Headaches

Most people experience a headache from time to time. However, for some, headaches are frequent and severe, and can interfere with everyday activities. Getting help for these types of headaches should start with an expert who specializes in the evaluation and treatment of headaches.

A headache expert will want to know the patient’s full medical and dental history including diet, depression and anxiety symptoms, work and family background. The doctor will also want to know details about the frequency, nature and locations of the headaches.

A thorough examination of the cranial nerves in the head, neck, ears and eyes will then take place. Pain in the trigeminal nerve’s distribution, including the jaw joints, jaw and neck muscles, teeth and other oral structures, can also trigger headaches, so the examination should also cover this area. Diagnostic tests may include MRI and CT scans, as well as blood tests and a urinalysis to determine if there is a secondary cause for the headaches.

Once all of the information has been assembled, and a diagnosis is made, a treatment can be planned. Typically, simple lifestyle changes, such as eating or avoiding certain foods are recommended first. Medications may then be administered, and the patient might also be advised to see a psychologist, physical therapist, chiropractor or acupuncturist as part of the overall treatment plan. Before initiating any treatments, the physician will explain any risks or side effects that may accompany them.

There are a number of different types of headaches, characterized by the severity, location and length of the pain, as well as the associated symptoms.

Migraine Headache

Migraine headaches affect over 23 million Americans, and women are three times as likely to suffer from them then men. These headaches are a result of neurochemical changes in the brain, not psychological problems, although anxiety and depression can sometimes accompany these headaches.

Migraine can occur anywhere in the head, neck, face or mouth. It is often one sided, and concentrates around one of the eyes. Many migraine sufferers experience light and sound sensitivity, as well as nausea and vomiting. In some patients, the migraine is triggered by specific stimuli, such as stress and lack of sleep. Certain foods can also trigger a migraine headache, such as those containing MSG, citrus fruits, red wines, aged cheeses and chocolate. Migraine may be related to a woman’s menstrual cycle, or start after a traumatic head injury.

Migraine with aura is the “classical” type of migraine headache, and is divided into four phases:

· Prodome occurs anywhere from 2 to 24 hours before the onset of the headache. This phase can include symptoms such as lightheadedness, strange smells, upset stomach and dizziness.

· Aura occurs several minutes to an hour before the headache starts and can include symptoms such as disturbances in vision, numbness, muscle weakness, speech disturbance, lightheadedness and nausea.

· Headache is usally one sided, often has a pulsating quality, and can last up to three days-sometimes longer. During the headache phase, the patient experiences moderate to severe head, neck, facial or oral pain, sometimes accompanied by nausea and vomiting, and sensitivity to light or sound.

· Postdrome is the after effect of the headache and can involve symptoms such as fatigue, irritability, mood changes, and listlessness.

Treatments for migraine fall into three categories:

· Behavior Modification can include dietary avoidance stress reduction techniques, avoidance of headache triggers. Other triggers that can be altered are smoking, sleep schedules, altitude and hormonal changes.

· Physical Therapy/Exercise can include stretching and other exercises aimed at alleviating muscle soreness in the head and neck. Patients can be taught to apply heat and cold and to massage these areas, giving them at least some sense of relief.

· Medications are tailored to the patient’s needs by taking into consideration the patient’s past experiences with medication, different medications being taken at the time and other medical problems. They are prescribed using two different approaches, preventative and abortive:

o Preventative medications are prescribed when the headaches are frequent, long lasting, and severe enough to interfere with the patient’s everyday activities. These medications can lower both the frequency and intensity of the headaches. Anti-seizure, anti-depressant and blood pressure medications are often prescribed to prevent migraine.

o Abortive medications are designed to stop the headache once it has begun. They can be over-the-counter or prescription medications, and are taken orally, by nasal spray or injected.

Some migraine patients who take medications for a long period of time may experience an increase in the frequency and intensity of their pain. This can lead to medication-induced chronic migraine headaches, which are fairly common, but often go unrecognized. Once they are diagnosed, there are treatments available that can break this cycle, and allow the patient to respond to treatment once again.

Cluster Headache

Cluster headache typically involves a sharp pain behind one eye, and may be accompanied by a runny nose and tearing of the eye. These headaches most commonly affect middle-age men, and can be so painful that the patient may become restless and feel the need to pace around the room.

These headaches occur in clusters of one to seven days, and last anywhere from 20 to 60 minutes. They also tend to wake a patient from sleep. Medications used to treat cluster headache are similar to those used to treat migraine, however, with this type of headache, quick relief can also be found inhaling 100% oxygen.

Chronic Paroxysmal Hemicrania (CPH) is a variant of cluster headache that mostly affects women. These headaches only last between 5 and 20 minutes, but can occur as many as 15 times a day. Fortunately, this type of headache frequently responds to an anti-inflammatory drug called Indomethacin.

Tension-Type Headache

Tension-type headache (TTH) is the most common form of headache. These headaches can be either chronic or episodic, and may or may not be accompanied by muscle pain in the head and neck. TTH usually affects both sides of the head, and can vary in location from the base of the neck, the temples, the top of the head and the eyes.

TTH may or may not be associated with stress. What are often described as “eye strains” or “sinus headaches” may actually be TTH. These types of headaches may also be caused by the clenching and grinding of the teeth. Tooth, ear and facial pain, along with jaw clicking or popping may accompany TTH in these cases.

Treatment options for tension-type headache vary, but typically include pain medication, anti-depressants, muscle relaxants or anti-inflammatory medications. Stress management techniques including relaxation training, counseling and physical therapy may also help to manage TTH. Cervicogenic Headache

Cervicogenic headaches involve pain that is present in the head, but originates in the cervical spine. The pain with these headaches can be constant or intermittent, and range from moderate to severe intensity. They are triggered by neck movement, or sustained neck posture, and even by coughing or sneezing. In many cases, these headaches occur as a result of neck injury, or muscle trauma due to poor posture.

Treatment options for cervicogenic headaches may include muscle relaxants, painkillers, antidepressants and anti-seizure medications. Anesthetic blockades, neurolytic procedures, botulinum toxin injections and neurostimulation are all interventional treatments that may be used for this type of headache. Physical, biofeedback and relaxation therapies are also treatment options.