What works for you, and what kind of headaches do I get?

December 26, 2023 12:32 PM

YANMD, but my doctor has finally prescribed medicine which disperses my headaches. It's Sumatriptan, so what kind of headaches do I get? My worst cases are accompanied by feverish chills, and note that my father would get pain-free migraines accompanied by their usual visual effects (which I never experience). Is it all because of caffeine?

And if you get headaches often, what works for you? I get some (but not enough) relief with aspirin, none at all with Tylenol/acetaminophen (which I'm convinced is just a placebo - how did that drug become the default!?) and I avoid Ibuprofen for headaches as in my experience it works best on muscle aches and sprains. As for the caffeine I try to avoid it but I've been drinking too much tea again, and I think not enough yesterday when too much the day before = headache today.

Why is the caffeine withdrawal headache so painful?

[soundtrack for this Ask by Black Francis]

posted by Rash to Health & Fitness (28 answers total)

Best answer: I was prescribed that for migraines, and mine are also sometimes accompanied by chills. I definitely get caffeine withdrawal headaches too, and sometimes visual migraines with no pain (for these, I just close my eyes). I barely get them anymore and I was too freaked out to use the medicine often because my doc told me it can also cause rebound headaches. Mine often seem to be sinus related and sometimes alternating hot and cold things on my face helps. Like a hot cup of tea against my face and then an ice pack.
posted by beyond_pink at 12:50 PM on December 26, 2023

Sumatriptan is typically prescribed for migraines, and I've used it effectively for that. Not everyone gets visual auras; I don't, though I do get photosensitivity. Usually though, Tylenol or Excedrin work for me. If it's a headache that's mostly from neck strain/tension, then I alternate Tylenol/Motrin plus Icyhot or a heating pad on my neck.

Tylenol is the "default" painkiller because it has very few, if any, side effects for most people. NSAIDs are hard on the stomach, and interact in not great ways with some common conditions or medications. Tylenol/acetaminophen is least likely to cause any issues in the recommended amounts.

Also I have no idea why caffeine withdrawal headaches are so painful, but yeah, seconding that they're miserable. If you're concerned that caffeine withdrawal is causing your headaches, then it might be time for a looooong slow taper down to wean yourself off it. I did this a couple times in high school and college when my caffeine consumption crept upwards too much and I was getting too anxious/too many withdrawal headaches. Resetting to a baseline really helps a lot, provided you can stay disciplined afterwards and maintain a stable and regular amount of caffeine consumption. I've never needed to taper down again since college because now I maintain a very basic, predictable amount of caffeine: same amount of coffee/tea in the morning, same amount in the afternoon, preferably from a consistent kind/brand/source. This way you're at least never in doubt about whether it's a lack of caffeine causing your headache, thus avoiding the vicious cycle of letting your caffeine consumption and tolerance creep up on you.
posted by yasaman at 12:56 PM on December 26, 2023 [1 favorite]

Top 10 Migraine Triggers and How to Deal with Them

Magic Gel Ice Cap - Wrap Around Ice Pack for Head. If your headaches are intense and last all day, I recommend getting two or three of these, although they do take up a lot of freezer space.

Electrolyte tablets help a lot if you get headaches from undereating, overheating, overexercising, or overwork. They are also great if your headaches make you nauseated so that you go too long without eating - not eating enough also causes headaches, which is a bad cycle; the electrolytes stop that not-enough-food pain and can let you start eating real food again.


Use a 14-day pill container to measure out 14 gradually decreasing amounts of loose-leaf green tea, to be brewed daily at the same temperature and brewing time, to taper off caffeine.
posted by amtho at 1:01 PM on December 26, 2023 [2 favorites]

A tight cloth band around the head was used in medieval times. This study used a similar methodology with success.
posted by amtho at 1:10 PM on December 26, 2023 [1 favorite]

I get some (but not enough) relief with aspirin, none at all with Tylenol/acetaminophen (which I'm convinced is just a placebo . . .

Here is a Rebecca Watson video where she claims that Tylenol is worthless and also dangerous, but when I linked that video a few months ago, a multitude stepped forward to say that Tylenol was the only thing which was able to reduce their fevers.

I think caffeine withdrawal headaches are bad because your system adapts to caffeine by dilating blood vessels in the brain when it has learned to expect caffeine to arrive and constrict them, and so when caffeine doesn’t arrive, you’re left with all these dilated blood vessels in your brain, and a big part of the pain of migraines has been attributed to dilated blood vessels in the brain, so such dilated vessels are probably intrinsically painful.
posted by jamjam at 1:13 PM on December 26, 2023 [4 favorites]

Caffeine has some genuine health benefits. It is generally a vasodilator, opening up your veins. lack of caffeine results in vasoconstriction and headaches, as jamjam commented. I have 2 - 3 cups of coffee daily and get a headache if I'm deprived of coffee.

Tylenol is not great for your liver; I use it sparingly.
posted by theora55 at 1:45 PM on December 26, 2023

Best answer: I can't diagnose you with migraine because IANAD, but if sumatriptan works, and migraine runs in your family, I would not be surprised if you have it. Migraine is a super complicated disease, not really that well understood, and it presents differently in different people. It's not really a "headache," it's a neurological disorder that sometimes causes episodes with symptoms that include headache.

One major suggestion: take the meds as soon as you feel the episode coming on. Don't wait. Don't tell yourself "oh it's probably nothing." The drugs work better when you take them early. If they persist, it might be worth it to go to a neurologist.

If you want to learn more about migraine, I really like The Migraine Dietician, her website has a ton of info and her Insta is amazing. You'll learn a ton from her. I also thought Understanding Your Migraines: A Guide for Patients and Families was super helpful, it's by the head of the UCSF headache center.
posted by radioamy at 1:46 PM on December 26, 2023 [7 favorites]

I get migraines that respond to sumatriptan! Mine are weather-linked. Things I have learned over probably twelve or thirteen years of use:

- Sumatriptan can cause rebound headaches or an increase overall in headache frequency. Don't let worry over this keep you from using it. If I've had multiple migraines in a short period, I may get a rebound headache which is not a true migraine - for me, this means it starts later in the day, doesn't intensify much and is not accompanied by nausea. For this type of headache, I tough it out with aspirin and caffeine. After this type of headache, the rebounds stop. Your mileage may vary, but know that IME rebounds are manageable as I've gotten used to taking triptans.

- Your migraine symptoms may change over time. I never used to get visual migraines/painless migraines with aura but I now get them occasionally, for instance, and I get more fatigue with migraines now.

- I believe that my migraines without triptans are worse now than before I started taking them, but the overall benefit of having, like, one breakthrough migraine a year and no others is worth it.

- Sometimes if I take a larger dose of aspirin right away - three or four, this is recommended in some peer reviewed studies - with caffeine, I don't need the triptan. You can take triptans with aspirin; this in fact makes them more effective, so you can take the triptan later if needed. When I take aspirin for migraine, I crack one of the pills so that I don't have to wait for the "buffered" coating to dissolve.

- If the triptan is working but I'm still feeling headachey and yuck or if I'm coming off of a breakthrough migraine, a small regular coke/pepsi and some potato chips or salty crackers really helps.

- And most importantly - ask for a small prescription for the nasal inhalers. As a migraine progresses, your stomach often stops digesting, so if you take the triptan too late it won't work and you may just vomit it up. I've found that when I wake up with a bad migraine, the nasal triptan can interrupt it while a pill is useless. Generally, the pills are better, but the nasal triptans are a godsend. As long as I have them on hand, I no longer get breakthrough migraines at all, since those only happened because they came on too fast for the triptan to work.
posted by Frowner at 2:06 PM on December 26, 2023 [6 favorites]

Full caffeine coffee to swallow down Sudafed. It's okay to say "my migraines are not sinus headaches; why would I try this?" but it costs like $10.00 to see if it helps. I post this suggestion often and I get memails and comments saying "thanks, this works for me now" pretty regularly.

And hey, if it doesn't, you have Sudafed on hand for the future.

But it has to be the real blue Sudafed, not the red one.
posted by DarlingBri at 3:08 PM on December 26, 2023 [2 favorites]

I get migraines. After many years of experimentation and many different meds, I now commonly use Excedrin. For me, the key is it has to be taken quickly, and with a decent amount of food. (like, two pieces of toast.) If I wait too long, it either straight-up doesn't work, or I'm too nauseated and struggle to keep it down.
posted by BlahLaLa at 3:53 PM on December 26, 2023 [1 favorite]

I'm really tired and might not be as coherent as I'd like, but if you suffer from headaches at all, it's worth watching the Migraine World Summit every year (at least the wrap-up/summary video). It's also worth checking out the book Heal Your Headache by David Buchholz, which is informative even if you don't ultimately follow his recs and diet.

Most doctors have very little education about headache and migraine, the rarity of headache specialists means it can be very difficult to get an appointment with one, migraine research is underfunded compared to the number of affected people and the level of disability it causes, and many doctors are working with outdated information instead of cutting-edge research. The result is that MWS viewers are probably going to be more informed on that specific topic than some clinicians are, and will likely have a pretty good grasp of tools and techniques if they try stuff and see what works for them.

One thing that headache specialists know that has not really filtered down to the general population, service journalism, even some PCPs/GPs, is that most headaches are migraine-related. You won't have a "sinus headache" unless you have a pretty intense sinus infection, and "tension headaches" probably don't really exist (but stress can be a migraine trigger). Migraine itself is a neurological event that has headache as a common (but not universal) symptom. The trigeminal nerve is usually involved in a migraine headache. Nasal and sinus tissue tends to swell. This leads people to think they're having a "sinus headache." It's also why a nasal decongestant like Sudafed/pseudoephedrine (a pill) or Afrin (topical) can help a lot. Caffeine (the coffee some people drink, or as an ingredient in Excedrin) also helps constrict blood vessels and can lead to some relief. Got stiff neck and shoulder muscles and think that means you have a tension headache for sure? Well, migraine is known to cause that kind of stiffness and pain. Migraine can also present mostly as prodrome, vomiting, and postdrome, with no headache or sinus issues at all. (I think it would be easier for people to look up prodrome and postdrome, but they're basically the early and late stages of the migraine event, and can involve stuff like sleepiness and depression.)

Journaling can help you figure out your triggers (barometric pressure, stress, and sleep schedule issues are mine). Medications like triptans tend to be most effective when taken early. It can also help to skip medication for some headaches if you can stand to, because rebound headaches appear to be a problem.

Other than that, there are already lots of good recs here! For me, I like some kind of ice hat, a hydrating beverage like Gatorade/Propel/LiquidIV with a bit of extra water and lots of ice, a sleep mask if I'm light-sensitive, a heating pad that wraps around my shoulders, roll-ons of Lavender Aspercreme with Lidocaine and Biofreeze, and a Migrasoothe roller which is a blend of lavender and peppermint oils. I use Afrin to relieve internal sinus pressure, keep Excedrin Migraine (which is functionally identical to the Extra Strength version) on hand, and take a triptan if I need to. Be careful if using Aspercreme or Biofreeze with a heating pad or ice pack: it's not recommended because you won't be able to feel skin damage as it's happening. I use these things in some combination depending on what seems like it will feel good at the time, so as an example, the ice hat is the "big guns," while the Excedrin, Afrin, shoulder wrap heading pad, and Aspercreme are the first line of defense. Ginger pills help some people as much as prescription migraine treatments do, but I stopped taking them because I have other health issues that make them not the best choice for me.
posted by verbminx at 4:28 PM on December 26, 2023 [11 favorites]

PS: After rereading everyone else's comments, Frowner's is really good and well-informed and radioamy's is also likely to be very helpful. I can only echo some of their points. I also, personally, have not had noticeable rebound headaches from meds, but only you can figure out whether or not that's an issue for you and if you can work out how to get around it.

I am lucky enough to not usually get very nauseated with migraine, but I do tend to get very sensitive to light, sound, or both. I keep sunglasses in my headache kit, too, and use them if I don't want to go for full darkness. I have another friend whose migraines are usually 2-3 days of throwing up with little to no head pain.
posted by verbminx at 4:37 PM on December 26, 2023 [1 favorite]

Imitrex with an Aleve or 2 plus a cold caffeinated soda are what help my normal migraine. My really bad ones I just have to try my hardest to sleep it off after the aforementioned cocktail. I will usually sleep for 8-12+ hours when I am hurting like that. Occasionally I have to take the second imitrex after 2 hours if my pain does not abate or increases in severity. I don’t usually sleep well (since I was a smol smol toddler) and I have a paradoxical relationship with caffeine in that it doesn’t excite me/keep me awake, but puts me in my rhythm (I can have a Pepsi or a cup of coffee and go directly to sleep for the night), so some of that might make some folks a little fidgety. Ibuprofen works for “normal” headaches, but I prefer Aleve. Tylenol only functions as an antipyretic for me and not a pain reliever. I have occasionally had rebound headaches - more Aleve and sleep and water.

Frowned mentioned the nasal sprays - there are folks in my family with migraine who swear by them. I was given one, at a smaller dosage than the same triptan I’ve been taking for almost 20 years, and I had the opportunity to use it. I thought I was gonna die. My migraine went from ugh need sleep and my freakin head to dear Jesus do I need to go to the ER right now or can I tough this out. The nasal spray intensified my pain exponentially and I had to wait two hours until I could take my pill. Never again. So ymmv with the nasal spray. I’m fortunate in that I get nauseous with migraine, but I haven’t ever puked, so I haven’t had to worry about not keeping the pill down.
posted by sara is disenchanted at 10:42 PM on December 26, 2023 [3 favorites]

90% of my migraines disappeared when I started consuming at least a strong coffee's worth of caffeine daily. Of course I get monster headaches that aren't just withdrawal when I stop caffeine, so I make sure I don't stop. It's a reasonable price.

Caffeine can be good for migraine, in short.
posted by deadwax at 3:29 AM on December 27, 2023 [2 favorites]

My migraines can be stopped/eased with a version of Sumatriptan plus a version of ibuprofen (zolmitriptan and ketoprofene) as I feel like the ibuprofen brings down inflammation that was contributing to my migraines. I’m having some preventative success (chronic structural migraines) with a monthly injection of Emgality. I hope you get some relief!
posted by ellieBOA at 3:51 AM on December 27, 2023 [1 favorite]

I get migraines and take Sumatriptan (previously Zolmitriptan). I don't get any visual symptoms and my migraines are either a pain on the right hand side of my head, or an extreme grogginess with, later, an added right-hand-side pain.

Sumatriptan works best for me the sooner I take it, so it's possible I sometimes take it unnecessarily, when I think a migraines coming but maybe it wouldn't have, but whatever. On average I have them once or twice a week. A "good" one just means a couple of hours of headache while the medication does its work. A groggy, bad one means I'm not doing anything for most of the day.

I have 100mg pills, because 50mg didn't always work. But I've realised that if I take 50mg early enough with a "good" migraine, it's enough, so I cut some pills in half.

Years ago I tried giving up (at different times) caffeine, alcohol, cheese (or maybe all dairy, I forget), and citric acid. None made a noticeable difference. I keep my caffeine intake steady (2-3 coffees/teas a day) and don't drink much alcohol.

I've also tried various daily preventative medications but none made a noticeable difference to me.

I think mine have various causes, with varying degrees of certainty, which maybe combine: clenching my teeth (usually at night, always on the right-hand-side), stress, dehydration, maybe (some?) alcoholic drinks.
posted by fabius at 5:19 AM on December 27, 2023

> But it has to be the real blue Sudafed, not the red one.

Wait, wat? Around here, the awful stuff (Phenylephrine) is the blue, and the real stuff (pseudoephedrine) is the red. Lesson is "read the fine print", I guess.
posted by jferg at 5:29 AM on December 27, 2023 [2 favorites]

My migraine frequency dropped dramatically after starting to take 400 mcg of magnesium glycinate daily. I take 200 in the morning and 200 at night. I have sumatriptan for when I get a migraine.
posted by poppunkcat at 5:58 AM on December 27, 2023 [1 favorite]

You may want to look into the supplement regime that is recommended by neurologists for people diagnosed with vestibular migraines. It often involves magnesium glycinate, riboflavin (B2), CoQ10, Vitamin D + K and B12.
posted by nanook at 6:14 AM on December 27, 2023 [1 favorite]

Best answer: I would encourage anyone who experiences chronic headaches to seek specific treatment for migraines. I've met people who take only OTC meds for them, which do little for symptoms, and just suffer through or try to sleep it off.

Before I got them I thought a migraine was only a severe, intractable headache, but mine are rarely sharply painful like that. They will still absolutely ruin a day if untreated. It's a condition I have to deal with, and I had to largely say goodbye to triggers like booze, but it's totally manageable thanks to the right mix of targeted drugs.
posted by nev at 7:09 AM on December 27, 2023 [1 favorite]

Response by poster: Caffeine can be good for migraine, in short.

Yes, absolutely. Unfortunately too much caffeine triggers an unpleasant heart condition I used to get, back when I was drinking espresso: PVC. Doctor said it was caused by stimulants so I gave up the coffee, so difficult; but as I said upthread, now I'm drinking tea, probably too much, so I'm interested in all the non-caffeinated suggestions here. Thanks!
posted by Rash at 9:39 AM on December 27, 2023

a tight cloth band around the head was used in medieval times... thanks amtho!

I've had debilitating migraines my whole life. I had no idea. When I was about 11 or 12 (before any therapeutic drugs were invented), I started doing this with a bandana carefully positioned on the brow, precisely over the temples, and tied in back.

Works way better than ice and aspirin, which was all we had back then - uh, and onions on our belts.
posted by j_curiouser at 11:02 AM on December 27, 2023 [2 favorites]

PS: I just started rizatriptan this year. Game changer.
posted by j_curiouser at 11:08 AM on December 27, 2023 [2 favorites]

Triptans work, so use as prescribed. I've been using them for years and I believe they are safe. Many people have told me that 2 Advil and a cup of coffee staves off their headache. I find generic extra strength ibuprofen is great, too.
I read a comparison study of scientific studies on o/c pain relievers. Conclusion: Tylenol for aches and fever, Ibuprofen for headaches.

You may find that air pressure changes affect you. You will be asked to do a food diary, which may indicate triggers.
A site called "Stuff that works" collects personal info about symptoms and what works and doesn't. It's free.
posted by Enid Lareg at 6:26 PM on December 27, 2023 [2 favorites]

The headache specialist doctor I saw told me to take three ibuprofen gel caps -- she was very specific about that -- when I first start to get a headache. That sometimes helps. Rebound headaches are real, and she told me not to take ibuprofen more than three times in a week.

The best thing is a nap, where I basically pass out for 30 - 60 minutes.

My headaches started with a concussion, but the specialist said I could call them migraines; it seems that's a more general term than you might think.

As far as supplements: SAMe seems to help me, as do B vitamins, both of which the doctor recommended, but it's hard to tell for sure.

I haven't figured out caffeine. I quit three years ago for unrelated reasons and just recently started drinking it again; I started largely because it helps my headaches. But am I setting myself up for more headaches down the road?
posted by The corpse in the library at 6:44 AM on December 28, 2023 [1 favorite]

Response by poster: Thanks for all the answers, very helpful, although marking any as Best was difficult, possibly because my question wasn't very clear, mostly I wanted a discussion with anecdata, thanks!
posted by Rash at 9:12 AM on January 3, 2024 [1 favorite]

Wait, wat? Around here, the awful stuff (Phenylephrine) is the blue, and the real stuff (pseudoephedrine) is the red. Lesson is "read the fine print", I guess.

Yes, it's the Psudoephedrine you want, whatever color it comes in for you.
posted by DarlingBri at 5:20 AM on January 4, 2024

Response by poster: NPR in 2019: Green Light therapy for migraine relief
posted by Rash at 9:49 PM on January 6, 2024 [1 favorite]