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Headaches a pain, but migraines can be crippling

Headaches a pain, but migraines can be crippling physiciansfocus.gif
February 6, 2012 By Brian McGeeney, M.D. PhysicianFocus@mms.org For most of us, headaches are mere annoyances, quickly erased with a few over-the-counter medicines. But for some, like those who suffer migraines, a headache can be debilitating and impair function, sometimes for days. Headaches cause concern in most of us because we all worry if there’s something more serious going on. But the majority of patients experience what headache specialists call a tension-type or primary headache — clinically described as a disturbance of the pain system in the head with no other disease process going on. Such a headache involves a tightening or pressing pain of mild to moderate intensity affecting one or both sides of the head. The condition is usually treated and eliminated with aspirin or similar pain reliever. Headaches must be recognized as a normal, occasional occurrence for everyone for one basic reason: the head is much more sensitive than other parts of the body. That’s also why headaches are also a normal part of general illnesses, such as a cold or the flu. While we don’t yet know the specific causes of headaches, we do know that headaches run along a spectrum in terms of severity, from the common tension-type or muscular contraction headache to the most severe or migraine headaches. In some cases, patients may be unknowingly doing things to make headaches more likely. The choices one makes in his or her diet, for example, can contribute to headaches. Excessive caffeine can be an irritant. Foods with nitrates or monosodium glutamate (MSG, a flavor enhancer in many foods) can also trigger headaches. Likewise, one or two drinks of alcohol and even chocolate can lead to headaches for those with sensitive heads. Migraine headaches, the most serious type, affect about 13 percent of the U.S. population — nearly 30 million people. Women are disproportionately afflicted: they are three times more likely to have migraines than men, and nearly 13 million women suffer from menstrual migraines. Children as young as 5 or 6 can suffer migraines, but it’s most commonly experienced between the ages of 15 and 55. Genetics play an important role, too: Most of those who suffer migraines — 70 to 80 percent — have a family history of the condition. Many elements, alone or in combination, can trigger a migraine: diet, activity, environment, emotions, medications, bright lights, excessive noise, or hormones. Migraines can be described as an “episodic disorder with impairment,” and it may have associated symptoms, such as sensitivity to light and sound or nausea. A small number of migraine patients — about 5 to 10 percent — also experience an “aura,” or unusual visual abnormalities. A migraine may last anywhere from a half day to several days. An associated problem with migraines is the psychological factor of anticipation: Worrying about when the next migraine will occur can be incredibly crippling. A patient who experiences headaches should see a physician if one of these three conditions exist:
  • If the use of over-the-counter medicines, such as aspirin or other pain medications, isn’t eliminating the headache;
  • If the pattern of headaches changes, such as the timing or severity;
  • If the headaches are impairing daily routine and function.
In those cases, patients should not ignore the condition and promptly see their primary care physician. If concerns or questions are still present after a physician-patient encounter, a referral to a neurologist or a headache or pain specialist may be advisable. The important points for patients to remember are that headaches are extremely common, that some people have more sensitive heads than others, and that some people may be genetically predisposed to headaches. For those with migraines or recurrent headaches, a wide range of treatment options are available, including prescription medications for severe conditions. Lifestyle changes may also be prescribed. As to what may be done to prevent headaches, I offer three suggestions, which apply to attaining and maintaining good health in general: eat healthy, exercise, and get enough good sleep. Those three steps are all protective factors for the burden of headaches. For more information on headaches, visit the American Headache Society at www.achenet.org. For a video discussion on the topic, visit www.physicianfocus.org. Brian McGeeney, M.D. is a staff neurologist at Boston Medical Center and assistant professor of Neurology at Boston University School of Medicine. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org Bookmark and Share

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