A headache journal can guide in care

By Cindy O. Herman For The Daily Item

Pounding and pulsing or unrelentingly steady, headaches make it tough to focus on daily activities. Doctors at the Headache Clinic of Evangelical can help.

“There are a lot of different headaches,” said Dr. Jessica Ahlum, Neurology of Evangelical, where headache clinics are held every Monday. “I would say the most common ones I tend to see are migraines, and there are different types of headaches.”

Classic migraine symptoms include a one-sided, throbbing headache, which can be associated with light sensitivity, sound sensitivity, nausea and vomiting. There are also nonmigrainous headaches, which include tension headaches, occipital neuralgia and atypical headaches.

“Non-migrainous headaches like occipital neuralgia can be triggered by things like arthritis and muscle spasm in the neck, or can present as pain in the back of the head, so that it radiates up over the sides,” Ahlum said. “And then tension headaches are more of the band-aroundthe-head, squeezing sensation that people can have.”

Most headaches can be soothed with over-the-counter pain relievers, but some require a specialist’s help.

“What I typically say is, if you find that you’re requiring escalating doses of over-the-counter pain medication, and it’s not significantly helpful, at that point I think it would be time to ask for a referral to a specialist,” Ahlum said.

The referral typically comes from a primary care provider (PCP). If headaches are worsening or changing in some way, specialists would likely request an MRI, which could also be ordered by the PCP and brought to the first appointment. There, neurologists start with listening to the patient’s story.

“The most important thing for me is hearing in the patient’s own words what their headaches are like, how often they get their headaches, and different symptoms that could be associated with them,” Ahlum said. “It’s really the patient’s report that I go by.”

A headache journal can help find pain triggers and track things like intensity, frequency, location and quality – is it a sharp, shooting pain, is it a dull, aching pain? Is it triggered by different foods, smells or stressful experiences?

“Stress is very important in dealing with headaches,” Ahlum said. “One of the things we definitely ask is, do you feel muscle tightness, muscle spasm in the neck or shoulders? Do you feel like that could be contributing to the headaches?”

In a clinical exam, doctors might use an ophthalmoscope to look for swelling at the back of the eyes, a rare sign of certain types of headaches. Treatment typically starts with oral medications.

“Sometimes there is an element of trial and error,” Ahlum said. “You may try one thing and it may not be effective, or it may be a little bit effective and then you need to determine the correct dose for that patient. It’s a matter of finding what medication is best for which individual.”

Chronic migraine— technically defined as least 15 headache days per month with eight of those having migraine features— can be helped with a procedure of 31 Botox injections made with a tiny needle in the head and around the neck, usually once every three months.

“I’ve had patients say, ‘This has really changed my life,’” Ahlum said. “I can say that, for the right person, Botox is a good option.”

Neurologists work to find the best plan for each situation. Sometimes that can require continued follow-up evaluations, but most of Ahlum’s patients report seeing progress.

“I’m glad I can offer this service to people and be able to help them,” she said. “You know, that’s why I went into medicine, so I’m really happy that’s an outcome we can have.”

To learn more about Neurology of Evangelical and headache care, visit www.EvanHospital.com or call 570-522-9771.

O. Herman lives in Snyder County. Email comments to her at CindyOHerman@ gmail.com