Headaches

For many of those who suffer from migraines, the condition is chronic or persistent. When treatment is unsuccessful, these individuals are likely to experience a reduced quality of life. The Migraine Research Foundation explains that nearly four million adults experience a migraine at least 15 days a month. The problem may be exacerbated if pain relievers result in “medication overuse” headaches. 

Chronic migraine sufferers are often plagued with feelings of depression and anxiety and are likely to have sleep-related problems. More than one in five people struggling with chronic migraines are disabled. Those most likely to be disabled have other serious health conditions as well. 

Common Migraine Triggers

Those who suffer from migraines may find certain things that may trigger them. Many are attributed to environmental factors such as heat or humidity. Often they may begin when an individual lacks sleep or experiences a very stressful situation. Other triggers include exposure to certain foods including chocolate, cured meats, or cheeses. 

Thunderclap Headaches

One type of headache that can be very painful is a “thunderclap” headache. These tend to occur suddenly and last for several minutes. Some people become nauseous. This may be a sign of internal bleeding in the area of the brain and you should promptly seek medical attention. 

Sinus-Related Headaches

The sinus cavities exist within the region of the cheekbones, nose, and forehead. The sinuses may become irritated, leading to inflammation and feelings of pressure and head pain. Some people will develop a painful headache during these episodes. Sinus headaches are commonly mistaken as being migraines and vice versa. 

Cerebral Aneurysm

A cerebral aneurysm is often the result of very high blood pressure and could be misinterpreted as a migraine or cluster headache. This is an extremely serious condition where a blood vessel may expand and potentially rupture, causing a stroke. Other signs that may accompany the headache include blurred vision and a stiff neck. Those with symptoms should immediately seek medical care. 

“Ice Pick”

The term “ice pick” refers to those where the sufferer feels intense “stabbing” pain. These may be primary or secondary headaches that last for a few seconds. These episodes may be mild or extreme in severity and it is important to promptly seek medical attention. 

“Rebound” Headaches

A rebound headache is one that results from using excessive medication for a headache. They are most likely to occur after taking some type of analgesic or other treatment for more than a week. Often the problem will begin after the medication is discontinued. These are commonly treated with dihydroergotamine (DHE) and the majority of people experience improvement.

Dental-Related Headaches

Often, conditions that impact the teeth or jaw can result in headaches and/or facial area pain. One common cause is bruxism, which is excessive grinding of the teeth. Another common cause is a temporomandibular joint disorder (TMJ), which is associated with poor alignment of the jaw, arthritis or ligament damage. 

Menstrual Headaches

These may occur among women when there are changes relating to estrogen and progesterone. Menstrual migraines occur in some women before or in the early days of menstruation. This is in response to a drop in the levels of both of these hormones. 

Some women who use birth control may also be more prone to headaches of varying severity. This is also associated with fluctuations that occur in hormone levels. Post-menopausal women may benefit from using an estrogen patch. This serves to maintain a low but steady estrogen level. 

Spinal Headaches

One type of headache that can result in significant pain is a spinal headache. These may occur when the spinal fluid that is responsible for cushioning begins leaking. The fluid drainage may cause pain in the nerves and tissue in the area of the brain. A spinal headache may last for a short period of time or extend for several days. 

Many people find pain relief from lying down. The pain may reappear when a person sits up or stands. Roughly 32% of people who undergo a spinal tap develop headaches. A spinal tap or lumbar puncture may be needed to make a diagnosis or to administer anesthesia.

High-Altitude Sickness

Many people develop illnesses when they reach higher altitudes, usually when they are more than 3000 feet above sea level. These problems may also be referred to as “acute mountain sickness.” Headaches are among the most common symptoms that occur. The cause is typically a lack of oxygen. 

Arthritis-Related Headaches

Many people begin to experience arthritis as they age. This is when there is inflammation in the joints that creates stiffness. Headaches can result from arthritis that resides in the head and neck region. The pain tends to worsen when movement occurs and is often treated with muscle relaxers or medications that suppress inflammation. 

Caffeine Withdrawal 

Roughly 90% of people consume caffeine, typically in the form of beverages or chocolate. Those who consume significant amounts may experience headaches several days after consumption. This is usually the result of blood vessel dilation. 

Role of Psychological Factors in Headaches

Headaches most commonly occur from biochemical-related problems. Studies have shown that psychological issues often contribute to problems with headaches. A correlation has been found between headaches and disorders such as depression and anxiety. Patients who engage in counseling or therapy find that improvements in their day-to-day lifestyle can reduce their headaches.

Sometimes, headaches are experienced among those suffering from somatoform disorders. These are conditions where the individual experiences physical symptoms without any confirmed medical or neurological condition. The American Psychiatric Association has acknowledged that headaches are a potential symptom.

Are They Hereditary?

Studies have shown that children who struggle with migraine headaches generally have at least one parent who also suffers from them. In many cases, the shared physical environment of both the child and parent can be attributed to their migraines. Examples may include the presence of allergens in the family home or exposure to tobacco smoke.

Headaches as a Disability

A Global Burden of Disease Study revealed that headaches are among the leading causes of disability. Their report suggests that the World Health Organization had largely “ignored” the prevalence of headache disorders up until the last twenty years. Other findings include the following: 

• Migraines are estimated to be the seventh most common cause of disability.
• Medication-overuse headaches are approximately the 18th leading cause of disability.
• Tension headaches are the most common type of headache and often can be disabling.

Diagnosis

Many patients who begin experiencing headaches will seek help from their primary care provider. The physician is likely to assess their symptoms and attempt to determine if any pattern or triggers exist. To investigate further, a doctor may order additional testing. 

Often, blood tests will be performed and imaging will be conducted such as X-rays, CT scans, or MRIs. In certain cases, a headache may be a symptom of a serious underlying condition. Some of the questions your doctor may ask you include: 

• How long you have been experiencing these types of occurrences
• Whether you suffer from one or more different types of headaches 
• How often you experience them (frequency)
• Whether you have a family history of headaches or related health conditions
• The extent that they are impacting your life such as work, school, relationships, etc. 

Commonly Used Prescription Medications

There are many different types of prescription medications used for treatment. Ergotamines are a class that is prescribed specifically for migraines. They function by causing contraction of the blood vessels that surround the brain. These drugs tend to be fast-acting and are administered in the form of a pill, tablet, injection, and others. Commonly prescribed ergotamines include dihydroergotamine (DHE-45, Migranal), ergotamine (Ergomar), and methysergide (Sansert). 

A class of drugs known as triptans has emerged more recently and has proven to be effective in treating migraines. They increase the level of serotonin within the brain to reduce pressure on the blood vessels and alleviate inflammation. They are most commonly administered in the form of pills, dissolving tablets and nasal sprays. Common triptans include almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), and more. 

Opioids are tightly controlled pain medications often prescribed when other medications have proven to be ineffective. These are a potent class of medications that pose safety concerns including overdose and addiction. Some of the most common opioids include codeine, meperidine (Demerol), morphine, and oxycodone (OxyContin). 

Prevention 

What are some of the best practices for preventing headaches? One potentially effective practice is to moderate or avoid certain drugs. These include caffeine, nicotine, and alcohol. Many people who consume moderate to high levels of caffeine experience headaches when they withdraw from it. Withdrawals are common in those who recently consumed a significant amount of alcohol. 

Many people that struggle with headaches find relief by limiting their stress. This can often be achieved by finding ways that allow you to relax. Some common ways to reduce stress include breathing deeply or muscle relaxation techniques. Many individuals enjoy relaxing to music or practice meditative exercises. 

What Types of Clinicians Treat These Conditions?

As with most painful conditions, the majority of people who experience headaches will initially visit their primary care doctor. These are typically physicians such as those practicing in internal medicine, family practice, or pediatrics. When necessary, your doctor may refer you to a specialist. 

Those practicing in the realm of physical medicine and rehabilitation (physiatrists) commonly treat these problems and dozens of other painful conditions. When it appears that allergies are triggering your migraines, you may be referred to an allergist. Many physicians that specialize in neurology have expertise in treating migraines and similar problems as well. 

If you experience problems with your vision, such as blindness, you may be referred to an ophthalmologist for an examination. You may need to see a psychiatrist if your doctor believes your headaches are caused by stress or associated with mental health conditions. Individuals who suffer from sinus headaches may be seen by an otolaryngologist, also known as an ENT specialist.

The United Council for Neurologic Subspecialties is a group that has introduced accreditation known as UCNS. Some practitioners obtain this certification and can be designated as a “headache specialist.” 

Medical Provider for the Treatment of Pain in Arizona

The Arizona Pain and Spine Institute is a local medical practice that employs a comprehensive approach to managing headache and migraine pain. Our patients benefit significantly from our multidisciplinary approach that uses the latest medical advancements and technology. Are you or a loved one struggling with pain? Contact us today at (480) 986-7246 to schedule an appointment.