Over the last several years, health care professionals have increasingly ordered advanced imaging and referred their headache patients to other physicians, and less frequently they have offered lifestyle counseling and education, a new study indicates. Both of these trends run counter to current guidelines for treating patients with headache. Researchers led by John Mafi, MD, of the Beth Israel Deaconness Medical Center in Boston, reviewed information from more than 9,300 headache visits to clinicians between 1999 and 2010 included in the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Nearly three-quarters of patients were female, with a mean age of about 46 years. The study appeared in The Journal of General Internal Medicine.

Q. I feel like every afternoon around the same time I experience a burning sensation that begins at the right side of my forehead and crosses to the left side. It surrounds my eyebrows and eyelids. It’s not dissimilar from the sensation of sunburn, but the best way to describe it is tightness in the forehead. It can cause my eyelids to burn and swell and exacerbate my dry-eye problem. At times, I experience a sharp dagger-like pain in my right eye and under the brow bone. The whole thing lasts about three hours. A CT scan of my sinuses was clear. Is this description consistent with cluster headaches?

To help improve patient care, The American Headache Society (AHS) recently released five practices that health care professionals and patients should avoid or question regarding headache treatment. The guidelines and considerable information about them appeared in the November-December issue of Headache. The list was created as part of the Choosing Wisely initiative of the American Board of Internal Medicine Foundation, which stresses the importance of physician and patient conversations in improving care and eliminating unnecessary tests and procedures. The Choosing Wiselyrecommendations should not be the final word in decisions about treating headache disorders or any other condition, experts say.  Instead, they are intended to foster conversation about what is — and is not — appropriate and necessary treatment.

Q. I had a migraine yesterday morning and took my medication to get rid of it. It got rid of my pounding pain, but about 2 hours later a portion of the right side of my face became numb. Within another 3 hours, the entire right side of my face was numb, my mouth was drooping, and my right arm and leg were heavy. As you can imagine, we thought I could be having a stroke. I am 43. We went to the emergency room, and by the time I arrived, even my speech was affected. All CT scans came back clear. The doctors decided I was having a complex migraine and explained the headaches can present as though the patient is having a stroke. They gave me a migraine "cocktail" and massive steroids and within a half hour, my symptoms were much improved. I am still regaining more control even today. What was so odd was that I had no pain.  Have you heard of this kind of migraine before?

Q. I am suffering with new daily persistent headache. My headache began Jan. 21, 2012, and I have had it every day since. From what I have read, my situation is like others who have this condition. Medications do not seem to work, so I have continued to try new ones via a neurologist who specializes in headaches.  All tests are clear–MRI, MRA, MRV, CT scans, blood work and spinal tap. I have occasionally tried alternative methods–Botox, occipital nerve block, chiropractic care, naturopathy, Chinese herbalism, massage, yoga, Thai yoga therapy, none of which helped with the headache either. I have read that this can last from months to decades.  Is there any current information on the most successful approaches to make the headache go away?

Migraineurs have twice the risk of developing depression as those without migraine, and researchers have learned that the disorders may be connected in a striking way: The combination of the two has been linked to smaller brain size in older adults. In a recent study, the brains of patients with migraine and depression had about 2% less volume than the brains of people who experienced neither or only one of the disorders. The information is not alarming, researchers said, but more study is warranted to fully understand the connection and its implications, including if the smaller volume is accompanied by a decline in cognitive abilities.

While most individuals who experience a mild traumatic brain injury recover fully, about 15% will suffer long-term neurological issues, including headache. Currently, computed tomography CT scans are used to assess such injuries, but a recent study reveals that magnetic resonance imaging (MRIs) may be the more effective tool for predicting long-term outcomes.