Migraines & Other Headaches
Perhaps the most common neurological conditions of all are headaches. They come in various intensities, lengths and locations.
In any given year, most Americans have at least 1 headache and most treat them with nonprescription pain relievers.
The migraine headache is the most renowned – a headache type experienced by about 6 percent of all men and 18 percent of all women, costing about 65 million workdays each year.
Migraines often start early in life and can stop by middle age. They can cause severe pain and disable a person for hours or even days. Most migraines are occasional, rarely daily.
Recent research shows that migraines may be caused by the chemicals through which our nerve and brain cells communicate (neurotransmitters). Changes in concentrations of these chemicals may cause blood vessels to change size, bringing on the migraine.
The most common headaches are tension headaches. They can be infrequent or chronic, occurring almost daily. Most men and women have had tension headaches.
A rare type of headache is the cluster, which affects about 1 percent of the population, by far most of them men. Clusters come in groups and can last for weeks. Alcohol can trigger attacks, as well as smoking.
Rebound headaches occur in people who have tension headaches and migraines. They are typically related to pain relievers.
All of the above headaches are considered primary headaches. Secondary headaches are brought on by other medical conditions, such as an infection, neurological problem or tumor.
Headache symptoms vary and can overlap. For example, a person can get migraines and tension headaches. The symptoms for each type are generally as follows:
- Migraine – Symptoms include intense throbbing, sensitivity to light and sound, vision changes, loss of appetite or nausea, vomiting, and inability to function. Pain can be on one side of the head. The sufferer may have an aura, sometimes before the pain begins. Headaches can vary from mild to severe.
- Tension – Pain is usually steady and on both sides of head. Can be chronic or periodic. Can vary from moderate to severe. Distracting, but not usually debilitating.
- Rebound – Pain can be similar to whatever headache it follows.
- Cluster – Headache causes severe pain, but it not last very long. Pain can center around one eye. Can occur in the middle of the night or the same time of day during a series.
A diagnosis of migraines and other headaches begins with a medical history, physical exam and neurological exam.
A careful headache history is the most helpful diagnostic tool. Patients who keep a diary can give the doctor valuable information like the timing and length of headaches, type and location of pain, food and drink before the headache began, use of stimulants, sleep patterns and use of female hormones.
The doctor will be looking for headache triggers that can include certain foods, stress, changes in weather and menstrual periods.
Testing to eliminate other conditions or problems may include blood tests, X-rays, eye exams and angiograms. The doctor can also take closer looks at the brain with an electroencephalogram (EEG), magnetic resonance imaging (MRI) or a computed tomographic (CT) scan.
Treatment depends on the frequency and severity of the headaches and often focuses on preventing frequent headaches, which may mean taking daily medication.
Other treatments may include change of diet and stress management through relaxation, exercise and biofeedback.
Over-the-counter medicines may help with milder headaches. Even simple treatments like heat or ice packs, rest or hot showers can give some relief.
Because specific foods or activities trigger headaches, avoiding the triggers (like alcohol, chocolate, peanuts or fatigue) can prevent a headache.
If migraines are severe and recurring, several medications can be taken on a regular basis to prevent headaches. These drugs include calcium channel blockers, beta blockers, antidepressants, serotonin antagonists and anticonvulsants.
To treat an acute headache and prevent it from getting worse, the patient may take medication soon after the migraine begins. Three types of commonly used medications include: triptan drugs, such as Imitrex (sumatriptan), Maxalt (rizatriptan), or Zomig (zolmatriptan); Midrin, which contains isometheptene, dichloralphenazone and acetaminophen; and D.H.E. (dihydroergotamine).
Migraine research has taken a dramatic turn in recent years because scientists have pinpointed a new source of the pain. For years, it was thought that abnormally dilating blood vessels caused the pain, so many of the pain relievers given to migraine sufferers constricted the blood vessels.
However, new technology has shown that migraine sufferers have abnormally excitable brain nerve cells that fire off electrical pulses at the back of the brain causing blood flow to jump. These firings ripple across the top of the brain and back down to the brainstem, the location of important pain cells.
The headache pain comes either from the activity in the brain stem or from inflamed blood vessels or both.
Studies are being done to address this new evidence, particularly since scientists think that frequent migraines may alter the pain centers and could lead to chronic pain.
Research on new medications for pain, such as anticonvulsants, also continues.
Wake Forest Baptist Approach
Headache patients may be referred by their own doctors or by the Emergency Department to the Neurology Department.
After thorough physical and neurological examinations, the patient may undergo brain scans such as MRI to eliminate other problems.
If there are any unusual aspects, such as weakness on one side or vision problems, the patient may be sent to Diagnostic Neurology for sleep studies, electroencephalograms or other studies.
Headache treatment could include pain relievers or changes in lifestyle, such as stress management, exercise and diet, or medications aimed at preventing headaches. New preventative treatments include the latest class of anticonvulsants and injections of botulinum toxins.
The Medical Center has and will continue to participate in clinical trials of medications to treat headaches.
Request an appointment online today to receive more information about your personal health and learn how Wake Forest can help.