Brain Sprain

Don’t let headaches ruin your life

Headaches may be one of the most common afflictions we share as humans. But beneath that everyday description lies a more complex web of disorders and causes. Some headaches may cause minor discomfort, but some can be extremely painful and debilitating. Some headaches may also indicate the presence of other serious health problems.

Dr. Duane Campbell, a neurologist at Novant Health UVA Health System, helps explain the differences and why people who’ve suffered migraines shouldn’t give up on getting help.

Types of headache

Headache disorders fall into two broad categories:

  •       A primary headache is one due to the headache condition itself and not brought on by another cause.
  •       A secondary headache is one caused by another condition.

Primary headaches include tension-type headaches, migraines and cluster headaches.

Tension-type headaches are often described as pain that can feel like a tight band is squeezing your head. It is the most common type of headache and accounts for about 90 percent of all headaches.

Causes of tension-type headaches include emotional stress, anxiety, depression, poor posture and lack of sleep.

Tension-type headaches can become disabling when they are chronic. Overusing painkillers to treat tension-type headaches can cause daily chronic headaches.

Campbell said the most common headache type he sees are migraines. “Almost two-thirds of all headaches are migraines, especially in younger patients ages 20 to 50.”

Migraines are well-known for being more debilitating headaches. The International Headache Society notes that migraines can take place with or without an “aura.” An aura is a warning sign that can occur hours or even a day before the onset of a migraine. Women are more likely than men to suffer from migraines.

Migraines without aura are recurrent headaches that last anywhere between four to 72 hours.

Patients describe the moderate to severe pain as throbbing in one area of the head. During an episode, patients are very sensitive to light and sound and they may also experience nausea and vomiting. Routine physical activity such as walking can aggravate the pain.

“The reality is that a lot of people may not realize they have migraines,” Campbell said. “They may think its sinus or tension. But headaches affect a lot of Americans.”

“For healthy people between the ages of 20 and 50, migraines are one of the top reasons people miss work,” Campbell said. “They can be debilitating and miserable.”

In cases of migraines with aura, patients experience warning symptoms hours or even a day before the attack including fatigue, sensitivity to light or sound, nausea, or blurred vision. The migraine will develop gradually over five to 20 minutes and usually last less than hour.

Cluster headaches cause intense, repeated bouts of pain on one side of the head. During a bout with cluster headaches, the pain can occur at the same time each day, often at night, and become intense for half an hour to an hour. Episodes occur regularly for a week to a year and are separated by periods without pain. Patients may also experience watery eyes and a stuffy nose during an attack.

“Cluster headaches can be pretty severe, and may even be confused with having a stroke because the pupil may dilate on one side,” Campbell said.

Secondary headaches are caused by other conditions such as high blood pressure or infections such as sinusitis or meningitis. A mild head injury can cause a headache and so can tumors in the head. Blood vessel problems, such as a hemorrhage following the rupture of an aneurysm, can also cause a severe headache.

What are the causes of a headache?

A number of factors can trigger a tension-type headache, including stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal position.

The pain in a tension headache usually affects both sides of the head, starting at the back and spreading forward. It can be accompanied by soreness in the shoulders, neck or jaw.

Researchers are not certain what causes migraines, but most people have some triggers.

“Different seasons can trigger migraines – especially if someone’s trigger is an allergic reaction to something that blooms during specific times of the year,” Campbell said. “Different levels of caffeine or alcohol can also trigger migraines.”

Foods that can trigger migraines may include chocolate or certain types of cheese or seasonings such as monosodium glutamate or nitrites in processed meats.

Future treatment for migraines

Currently, migraines are treated with triptan medications, which are prescribed by a physician and available in pill, nasal spray and injection form.

“You have to take these drugs in a tight time window in the early phases of a migraine in order to be effective,” Campbell said. “We know migraines happen at the worst possible time and when they happen, you only have an hour or so to get these pain-relieving drugs in your system.”

New research is being done for a new class of medications that don’t require a specific time window.

“For those who feel frustrated with their current options, there may be hope on the horizon,” Campbell said.

He encourages those who have had migraines for years and given up on treatment to try again.

“You shouldn’t have to grin and bear it, or work through the pain,” Campbell said. “There are many treatment options now and I’d encourage patients to see a neurologist about what options would work best for them.”


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