2005-04-19
R.J. Ignelzi

During the past year, nearly 90 percent of men and 95 percent of women have had at least one headache, and as many as 1 in 20 adults have a headache nearly every day, says the National Headache Foundation. The discomfort can range from a nagging pressure around the forehead to a throbbing pain that leaves you weak and nauseated to a stabbing sensation that jars you awake in the middle of the night.

No matter what the degree or duration of pain, sufferers agree that headaches are real and often disabling.

"I think a lot of people may dismiss headaches, thinking it's just a headache. It's not serious," says Dr. David Leopold, family practitioner and integrative medicine specialist at the Scripps Center for Integrative Medicine, who sees at least 10 patients per week for headache complaints.

"But, headaches are a major problem for people. Headaches can have a devastating impact on people's lives."

While there is no cure for headaches, science has made great strides in helping us manage them. There are medications that can be taken prophylactically or as soon as pain strikes, to minimize the torment. We now know that there are also some lifestyle changes and natural remedies than can bring relief. To know what works for your headache, however, you need to know what kind of headache you have.

But changing and conflicting information about headaches is enough to give you one. About 90 percent of headaches fit into one of three categories ... migraine, tension-type or cluster. However, within the last five years, the migraine category has swelled. Many neurologists have concluded that the majority of our head pains, even those we usually associate with menstrual cycles, allergies and sinus congestion, fall into the migraine classification.

"The more we learn about headaches, the more we find that most of them are migraines triggered by a variety of things," says Scripps Clinic neurologist Dr. Emily Rubenstein, who calls the "sinus headaches" that afflict so many San Diegans "just a myth." "Ninety percent of patients who complain of what they think is a sinus headache turn out to have a migraine and it needs to be treated as such." During certain San Diego weather conditions like dry Santa Anas or rainy days when the barometric pressure is particularly low, people often misdiagnose themselves with a sinus headache because they feel the pain around the sinuses and a decongestant gives them relief. However, weather is now known to be a common trigger for migraines, which are also felt in the sinus regions of the face and head.

"Just because you took a decongestant and it got rid of your headache, doesn't mean you had a sinus headachequot; says Dr. Bill Samuel, neurologist at Palomar Hospital, who notes that a true sinus headache is usually accompanied by a fever and thick green or yellow mucous. "A decongestant is also an anti-inflammatory and anti-inflammatories are used for all kinds of headaches."

And while it's often been believed that migraines come with auras, sensitivity to light and vomiting, it's not always the case.

"Some people are fixated on the classic migraine and that it has to fit a strict criteria. We now know that people don't always get exactly those symptoms ... (the pain) doesn't have to be just on one side and you don't always have nausea ... but it can still be a migraine," says Dr. Erik Perkins, a neurologist at Sharp Memorial Hospital.

The problem with misdiagnosing your headache can be inappropriate and too much medication, which can lead to a vicious merry-go-round of rebound headaches.

Many over-the-counter headache medications, especially those containing caffeine, offer a bit of relief because they reduce swollen blood vessels that come with a headache. But eventually the brain becomes used to the presence of the drug and when it wears off, the vessels swell again to an even greater degree. Your head throbs, more medication is taken and the rebound headache cycle continues.

"For patients who have chronic daily headaches (more than 15 days a month), the No. 1 cause is rebound headaches caused by taking too much over-the-counter medications," Rubenstein says. "These medications just take the edge off the pain and don't make it totally go away so you just end up chasing your tail."

People with chronic headaches need to have a medical evaluation and should probably be on preventive headache therapy, at least for a few months, she says. Some of the treatments include those that were designed for other ailments such as high blood pressure, depression and even wrinkles.

"People shouldn't have to suffer. There are a number of medications available that can make migraines completely go away," she added.

Diagnosing your headache doesn't require an MRI or brain scan. It does, however, require you to pay attention to your pain for a few weeks. By keeping track of when each starts, stops, where the pain is and what you did or ate before it started, you and your doctor may be able to identify the type that bothers you and how best to prevent and treat it.

"We have to acknowledge that we can't cure headaches," says Leopold of Scripps. "But, we can offer people ways to help regulate their headaches and let them go about their day-to-day life."

A TRIO OF HEAD HURTS

Most headaches fall into one of these three categories:

MIGRAINE HEADACHES

What they feel like: Usually begin on one side and build to an intense, throbbing pain, often with nausea or vomiting. Light, noise and movement make it worse. One in 6 sufferers gets an aura ... flashing lights or bright spots before the eyes.

Some sufferers also experience neck pain and eye tearing, runny nose or nasal congestion.

TENSION HEADACHES

What they feel like: A dull, steady pressure ache on both sides of the head, back of head and neck. Usually mild and transient, makes you feel as if you're wearing a tight headband.

CLUSTER HEADACHES

What they feel like: Hits suddenly, often during sleep, and can quickly escalate to a continuous explosive pain on one side of the head, usually near an eye. Often causes teary eyes, runny or stuffy nose. Recognized as the most intense and debilitating headache o all.

A TRIO OF HEAD HURTS

MIGRAINES

HOW LONG THEY LAST: Without treatment, four hours to three days.

WHO GETS THEM: More than 10 percent of adults and almost 20 percent of women. Migraines run in families.

WHAT CAUSES THEM: A variety of stimuli inflames blood vessels and provokes nerves in and around the brain to release pain-inducing neurotransmitters. Triggers can include food and drink, (red wine, chocolate, MSG are infamous) hunger, lack of sleep, hormones and weather changes.

PREVENTIVE MEASURES: Lifestyle consistency is often key. Change ... hormonal fluctuation, stress, what you eat or drink or the weather can trigger migraines.

Some drugs including some antiseizure medications, low doses of antidepressants, and beta-blockers and calcium channel blockers (used to treat high blood pressure), are used for migraine prevention.

Nutritional supplements magnesium, riboflavin and coenzyme Q10 may help. The herbs feverfew and and butterbur may help curb migraine frequency. Consult your healthcare practitioner before using any of these remedies.

Biofeedback, which teaches you to relax muscles during times of stress, may help some people.

Injections of Botox, the popular wrinkle-reducer, may help reduce the frequency and intensity of headaches possibly by blocking the protein that carries the pain message to the brain.

TREATMENT OPTIONS: Over-the-counter migraine remedies that include acetaminophen, aspirin or ibuprofen and caffeine can sometimes relieve mild-to-moderate migraines. But, frequent use can cause rebound headaches.

Triptan drugs, which constrict vessels and moderate chemical reactions in the brain, are often prescribed. Best taken at the first twinge of a headache, some can be formulated to melt on the tongue, inhaled as a nasal spray or self-injected for times when nausea makes ingesting oral meds impossible.

TENSION HEADACHES

HOW LONG THEY LAST: A few hours or until you sleep. Can occur daily.

WHO GETS THEM: Nearly 70 percent of men and 90 percent of women have tension headaches occasionally.

WHAT CAUSES THEM: Doctors used to blame muscle tension. However, more recent studies show that certain stimuli ... stress, loss of sleep, dehydration, etc. ... produce biochemical changes in the body that can increase pain sensitivity and are felt by some people as headache.

PREVENTIVE MEASURES: A headache diary can help you learn what brings them on. Don't skip meals, get enough sleep, exercise regularly to counter stress.

TREATMENT OPTIONS: Aspirin, acetaminophen, ibuprofen and naproxen all are effective. If one doesn't work well for you, try another. Relaxation techniques, including meditation, yoga, deep breathing and guided imagery can work to reduce tension and lessen the pain.

If the headaches are frequent, see a doctor to confirm that it's not a migraine.

CLUSTER HEADACHE

HOW LONG THEY LAST: Tend to come in a cluster over a period of days, weeks or even months and then subside for six months to a year. Clusters typically last from 30 minutes to three hours.

WHO GETS THEM: Only about 1 in 200 people. Male sufferers outnumber females by about 5 to 1.

WHAT CAUSES THEM: Related to an explosive release of nerve impulses by the hypothalamus in the brain; alcohol and smoking may trigger them.

PREVENTIVE MEASURES: Calcium channel blockers, a high blood pressure medicine, may help. Avoid smoking and alcohol if they trigger headaches.

TREATMENT OPTIONS: Injectable forms of triptans often help. Inhaling pure oxygen for 15 minutes relieves headaches in up to 80 percent of cases.

BY R.J. IGNELZI, STAFF WRITER

DIARY WILL HELP WITH CURE

Keep track of your headaches with a headache diary, recommends the National Headache Foundation. It will offer your doctor valuable information that will help accurately diagnose and effectively treat your headache.

Your diary should include the following entries:

Date and time the headache starts Date and time it ends Intensity of the pain, on a scale of 1 to 10 (with 10 being the most severe)

Words to describe your pain (for example, throbbing or piercing) and its location in your head.

Symptoms you experienced just before you got the headache.

Possible triggers, including certain foods, physical activity, noise, smoke, stress, too much or too little sleep, caffeine, etc.

Medication you took and the dose

Whether the medicine helped and if so, how much relief it provided.

– R.J. IGNELZI