The Nature of Headaches
Daniel leaned forward over the edge of his chair at work, elbows on his knees, careful not to move too fast or bend too far over. His next customer was due in twenty minutes but the nausea hadn't reached its peak. He rubbed his temples to calm the piercing pains that kept a constant pulse of their own. He had never been able to predict when a migraine headache was going to strike.
Six days had passed since his last migrainefar longer than usual. This one had lurked for hours with stark white lights shooting through his head. He had taken something for it, but not in time. He looked at the calendar above his desk, his vision so out of focus the numbers appeared double. He longed for a cool, dark, quiet cave to crawl into until his symptoms disappeared.
Daniel has endured migraine and tension headaches since he was a youngster, and he is far from alone. As many as 10% of all males and females may have some form of migraine headache, often beginning in childhood or early adulthood. We don't really know how common migraine headache is because many sufferers do not report their conditions to their physicians, or they go undiagnosed. Surveys show that physicians diagnose less than half of all migraine headaches. Half or so of all recurrent headaches that physicians do evaluate turn out to be a form of migraine or a mixture of migraine and tension headache.
We do know headaches are somewhat more prevalent in women than men. Some women develop them only after menopause. For others menopause increases the frequency of their headache events. Most people average about 12 attacks a year but a migraine headache can strike more frequentlyas often as several times a week.
All Too Common Problem
Almost everyone has experienced some kind of significant headache at one time or another, and more than 40% of us have endured a severe headache at least once in our lives. For most individuals, it's an occasional problem associated with a case of the flu or a particularly stressful day. Yet for more than 15% of the population, recurrent or chronic headaches are commonplace. Headache is one of the chief reasons Americans visit the doctor, and more than 5% of adults are currently receiving medical care related to headaches. Americans swallow over 15,000 tons of aspirin a year to quell headaches, and truck loads of ibuprofen and acetaminophen (Tylenol). Untold millions of hours of work are missed each year because of headache related problems. Migraine headaches alone are thought to result in up to 17 billion dollars worth of lost annual productivity.
Individuals with chronic headaches are also more likely to experience decreased emotional, social, and physical health. Those with recurrent migraine headaches are three times more likely to suffer from depression. Many of those plagued with headaches never seek medical care for diagnosis and possible treatmentthey simply suffer, often in silence and isolation.
What Kind of Headache?
The cranial arteries dilate during a migraine episode, often resulting in a multitude of symptoms besides a headache. The whole head can be involved or only one side, often with throbbing or pounding sensations. Exercise tends to worsen the pain, which can last a few hours to well over twenty-four. Worse yet, an episode can produce nausea with vomiting and extreme sensitivity to light and noise.
Cause of Migraine
Although the exact cause of migraine headaches has not yet surfaced, we know that genes play an important role for some people. More than half of all migraine sufferers has a family history of the disorder and the frequency of migraines attacks is in three times higher in women than men. A whopping one out of every five women may be affected.
There are also dozens of different events that can lead to recurrent headache, ranging from the development of high blood pressure to side effects from various medications taken for a multitude of health reasons.
Our knowledge of the actual events that occur in the brain during a migraine headache has improved in recent years. It seems likely that an imbalance in the brain's neurotransmitters, such as serotonin, touches off a cascade of events that can lead to a migraine headache: inflammation and irritation in the brain, accompanied by swelling of the blood vessels that produces a painful stretching of the vessels.
Migraine Warning Signs
A migraine can either strike without warning or produce early symptoms such as bright visual flashes of light or geometric patterns, confusion, weakness or tingling in an arm or leg, or even difficulty speaking. These pre-headache symptoms are called an aura and usually last less than 30 minutes, most often ending with the beginning of a full-fledged headache.
Many things can provoke migraine headaches. Psychological stress or emotional upsets are common triggers. Some women have migraines only around the time of their menstrual period, most likely set off by hormonal changes. Foods such as red wine, certain cheeses, nuts, and chocolate are common culprits, as well as changes in sleep patterns, weather, high altitude, and strong odors. Some individuals who take frequent doses of pain relievers develop headaches whenever they miss their usual dose.
Common Tension Headaches
Tension headache is the most common kind of headache, and the one that most people have experienced at least once during a time of stress. For some individuals, tension headaches become recurrent. Physicians have found that approximately half of the individuals who seek medical help for recurrent headache suffer from the tension headache, sometimes in combination with migraine.
Pain common to a tension headache can be just as severe as from a migraine but is more often described as band-like and aching on both sides of the head. The pain will be dull and steady and exercise can often lessen the discomfort. Some people complain of neck stiffness with pain at the back of the head that radiates toward the front. Tension headaches tend to come on slowly over hours and may persist for days or even months.
Tension Headache Causes
In the past, we thought that the cause of pain from a tension headache was completely due to unrelieved muscle tension in the scalp and neck that cut off the normal blood circulation to that area. We now understand that in addition, there are substantial changes in the brain's neurotransmitters and blood vessels. A build up of specific irritants and inflammation in the scalp muscles can cause excruciating pain. The tenderness and sensitivity is often out of proportion to the singular muscular tension involved. Sometimes the scalp can become very tender to the touch. Scientific researchers now find that both migraines and tension headaches can cause somewhat similar changes in brain functions and that both are likely more related than we suspected.
Tension Headache Triggers
Anxiety, depression, life's emotional and psychological stresses, missed meals, under-sleeping, and exposure to cigarette smoke, are all common triggers for tension headaches. Poor posture or sitting in one position for too longas many of us do hunched over our desks day after day, as well as leading sedentary lifestyles predisposes us to tension headaches.
Other Kinds of Headaches
Approximately 90% of the chronic headaches that physicians evaluate turn out to be tension or migraine headaches, but the remaining 10% have a broad range of causes, few of them serious. Often those with recurrent headaches assume they are caused by eyestrain, yet new glasses rarely help. Only in rare instances do visual problems cause chronic headaches.
Physicians may sometimes mistake both tension and migraine headaches for sinus headaches, which are actually quite uncommon and usually involve some facial pain over the sinuses.
Side effects from some medications can cause headaches, such as ones to treat high blood pressure and oral contraceptives for women. An abrupt halt to drinking coffee may cause a caffeine withdrawal headache painful enough to drive an individual into an Emergency Room. Dehydration, even when mild, is another common headache cause.
Less Common Sources of Chronic Headaches
Carbon Monoxide Poisoning
Significant Untreated High Blood Pressure