This week’s guest blogger, Alan Zacharias, M.D., is one of five neurologists affiliated with Boulder Community Health. Click here for more about Dr. Zacharias and Associated Neurologists.

Hi there,

I am a neurologist in Boulder and frequently see and treat headaches of all types. In fact, headaches are the most common referral to a neurologist. The two most common types of headaches are tension and migraine. The main difference is the severity and management of the two conditions. Most tension headaches are mild to moderate in severity, diffuse in pain, don’t disable the person and respond to standard over the counter medications like acetaminophen or ibuprofen. The duration is usually under 4 hours.

Migraines tend to be moderate to severe and disabling with associated symptoms of nausea or vomiting, pulsing one-sided pain, and light/sound sensitivity. They last greater than 4 hrs and can last for days. They occur in 5% of men and 15% of women. They may respond partially to the over the counter medications but usually require more. Acute treatment with anti-nausea medications and drugs referred to as “triptans” (e.g Imitrex) is common. To prevent migraine from occurring in the first place, we often use supplements like riboflavin (400mg daily), prescription medications in the categories of blood pressure control, anti-seizure, and antidepressants. Other prevention strategies include Botox, electrical stimulation of the forehead (Cefaly), and the newest approved treatment of Aimovig which is a self-administered injection of an antibody to a protein (CGRP) involved in the mechanism of migraine.

Mindfullness and biofeedback techniques can be helpful as well.

The good news is that most headaches can be effectively treated with one of these many strategies.

— Alan Zacharias, M.D.