By John Messmer
Penn State Family & Community Medicine
Penn State Milton S. Hershey Medical Center
Who has not had a headache? A poem on an ancient Sumerian tablet includes the line, "The head throbs, when pain smites the eyes and vision is dimmed." For centuries, most of us have experienced this common affliction, yet many misconceptions about headaches persist.
Two common misperceptions about headaches are that a migraine is just a bad headache and new headaches may be due to a brain tumor. Migraines are a very specific type of headache, not just a bad one. In fact, there are many different types of headache -- the International Headache Society lists 20 types -- and only a very small percentage of new headaches are due to a brain tumor.
Migraine headaches afflict one in four Americans, two-thirds of whom are women. Research has improved our understanding and treatment of migraine pain. This is fortunate since migraines cost U.S. companies and workers $13 billion annually in lost wages and productivity.
Migraines tend to run in families. Stress, hormones, foods, alcohol, lack of sleep, bright light, anxiety and motion can trigger migraines, but they can occur for no apparent reason.
The typical migraine develops on one side of the head, throbs and is associated with nausea. Occasionally visual changes such as flashing lights or blurring occur before the headache develops. Most times light and sound make the pain worse. The migraine probably originates in a cluster of nerve cells deep in the brain termed the "migraine generator." When stimulated, these nerves send signals to other parts of the brain resulting in a complex series of chemical events culminating in the head pain we call a migraine. Untreated, migraines last from a few hours to most of a day, sometimes longer. Current therapies, fortunately, can stop a migraine so there is little or no lost time from work or school. There are also options for prevention of migraines.
Tension-type headaches are the most common form of headache, occurring in 70 percent of men and 90 percent of women. They were once thought to be due to tense muscles in the neck and head. Current research shows a more complicated explanation involving sensory nerves and brain chemistry. The term "tension-type headache" is now used to reflect this new understanding.
Tension-type headaches can last from minutes to days. The muscles in the area of the pain are often tight and tender, but the person does not usually have nausea, throbbing or light and sound sensitivity. Stress can be a significant contributing factor, but tension-type headaches can arise from fatigue, poor sleep, illness, anxiety or depression.
Tension-type headaches can be located in the neck, the back of the head, one or both sides of the head and the face. Usually these headaches come and go, but about 3 percent of the population has daily tension-type headaches.
Brain tumors are a scary but uncommon cause of headaches. A headache caused by a brain tumor is more common in people who already have a history of headaches, but it is usually more severe and constant. Brain tumors do not always cause headaches, but new onset headaches or a significant change in the pattern of a headache should raise suspicion particularly in a person with a new neurologic abnormality or a prior history of cancer that can spread to the brain.
Bleeding in the brain typically causes a sudden onset, very severe headache often described as "the worst headache of my life." Neck stiffness often occurs along with some degree of confusion and often symptoms such as weakness. In many cases, the bleeding comes from an aneurysm -- a weak area of a brain artery.
Cluster headaches occur in less than 1 percent of the population and are six times more common in men. Family history is rare. The name comes from the pattern of multiple, severe, disabling and intense headaches around the eye that come for several days often at change of season then go away for months or years at a time. They usually last less than two hours but can occur multiple times in a day. Clusters also cause one of several other signs, such as tearing, nasal congestion, eye redness, eyelid weakness, sweating and runny nose.
Neuralgia is another type of headache pain arising from the large nerves of the face and the neck. Trigeminal neuralgia causes severe facial pain triggered by touch, cold, eating and other stimuli. Cervical neuralgia stems from the spinal nerves in the neck and cause shooting pain up over the back of the head.
The jaw or temporomandibular joint has been associated with headaches, as have sinus infections. Older people can have headaches from temporal arteritis, an inflammatory condition of one of the arteries in the scalp. This is a serious medical condition, rather than just another type of headache, as it can lead to blindness. Other causes of recurring headache include cough or exertion, intercourse, trauma, bony abnormalities, inflammation or tearing of the carotid artery and more. Headaches can even occur from taking too many pain medications, the so-called rebound headache.
Enough causes of headache exist to require a medical education to sort them out. What the ancient Sumerians probably did not know is that all that writing about headaches actually can prove useful. The most accurate way to diagnose the type of headache is by the description. Tests and X-rays have limited usefulness in headache diagnosis. A headache diary that includes such information as when the headaches occur, how long they last, whether or not there are other symptoms, whether they are in one or more locations or are associated with menstrual cycles, fatigue, alcohol or certain foods will be a huge asset to determining cause and prescribing treatment.
The risk of chronic headaches can be reduced by eating balanced meals at regular intervals, maintaining regular sleeping and waking patterns and exercising regularly. If activities or foods provoke headaches, naturally these should be avoided. It is very important to avoid using other people's headache medications and sharing one's own medications with others since medications may be harmful used incorrectly.
Even though headaches are a common problem, most headaches can be managed.
Detailed headache information is available at http://www.ninds.nih.gov/health_and_medical/disorders/headache.htm and http://ahsnet.org/resources/headachefacts.php online.