Proper Diagnosis and Treatment Can Help Manage Headache Pain

SIOUX FALLS (Dec. 1, 2008) - Ever had a headache? You're not alone. Headaches are so common that almost everyone experiences them at least once in awhile. Taking an over-the-counter pain reliever, or getting a good night's sleep is the easy answer for most occasional bouts.

For some people, however, the solution is not so simple. When headaches keep coming back or keep you closed away in a dark room, it's time to seek help, said Dr. Carol Miles, neurologist with Neurology Associates in Sioux Falls.

"It's easy to jump to conclusions - that it's a tumor or an aneurysm," said Dr. Miles, who has a special interest in headaches. While these serious conditions must be ruled out, they are rarely the reason behind headaches. Migraines, tension headaches and medication overuse headaches are the three most common types of headaches leading to physician office visits.

Migraine headaches are three times more common in women than in men, and typically begin in the 20s, 30s or 40s. Migraines tend to be one-sided, throbbing and severe headaches, with nausea or vomiting and sensitivity to light and sound. They may be accompanied by an "aura" such as numbness or weakness on one side of the body, or visual changes such as dark spots or flashing lights.

Migraine triggers can include stress, sleep deprivation or changes in sleep patterns, or even eating certain types of foods, such as bacon or pepperoni, citrus fruits, Chinese food, flavored chips or alcohol.

Some women have specific menstrual migraines which happen a day or so before their period, and sometimes again at the end, due to changes in estrogen levels. A more mild version of these headaches may happen again at ovulation.

"Migraines are terribly under-diagnosed and under-treated," Dr. Miles said. In fact, only about 50 percent of actual migraine sufferers have been diagnosed with the condition.

Without treatment, most migraines last around 8 hours, but can go on for days in what is known as a headache cycle. "With adequate treatment, we should be able to get headache duration down to 2 hours at the most," Dr. Miles said.

The latest migraine medications treat the specific, underlying causes of migraines, namely neurotransmitter changes in the brain, vascular changes and inflammation.  Preventative medicines decrease the severity, duration and frequency of headaches.

Tension headaches are caused by muscle tension - tension of muscles in the upper shoulders and neck, which connect to the muscles at the base of the skull. Those muscles connect to the thin layer of muscle that goes all around the skull and into the face. "These are very thin muscles, but they can hurt," Dr. Miles said.

Tension headaches typically come on in the afternoon. The pain is dull and all over the head, perhaps worse in the scalp, temples or back of the neck. They are the result of holding your head in one position for too long, for example, bent over a computer keyboard or textbook, carrying a heavy purse, or even a car accident that jars the neck.

This type of headache is best alleviated by prescribed exercises to stretch those muscles, as well as stretching breaks during work. Unlike migraines, which get worse with exercise or physical activity, tension headaches usually get better.

Overuse of pain relievers can lead to another common type of chronic headaches, also known as "rebound" headaches. The best way to get rid of medication overuse headache is to stop taking the offending medication. This can be difficult, because those most likely to get this type of headache are migraine sufferers, who take medications to ease pain.

Migraine, tension or medication overuse headaches can be debilitating, but they are not life-threatening. However, a sudden, severe headache can be a sign of a dangerous condition like stroke or aneurysm. So if you suddenly experience the "worst headache of your life," seek help. It's also advisable to see a physician for any new headaches, a change in headaches or new symptoms such as numbness or weakness.

"It's important to go in, get diagnosed, and get treated so you can manage your life, rather than having the headaches manage your life," Dr. Miles said.

For more information about headaches and other health topics, click on "health library" on the upper right corner of the Avera McKennan web site.