More than 200 types of headaches are listed in the International Classification of Headache Disorders. That is bad news for people prone to the debilitating effects of throbbing temples, pressure behind the eyes and the myriad of other symptoms associated with this common ailment. The good news: Help is out there in the form of medicines, therapies and lifestyle changes. The goal is to get from being a migraine sufferer to a migraine manager.
[headache 101]
still a mystery
“Headache is the most common disease in the world. I do not know of a single person who has never had a headache,” says Dr. Ahmed Jafri, a neurologist and headache specialist at Saint Louis University School of Medicine. “And the degree of pain may not necessarily be a sign of the seriousness of the underlying headache or its causes.”
Scientists have been studying headaches for centuries. The first classification was published by Dr. Thomas Willis of London in 1672, but even after more than three centuries, much still remains to be discovered. “The cause of headaches is a big question,” says Dr. Sylvia Awadalla, section head of general neurology at Washington University School of Medicine and a headache specialist. “We suspect there are a number of triggers that release chemicals in the brain, but the cause for that is difficult to determine.”
Even though headaches may seem to flare inside the head, says Jafri, “the pain doesn’t come from the brain. It comes from the scalp, the covering of the brain, and the blood vessels and nerves.”
why me
Tension-type headaches and migraines are called primary headaches because the headache itself is the disorder. Secondary headaches are less common and follow other conditions such as hypertension, infections, trauma, tumors or hemorrhages.
Doctors may not know why you get headaches, but they do know a list of culprits that trigger primary headaches. “The list is long. Some of the provocateurs are dietary and can include chocolate, red wine, cheese and bananas,” Jafri says. “Some headaches are associated with aversion to certain odors, or to lack of sleep.”
Also, Awadalla adds, “Triggers can be weather changes (rain or fluctuations in temperature), stress, anticipation and anxiety.” If you’re really unlucky, all of the above will affect you.
the headache scale
Classifications are based on the part of the head or face affected and the severity and frequency of symptoms. The rare cluster headache, sometimes called the suicide headache, is considered the worst. “It is described as an ice pick being shoved in the eye,” Jafri says.
One of the most common, migraines afflict 18 percent of women and 6 percent of men, totaling 28 million people, according to the American Headache Society. “Genetics play a part—close to 90 percent of people who have migraine headaches have family members who are affected,” says Awadalla. “On average, they happen one to two times a week, but more often for some people. Those suffering eight a month are in the category of chronic migraines.”
Migraine headache is characterized as a throbbing pain, usually on one side of the head, says the National Headache Foundation. Attacks last four to 72 hours and may include nausea, vomiting and light sensitivity.
Migraines can offer warnings, Jafri says: an aura or a prodrome, a feeling of weakness or tiredness up to days before the headache. Good news: An approaching migraine can be blocked by a type of medication known as triptan.
no silver bullets
Headache treatment requires a delicate balance. “When people use pain medication frequently, they can get rebound headaches,” Jafri says. And medicine overuse can cause liver, kidney, heart or stomach problems, Awadalla warns.
Secondary headaches may be red flags that warrant an immediate trip to an emergency room. Severe headaches in older people should be taken more seriously, too, because this population is predisposed to other diseases.
[sinuses, allergies & headaches]
We’ve all heard of a sinus headache. Sinus passages inhabit all the areas of the face where headache pressure is felt, so it’s no surprise that we can’t always tell whether our discomfort should be blamed on sinus irritation or headache. It will take an expert to sort it out.
the chicken or the egg
“There are so many reasons for headaches, and they overlap so many other conditions,” says Dr. Hamsa N. Subramanian, an allergist and immunologist at Signature Medical Group in Creve Coeur. “Treatment depends on a very good history and finding what is triggering the chronic headache.”
Many people believe their headaches are triggered by sinus and nasal disease. “In my practice, headaches are mentioned by almost every other patient who comes in,” Subramanian says. True sinus headaches, however, are rare, she says. “Allergies by themselves don’t cause headaches, but nasal congestion and sinus pressure can contribute to headaches. Also, these kinds of headaches mimic a migraine. Should they be treated for allergies? For a sinus infection? Or is it a migraine?”
what is rhinitis?
Non-allergic rhinitis mimics the symptoms of an allergic disease such as hay fever (stuffy nose and sneezing) but does not activate the immune system. About 19 million Americans have non-allergic rhinitis, versus 58 million who have the allergic form. “Non-allergic rhinitis sometimes is precipitated by sudden fluctuations in temperature, high humidity and smells,” Subramanian says. “These also can trigger headaches.”
finding your triggers
“I go through a checklist systematically,” says Subramanian. “Are you getting enough sleep or too much sleep? Are you hydrated? Dehydration sometimes gives you the feeling of a headache.” Caffeine can play a role if you are consuming too much in beverages or foods or suddenly cut back. People who have sleep apnea or grind their teeth at night also may wake up with headaches. “If patients have chronic headaches, we have them maintain a log of things such as the foods they eat,” Subramanian says. “We must find their triggers, especially if their headaches are chronic and are affecting their quality of life.”
a chronic culprit
The majority of headaches we suffer are classified as the ‘tension-type,’ which the National Headache Foundation describes as “aching and non-pulsating pain (that affects) both sides of the head” and is “usually triggered by temporary stress, anxiety, fatigue or anger.”
“Stress-induced headaches can be caused by all kinds of things that people don’t think about,” says Mark Lumpkin, a massage therapist at the Aquarius Wellness Center for the Healing Arts. Causes can range from wearing contact lenses or dental braces to working at the computer day after day. Tightness originating in the muscles often crawls up the neck all the way to the head and face, Lumpkin says. “We call it a holding pattern. It is the way your body is accustomed to holding itself, day after day.”
definitely de-stress
Massage therapy is a non-pharmaceutical way to relieve stress. “Massage loosens and relaxes tight muscles in places we can’t reach on our own, especially the back of the neck,” says Lumpkin. “It results in increased blood flow and increased lymph flow, which helps muscle connections become more pliable so it becomes easier to live in your body.”
Yoga and meditation also can help with stress and tightness, he notes. “Yoga, meditation and massage therapy all help people focus on being present in their body and becoming less stressed.” He also recommends aromatherapy, especially at bedtime. “Aroma bypasses all the circuits in the brain and helps people go straight to a place where they can relax and focus on being at ease,” Lumpkin says.
[the emotional toll]
The fact that stress causes headaches Is well-documented. But not as widely discussed is the stress that headaches cause in chronic sufferers. imagine the emotional toll of waking up with pain day in and day out. What do the experts have to say about the psychology of headaches?
cause and effect
“Headaches can cause stress, and stress can cause headaches,” says Priscilla Bass-Timmerberg of Life Transitions Counseling in Webster Groves. “Some people are prone to headaches. When I am seeing someone with anxiety or emotional issues, they probably have headaches about 50 percent of the time.”
Rachel Hasper, M.A., a licensed professional counselor at Rachel Hasper Therapy, says, “There are phases of life than can put us into situations where we are compromised mentally and physically.” And mental stress can lead to physical symptoms. “When people are suffering chronic stress, depression or anxiety, that may mean their autonomic immune system is in distress,” she says. “They may be having cortisol excreted into their system, which makes muscles feel tight. That leads to tension headaches and shoulder problems. If it happens for a long period of time, it weakens the immune system, as well. Mental health and physical health are extremely integrated.”
a non-pharmaceutical focus
People who are suffer from significant headache pain should be evaluated by their physician, Hasper says, “but anyone who is suffering from headaches would benefit from unplugging and doing things that make them feel recharged.”
Bass-Timmerberg also recommends lifestyle changes. “Headaches can be treated with medication, of course, but often with medication there are side effects, so I try to use more natural things,” she says. “I teach about mindfulness—taking your attention off the things that stress you and putting your mind in the moment. Deep breathing is helpful, too, because it releases stress from your body.”
Such techniques, called autogenic training, are aimed at controlling breathing, blood pressure, heartbeat and body temperature to achieve deep relaxation. “Some counselors offer autogenic training and biofeedback to help patients connect the body and mind,” Hasper says. “It takes a lot of work and discipline.” A simpler technique, progressive muscle relaxation, drains the stress from the arms and legs, then the entire body, she says. “When I do this with my clients, I feel my arms and legs become heavy, and my mind and body are calm and peaceful,” she says.
“There are awesome ways to get the body back into alignment and make it much easier to deal with stress,” says Bass-Timmerberg. “Essential oils and aromatherapy can be very relaxing. It takes a little bit of everything.”
mental fitness
“Prevention is key,” says Hasper. “The more often we do things to feel well and rested, to unload our stress and deal with our emotions, the better off we will be.” A regular exercise program is good for mental health, as well as for fitness, she notes. “Talk with someone you are close to on a regular basis. Do things you enjoy, like gardening, listening to music or playing music.”
Think of mental fitness as you would physical fitness, Hasper suggests. “If you are having physical pain, it is easier to rest, ice and elevate when you have the first signs than to wait until you are in serious pain,” she says. “The same is true for stress management. If I take my daily walk, have a cup of tea with a friend, and go out in the garden or take the kids to the playground, I can decompress and won’t have quite as much stress build-up.”
