There’s no unique correct answer to which option, surgery or drugs (or some other), is best. The answer depends on individual factors, not least of which is the specific condition the patient suffers from that produces regular headaches.

The causes of migraines, for example, are not well understood. Currently, surgery is rarely used. But when the underlying cause is, for example, a brain tumor or cancer, surgery may well be the best course of treatment. For the majority, treatment with triptans and other drugs continues to be the most common route.

Cluster headaches - intense, but usually short-lived pain behind the eye or temple that occurs regularly for weeks or months, then disappears - is rare and mysterious. But researchers are leaning toward the view that some abnormality in the hypothalamus is responsible. Radiotherapy techniques are beginning to be used to treat the condition, with some success, which promises to eliminate any need for surgery.

Currently heavy doses of pure oxygen breathed for a few minutes at the onset of symptoms is the most common treatment. In this sense, the oxygen is performing the role of a drug.

Even ordinary or tension headaches can be treated with surgery in some cases. When the headache is the result of misalignment, it’s possible to correct the condition surgically. For a type often misdiagnosed, sinus headaches, the condition that produces pain may be the result of a deviated septum. When that is so, surgery has been used in some cases to correct what is in essence a mild birth defect.

For the vast majority of tension-type headaches, over the counter drugs continues to be the preferred option. This is sensible when the headaches are mild, relatively infrequent or responsive to those medications. In more severe cases, the treatment options become muddier.

In all these instances, good diagnosis is vital. CT (Computer Tomography) scans, MRI (Magnetic Resonance Imaging) and blood tests continue to be among the best tools available.

With a dynamic, 3-D image of the head it’s possible to visually detect a very wide range of possible circumstances. After years of research, those are well correlated in many cases with a specific, treatable condition. Combining that information with blood tests provides a very full set of data about any chemical or physical abnormalities.

Naturally, only a physician can provide the proper tests and analysis. In the case of severe, repeated headache episodes - since the condition is often neurological at base - it is, unfortunately, often necessary to seek the advice of one or more specialists.

Surgery is always risky. But drugs carry side effects and can represent even greater risk. Only a physician armed with all the data possible can provide patients with the rational options. To maximize those options, keep a careful diary of your headache episodes, research them and ask probing questions when you visit your doctor.

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