Headache: Hope through Research

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 doctors’ offices. Migraine victims alone lose over 157 million workdays because of headache pain.
Understanding why headaches occur and improving therapies are among 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 find ways to prevent them.
When Should You See a Physician?
Not all headaches require medical attention. However, some types of headache are signals of more serious disorders and call for prompt medical attention, for example: a sudden severe headache; headache associated with convulsions; headache accompanied by confusion or loss of consciousness; headache following a head injury; headache associated with eye or ear pain; persistent headache in someone who was previously headache free; recurring headache in children; headache associated with fever; and headache that interferes with normal life.
Diagnosing a Headache
Experts agree that a detailed question and answer session with a patient can often produce enough information for a diagnosis. Most physicians will also obtain a full medical history from the patient, inquiring about past head trauma, surgery and medication use. A blood test may be ordered to screen for thyroid disease, anemia, or infections which might cause headache. X-rays or CT Scans or MRIs may be ordered to rule out the possibility of a brain tumor or blood clot. Sometimes eye exams are recommended, and an experimental technique called Thermography – using an infrared camera to measure blood flow through the skin – can show strikingly different heat patterns from headache sufferers vs. those that rarely get headaches.
A physician will analyze the results of all of these tests and arrive at the following headache diagnoses: (1) Vascular, (2) Muscle contraction (tension), (3) Traction, or (4) Inflammatory headache.
Vascular headaches include the well-known Migraine type. It is thought to involve abnormal function of the brain’s blood vessels or vascular system. Migraine headache involves severe pain on one or both sides of the head, an upset stomach, and, at times disturbed vision. Sometimes migraine headaches begin with an “aura.” The individual sees zigzag lines or flashing lights before the headache actually begins.
While researchers are unclear about the precise cause of migraine headaches, there seems to be agreement that a key element is blood flow changes in the brain. People who get migraines appear to have blood vessels that overreact to various triggers.
There are two ways to approach the treatment of migraine with drugs: prevent the attack, or relieve symptoms after the headache occurs. For infrequent migraines, drugs can be taken at the first sign of a headache in order to stop it or at least relieve the pain. For occasional or mild migraine, sometimes aspirin or acetaminophen taken at the start of the headache can help. Small amounts of caffeine may be useful also if taken in the early stages of migraine.
For those who get moderate to severe headaches, and for all cluster patients – those that get a severe, but shorter-type of migraine that comes in groups or clusters – there are stronger drugs such as Ergotamine Tartrate. This is a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken at the start of the headache.
For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel contriction; propranolol hydrochloride, which stops blood vessel dilation; and amitryptline, an antidepressant.
Several drugs for the prevention of migraine have been developed in recent years, including serotonin agonists which mimic the action of this key brain chemical. Prompt administration of these drugs is important.
There are other vascular headaches besides Migraine. Some can be caused by infection, exposure to chemicals, solvents and certain drugs.
Muscle Contraction Headaches are also known as “tension” headaches. They are often triggered by stress. They are named contraction headaches as the headache is caused by the contraction of neck, face, and scalp muscles as a result of stressful events. It is believed ninety percent of all headaches are classified as tension/muscle-contraction headaches.
Non-drug therapy for these headaches includes biofeedback, relaxation training, and sometimes counseling. A technique called cognitive restructuring teaches people to change their attitudes and responses to stress. In progressive relaxation therapy, patients are taught to first tense and then relax individual muscle groups. Sometimes, those suffering from infrequent headaches may benefit from something as simple as a hot shower or moist heat applied to the back of the neck.
People with chronic muscle contraction headaches may 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.
The two other types of headache: Traction and Inflammatory can be caused by very serious disorders. Traction headaches occur if the pain-sensitive parts of the head are pulled, stretched or displaced, such as with a brain tumor. Inflammatory headaches could be caused by meningitis, or diseases of the sinuses, spine, neck, ears or teeth. These headaches are treated by curing the underlying problem.
Children can also experience headaches as a result of infections, stress or trauma. These headaches can also include migraine. Parents should alert the family pediatrician if a child develops headaches along with other symptoms such as change in mood and sleep patterns.
Finally, today’s headache research offers hope for many chronic headache sufferers. The work of NINDS- supported scientists around the world promise to improve our understanding of this complex disorder and provide better ways to treat it.
(Summarized from Headache: Hope Through Research, October, 1996; Pages 1-36; Health and Human Services Department (HHS); National Institute of Neurological Disorders and Strokes; SuDoc Number: HE 20.3502:H 34/4/996