Ow! Know your headaches from A-to-Z

Ow! Know your headaches from A-to-Z

Credit: myRegence

Ow! Know your headaches from A-to-Z


by LIZ BROWN, Contributor / myRegence Contributor


Posted on October 30, 2009 at 3:30 PM

Updated Wednesday, Oct 30 at 10:08 AM

Headaches can be such a pain. But knowing what type you're experiencing, identifying headache triggers and taking a preventive approach can help head them off at the pass. This overview of various kinds of headaches is a good place to start, and your doctor can help with diagnosis and treatment.

Rare Yet Painful: Cluster Headaches
Cluster headaches are one of the least common types, and can last weeks or months at a time. Most sufferers experience one to four headaches a day during a cluster period. Because they tend to affect sufferers in the spring or fall, they're often mistaken for allergies or work stress. Ninety percent of those affected are men.

Triggers: The only specific known trigger is alcohol, according to Robert S. Kunkel, MD, FACP, a consultant for the Section for Headache and Pain at the Cleveland Clinic Neurological Institute and former president of both the American Headache Society and the National Headache Foundation. The cause of cluster headaches is generally considered unknown.   

Treatment: Most sufferers will need prescription drugs, Kunkel says. "Verapamil, lithium carbonate, Prednisone and Methysergide [no longer available in the US] are effective," he says. "The Triptan drugs are also effective, but inappropriate if there are several cluster attacks in a day."

Breathing 100 percent oxygen by mask for a few minutes will also help with 60 to 70 percent of attacks, according to Kunkel.

Pain in the Nerve: Cranial Neuralgias
Neuralgia is pain that follows the path of a nerve. Cranial neuralgias include cold-stimulus headaches (often referred to as "ice-cream" headaches or "brain freeze"), facial neuralgia, occipital neuralgia (pain originating at the base of the skull and radiating out to other parts of the head), trigeminal neuralgia (a painful swelling of the nerve associated with feeling to the face) and others.

Triggers: Injuries, infections, inflammation and tumors are among the triggers and causes. The dilation of blood vessels that occurs when something very cold touches the roof of your mouth causes a cold-stimulus headache.

Treatment: "For trigeminal neuralgia, carbamazepam [Tegretol] or gabapentin [Neurontin] are usually effective," says Kunkel. "If not, radiofrequency treatment of the ganglion can be done, and, rarely, a craniotomy [a type of surgery] is done in an effort to decompress the nerve." 

Under Attack: Migraine
Migraine sufferers experience throbbing head pain, typically on one side, as well as nausea and sensitivity to light and sound in many cases. Debilitating attacks can last from a few hours up to three days and include pre-headache, headache and post-headache phases. Some people experience an "aura" before the onset of migraine, such as seeing flashing light. Women are three times more likely than men to experience a migraine.

Triggers: Migraine triggers can include certain foods, glare, stress and odors, among others. Keeping a diary for a few weeks to help identify any foods or other factors that might be triggers is recommended. Skipping meals, fasting and erratic sleep patters can all trigger migraine, and the menstrual cycle is a very common trigger among women.

Treatment: FDA-approved preventive drugs include beta-blockers and anti-epileptic drugs (Depakote and Topamax). Low-dose oral contraceptives taken for a three-month cycle may help with migraines brought on by the menstrual cycle. To treat a migraine attack, any of the seven Triptan drugs are effective. "When taken early they will stop the migraine attack within two hours in about seventy percent of people," says Kunkel. "And a Triptan drug taken with an anti-inflammatory drug may work better."

Some studies suggest that 400 mg of riboflavin (vitamin B2) or 400 mg of magnesium daily may reduce the frequency of migraine, Kunkel notes. The herbs butterbur and feverfew have been reported to help, but doses aren't standardized and different preparations vary in terms of potency, he cautions. (Seek the guidance of a licensed naturopathic physician or herbalist if you'd like to explore these options.) An ice bag on the head provides relief to some sufferers as well.

Acupuncture may also help. Needles are commonly placed between the first and second digits in the hands and feet, as well as in the head or forehead, to help move the energy and complete a circuit, says Kyle Smoot, MD, a board-certified neurologist and acupuncturist. "The goal is to move energy through channels located throughout the body," he says. Acupuncture is safe and has no adverse side effects.

Pressure's On: Tension Headaches
The three types of tension headaches include episodic (occurring less than once a month and typically triggered by temporary fatigue, anger, stress or anxiety) to frequent (occurring from one to 15 days a month and often with migraine) to chronic (occurring 15 or more days a month and often a daily or continuous headache).

Triggers: Triggers include stressful situations, neck problems, bite problems and clenching.

Treatment: "No drugs are approved for the treatment of tension headache," says Kunkel. But, he adds, tricyclic antidpressants are the most effective preventive medications, and muscle relaxants may also help.

Anti-inflammatory drugs, other analgesics and heat might provide relief during an attack, and physical therapy can be beneficial if the neck is involved. Some people find relief with a hot shower or a heating pad, and methods of relaxation (meditation, for example) are worth a try. As with migraine (see above), acupuncture can help alleviate tension headaches.

Other Primary Headache Syndromes
Daily persistent headaches are generalized, start suddenly one day and persist. These tend to come on during a viral illness, and aren't very responsive to the usual headache medications.

Hemicrania continuum refers to a persistent, continuous, one-sided headache that can vary in intensity. "It lasts for months or years and is usually associated with nasal congestion, tearing or eye redness such as seen in cluster," says Kunkel.

Hypnic headaches occur during the night, often at the same time each night. They're less severe than cluster headaches and don't have the associated tearing, nasal congestion and redness of the eye that often accompanies cluster, Kunkel notes. They occur more often in older people and involve the forehead area.

Prevention/Treatment: "Indomethacin [Indocin, an anti-inflammatory drug] is helpful for hemicrania continuum, and recently anti-epileptic drugs such as Topamax and Neurontin have been reported to occasionally be beneficial in some of these rare headache syndromes," says Kunkel. "Hypnic headaches usually clear in a few weeks and respond to Lithium, Amitriptyline or non-steroidal anti-inflammatory medication."

Whatever type of headache you're experiencing, Kunkel recommends consulting a doctor for diagnosis and treatment if your headaches are severe, frequent or causing disability. And, he cautions, anyone over age 45 who begins having headaches for the first time should seek medical evaluation promptly. Besides, the sooner you seek help, the sooner you can halt the hurt and get on with life, pain-free.


About the Author

Liz Brown is a health, nutrition and travel writer based in Portland, Oregon. She holds a B.S. degree in Nutrition and is co-author (with Chris Meletis, N.D.) of the book "Enhancing Fertility: A Couple's Guide to Natural Approaches " (Basic Health Publications, Inc., 2004). Brown is also a Spa magazine contributing editor.