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Understanding Headaches

by Dr. Eva Bell
(Bangalore)

Everyone suffers from headache once in a while. It is the most common health disorder known to man. Almost 3 out of 4 adults between the age groups of 18 – 65 years complain of headache several times during their lifetime. According to WHO’s “Atlas of Headache Disorders 2011,” only about 10% are likely to consult doctors. Most prefer to self medicate themselves with a tablet of Aspirin or Paracetamol. There are many types of headaches. Some resolve quickly. Others last for longer periods and interfere with daily routine.

Three types of Primary Headaches have been identified – Tension headache, Migraine and Cluster headache.

Tension Headache: In this stress-ridden world of today, the incidence of tensions headaches has increased. Almost 90% of adults are prone to such headaches, women being in the majority. Stress may be physical or emotional. Sitting at a desk or computer or TV for long periods of time in deep concentration, heavy work load, excessive physical exercise, worry, difficult labour or anxiety are some of the triggers of tension headache.

Muscles covering the skull go into spasm causing pain. Pain begins at the back of the head and upper part of neck, and spreads bilaterally. Headache usually subsides after taking pain killers. However, overuse of medication can lead to chronic tension headache. As the effect of the analgesic wears off there is a rebound headache. So another pill is taken, which in turn becomes a vicious circle.

Migraine: Aretaeus of Cappadocia is credited with discovering Migraine in the 2nd century. But from cave paintings, archaeologists have speculated that people might have suffered from migraine 9000 years ago, and drilling holes in the skull might have been used to ease the pain. But it was not until the Middle Ages that migraine was considered a medical disorder.

Migraine is responsible for 10% of headaches. It is estimated that globally 1.3% of people suffer from migraine. In India alone the figures add up to 3 crores. Many get their first attack in childhood or puberty. Women are three times more likely to suffer especially in relation to menstruation, pregnancy or menopause.

Throbbing headache starts on rising from bed in the morning. It is usually unilateral but can be generalized. It may last from 2 – 72 hours. One or two days before the attack 40 -60% of sufferers experience what is called prodromal symptoms like euphoria, fatigue, irritability, dizziness or difficulty in concentrating.

Immediately before the attack there may be blurred vision, double vision, flashes of light, nausea and vomiting. These symptoms are called the aura.

The pain is quite severe and can be incapacitating. Other than the pain, the person is in good health. Diagnosis is clinched only clinically. Skull X-rays, MRI, EEG are all normal. Usually those who suffer from migraine are intelligent, diligent and very methodical in their work.

The headache is said to be a combination of dilated vessels (often the temporal artery and its branches) and release of chemicals from nerve fibres that surround the vessels. Pain is not relieved by the usual analgesics. But specific medication under medical supervision can bring relief. Various triggers have been listed. Allergies, loud noises, bright lights, changes in sleep patterns, smoking active or passive, alcohol or even certain foods like cheese, chocolates, red wine, pickles, peanut butter, ajinomoto.

Women suffer in the premenstrual phase or during pregnancy or menopause. Those who are on oral contraceptives also might suffer from migraine.

After the pain subsides there may be a post-dromal phase where the person feels weak, lethargic, unable to concentrate for a day or two.

The risk of strokes, transient ischaemic attacks and cardiac disorders are 2-3 times higher in those who suffer from migraine.

Cluster headaches come in groups and last for weeks or months, with short free intervals between attacks. Each episode lasts for 30 – 90 minutes and is excruciating. The pain is sharp and felt behind the eye. The eye gets red and inflamed and the nose may be congested and runny. This type of headache is more frequently seen in men. Pain is so severe that the person may become restless, pace the floor or bang his head against the wall. The cause is blamed on abnormal activity within the hypothalamus.

There are other types of headaches secondary to conditions like brain tumour, meningitis, encephalitis, head injury, rupture of an aneurysm. A sudden severe pain which feels like a blow on the back of the head could be due to a ruptures aneurysm or bleeding below the outer membrane of the brain.

Other causes are hypertension when the diastolic pressure is above 130 or glaucoma.

People with secondary headaches need immediate hospitalization and intensive treatment.

How to manage primary headaches:

1. Be aware of what triggers your headache and avoid them.
a. If you have a stressful job requiring deep concentration or long hours on the Internet, take frequent breaks at intervals.
b. Do you have food allergies? Then avoid such foods.
c. Check your eyesight for refractory errors and get correctional glasses. Glaucoma causes severe frontal headache with watering of eyes. This needs prompt attention.
d. Disorders of digestive system should be treated.
e. Reduce cigarettes and alcohol.
f. If there are endocrine problems they must receive treatment.

2. De-stress muscles of neck frequently. Pull up your shoulders towards your ears and hold for a minute. Then gradually release. Do this for about five minutes. This signals the brain to relax muscles of neck and shoulders.

3. Symptom control through medication. Sometimes simple analgesics will do depending on the type of headache. However there should not be a repetitive use of medicines. Caffeine also helps in relieving headache. In migraine, medication should be started when the prodromal symptoms appear. One should not wait till the onset of headache.

4. Alternative Therapies:
a. Yoga, meditation, massage of muscles of the head or other simple exercises.
b. Acupuncture is supposed to remove the Qi energy blockage from the Yang channel in the head.
c. Bio-feedback: Therapists use a machine to which the machine is hooked and can observe physical and mental changes during the migraine attack. Patients are then taught to control their physiological parameters by learning relaxation techniques, breathing exercises or meditation. This has proved to be useful in treatment of migraine and tension headaches. Training sessions are one every week for six weeks. Biofeedback is supposed to be based on scientific principles.
d. Some intractable and recurrent headaches are helped through a surgical procedure. Decompression of nerves around the head and neck are performed.
e. Neurostimulators: Implantable neurostimulators in the brain (like pace makers in th heart) are used for chronic headaches.

Frequent headaches should not be taken casually but must be investigated. Pill popping will only result in rebound headaches.