Headaches can often be relieved by a great massage and some nice deep breaths.

Common Types of Headaches

The following would actually benefit from a visit to the doctor, I review here for education purposes.


If your headache is over a day old or the worst headache of your life, I have to recommend you go to the emergency room. At least try to contact your doctor for care. Don’t try to self medicate with prescription medications, especially controlled substances, for headache management ever. Always care for your headache under the direct guidance of a physician.


Classically, a headache that has been there for over 48 hours in a patient that doesn’t have a history of headaches is going to be something that needs acute care. Classically, headaches that worsen throughout the day, reaching their peak every evening, night after night, are the headaches we experience with malignancy (cancer). Classically, if you can ever say your headache is the worst headache of your life, then it is more likely than any of your headaches to be something that needs immediate medical care. Classically, any headache associated with fever and or neck pain should raise an interest in meningitis or encephalitis as possibilities for an underlying cause.

Those are the bad ones. What about the regular ones.

Muscle Tension and Sinus Headaches

Probably the two most common are muscle tension headaches and sinus headaches.

Muscle tension headaches are mostly at the back of your head associated with neck and or back spasms. They respond nicely to MASSAGE, Tylenol, Advil. Chiropractic care can help. I’m a big big believer in acupuncture as well.

Sinus headaches are in your face. They may even be associated with ear pain. They respond nicely to Sudafed and Afrin. Stick to the regular adult doses if you are an adult; stick to the regular children doses if you are caring for a child. Don’t use pseudoephedrine or Afrin for more than a day ever please. Don’t use either of these if you have blood pressure problems (i.e., blood pressure lability or you use blood pressure medications).


Migraine and Cluster Headaches

That brings me to migraines and cluster headaches, two of the most common of types of headaches that might benefit from prescription medications.

Migraine headaches are throbbing. They are throbbing because they are of a vascular nature. By that, I mean there is a blood vessel that’s pumping painfully. There’s a vascular problem, and that leads to a migraine headache. The word migrainous actually implies vascular. So a blood vessel oriented, throbbing headache – think migraine. Seek care by your physician. Neurologists are usually not needed. Your doc is likely to prescribe one of the sumatriptan‘s. But some patients either don’t respond to them or or don’t tolerate them because these drugs cause hypertension.

So. Other medications that work for migraine headaches that need more care than Imitrex or the sumatriptan’s include barbiturates. Fioricet is a nice choice. Some potential for dependence and abuse with fioricet and barbiturates, so be careful.

Cluster headaches are also extremely common. Neurologists know how to distinguish them from migraine headaches, and it’s very easy usually.

And here are some nice pearls about cluster headaches. Cluster headaches arise from a tiny area deep inside your brain that is not getting enough oxygen. So, if you breathe oxygen from an oxygen tank in a higher concentration than you get from room air, those headaches will go away. And that’s actually a nice way of securing that diagnosis. But not everybody has oxygen at their house. One way you can mimic oxygen blow by is by getting into a car, and cracking all your windows as you go for a drive. This is in fact what is advised for taking a patient to the emergency room if there’s ever an emergency because oxygen helps so many acute things. Drive them safely to the emergency room without delay “with your windows cracked“. Cracking your windows It’s a nice trick for mimicking blow by oxygen.

So let’s say you have a headache that does not seem throbbing, so not migrainous. You don’t have access to oxygen. So you get in your car, drive around with the windows cracked, and it goes away. You probably have a cluster headache. Of course, you’re not going to live in your car riding around to get blow by oxygen for your headaches. You’re going to need other care. Prescription medications that help cluster headaches include steroids and calcium channel blocker‘s. Some patients require stronger control. It’s always nice to avoid opiates because these headaches aren’t going to go away, if you’re gonna continue throwing opiates at them, you will get addicted to opiates. So not the right choice.


If a headache is low risk but brings you to a neurologist and it’s neither a cluster nor a migraine headache, the neurologists like to call them atypical headaches. Follow their guidance. Imaging is often needed.