migrane, migrain
Introduction
For 2 years, Jim suffered the excruciating pain of cluster headaches.
Night after night he paced the floor, the pain driving him to constant
motion. He was only 48 years old when the clusters forced him to quit his
job as a systems analyst. One year later, his headaches are controlled.
The credit for Jim's recovery belongs to the medical staff of a headache
clinic. Physicians there applied the latest research findings on headache,
and prescribed for Jim a combination of new drugs.
Joan was a victim of frequent migraine. Her headaches lasted 2 days.
Nauseous and weak, she stayed in the dark until each attack was over.
Today, although migraine still interferes with her life, she has fewer
attacks and less severe headaches than before. A specialist prescribed an
antimigraine program for Joan that included improved drug therapy, a new
diet and relaxation training.
An avid reader, Peggy couldn't put down the new mystery thriller. After
4 hours of reading slumped in bed, she knew she had overdone it. Her
tensed head and neck muscles felt as if they were being squeezed between
two giant hands. But for Peggy, the muscle-contraction headache and neck
pain were soon relieved by a hot shower and aspirin.
An estimated 45 million Americans experience chronic headaches. For at
least half of these people, the problem is severe and sometimes disabling.
It can also be costly: headache sufferers make over 8 million visits a
year to doctor's offices. Migraine victims alone lose over 157 million
workdays because of headache pain.
Understanding why headaches occur and improving headache treatment are
among the research goals of the National Institute of Neurological
Disorders and Stroke (NINDS). As the leading supporter of brain research
in the Federal Government, the NINDS also supports and conducts studies to
improve the diagnosis of headaches and to find ways to prevent
them.
Why Does it Hurt?
What hurts when you have a headache? The bones of the skull and tissues
of the brain itself never hurt, because they lack pain-sensitive nerve
fibers. Several areas of the head can hurt, including a network of nerves
which extends over the scalp and certain nerves in the face, mouth, and
throat. Also sensitive to pain, because they contain delicate nerve
fibers, are the muscles of the head and blood vessels found along the
surface and at the base of the brain.
The ends of these pain-sensitive nerves, called nociceptors, can be
stimulated by stress, muscular tension, dilated blood vessels, and other
triggers of headache. Once stimulated, a nociceptor sends a message up the
length of the nerve fiber to the nerve cells in the brain, signaling that
a part of the body hurts. The message is determined by the location of the
nociceptor. A person who suddenly realizes "My toe hurts," is responding
to nociceptors in the foot that have been stimulated by the stubbing of a
toe.
A number of chemicals help transmit pain-related information to the
brain. Some of these chemicals are natural painkilling proteins called
endorphins, Greek for "the morphine within." One theory suggests that
people who suffer from severe headache and other types of chronic pain
have lower levels of endorphins than people who are generally pain
free.
When Should You See a Physician?
Not all headaches require medical attention. Some result from missed
meals or occasional muscle tension and are easily remedied. But some types
of headache are signals of more serious disorders, and call for prompt
medical care. These include:
- Sudden, severe headache
- Sudden, severe headache associated with a stiff neck
- Headache associated with fever
- Headache associated with convulsions
- Headache accompanied by confusion or loss of consciousness
- Headache following a blow on the head
- Headache associated with pain in the eye or ear
- Persistent headache in a person who was previously headache free
- Recurring headache in children
- Headache which interferes with normal life
A headache sufferer usually seeks help from a family practitioner. If
the problem is not relieved by standard treatments, the patient may then
be referred to a specialist—perhaps an internist or neurologist.
Additional referrals may be made to psychologists.
What Tests Are Used to Diagnose Migraine Headache?
Diagnosing a headache is like playing Twenty Questions. Experts agree
that a detailed question-and-answer session with a patient can often
produce enough information for a diagnosis. Many types of headaches have
clear-cut symptoms which fall into an easily recognizable pattern.
Patients may be asked: How often do you have headaches? Where is the
pain? How long do the headaches last? When did you first develop
headaches? The patient's sleep habits and family and work situations may
also be probed.
Most physicians will also obtain a full medical history from the
patient, inquiring about past head trauma or surgery, eye strain, sinus
problems, dental problems, difficulties with opening and closing of the
jaw, and the use of medications. This may be enough to suggest strongly
that the patient has migraine or cluster headaches. A complete and careful
physical and neurological examination will exclude many possibilities and
the suspicion of aneurysm, meningitis, or certain brain tumors. A blood
test may be ordered to screen for thyroid disease, anemia, or infections
which might cause a headache.
A test called an electroencephalogram (EEG) may be given to measure
brain activity. EEG's can indicate a malfunction in the brain, but they
cannot usually pinpoint a problem that might be causing a headache. A
physician may suggest that a patient with unusual headaches undergo a
computed tomographic (CT) scan and/or a magnetic resonance imaging (MRI)
scan. The scans enable the physician to distinguish, for example, between
a bleeding blood vessel in the brain and a brain tumor, and are important
diagnostic tools in cases of headache associated with brain lesions or
other serious disease. CT scans produce X-ray images of the brain that
show structures or variations in the density of different types of tissue.
MRI scans use magnetic fields and radio waves to produce an image that
provides information about the structure and biochemistry of the
brain.
If an aneurysm-an abnormal ballooning of a blood vessel-is suspected, a
physician may order a CT scan to examine for blood and then an angiogram.
In this test, a special fluid which can be seen on an X-ray is injected
into the patient and carried in the bloodstream to the brain to reveal any
abnormalities in the blood vessels there.
A physician analyzes the results of all these diagnostic tests along
with a patient's medical history and examination in order to arrive at a
diagnosis.
Headaches are diagnosed as
- Vascular
- Muscle contraction (tension)
- Traction
- Inflammatory
Vascular headaches—a group that includes the well-known migraine—are so
named because they are thought to involve abnormal function of the brain's
blood vessels or vascular system. Muscle contraction headaches appear to
involve the tightening or tensing of facial and neck muscles. Traction and
inflammatory headaches are symptoms of other disorders, ranging from
stroke to sinus infection. Some people have more than one type of
headache.
What Are Migraine Headaches?
The most common type of vascular headaches are migraine headaches. Migraine headaches are usually characterized by severe pain on one or both sides of
the head, an upset stomach, and at times disturbed vision.
Former basketball star Kareem Abdul-Jabbar remembers experiencing his
first migraine headache at age 14. The pain was unlike the discomfort of his
previous mild headaches.
"When I got this one I thought, 'This is a headache'," he says.
"The pain was intense and I felt nausea and a great sensitivity to light.
All I could think about was when it would stop. I sat in a dark room for
an hour and it passed."
Symptoms of migraine headache. Abdul-Jabbar's sensitivity to light
is a standard symptom of the two most prevalent types of migraine
headache: classic and common.
The major difference between the two types is the appearance of
neurological symptoms 10 to 30 minutes before a classic migraine headache.
These symptoms are called an aura. The person may see flashing lights or
zigzag lines, or may temporarily lose vision. Other classic symptoms
include speech difficulty, weakness of an arm or leg, tingling of the face
or hands, and confusion.
The pain of a classic migraine headache may be described as intense,
throbbing, or pounding and is felt in the forehead, temple, ear, jaw, or
around the eye. Classic migraine headache starts on one side of the head but may
eventually spread to the other side. An attack lasts 1 to 2 pain-wracked
days.
Common migraine headache—a term that reflects the disorder's greater occurrence
in the general population—is not preceded by an aura. But some people
experience a variety of vague symptoms beforehand, including mental
fuzziness, mood changes, fatigue, and unusual retention of fluids. During
the headache phase of a common migraine, a person may have diarrhea and
increased urination, as well as nausea and vomiting. Common migraine headache pain
can last 3 or 4 days.
Both classic and common migraine headache can strike as often as several times a
week, or as rarely as once every few years. Both types can occur at any
time. Some people, however, experience migraine headaches at predictable times—for
example, near the days of menstruation or every Saturday morning after a
stressful week of work.
The migraine process. Research scientists are unclear
about the precise cause of migraine headaches. There seems to be general
agreement, however, that a key element is blood flow changes in the brain.
People who get migraine headaches appear to have blood vessels that
overreact to various triggers.
Scientists have devised one theory of migraine headaches which explains these
blood flow changes and also certain biochemical changes that may be
involved in the migraine headache process. According to this theory, the nervous
system responds to a trigger such as stress by causing a spasm of the
nerve-rich arteries at the base of the brain. The spasm closes down or
constricts several arteries supplying blood to the brain, including the
scalp artery and the carotid or neck arteries.
As these arteries constrict, the flow of blood to the brain is reduced.
At the same time, blood-clotting particles called platelets clump
together-a process which is believed to release a chemical called
serotonin. Serotonin acts as a powerful constrictor of arteries, further
reducing the blood supply to the brain.
Reduced blood flow decreases the brain's supply of oxygen. Symptoms
signaling a migraine headache, such as distorted vision or speech, may then result,
similar to symptoms of stroke.
Reacting to the reduced oxygen supply, certain arteries within the
brain open wider to meet the brain's energy needs. This widening or
dilation spreads, finally affecting the neck and scalp arteries. The
dilation of these arteries triggers the release of pain-producing
substances called prostaglandins from various tissues and blood cells.
Chemicals which cause inflammation and swelling, and substances which
increase sensitivity to pain, are also released. The circulation of these
chemicals and the dilation of the scalp arteries stimulate the
pain-sensitive nociceptors. The result, according to this theory: a
throbbing pain in the head.
Women and migraine headaches. Although both males and females seem
to be equally affected by migraine headaches, the condition is more common in adult
women. Both sexes may develop migraine in infancy, but most often the
disorder begins between the ages of 5 and 35.
The relationship between female hormones and migraine is still unclear.
Women may have "menstrual migraine" headaches around the time of their
menstrual period which may disappear during pregnancy. Other women develop
migraine for the first time when they are pregnant. Some are first
affected after menopause.
The effect of oral contraceptives on migraine headaches is perplexing.
Scientists report that some women with migraine headaches who take birth control
pills experience more frequent and severe attacks. However, a small
percentage of women have fewer and less severe migraine headaches when
they take birth control pills. And normal women who do not suffer from
headaches may develop migraines as a side effect when they use oral
contraceptives. Investigators around the world are studying hormonal
changes in women with migraine headache in the hope of identifying the specific
ways these naturally occurring chemicals cause headaches.
Triggers of migraine headache. Although many sufferers have a
family history of migraine, the exact hereditary nature of this condition
is still unknown. People who get migraine headaches are thought to have an
inherited abnormality in the regulation of blood vessels.
"It's like a cocked gun with a hair trigger," explains one specialist.
"A person is born with a potential for migraine and the headache is
triggered by things that are really not so terrible."
These triggers include stress and other normal emotions, as well as
biological and environmental conditions. Fatigue, glaring or flickering
lights, changes in the weather, and certain foods can set off migraine headaches. It
may seem hard to believe that eating such seemingly harmless foods as
yogurt, nuts, and lima beans can result in a painful migraine headache.
However, some scientists believe that these foods and several others
contain chemical substances, such as tyramine, which constrict
arteries—the first step of the migraine process. Other scientists believe
that foods cause headaches by setting off an allergic reaction in
susceptible people.
While a food-triggered migraine headache usually occurs soon after eating, other
triggers may not cause immediate pain. Scientists report that people can
develop migraine headaches not only during a period of stress but also afterwards
when their vascular systems are still reacting. For example, migraines
that wake people up in the middle of the night are believed to result from
a delayed reaction to stress.
Other forms of migraine headache . In addition to classic and
common, migraine headache can take several other forms:
Patients with hemiplegic migraine have temporary paralysis on
one side of the body, a condition known as hemiplegia. Some people may
experience vision problems and vertigo—a feeling that the world is
spinning. These symptoms begin 10 to 90 minutes before the onset of
headache pain.
In ophthalmoplegic migraine, the pain is around the eye and is
associated with a droopy eyelid, double vision, and other problems with
vision.
Basilar artery migraine involves a disturbance of a major brain
artery at the base of the brain. Preheadache symptoms include vertigo,
double vision, and poor muscular coordination. This type of migraine
occurs primarily in adolescent and young adult women and is often
associated with the menstrual cycle.
Benign exertional headache is brought on by running, lifting,
coughing, sneezing, or bending. The headache begins at the onset of
activity, and pain rarely lasts more than several minutes.
Status migrainosus is a rare and severe type of migraine that
can last 72 hours or longer. The pain and nausea are so intense that
people who have this type of headache must be hospitalized. The use of
certain drugs can trigger status migrainosus. Neurologists report that
many of their status migrainosus patients were depressed and anxious
before they experienced headache attacks.
Headache-free migraine is characterized by such migraine
symptoms as visual problems, nausea, vomiting, constipation, or diarrhea.
Patients, however, do not experience head pain. Headache specialists have
suggested that unexplained pain in a particular part of the body, fever,
and dizziness could also be possible types of headache-free
migraine.
Migraine Headache Treatment
During the Stone Age, pieces of a headache sufferer's skull were cut
away with flint instruments to relieve pain. Another unpleasant remedy
used in the British Isles around the ninth Century involved drinking "the
juice of elderseed, cow's brain, and goat's dung dissolved in vinegar."
Fortunately, today's headache patients are spared such drastic
measures.
Drug therapy, biofeedback training, stress reduction, and elimination
of certain foods from the diet are the most common methods of preventing
and controlling migraine headache and other vascular headaches. Joan, the migraine
sufferer, was helped by treatment with a combination of an antimigraine
drug and diet control.
Regular exercise, such as swimming or vigorous walking, can also reduce
the frequency and severity of migraine headaches. Joan found that
whirlpool and yoga baths helped her relax.
During a migraine headache, temporary relief can sometimes be obtained
by applying cold packs to the head or by pressing on the bulging artery
found in front of the ear on the painful side of the head.
Drug therapy. There are two ways to approach the
treatment of migraine headache with drugs: prevent the attacks, or relieve
symptoms after the headache occurs.
For infrequent migraine, drugs can be taken at the first sign of a migraine headache in order to stop it or to at least ease the pain. People who get
occasional mild migraine may benefit by taking aspirin or acetaminophen at
the start of an attack. Aspirin raises a person's tolerance to pain and
also discourages clumping of blood platelets. Small amounts of caffeine
may be useful if taken in the early stages of migraine. But for most
migraine sufferers who get moderate to severe headaches, and for all
cluster headache patients (see section "Besides Migraine, What Are Other
Types of Vascular Headaches?"), stronger drugs may be necessary to control
the pain.
Several drugs for the prevention of migraine headache have been developed in
recent years, including serotonin agonists which mimic the action of this
key brain chemical. One of the most commonly used drugs for the relief of
classic and common migraine headache symptoms is sumatriptan, which binds to
serotonin receptors. For optimal benefit, the drug is taken during the
early stages of an attack. If a migraine has been in progress for about an
hour after the drug is taken, a repeat dose can be given.
Physicians caution that sumatriptan should not be taken by people who
have angina pectoris, basilar migraine, severe hypertension, or vascular,
or liver disease.
Another migraine drug is ergotamine tartrate, a vasoconstrictor which
helps counteract the painful dilation stage of the headache. Other drugs
that constrict dilated blood vessels or help reduce blood vessel
inflammation also are available.
For headaches that occur three or more times a month, preventive
treatment is usually recommended. Drugs used to prevent classic and common
migraine headaches include methysergide maleate, which counteracts blood vessel
constriction; propranolol hydrochloride, which stops blood vessel
dilation; amitriptyline, an antidepressant; valproic acid, an
anticonvulsant; and verapamil, a calcium channel blocker.
Antidepressants called MAO inhibitors also prevent migraine. These
drugs block an enzyme called monoamine oxidase which normally helps nerve
cells absorb the artery-constricting brain chemical, serotonin. MAO
inhibitors can have potentially serious side effects—particularly if taken
while ingesting foods or beverages that contain tyramine, a substance that
constricts arteries.
Many antimigraine drugs can have adverse side effects. But like most
medicines they are relatively safe when used carefully and under a
physician's supervision. To avoid long-term side effects of preventive
medications, headache specialists advise patients to reduce the dosage of
these drugs and then stop taking them as soon as possible.
Biofeedback and relaxation training. Drug therapy for
migraine is often combined with biofeedback and relaxation training.
Biofeedback refers to a technique that can give people better control over
such body function indicators as blood pressure, heart rate, temperature,
muscle tension, and brain waves. Thermal biofeedback allows a
patient to consciously raise hand temperature. Some patients who are able
to increase hand temperature can reduce the number and intensity of
migraines. The mechanisms underlying these self-regulation treatments are
being studied by research scientists.
"To succeed in biofeedback," says a headache specialist, "you must be
able to concentrate and you must be motivated to get well."
A patient learning thermal biofeedback wears a device which transmits
the temperature of an index finger or hand to a monitor. While the patient
tries to warm his hands, the monitor provides feedback either on a gauge
that shows the temperature reading or by emitting a sound or beep that
increases in intensity as the temperature increases. The patient is not
told how to raise hand temperature, but is given suggestions such as
"Imagine your hands feel very warm and heavy."
"I have a good imagination," says one headache sufferer who traded in
her medication for thermal biofeedback. The technique decreased the number
and severity of headaches she experienced.
In another type of biofeedback called electromyographic or
EMG training, the patient learns to control muscle tension in the
face, neck, and shoulders.
Either kind of biofeedback may be combined with relaxation training,
during which patients learn to relax the mind and body.
Biofeedback can be practiced at home with a portable monitor. But the
ultimate goal of treatment is to wean the patient from the machine. The
patient can then use biofeedback anywhere at the first sign of a
headache.
The antimigraine diet. Scientists estimate that a small
percentage of migraine headache sufferers will benefit from a treatment program
focused solely on eliminating headache-provoking foods and beverages.
Other migraine patients may be helped by a diet to prevent low blood
sugar. Low blood sugar, or hypoglycemia, can cause headache. This
condition can occur after a period without food: overnight, for example,
or when a meal is skipped. People who wake up in the morning with a
headache may be reacting to the low blood sugar caused by the lack of food
overnight.
Treatment for headaches caused by low blood sugar consists of
scheduling smaller, more frequent meals for the patient. A special diet
designed to stabilize the body's sugar-regulating system is sometimes
recommended.
For the same reason, many specialists also recommend that migraine
patients avoid oversleeping on weekends. Sleeping late can change the
body's normal blood sugar level and lead to a headache.
Besides Migraine Headaches, What Are Other Types of
Vascular Headaches?
After migraine, the most common type of vascular headache is the toxic
headache produced by fever. Pneumonia, measles, mumps, and tonsillitis are
among the diseases that can cause severe toxic vascular headaches. Toxic
headaches can also result from the presence of foreign chemicals in the
body. Other kinds of vascular headaches include "clusters," which cause
repeated episodes of intense pain, and headaches resulting from a rise in
blood pressure.
Chemical culprits. Repeated exposure to nitrite compounds
can result in a dull, pounding headache that may be accompanied by a
flushed face. Nitrite, which dilates blood vessels, is found in such
products as heart medicine and dynamite, but is also used as a chemical to
preserve meat. Hot dogs and other processed meats containing sodium
nitrite can cause headaches.
Eating foods prepared with monosodium glutamate (MSG) can result in
headache. Soy sauce, meat tenderizer, and a variety of packaged foods
contain this chemical which is touted as a flavor enhancer.
Headache can also result from exposure to poisons, even common
household varieties like insecticides, carbon tetrachloride, and lead.
Children who ingest flakes of lead paint may develop headaches. So may
anyone who has contact with lead batteries or lead-glazed pottery.
Artists and industrial workers may experience headaches after exposure
to materials that contain chemical solvents. These solvents, like benzene,
are found in turpentine, spray adhesives, rubber cement, and inks.
Drugs such as amphetamines can cause headaches as a side effect.
Another type of drug-related headache occurs during withdrawal from
long-term therapy with the antimigraine drug ergotamine tartrate.
Jokes are often made about alcohol hangovers but the headache
associated with "the morning after" is no laughing matter. Fortunately,
there are several suggested treatments for the pain. The hangover headache
may also be reduced by taking honey, which speeds alcohol metabolism, or
caffeine, a constrictor of dilated arteries. Caffeine, however, can cause
headaches as well as cure them. Heavy coffee drinkers often get headaches
when they try to break the caffeine habit.
Cluster headaches. Cluster headaches, named for their
repeated occurrence over weeks or months at roughly the same time of day
or night in clusters, begin as a minor pain around one eye, eventually
spreading to that side of the face. The pain quickly intensifies,
compelling the victim to pace the floor or rock in a chair. "You can't lie
down, you're fidgety," explains a cluster patient. "The pain is
unbearable." Other symptoms include a stuffed and runny nose and a droopy
eyelid over a red and tearing eye.
Cluster headaches last between 30 and 45 minutes. But the relief people
feel at the end of an attack is usually mixed with dread as they await a
recurrence. Clusters may mysteriously disappear for months or years. Many
people have cluster bouts during the spring and fall. At their worst,
chronic cluster headaches can last continuously for years.
Cluster attacks can strike at any age but usually start between the
ages of 20 and 40. Unlike migraine, cluster headaches are more common in
men and do not run in families.
Studies of cluster patients show that they are likely to have hazel
eyes and that they tend to be heavy smokers and drinkers. Paradoxically,
both nicotine, which constricts arteries, and alcohol, which dilates them,
trigger cluster headaches. The exact connection between these substances
and cluster attacks is not known.
Despite a cluster headache's distinguishing characteristics, its
relative infrequency and similarity to such disorders as sinusitis can
lead to misdiagnosis. Some cluster patients have had tooth extractions,
sinus surgery, or psychiatric treatment in futile efforts to cure their
pain.
Research studies have turned up several clues as to the cause of
cluster headache, but no answers. One clue is found in the thermograms of
untreated cluster patients, which show a "cold spot" of reduced blood flow
above the eye.
The sudden start and brief duration of cluster headaches can make them
difficult to treat; however, research scientists have identified several
effective drugs for these headaches. The antimigraine drug sumatriptan can
subdue a cluster, if taken at the first sign of an attack. Injections of
dihydroergotamine, a form of ergotamine tartrate, are sometimes used to
treat clusters. Corticosteroids also can be used, either orally or by
intramuscular injection.
Some cluster patients can prevent attacks by taking propranolol,
methysergide, valproic acid, verapamil, or lithium carbonate.
Another option that works for some cluster patients is rapid inhalation
of pure oxygen through a mask for 5 to 15 minutes. The oxygen seems to
ease the pain of cluster headache by reducing blood flow to the brain.
In chronic cases of cluster headache, certain facial nerves may be
surgically cut or destroyed to provide relief. These procedures have had
limited success. Some cluster patients have had facial nerves cut only to
have them
regenerate years later.
Painful pressure. Chronic high blood pressure can cause
headache, as can rapid rises in blood pressure like those experienced
during anger, vigorous exercise, or sexual excitement.
The severe "orgasmic headache" occurs right before orgasm and is
believed to be a vascular headache. Since sudden rupture of a cerebral
blood vessel can occur, this type of headache should be evaluated by a
doctor.
What Are Muscle-Contraction Headaches?
It's 5:00 p.m. and your boss has just asked you to prepare a 20-page
briefing paper. Due date: tomorrow. You're angry and tired and the more
you think about the assignment, the tenser you become. Your teeth clench,
your brow wrinkles, and soon you have a splitting tension
headache.
Tension headache is named not only for the role of stress in triggering
the pain, but also for the contraction of neck, face, and scalp muscles
brought on by stressful events. Tension headache is a severe but temporary
form of muscle-contraction headache. The pain is mild to moderate and
feels like pressure is being applied to the head or neck. The headache
usually disappears after the period of stress is over. Ninety percent of
all headaches are classified as tension/muscle contraction headaches.
By contrast, chronic muscle-contraction headaches can last for weeks,
months, and sometimes years. The pain of these headaches is often
described as a tight band around the head or a feeling that the head and
neck are in a cast. "It feels like somebody is tightening a giant vise
around my head," says one patient. The pain is steady, and is usually felt
on both sides of the head. Chronic muscle-contraction headaches can cause
sore scalps—even combing one's hair can be painful.
In the past, many scientists believed that the primary cause of the
pain of muscle-contraction headache was sustained muscle tension. However,
a growing number of authorities now believe that a far more complex
mechanism is responsible.
Occasionally, muscle-contraction headaches will be accompanied by
nausea, vomiting, and blurred vision, but there is no preheadache syndrome
as with migraine. Muscle-contraction headaches have not been linked to
hormones or foods, as has migraine, nor is there a strong hereditary
connection.
Research has shown that for many people, chronic muscle-contraction
headaches are caused by depression and anxiety. These people tend to get
their headaches in the early morning or evening when conflicts in the
office or home are anticipated.
Emotional factors are not the only triggers of muscle-contraction
headaches. Certain physical postures that tense head and neck muscles—such
as holding one's chin down while reading—can lead to head and neck pain.
So can prolonged writing under poor light, or holding a phone between the
shoulder and ear, or even gum-chewing.
More serious problems that can cause muscle-contraction headaches
include degenerative arthritis of the neck and temporomandibular joint
dysfunction, or TMD. TMD is a disorder of the joint between the temporal
bone (above the ear) and the mandible or lower jaw bone. The disorder
results from poor bite and jaw clenching.
Treatment for muscle-contraction headache varies. The first
consideration is to treat any specific disorder or disease that may be
causing the headache. For example, arthritis of the neck is treated with
anti-inflammatory medication and TMD may be helped by corrective devices
for the mouth and jaw.
Acute tension headaches not associated with a disease are treated with
analgesics like aspirin and acetaminophen. Stronger analgesics, such as
propoxyphene and codeine, are sometimes prescribed. As prolonged use of
these drugs can lead to dependence, patients taking them should have
periodic medical checkups and follow their physicians' instructions
carefully.
Nondrug therapy for chronic muscle-contraction headaches includes
biofeedback, relaxation training, and counseling. A technique called
cognitive restructuring teaches people to change their attitudes
and responses to stress. Patients might be encouraged, for example, to
imagine that they are coping successfully with a stressful situation. In
progressive relaxation therapy, patients are taught to first tense
and then relax individual muscle groups. Finally, the patient tries to
relax his or her whole body. Many people imagine a peaceful scene—such as
lying on the beach or by a beautiful lake. Passive relaxation does
not involve tensing of muscles. Instead, patients are encouraged to focus
on different muscles, suggesting that they relax. Some people might think
to themselves, Relax or My muscles feel warm.
People with chronic muscle-contraction headaches my also be helped by
taking antidepressants or MAO inhibitors. Mixed muscle-contraction and
migraine headaches are sometimes treated with barbiturate compounds, which
slow down nerve function in the brain and spinal cord.
People who suffer infrequent muscle-contraction headaches may benefit
from a hot shower or moist heat applied to the back of the neck. Cervical
collars are sometimes recommended as an aid to good posture. Physical
therapy, massage, and gentle exercise of the neck may also be
helpful.
When is Headache a Warning of a More Serious
Condition?
Like other types of pain, headaches can serve as warning signals of
more serious disorders. This is particularly true for headaches caused by
traction or inflammation.
Traction headaches can occur if the pain-sensitive parts of the head
are pulled, stretched, or displaced, as, for example, when eye muscles are
tensed to compensate for eyestrain. Headaches caused by inflammation
include those related to meningitis as well as those resulting from
diseases of the sinuses, spine, neck, ears, and teeth. Ear and tooth
infections and glaucoma can cause headaches. In oral and dental disorders,
headache is experienced as pain in the entire head, including the face.
These headaches are treated by curing the underlying problem. This may
involve surgery, antibiotics, or other drugs.
Characteristics of the various types of more serious traction and
inflammatory headaches vary by disorder:
- Brain tumor. Brain tumors are diagnosed in about 11,000
people every year. As they grow, these tumors sometimes cause headache
by pushing on the outer layer of nerve tissue that covers the brain or
by pressing against pain-sensitive blood vessel walls. Headache
resulting from a brain tumor may be periodic or continuous. Typically,
it feels like a strong pressure is being applied to the head. The pain
is relieved when the tumor is treated by surgery, radiation, or
chemotherapy.
- Stroke. Headache may accompany several conditions that can
lead to stroke, including hypertension or high blood pressure,
arteriosclerosis, and heart disease. Headaches are also associated with
completed stroke, when brain cells die from lack of sufficient
oxygen.
Many stroke-related headaches can be prevented by careful management of
the patient's condition through diet, exercise, and medication.
Mild to moderate headaches are associated with transient ischemic
attacks (TIA's), sometimes called "mini-strokes,"which result from a
temporary lack of blood supply to the brain. The head pain occurs near the
clot or lesion that blocks blood flow. The similarity between migraine and
symptoms of TIA can cause problems in diagnosis. The rare person under age
40 who suffers a TIA may be misdiagnosed as having migraine; similarly,
TIA-prone older patients who suffer migraine may be misdiagnosed as having
stroke-related headaches.
- Spinal tap. About one-fourth of the people who undergo a
lumbar puncture or spinal tap develop a headache. Many scientists
believe these headaches result from leakage of the cerebrospinal fluid
that flows through pain-sensitive membranes around the brain and down to
the spinal cord. The fluid, they suggest, drains through the tiny hole
created by the spinal tap needle, causing the membranes to rub painfully
against the bony skull. Since headache pain occurs only when the patient
stands up, the "cure" is to remain lying down until the headache runs
its course—anywhere from a few hours to several days.
- Head trauma. Headaches may develop after a blow to the head,
either immediately or months later. There is little relationship between
the severity of the trauma and the intensity of headache pain. In most
cases, the cause of the headache is not known. Occasionally the cause is
ruptured blood vessels which result in an accumulation of blood called a
hematoma. This mass of blood can displace brain tissue and cause
headaches as well as weakness, confusion, memory loss, and seizures.
Hematomas can be drained to produce rapid relief of symptoms.
- Temporal arteritis. Arteritis, an inflammation of certain
arteries in the head, primarily affects people over age 50. Symptoms
include throbbing headache, fever, and loss of appetite. Some patients
experience blurring or loss of vision. Prompt treatment with
corticosteroid drugs helps to relieve symptoms.
Meningitis and encphalitis headaches are caused by infections of
meninges-the brain's outer covering-and in encephalitis, inflammation of
the brain itself.
- Trigeminal neuralgia. Trigeminal neuralgia, or tic
douloureux, results from a disorder of the trigeminal nerve. This nerve
supplies the face, teeth, mouth, and nasal cavity with feeling and also
enables the mouth muscles to chew. Symptoms are headache and intense
facial pain that comes in short, excruciating jabs set off by the
slightest touch to or movement of trigger points in the face or mouth.
People with trigeminal neuralgia often fear brushing their teeth or
chewing on the side of the mouth that is affected. Many trigeminal
neuralgia patients are controlled with drugs, including carbamazepine.
Patients who do not respond to drugs may be helped by surgery on the
trigeminal nerve.
- Sinus infection. In a condition called acute sinusitis, a
viral or bacterial infection of the upper respiratory tract spreads to
the membrane which lines the sinus cavities. When one or more of these
cavities are filled with fluid from the inflammation, they become
painful. Treatment of acute sinusitis includes antibiotics, analgesics,
and decongestants. Chronic sinusitis may be caused by an allergy to such
irritants as dust, ragweed, animal hair, and smoke. Research scientists
disagree about whether chronic sinusitis triggers headache.
What Causes Migraine Headache in Children?
Like adults, children experience the infections, trauma, and stresses
that can lead to headaches. In fact, research shows that as young people
enter adolescence and encounter the stresses of puberty and secondary
school, the frequency of headache increases.
Migraine headaches often begin in childhood or adolescence. According
to recent surveys, as many as half of all schoolchildren experience some
type of headache.
Children with migraine often have nausea and excessive vomiting. Some
children have periodic vomiting, but no headache—the so-called abdominal
migraine. Research scientists have found that these children usually
develop headaches when they are older.
Physicians have many drugs to treat migraine in children. Different
classes that may be tried include analgesics, antiemetics,
anticonvulsants, beta-blockers, and sedatives. A diet may also be
prescribed to protect the child from foods that trigger headache.
Sometimes psychological counseling or even psychiatric treatment for the
child and the parents is recommended
Childhood headache can be a sign of depression. Parents should alert
the family pediatrician if a child develops headaches along with other
symptoms such as a change in mood or sleep habits. Antidepressant
medication and psychotherapy are effective treatments for childhood
depression and related headache.
Conclusion
If you suffer from headaches and none of the standard treatments help,
do not despair. Some people find that their headaches disappear once they
deal with a troubled marriage, pass their certifying board exams, or
resolve some other stressful problem. Others find that if they control
their psychological reaction to stress, the headaches disappear.
"I had migraines for several years," says one woman, "and then they
went away. I think it was because I lowered my personal goals in life.
Today, even though I have 100 things to do at night, I don't worry about
it. I learned to say no."
For those who cannot say no, or who get headaches anyway, today's
headache research offers hope. The work of NINDS-supported scientists
around the world promises to improve our understanding of this complex
disorder and provide better tools to treat it.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
Migraine Headache Information Resources
BRAIN
P.O. Box 5801
Bethesda, Maryland 20824
(301)
496-5751
800-352-9424
http://www.ninds.nih.gov/
American Council for Headache Education (ACHE)
19 Mantua
Road
Mt. Royal, NJ 08061
856-423-0258
800-255-2243
856-423-0082 (fax)
achehq@talley.com
http://www.achenet.org/
National Headache Foundation
428 W. St. James Place
2nd
Floor
Chicago, IL 60614-2750
773-388-6399
888-NHF-5552
(643-5552)
773-525-7357 (fax)
info@headaches.org
http://www.headaches.org/
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