HEADACHE


DEFINITION

A headache is a pain in the head. A headache can be caused by some other physical disorder, or it may be a disorder in and of itself.

DESCRIPTION

There are three major types of headaches: tension (or stress), migraine, and cluster. A tension headache is caused by the tightening of muscles in the neck and head. A migraine headache occurs when blood vessels in the brain dilate (swell up). Cluster headaches are characterized by very severe pain.

Tension headaches are probably the most common form of the disorder. Nearly everyone has a tension headache from time to time. Migraine headaches are less common. About 18 percent of American women and 6 percent of American men experience migraine headaches on a relatively regular basis. Cluster headaches are fairly rare. Less than 0.5 percent of Americans experience cluster headaches. Men make up 80 percent of all cluster headache sufferers.

Approximately forty to forty-five million people in the United States suffer headaches on a regular basis over an extended period of time. Headaches have a major impact on society because of missed workdays.

Headaches can also be caused by other kinds of diseases, injuries, and disorders. Headaches of this kind are not discussed in this entry.

CAUSES

Brain tissue itself does not feel pain, but other kinds of tissue in and around the brain can feel pain. For example, muscles in the scalp, face, or neck can contract and become painful, and blood vessels in the brain and face can swell, causing pain in the muscles and tissue on the skull.

Headache: Words to Know

Abortive:
Describes an action that cuts something short or stops it.
Biofeedback:
A technique in which a person learns to consciously control the body's response to a stimulus.
Prophylactic:
Referring to a treatment that prevents the symptoms of a disorder from developing.
Transcutaneous electrical nerve stimulation:
A procedure in which mild electrical currents are used to stimulate nerves in order to prevent the transmission of pain messages in the body.

Tension headaches are thought to be caused when muscles in and around the head contract (tighten up) due often to stress or poor posture. Tension headaches are also triggered by eye-strain, overexertion, loud noises, and other disturbing factors in the environment.

Migraine headaches are thought to occur when blood vessels in the brain dilate. In either case, pressure is exerted on certain tissues that can feel pain. Migraines are often triggered by food items, such as red wine, chocolate, and aged cheeses. For women, hormone changes may also be a cause of migraines. Women may experience migraines at certain times in menstrual cycle, when they are taking oral contraceptives, or after menopause.

Cluster headaches seem to be associated with alcohol and tobacco use. They can also be triggered by tension and by histamines (a compound the body releases as part of an allergic reaction; see allergies entry).

SYMPTOMS

Migraine headaches are intense throbbing headaches that occur on one or both sides of the head. The pain is often accompanied by other symptoms, such as nausea, vomiting, blurred vision, and a high sensitivity to light, sound, and movement.

The usual tension headache is described as a tightening around the head and neck, accompanied by a steady ache that forms a tight band around the forehead. Tension headaches usually affect both sides of the head and usually appear at the front of the head, although they can appear at the top or back of the skull. Tension headaches often begin in the afternoon and can last for several hours. They can occur every day. When this happens it is called a chronic tension headache.

A cluster headache can cause excruciating pain. The headache is usually centered around one eye. It may also cause the eyes to tear and nasal (nose) congestion. A cluster headache usually lasts from fifteen minutes to four hours. It may occur several times in a day.

Cluster headaches are classified as either episodic or chronic. Approximately 80 percent of cluster headaches are episodic, that is, they occur during one to five month periods followed by six to twenty-four month attack-free period. There is no such reprieve for chronic cluster headache sufferers.

DIAGNOSIS

The first step in diagnosing a headache is to find out whether it is related to some other medical problem. For example, people who have experienced a head injury (see head injury entry) may also have headaches. A doctor needs to find out whether the headache is a result of such a condition or is the problem itself.

If the headache is the sole problem, a doctor conducts a physical examination and takes a medical history. He or she may ask how often the headache occurs, where it is located, what factors seem to cause the headache, and what other symptoms may accompany it. The answers to these questions help the doctor classify the headache into one of the three categories listed above.

Nearly everyone has headaches from time to time. Some conditions, however, are warning signs that medical care is necessary. These signs include:

  • "Worst headache of my life." This complaint could mean that damage has occurred to a blood vessel in the brain. Immediate medical attention may be required.
  • Headache accompanied by a weakness on one side of the body, numbness, loss of vision, or problems with speaking. These symptoms are possible indications of a stroke.
  • Headaches that become worse over a period of six months, especially if they occur in the morning. This pattern may suggest the presence of a brain tumor.
  • Sudden onset (beginning) of a headache. The presence of a fever along with the headache may indicate a serious brain disorder known as meningitis ("brain fever," pronounced meh-nen-JI-tiss).

ASPIRIN

Aspirin is one of the oldest drugs known to humans. Ancient people discovered long ago that pain and fever could be controlled by chewing on the bark of the willow tree or by rubbing oil of wintergreen on a sore part of the body. Willow trees and wintergreen both contain a chemical known as salicylic (pronounced SAL-ih-SILL-ik) acid.

Of course, the ancients did not know the chemical composition of willows and wintergreen. It was not until the mid-1800s that chemists gained that knowledge. Then, they became excited about the possible uses of salicylic acid. They thought it might be able to cure many different kinds of diseases. They also believed that it could be used to preserve foods.

They were right about the second point, but wrong about the first. For a time, salicylic acid became popular as a food preservative. But it was soon replaced by other, more effective methods.

Although salicylic acid did not cure disease, it was effective in reducing fever and relieving pain. But it had one serious side effect: It usually upset the stomach. Eventually, researchers found a solution to this problem. They converted salicylic acid into another form, called sodium acetylsalicylate (pronounced uh-SEAT-el-suh-LIS-ih-late). Sodium acetylsalicylate also acts to reduce fever and relieve pain. But it is less harmful to the stomach.

In 1899, the German chemical company, Bayer AG, began making sodium acetylsalicylate commercially. They named the product aspirin. Today, aspirin is probably the most widely used drug in the world.

To diagnose conditions such as these, a doctor may use a variety of tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI). A CT scan is a procedure by which X rays are directed at a patient's body from various angles and the set of photographs thus obtained assembled by a computer program. This procedure is sometimes called a computerized axial tomography (CAT) scan. An MRI is a technique for studying the structure of internal organs by using magnetic waves.

TREATMENT

There are two kinds of headache treatment, called abortive and prophylactic. Abortive treatment is used with headaches that are already in progress. Prophylactic treatments are used to prevent headaches from occurring.

The most common drugs used to treat tension and migraine headaches are aspirin, acetaminophen (pronounced uh-SEAT-uh-min-uh-fin), ibuprofen (pronounced EYE-byu-pro-fin), or naproxen. Antidepressants and muscle relaxants can also be used to treat tension headaches. Three drugs that have had some success in the treatment of migraines include ergotamine tartrate, sumatriptan, and extra-strength Excedrin (which includes caffeine). Cluster headaches are also treated with ergotamine tartrate (pronounced ur-GOT-uhmeen TAR-trait) and sumatriptan (pronounced SOO-muh-TRIP-tan), as well as with pure oxygen. Prophylactic treatments include prednisone (pronounced PRED-nih-zone), calcium channel blockers, and methysergide (pronounced METH-ih-SIR-jide).

Alternative Treatment

A number of alternative treatments have been recommended for treating and preventing headaches. These include:

  • Acupuncture or acupressure
  • Biofeedback

The phases of a typical migraine headache. (Illustration by Hans & Cassady, Inc.)
The phases of a typical migraine headache. (Illustration by
Hans & Cassady, Inc.
)

  • Chiropractic
  • Herbal remedies, such as chamomile, feverfew, valerian, white willow, and skullcap
  • Homeopathic remedies
  • Hydrotherapy
  • Massage
  • Magnesium supplements
  • Regular physical exercise
  • Relaxation techniques, such as meditation and yoga
  • Transcutaneous electrical nerve stimulation, a technique that uses mild electrical shocks in an effort to prevent pain signals in the body

PROGNOSIS

As painful as headaches can be, they are not fatal (as long as they are not a symptom of some more serious disease or disorder). Neither do they have harmful long-term effects. Most headaches disappear on their own or are relieved by the treatments mentioned above.

PREVENTION

People can avoid some headaches by avoiding the factors that cause them. For example, one is less likely to develop tension headaches if one avoids stress in everyday life. Headaches caused by food allergies can be prevented by not eating the foods that bring on the headaches. Regular exercise and certain alternative treatments, such as relaxation exercises, may also help prevent some headaches.

FOR MORE INFORMATION

Books

Burks, Susan L., and Fred D. Sheftell. Managing Your Migraine: A Migraine Sufferer's Practical Guide. Totowa, NJ: Humana Press, 1994.

Inlander, Charles B. Headaches: 47 Ways to Stop the Pain. New York: Walker & Company, 1995.

Robbins, Lawrence D. Headache Help: A Complete Guide to Understanding Headaches and the Medicines That Relieve Them. Boston: Houghton Mifflin Company, 1998.

Votava, Andrea. Coping With Migraines and Other Headaches. New York: Rosen Publishing Group, 1997.

Organizations

American Council for Headache Education. 19 Mantua Road, Mt. Royal, NJ 08061. (609) 423–0043; (800) 255–2243. http://www.achenet.org.

National Headache Foundation. 428 West St. James Place, Chicago, IL 60614. (773) 388–6399; (800) 843–2256. http://www.headache.org.

Web sites

"Ask NOAH About: Headache." NOAH: New York Online Access to Health. [Online] http://www.noah.cuny.edu/headache.headache.html (accessed on October 21, 1999).