Physician Focus: January 2012
By Brian McGeeney, M.D.
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
15-55. Genetics play an important role, too: Most of those who
suffer migraines - 70-80 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, and
- 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
