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Not tonight, dear

Headaches can ruin your life; here’s how to stop them

migraine-headache2Joey Mendoza’s head hurts. It began to ache last Tuesday, during his morning workout: A low, throbbing pain that has changed pitch and tempo, but hasn’t stopped drumming a tango on his temples for the past nine days. “It started during my first set of bench presses,” he recalls from under a five-pound ice pack. “By the time I hit the showers, my head was about to explode. It’s been with me ever since.”

Joey figures that anything that sticks around that long ought to have a name, so he’s calling his headache Elaine, after his ex-girlfriend. But headache specialists would call what Joey has a chronic exertional headache, an especially nasty malady common among athletes.

While nearly everyone has suffered the occasional head-banger, experts claim that between forty and fifty million Americans experience chronic or repeated headaches. Statistics collected by the American Council for Headache Education indicate that headaches are the most common reason American men miss work or skip school, while many more sufferers drag themselves to the office to endure a day of decreased productivity. In any given year, 90 percent of all men have at least one headache. That keeps the folks at Bayer pretty happy, but the rest of us aren’t so amused.

“There are multiple types of headaches,” says Javier Cardenas, director of Barrow’s Resource for Acquired Injury to the Nervous System (BRAINS) Program. “But [there are] two main classifications of headache. More than 90 percent of them are known as primary headaches, which are never caused by other underlying medical conditions and include tension-type, migraine and cluster headaches (see sidebar). Secondary headaches account for fewer than ten percent of all headaches, and result from other medical conditions, such as infection or increased pressure in the skull due to a tumor.

Medical evidence suggests that primary headaches are caused by an electrical and chemical instability in certain key brain centers. These centers regulate blood vessels around the head and the neck, as well as the flow of pain messages to the brain. The instability is genetic and involves chemical messengers known as neurotransmitters. Like seizure disorders, headaches caused by faulty neurotransmission can be treated with prescription drugs that stabilize brain chemistry.

But most headaches have simpler sources, according to Lawrence Newman, M.D., a practitioner with the Headache Institute in New York City. “Stress can be a trigger, and certain foods, odors and even changes in weather are among other factors that can initiate headaches.” Although psychological factors have been overemphasized as causing headaches, he believes that emotional factors such as depression, anxiety and frustration can lead to a nasty headache.

As Joey can tell you, even exercise can give you a pain in the neck. “Exertional headaches are pretty common among athletes,” reports Thomas N. Ward, M.D., co-director of the Dartmouth/Mayday Headache Clinic in New Hampshire. “They can occur after running a long distance or following other types of exertion. Sometimes they occur in people with a history of migraine and resemble their own migraine headaches.” Sex, our favorite form of exertion, can also trigger several different types of headache. If the headache is severe, sudden in its onset and accompanied by vomiting, a physician should be consulted promptly. 

However they start, most headaches involve a mixture of inflamed blood vessels and tight, aching muscles as well as other profound body changes. “Most headaches originate within the brain itself,” says Lawrence Newman. “Since the brain is the body’s control center, it’s not hard for the attack to then spread to involve other structures,” resulting in an upset stomach or a sore back, for instance.

Whether or not your pain stays mainly on the brain, there are cures – including the lowly aspirin – that can provide a quick fix. “Mild headaches usually respond to over-the-counter remedies like ibuprofen or aspirin,” Thomas Ward says, “but moderate to severe headaches may require prescription drugs.” According to Ward, migraine patients who take medication for attacks more than twice a week may provoke analgesic rebound headaches (see sidebar). The theory is that the daily or almost-daily use of painkillers interferes with the body’s own pain-fighting systems in the brain, and eventually the person becomes more vulnerable to headache as the medicine starts to wear off. Headache specialists agree that the best cure for drug rebound headaches is to stop the daily use of painkillers. Milder over-the-counter painkillers can usually be withdrawn abruptly with minimum discomfort, but kicking stronger painkillers may require the help of self-administered or office injections of anti-migraine medications or non-steroidal, anti-inflammatory drugs.

The more holistic among us may seek relief from our throbbing temples in simpler cures, like aromatherapy, acupressure or massage. Ward says that more and more men are seeking non-pharmacological therapies, such as biofeedback and stress management, which can be used in addition to drug treatments.

“There is little reliable evidence as to the efficacy of herbal remedies,” he says, “but there are some exceptions. Feverfew helps some patients, although the recommended dose varies dramatically. More headache patients benefit from 200 mg of vitamin B12 twice a day.” But, be patient if you go the riboflavin route, advises Ward; B12 might lessen the frequency and severity of your headaches, but the effect may take several months to appear.

It’s unwise to wait that long, warns Cardenas, before consulting your physician about chronic headache troubles. “People should see their doctor once headaches begin interfering with the quality of life. You should ask yourself some simple questions: Do headaches impair your job performance or attendance? Are they the cause of failure in school? Do they disrupt family functioning or leisure activities?” If so, Cardenas recommends informing your physician sooner rather than later, particularly if the pattern is worsening by becoming more frequent or more severe.

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This Article appears on the October 2013 issue of LPM under Health

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