The mystery of headaches is as old as humanity.  All ancient cultures have evolved myths to explain headaches and have devised myriad treatments to relieve them, including drilling holes in the skulls of sufferers to let the “headache devil” out.  The term migraine comes to us from Greek (hemi = half and kranion = skull), via Latin (migrania), through French (migraine).
      Even today, headaches continue to be shrouded in myths although science has achieved impressive progress in classifying and treating them.  Some of the commonest myths of today is that all headaches are caused by allergies or sinus diseases, attributions that are only partially true.  The following simplified classification reduces most headache disorders into three general types:
a) Headaches for which you don’t need to see a physician:
      These include the common-variety headaches such as migraines and tension-type headaches that begin early in life, continue on-and-off throughout adulthood, and require no special medical attention. A doctor’s help may be required only if these headaches become too frequent, too severe, or if they don’t respond to common remedies such as 2 aspirins etc.
b) Headaches that require a physician’s attention:
      These include unusual headaches that are different from the common varieties and that don’t respond to self-prescribed treatments such as aspirin etc.
      New-onset headaches and headaches that have radically changed their behavior are always worrisome because they may be the harbingers of serious diseases that require prompt medical attention.
      Malignant headaches, which are chronic, frequent, severe, disabling, and treatment resistant, provide the greatest challenge even to the best headache experts.  Because they may be near daily, daily, or else continuous, without even a momentary relief, they can seriously damage the quality of life and render their victims addicted to narcotics.
c) Headaches that are caused by overuse of common analgesics:
      These self-induced headaches, though prevalent, are under-recognized, misdiagnosed, and mistreated.  Any headache sufferer who treats his headaches with more than four pills a week—and whose headaches seem to be recurrent, frequent, recalcitrant, and resistant to preventive treatments—has the analgesic-overuse-headache syndrome unless otherwise proven.
      These headaches only respond to stopping the analgesics, which is easier said than done because such patients harbor a great fear of headaches and it is this very fear that fuels their analgesic overuse.  To stop, they will either need to slowly taper the analgesics to avoid rebound headaches or else they will need to see a headache physician who can help them discontinue the overuse and achieve recovery.  It takes three weeks to three months of analgesic abstinence before the headaches return to their basic, infrequent rhythm.  At that point, they can be treated with no more than two pills twice per week otherwise they will relapse.
      Headache preventive therapy may be necessary for frequent or severe headaches and a headache physician has multiple medications to chose from.  There is one nonprescription vitamin that has been shown in scientific studies to be a reliable migraine preventer.  Pyridoxine, which is Vitamin B6, at a dose of 200 mg twice daily is worth trying before one moves on to more complex preventive therapies.
      Although most headache work-ups, including brain MRIs, end up being negative and seldom reveal a hidden diagnosis, when in doubt, it is always wiser to consult a headache physician and let the physician decide if such expensive tests are really neaded.