Headache

BASIC FACTS ABOUT HEADACHES
Twenty million Americans see their doctors each year because of a headache.  Although headaches can be very uncomfortable and temporarily disabling, most are not associated with serious illness.  They can often be relieved by resting in a quiet room or by taking a nonprescription painkiller such as ibuprofen or acetaminophen.

When a person has a headache, several areas of the head can hurt, including a network of nerves that extends over the scalp and certain nerves in the face, mouth and throat.

Rarely, headache is a symptom of a dangerous condition such cerebral aneurysm, brain tumor, stroke, TIA, meningitis, or encephalitis.  Very high blood pressure can cause headaches and this situation is a medical emergency.  However, high blood pressure usually causes no symptoms at all, despite the damage that years of high blood pressure can do to blood vessels, heart, brain, and kidneys.  If you have any doubt about your headache, contact your physician.

HEADACHE BASICS
The most common type of headache is "tension headache."  Tension headaches generally develop gradually, often involve the entire head as well as the neck and shoulders.  They probably are not actually caused by increased muscle tension, although muscle relaxation techniques can be very useful in treatment.  Most people get tension headaches occasionally and these can usually be treated simply.  Some people get them often, but there are usually some useful interventions to help decrease the number of sick days.

Migraine headaches are "bad headaches."  With classic migraine, the headache is preceeded by a feeling that a headache will develop (prodrome) followed by visual phenomena such as dark or bright spots, streaks of light, or tunnel vision (aura).  The headache then develops, usually on one side.  It is throbbing in nature, accompanied by nausea and increased sensitivity to light and noise.

Most people with migraine headaches do not experience prodrome or aura.  Common migraine headache, like classic migraine headache is treatable and often preventable.

Migraineurs, those who develop migraine headaches often have a family history of migraine headache and they have headache triggers.  People who get headaches when they don't have enough of their daily caffeine are migraineurs.  They would have fewer migraines if they completely eliminated caffeine.  Chocolate, red wines, nuts and cheeses are common food triggers. Migraines before or during menstrual periods are common.  Not all migraineurs get terrible headaches, but some certainly do. Migraine is an important cause of lost days of school, work and enjoyment.

Women who smoke and who experience migraine headaches with aura have more than twice the risk of stroke if they take estrogen-containing birth control pills than those who use nonestrogen-based contraception.  Changing to a nonestrogen or very low-estrogen contraceptive not only can reduce the risk of stroke but can dramatically decrease the number of headaches.

Cluster headaches are headaches lasting minutes to hours that occur day after day at a similar time over a period of weeks.  They are sharp.  People with cluster headaches often describe the pain as similar to an icepick.

They are more common in men, and are more difficult to treat than most headaches.  Interestingly, oxygen therapy will often stop a daily cluster headache.  Many of the medications used to prevent or treat migraine headaches are used to treat cluster headaches.

Sinus headaches are those frontal headaches that some people experience with sinus infection and with changes in the weather.  Allergies can also provoke them.

TREATMENT
To avoid headaches, employ good health habits.  These include adequate sleep, healthy diet, regular exercise and good stress management.  Quitting smoking is essential in reducing the risks for all headaches.

Relaxation and related stress reduction therapies can diminish the frequency and intensity of headaches.  Alternative therapies used for headache management include hypnosis, biofeedback, meditation, visualization and guided imagery, acupuncture, accupressure, yoga and other physical relaxation exercises.

Any over-the-counter pain medications like aspirin, ibuprofen, naproxen sodium or acetaminophen can be very useful. No one medication has ever been proven to be more effective than the other, though there is great variability in effectiveness from person to person.  There is no difference in composition or effectiveness between migraine-formula over-the-counter preparations and their non-migraine brand names, other than the higher cost of the migraine-formula brands.  Narcotics such as codeine and Demerol are generally not useful for treating headache and are seldom prescribed for it any more.

There have been dramatic improvements in very selective medications that can be taken to stop migraine headaches.  These are available by prescription only and are generally not effective for nonmigraine headaches.

Virtually any of the headache medications, prescription or over-the-counter, can actually cause headaches if taken on a daily basis.  Too much acetaminophen can damage the liver and too much aspirin, ibuprofen, or naproxen sodium can damage kidneys and cause ulcers.

People with daily or frequent headaches will be interested to know that there are often very effective methods of headache prevention.  Primary prevention is always valuable.  Migraineurs can try to avoid triggers.  For anyone with frequent headaches, stress management and improvement of overall fitness through diet and exercise are important.  Tobacco cessation can be extremely effective in decreasing headache frequency, even though headaches may at first intensify.

There are many different groups of medications that are also used to decrease headache frequency.  Tricyclics, beta blockers, calcium channel blockers and neuroleptics are classes of medications that contain useful preventive drugs.  All are available by prescription only.

HEADACHE AS A WARNING SIGN
See a health care professional on an urgent basis if any of the following occur:

  1. Severe, sudden headaches that seem to come on like "a bolt out of the blue."

  2. Headaches that are accompanied by a loss of consciousness, alertness or sensation, confusion, or other neurological and/or personality changes.

  3. Headaches that recur in one particular area such as an eye, temple etc.

  4. Headaches that recur and are of high intensity or frequency.

  5. Headaches that are accompanied by neck stiffness and fever.

  6. Headaches that are associated with head injury.

  7. There is a change in the nature or frequency of headaches.

  8. The worst headache in one's life.

  9. Temporary change in vision or visual acuity may simply be a sign of migraine headache but deserves special attention if new.