By Joy Pierce Mathews for Summit Medical Group

What You Should Know About Headache

Headache is pain in the upper neck and head that varies in severity and frequency. Although most headaches are not life threatening, headache can negatively affect quality of life. In severe cases, headache is debilitating.

Headaches have a wide range of causes, including infection, hangovers from alcohol consumption, and fasting as well as serious conditions such as brain tumors and stroke. The most common headaches include tension and migraine, which are associated with nervous system disorders.

Headache Statistics

• Headache is the seventh most common reason for outpatient visits in the United States¹
• More than 90% of the US population experience some type of headache²
• Twenty-eight million Americans, including 1 in 5 women and 1 in 20 men, experience migraine headache¹  
• Cluster headaches are rare, affecting less than 3 in 100 people and mostly men²

Types of Headache
Although there are 3 categories (primary, secondary, and other) for headache, the most common are primary headaches, including:

• Tension (the most common type of headache; more frequent in women than men)
• Migraine (the second most common type of headache; boys and girls have equal incidence before puberty, but after puberty, more girls than boys experience migraine headaches)
• Cluster (rare; more common in men than women; average age of cluster headache sufferers is aged 28 to 30 years; often beginning in childhood)

Secondary headache results from other health problems such as bleeding in the brain, tumors, and meningitis and encephalitis. If you are experiencing frequent, repeated pain (mild or severe) on one side of your head, it is important to see your neurologist to identify and treat the cause early.

Other headaches are caused by inflamed nerves in the upper neck and head (cranial neuralgias) and facial pain. If you are having headache of any kind, your doctor should examine you, determine the type of headache you are having, and recommend the best ways to treat it.

Tension Headache
There is no definitive cause of tension headache; however, researchers believe this type of headache is likely associated with physical stress such as prolonged manual labor or studying a computer screen or reading for extended periods. Emotional stress also might have a role in tension headache, causing the muscles that cover the skull to contract and spasm.

Tension headache typically occurs at the forehead, base of the skull (where neck muscles join the skull), and temple (where jaw muscles are located). They can be frequent (as often as daily) or infrequent. Most people who have tension headache suggest the pain does not disable them.

Symptoms of tension headache include:

• Tightness and pressure that evolves into pain at the upper neck or back of the head
• A band of pressure that circles the head, with the most intense pain over the eyebrows
• Mild pain that affects both sides of the head

Treatment for Tension Headache
Tension headache is typically treated with nonprescription pain relievers such as aspirin or ibuprofen. Antidepressant therapy sometimes is used in patients who have frequent or severe tension headaches. Nonmedication alternatives for tension headache includes stress management and biofeedback.

Migraine Headache
In a migraine headache, the artery on the outside of the skull under the skin of the temple (temporal artery) enlarges. As this process occurs, nerves that surround the artery stretch and release chemicals that cause inflammation and pain. The larger the artery gets, the greater the pain. Often, the sympathetic nervous system (which controls responses to pain) is activated and causes nausea, vomiting, diarrhea, blurred vision, reduced circulation (causing cold hands and feet), and sensitivity to light and sound. In addition, the stomach empties more slowly into the small intestine and prevents oral medications that treat migraine from entering the small intestine and being absorbed adequately.

A chronic condition that occurs repeatedly, migraine most often is associated with headache but also can be associated with abdominal pain (abdominal migraine). Gastroenterologists usually diagnose and treat abdominal migraine.

Symptoms of migraine headache include:

• Intense, throbbing pain that usually occurs on one side of the head; involves the temple, forehead, area around the eye, or back of the head; and lasts between 4 and 72 hours
• Pain that changes sides from one attack to the next. (If pain occurs strictly on one side of the head for a prolonged period or repeatedly, it might be a symptom of a more serious condition and should be addressed immediately)
• Pain that worsens with activity such as walking upstairs or bending over
• Nausea, vomiting, diarrhea, cold hands and feet, sensitivity to light and sound
• Warning symptoms that can last hours or days such as sleepiness, irritability, depression, euphoria, excessive yawning, and cravings for sweet or salty food
• An aura that precedes or accompanies the headache, which can include speckles of light, flashing or brightly colored lights in a zigzag pattern, a blind spot in the middle of the visual field, pins and needles in the hand and arm or around the mouth and nose on one side, and hallucinatory sounds as well as abnormal tastes and smells
• Complicated migraines can be preceded or accompanied by lack of balance, dizziness, fainting, double vision, and the sense that the room is spinning
• Hemiplegic migraines can be accompanied with temporary (sometimes lasting days) paralysis or weakness on one side of the body
• Fatigue, a low-grade headache, and continued sensitivity to light and sound after the migraine subsides

Treatment for Migraine Headache
There is a wide range of treatment for migraine headache, including prescription and nonprescription medications such as analgesics (acetaminophen and nonsteroidal anti-inflammatory drugs [NSAIDs]). Nonmedication therapies include using ice, biofeedback, acupuncture, and relaxation techniques. Some patients find it helps to avoid certain foods that contain large amounts of tyramine (sharp cheeses), sulfites (wine), and nitrates (nuts and processed meats). Good nutrition, drinking enough water each day, getting enough sleep, and exercising also have helped some people avoid or better manage migraine headache.

Cluster Headache
The cause of cluster headache is unknown; however, researchers believe the part of the brain that regulates sleep, temperature, appetite, and hormones (hypothalmus) or the nerve that carries sensations from the head to the brain and ends in blood vessels surrounding the brain (trigeminal nerve) may be involved.

Cluster headache occurs in groups known as cluster periods or episodes. During a cluster period, the headaches may be as frequent as several per day and can last from hours to several days.

Symptoms of cluster headache include:

• Intense, stabbing pain around the eye or temple that can spread to the face and upper neck and typically lasts between 15 minutes and 3 hours; the pain can be absent for long periods and recur at the same intensity and frequency months or years later
• A stuffy or runny nose
• Teary, red eyes, and a drooping eyelid
• Severe pain that often occurs in a cycle and at the same time each day

Treatment for Cluster Headache
Most people who have cluster headache are treated with drug therapy to prevent or stop an attack. Some treatments include inhaling concentrated oxygen as well as oral, injectable, and nasal-spray pain relievers such as NSAIDs. The frequency and intensity of cluster headache can be lessened with preventive treatment, including blood pressure medications (beta- and calcium-channel blockers), antidepressants and mood stabilizers, anticonvulsants, antihistamines, and serotonin antagonists. In severe cases, surgery to block or remove a nerve can help patients who experience cluster headaches. Nonmedication and nonsurgical approaches for cluster headache include chiropractic techniques, acupuncture, and herbal remedies.

Taking Control of Your Health
The good news is that medical and technologic advances have made it easier for neurologists to identify and treat headache. Effective treatment is likely to involve a combination of medical, nonmedical, and preventive approaches. Because each patient’s symptoms and response to treatment differs, your neurologist will discuss treatment options for headache that are tailored to your age, condition, and lifestyle.

Neurologists at Summit Medical Group have expertise in all types of headache. If you are experiencing occasional or frequent headache, ask your neurologist to examine you and discuss what options might help you.

About Summit Medical Group

References
1. American Headache Society. Facts about headache. www.americanheadachesociety.org. Accessed June 3, 2009.
2. Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, PA; Saunders Elsevier; 2008.