Maintaining Your Health on Mackinac
Different Kinds of Headaches Cause Different Types of Pain
By Yvan Silva, M.D.

One of the most common ailments we've all experienced, at one time or another, is a headache that can be torture, if relief is not close at hand. From ice-cold compresses, to resting for awhile and taking some type of medication, we're successful at treating them most of the time. But how much do we really know about headaches and what causes them? The occasional headache is bad enough, but what about recurring headaches? What about the differences in intensity, and what about the increasing amount of medications that might be required? Behind all of this, for some people, is the nagging doubt that a brain tumor might be the cause.

Recent research has begun to elucidate the broad spectrum of this problem. Not all headaches are the same, and that has been well known for more than 40 years.

Most headache pain is primary, in that it is not related to a specific underlying condition or cause. Migraine is one of the three most common types of primary headaches. Different types of headaches usually cause different types of pain. The most well known is the socalled tension headache. Clenched muscles in the neck and head that set off abnormal impulses trigger it. The pain is dull and squeezing in nature; it builds slowly and may involve the forehead, scalp, back of the neck, and both sides of the head. Relief is obtained by commonly used analgesic medications, and the pain doesn't last long.

Cluster headaches are much less common than are migraines, and usually occur on one side of the head as a stabbing sensation in the eye.

Migraine is perhaps the most painful and incapacitating type of headache a person can have. It can be very intense, and most people who have never suffered one will not realize the serious nature of the problem. The pain usually prevents the individual from functioning normally, or even carrying out activities of daily living. It is more common than usually thought, and nearly 30 million Americans are affected by it. Migraine pain affects 17% of women, and 6% of men.

An attack of migraine can be triggered in those susceptible to this problem in a variety of ways. Stress, some alcohol beverages like red wine, foods like chocolate and some types of cheese, or food additives, such as monosodium glutamate, nitrites, and nitrates, can be linked to the onset. The association becomes well known to the sufferer. Lack of sleep, excessive tiredness, and hormonal changes in women are known triggers, and exposure to bright lights or loud noises can set off a migraine headache in some. Many people with migraine suffer a prodrome during the genesis of the attack, in the form of an "aura," a neurological disturbance that occurs before the migraine begins. Yet, not all sufferers do. The disturbances may be visual in the form of flashing lights or blind spots in the visual fields; they may be auditory, like ringing in the ears, or there can be aberrations in the sense of smell or generalized numbness and tingling. Auras may occur with or without the headache.

The cause of migraine is not fully understood. Because it often runs in families, there is probably a genetic disposition. The symptoms of migraine occur in a wide spectrum; they're different for each individual. Each individual may experience some symptoms and not others, and symptoms may occur in various combinations. Migraine headaches tend to be moderate to severe and last for four to 72 hours; they may continue for longer periods. The pain is throbbing, and it can start on one side of the head, travel to the other side, and occur on both sides. Nausea and vomiting can occur. Pain intensifies with activity, and there is sensitivity to light, sound, or odors.

Medications to prevent migraine are recommended if you have two or more debilitating attacks in a month, if pain medications are needed more than twice a week, if commonly used medications are not working, or if prolonged symptoms persist. Medications are taken whether or not you have a headache, often daily or at regular intervals. The drugs fall into different classes of cardiovascular drugs, antidepressants, and antiseizure medications. The reasons they work are not completely understood. The family of NSAID drugs can be used for prevention, as well as for treatment. Treatment of migraine is most efficient when tailored to the individual. A specific medication or a combination is prescribed. There are well known popular medications approved for treatment of migraine.

People with recurring headaches are well advised to keep a record of their headaches. Such a diary of events helps in identifying factors that trigger headaches, and the efficacy of medications can be documented. Recent research in the area of migraine headaches has led to the discovery of a gene linked to a type of migraine that seems to run in families. Cautiously, experts state that while these genes are being studied, other factors, such as lifestyle and environment, do play an important role. Some of the symptoms that relate to migraine may point to more serious problems. Severe and recurring headaches require proper testing to ascertain the cause, and to find effective methods of treatment. Medications can be used to abort, minimize, or manage the attack, relieve pain, and restore the patient's function. Stress management, acupuncture, avoiding triggers that lead to migraine, and other strategies like exercise, relaxation training, massage, and biofeedback are important in overall treatment. Alternative treatments are best discussed with your doctor and placed into context in overall management.

Dr. Silva is a professor of surgery at Wayne State University and a resident of Woodbluff on Mackinac Island.