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Headaches & Migraines
Headaches & Migraines
Everyone has a headache from time to time. But for some people headaches are a serious, chronic problem – frequently recurring, unusually painful, sometimes disabling. There are actually more than 150 diagnostic categories of headaches – the best-known are migraine, tension-type and cluster headaches. And from patient to patient, triggers for headaches are as diverse as bright lights, foods like aged cheese and red wine, perfumes, sinus problems, caffeine and caffeine-withdrawal.
Some 45 million Americans suffer chronic headaches annually. A good 28 million experience migraines. Most people treat themselves for their headaches, to the extent of $4 billion worth of over-the-counter medications each year. Many of those who do so are undertreated.
The good news: Much has been learned about headache in recent years, and effective medical care is available headache sufferers. Much progress has been made in the field of medications for both preventing and treating chronic headache, including migraines. Some patients have even found Botox treatments useful in preventing and treating migraines.
Headaches & Migraines Overview:
There are many types of headaches, but the most common chronic headaches are:
- Migraine Headache
Migraines are perhaps the most famous type of headache, even though tension-type headaches are the most common. If you suffer from migraine headaches, you’re in great company – literally. Famous migraine victims have included Julius Caesar, Joan of Arc, Spanish writer Miguel de Cervantes, Russian composer Pyotr Ilyich Tchaikovsky and Civil War generals Ulysses S. Grant and Robert E. Lee. It’s estimated that nearly 30 million Americans experience migraines – it’s responsible for more job absenteeism than any other type of headache. Migraines can afflict anyone at any age, but some 70 percent of migraine sufferers are women. It’s perhaps the most complex type of headache to treat, which is why it has its own section below.
- Tension-Type Headache
Representing about 78 percent of all headaches, tension-type headaches are the most common type of adult headache. Their characteristics are dull, aching and non-pulsating pain that affects both sides of the head. They’re thought to be caused by tightened muscles in the back of the neck and scalp. They can be episodic (random and occurring during periods of stress, fatigue or anger) or chronic (occurring daily or as a continuous problem). Episodic headaches can often be effectively treated with over-the-counter medications like aspirin, acetaminophen, ibuprofen or naproxen sodium. But if you’re taking any of these daily for your headache with little or no relief, you should consult a physician.
- Rebound Headache
A rebound headache is one that occurs from over-using medications for headache pain, whether over-the-counter analgesics or prescription medications. The rebound effect is more a factor of the frequency with which the medication is taken rather than the absolute dosage – the issue is the creation of a dependency on the drug at a comfort level. If your medication contains caffeine (which speeds the effect of the other drugs) and you also ingest caffeine in beverages, you’re increasing your risk of a rebound into another headache.
- Cluster Headache
Cluster headaches are intense headaches that come on one to three times per day, occurring in waves that may last two weeks to three months. They usually start around or behind the eye, then move to other parts of the head, often recurring at the same time each day for days or weeks. They’ve been described as the most intensely painful of all the types of headache. Fortunately, it’s estimated that cluster headaches affect less than one percent of the population.
A migraine is a headache in which the blood vessels constrict and dilate, releasing inflammatory substances that cause painful pulsations accompanied by sensitivity to light and sound. The pain can range in intensity from mild to severe, can last from a few hours up to a week and typically recurs two to four times a month. While the pain is the overriding issue, a notable characteristic for about a third of migraine sufferers is the “aura” that precedes it, often as a perception of flashing lights or zigzag patterns, tunnel vision or blind spots.
Your headache may be a migraine if you have any combination of these symptoms:
- Moderate to severe pain (often described as pounding, throbbing pain) that can affect the whole head, or can shift from one side of the head to the other.
- Sensitivity to light, noise or odors.
- Blurred vision.
- Bright flashing dots or lights, blind spots, wavy or jagged lines (aura).
When to See a Physician for Your Headache
There are times when headaches or uncharacteristic migraine symptoms are indications of something that needs medical attention. Some individuals are reluctant to call their doctors or go to an Emergency Department because they don’t want to arrive only to learn that nothing out of the ordinary is wrong. Please, don’t be concerned about that.
You should seek medical attention if you think you fit the following criteria:
- You have more than the occasional headache.
- Your headaches are severe or come on quickly.
- Your headache is accompanied by any of the following (and you have not discussed these symptoms with your doctor before): confusion, dizziness, fever, numbness, persistent vomiting, shortness of breath, slurred speech, stiff neck, unrelenting diarrhea, vision loss, weakness or unpredicted symptoms affecting your ears, nose, throat or eyes.
- Your have a headache that persists, and continues to get worse or won’t stop.
- Your headaches interfere with your normal activities of daily life.
- You find yourself taking pain relievers more than two days a week.
- You take over-the-counter medications for headache relief but the recommended dosage is not adequate.
- Coughing, sneezing, bending over, exercise or sexual activity cause headaches.
- You have headaches that continue and that began after a head injury, or other trauma.
- The characteristics of your headaches change.
- The symptoms of your migraine attacks change.
You should see your physician immediately or go to an ER if:
- You are having “the worst headache ever.”
- You are having your worst migraine attack ever.
- Your headache is accompanied by the following symptoms: unresolved loss of vision, loss of consciousness, uncontrollable vomiting.
- The pain of your headache lasts more than 72 hours with less than a solid four-hour pain-free period while awake.
- You experience a headache or a migraine attack that presents unusual symptoms that are abnormal for you and frightening.
For More Information:
National Headache Foundation
National Institutes of Health National Institute on Deafness and Other Communications Disorders
American Headache Society Committee for Headache Education
Migraine Research Foundation
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