Managing Pain — The Latest On Headaches

Circa 2008

You were probably wondering where headaches would pop up in this pain series. Well, now seems as good a time as any.

Few people go their entire lives without a headache, some experience them quite often, and still others suffer the debilitating variety. If I go too long without eating, my blood sugar drops and I can count on a headache. Same if I decide to stop drinking caffeinated coffee for a few days.

When I get a run-of-the-mill headache, I take two extra strength Tylenol and I feel better so soon that I’m convinced that it must be the placebo effect, given that the medicine scarcely has had time to reach my bloodstream.

As is the case with everything in the world of medicine, headaches can be generally categorized. The chronic recurring ones include migraines and tension headaches, which most of us have from time to time. There is also headache due to abnormality or disease, typically of the brain. Though the brain does not “feel” pain, the sensation comes mostly from the dura mater—or tough mother—which is the thick covering around the brain and beneath the skull. Disease or injury to other parts of the head such as the eye, the nose, the ear or the throat can cause headaches, too.

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The word “migraine” is frequently used incorrectly by doctors and patients alike. The term refers to a specific type of headache, which is almost always severe; however “migraine” should not be used to refer to just any severe headache. The genuine article involves disturbances to the blood vessels around the brain. There are several types of migraines, and they are typically associated with nausea, vomiting and visual disturbances, such as seeing wavy lines or spots.

Many migraine sufferers notice the visual disturbances or neurologic symptoms before a headache starts. This is called an aura. Sometimes there is numbness or tingling in one arm or hand, or on one side of the mouth. Seldom is there weakness, as is the case with a stroke; but it is believed that people with certain types of migraines are at greater risk for strokes.

If there are no neurologic symptoms or auras, the headaches are called common migraines. If the neurologic symptoms go away in less than 24 hours, the headaches are considered to be classic migraines. If the headaches are less prominent than the neurologic symptoms, they’re called complicated migraines. If there is nausea, vomiting, auras or neurologic symptoms but no headache, it’s called a migraine equivalent. These typically occur in children who eventually develop the headaches later in life.

One rare type of migraine is the cluster headache. These usually occur in older men. The pain is excruciating and typically on one side of the head, behind one of the eyes. Associated symptoms include redness of the face, a stuffy, runny nose, and tearing from the eye on the affected side. In keeping with the name, cluster headaches often occur daily and at about the same time for four to 12 weeks. The headaches then typically go away for a year or more before the cycle begins again.

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Most peoples’ headaches respond to over-the-counter or home remedies, rest, and the passage of time. Others require medication from a doctor. Anti-inflammatory agents or narcotics are prescribed for severe pain, while migraines require a special category of drugs that affect the blood vessels around the brain. These often include a category of medications similar to caffeine or caffeine itself, so it should come as no surprise then that your head hurts when you skip coffee for a few days, or that some people get relief from a headache after drinking a few cups.

Headaches are sometime hard to diagnose and treat. In the overwhelming majority of cases, there is no identifiable underlying disease. On the other hand, they can be a warning sign of more serious problems. Since most of us are familiar with our usual headaches, how to avoid them or how to make them go away, all of us should be concerned if we experience a new type of headache, particularly if it’s more severe or won’t go away. Such headaches warrant prompt medical attention. If they are truly severe and sudden, like a thunderclap, then go straight to the emergency room. Headaches that are difficult to control and are not due to an identifiable problem may require the expertise of either a pain management specialist or a neurologist who specializes in headaches.

Until next time, be well.

by Thomas Chappell, MD

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