DENVER, Colo. – Most headache sufferers don’t need a picture of their brains to prove they’re in pain.
Recent information about the cause of headaches is opening the door to new treatment programs, said Judy Lane, a neurologist who runs a headache clinic at Colorado State University.
“A CAT scan shows you the anatomy of the brain but that is not the problem with the kinds of headache we’re talking about,” she said.
People often feel slighted if they don’t have a scan, but it’s generally unnecessary unless someone suddenly develops a persistent pain in one spot, she said at the American National Cattlewomen Association meeting last month.
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Boys are more susceptible to headaches than girls until the onset of puberty but after that, the picture changes. Three times more women than men suffer from various types of headache.
Patients at Lane’s clinic are often diagnosed using an interview rather than a brain scan.
The doctor wants to know how long the patient has suffered from a headache, what it feels like, how long it lasts, what seems to trigger it and how it affects the patient’s life.
This is followed with a physical exam of reflexes, strength, blood pressure and looking into the back of the eyes to see if there is increased pressure in the head.
With this information the doctor can prescribe treatment.
There are a variety of headaches – chronic, tension, rebound, daily and migraine. People need to understand they can have a migraine headache without the traditional symptoms, said Lane.
“Often people have migraine but it’s undiagnosed because they never go to the doctor or they don’t understand what is meant by migraine,” she said.
Many people think they must have an aura or a vision change with the onset of a migraine. The aura only appears in about 15 percent of migraine sufferers, she said.
A migraine can be a one-sided pain, worsened by movement. The sufferer may be sensitive to light and noise or experience nausea and vomiting. In the last five to 10 years incredible gains have been made in understanding the cause of migraine, which leads to better treatment, she said.
The headaches are caused by a chemical abnormality in the brain when it does not release enough serotonin.
“In this area of the brain stem, it’s thought that we all have a pain generator, an area of nerves where pain starts,” said Lane.
Scientists learned only recently that everyone has a variety of active chemicals in the brain including serotonin which affects sleep, mood and pain; particularly head pain. Migraines are often triggered by another event. When this happens the level of chemical drops in the brain and the person gets a headache.
Migraine triggers include:
- The menstrual cycle when estrogen and progesterone
levels drop.
- Ovulation. Sufferers need to track their headaches to their periods and see if there is a relationship with the hormone level.
- A reaction to caffeine, red wine, chocolate, preserved meats, MSG or artificial sweeteners.
- Exposure to perfumes, other smells, bright flickering lights or loud noises.
Tension, chronic and rebound headaches
Tension headaches arise when there isn’t enough serotonin in the brain, but Lane said there is a lot of controversy about the cause. The pain centres in the muscles of the head and is mild to moderate. Stress is a trigger, not a cause. People won’t get a headache just because they are stressed.
Chronic daily headache is when someone has a headache for more than 15 days a month. It can be on one side of the head, become a migraine and then ease off or move to another side of the head.
Rebound headaches are almost daily and occur because the patient takes over-the-counter and prescription pain medication daily. They have to be weaned off the medicine and the headaches ease off. These people can be helped with lifestyle changes or physiotherapy.
Headache medication comes in two forms. Preventive medicine is taken daily to break the headache cycle. The patient may need a calcium channel block or beta blockers. These are often prescribed for those with high blood pressure medicine or as anti-depressants.
Abortive medicine acts fast. It stops any further chemical releases in the brain. These are potent medicines that increase serotonin and are usually non-steroidal, anti-inflammatory type drugs. Advil or Tylenol are examples.
If someone needs abortive medicine more than twice a week, he or she should switch to preventive medicine which works slowly, said Lane.
Not everyone can use these various medications. Women who are post menopausal, men who are over 40 and people with high blood pressure or heart disease require a medical screening before receiving drugs for headache.
