well, but Botox treatment for tension headaches. Remember, it's not that you're tense, but it's because your muscles are tense.
Interviewer: Muscles are tense therefore Botox. It makes sense.
Severe Headaches: When to Seek Medical Attention
Dr. Jones: So that works as well. Now, I want to say at the end that these are headaches that you are living with, but you're not happy to live with. So they're normal, but you're not happy to have them. There is the person who's having, "Oh, this is the worst headache of my life." And particularly for women, there are some headaches that are a signal for a devastating problem.
So these are people who might have bleeding in their brain from an arteriovenous malformation, something called an AVM, a little blood venous area that starts to bleed in their brain. They could have a clot in their brain. They could be having a stroke. So these are various serious headaches. If this is the worst headache of your life and you are writhing, then you need to go to the ER.
Interviewer: How do you tell? Like, how can you tell if... because I feel like once a headache hits it's always going to be the worst headache of your life because it's just... it hurts.
Dr. Jones: Of course, but if you're having it once a month or once a week you could say, "This is the worst headache of my life," but it's just like the headache I had last week or the following week.
Interviewer: You can live through it.
Dr. Jones: You can live through it. But when you say, "This is not like that headache. I can't see. This is blindingly... I'm throwing up. I'm incredibly uncomfortable..."
Interviewer: So there's a lot more serious signs and symptoms that go along with it?
Dr. Jones: Right. So if it's the worst headache of your life...
Interviewer: Go to the ER.
Dr. Jones: And you haven't had a headache, well then it's a visit to the ER. So a bad headache, not all headaches are migraines, but migraines are common. Eighty percent of headaches are tension. They have to do with the muscles around the head, work well with ibuprofen, and some changes in behaviors that might actually... Eat well, sleep well, and do your exercise about the same way. Migraines have a treatment for the headache in Triptans. And then try to avoid your triggers. If you have a headache, it's normal. More than twice a week, it's not normal.
updated: June 29, 2023
originally published: September 7, 2017
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