Maj. Frances Lang, a physician assistant with First Army's 5th Armored Brigade, prepares a Botox injection for a migraine treatment.

June is Migraine and Headache Awareness Month. Migraines are the second-leading cause of disability in the United States. Among Veterans in the VA health care system, 1.6 million have been diagnosed with headache disorder, 621,000 have been diagnosed with migraines, and 77,000 have been diagnosed with post-traumatic headache or traumatic brain injury plus headache. Despite multiple options for treatment, it can be difficult to obtain optimal therapy.

There are many kinds of headache triggers. Common ones include dehydration, caffeine withdrawal, sleep apnea, medication overuse, stress, traumatic brain injury, and smells. Before taking medication, try to address the underlying issue. Is it from inadequate hydration, lack of sleep, stress, allergies, unbalanced hormones, untreated hypertension, or lack of exercise?

Next, do an honest assessment on how frequently you take medication to treat headaches. If it is more than three times a week, the headaches may be caused by medication overuse. Medications that treat headaches may actually cause them once the body starts to need it.

Migraines are in their own category of headaches. They can be disabling, typically effect one side of the head, may be associated with a tingling of the face or visual symptoms, typically build over the course of 30 to 60 minutes, may be associated with nausea and vomiting, and are pulsatile.

Treatment varies depending on headache frequency. For those who have more than 15 days of headaches a month, even if controlled with over the counter medication, it is important to see your primary care manager. The provider will check for more serious underlying health conditions and can potentially prescribe a daily prevention medication. Treatment can be tailored to address multiple issues with one medication if there are other underlying health issues. If daily prevention medication fails, Botox (Botulinum toxin type A) may be considered. This injection paralyzes muscles for up to three months and works for migraines by blocking neurotransmitters that carry pain signals from the brain.

If experiencing any of the following conditions, seek medical care: Thunderclap headaches that reach maximum severity in a few minutes; positional headaches in which the severity changes with position; new headaches, especially among those 50 years of age or older, or those with cancer or blood clotting disorders; headaches lasting more than two days or which increase in intensity; headaches with weakness on one side of body; stiff neck; slurred speech; and a fever of 100.4 or higher.

If headaches linger despite over-the-counter medication, it is recommended to keep a headache log that includes the frequency of headaches, their location, their severity, and their duration. This information will aid your primary care manager in devising a treatment plan.