Headaches

What is a headache problem?

Headaches are one of the top health complaints of Americans. We’re bombarded with advertisements encouraging us to pay millions of dollars for pain relievers each year. Headaches are also one of the most common reasons people see physicians.

Everybody gets headaches. How do you know when you should see a doctor about them? Because each of us is different in how we deal with pain, you must decide for yourself. However, there are some conditions that may call for consultation with a physician:

• The recent onset of frequent, moderate to severe headaches, associated with other symptoms such as nausea or vomiting
• Frequent headaches which occur on a daily or weekly basis
• Headaches that make it impossible for you to think, do your work, go to school or enjoy life
• Headaches that respond only to a great deal of over-the-counter medication such as aspirin and acetaminophen products
• Headaches with fever that last more than a day or two

According to one source, there are 15 different classifications of headaches, and there are several different types of headaches within many of these classifications. Your physician needs to know a great deal about your headaches and your health to determine just what type of headache you have. He or she also needs to know other things about you and may ask you to take certain laboratory tests or x-rays along with a special physical examination. Your physician will be able to put all this information together and determine a great deal about your headache.

Even though there are so many different types of headaches, most patients have one of two types. The first is called a vascular or migraine headache. This is a pain caused by the dilation or expansion of certain blood vessels. This dilation is a normal process, but with the headache patient the blood vessels simply dilate too much. The pain occurs when the blood vessel and the pulsing blood stimulate the nerves around the blood vessel itself. In certain situations, the blood vessel constricts or narrows a great deal before this expansion occurs. This constriction causes the warning symptoms that often precede headaches. The dilation, of course, causes the pain and the symptoms that accompany the headache. Some people have no warning symptoms before their headaches. It is helpful for your physician to know these types of feelings if they are occurring.

The vascular headache frequently occurs only on one side of the head, although sometimes it may shift to the other side. These headaches may last only a few minutes but can last for many hours or even days. There are many things your physician can do to help you with these headaches. It is most important that you follow your physician’s instructions very carefully.

The other major type of headache is called the muscle contraction or tension headache. However, the true cause of this type of headache is unknown. They can occur in any part of the head and sometimes seem to be all around the head. There are many ways in which the physician can treat the muscle contraction headache patient, and again it is important that instructions be followed very carefully.

How is a headache problem diagnosed?

Your physician will ask you to describe how severe your pain is, where it’s strongest, how you obtain relief, if other symptoms accompany your headaches, and if you’ve found that some things make your headache worse. A physical examination will reveal the cause of some headaches. If necessary, your physician will order laboratory tests, x-rays and brain-wave tests. Often these tests are ordered after consultation with a neurologist, a physician who specializes in nerve and brain problems.

Most people who come to an allergy and immunology specialist for evaluation and treatment of their headaches have been seen by other physicians. If you have not had such a preliminary evaluation, it may be worthwhile to visit your primary care physician first to rule out other causes of your headaches. One hint that allergy may play a role in your headaches is if you have other allergies such as hay fever, asthma or eczema.

Two types of headaches have been shown to be associated with allergies in some cases. These are sinus headaches and migraines, and both can occur simultaneously. In fact, scientists have found that many people who believe they have sinus headaches actually have migraine variant headaches.

What are the symptoms of sinus headache? The four groups of sinus cavities in the head are hollow air spaces with openings into the nose for the exchange of air and mucus. They’re located inside each cheekbone, behind the eyes, behind the bridge of the nose and in the forehead. Secretions from the sinus cavities normally drain into the nose. Sinus headaches and pain occur when the sinuses are swollen and their openings into the nasal passages are obstructed, stopping normal drainage and causing pressure to build up. Often the pain is localized over the affected sinus. For example, if the maxillary sinus in the cheeks is obstructed, your cheeks may be tender to the touch and pain may radiate to your jaw and teeth. Sinus pain can be dull to intense, often begins in the morning and becomes less intense after you move from a lying down to an upright position. Antihistamines (decongestants) or antibiotics may relieve the pain. Sinus headaches develop because of swollen sinus membranes. Allergic reactions to airborne pollens, dust, animal danders and molds, as well as foods, can lead to sinus obstruction and pain.

Occasionally, some migraines are provoked by food additives or naturally occurring food chemicals such as monosodium glutamate (often added to Chinese food and packaged foods), tyramine (found in many cheeses), phenylethylamine (found in chocolate) or alcohol. The artificial sweetener aspartame and the preservative metabisulfite also may cause migraine. If these are your triggers, limiting or avoiding their use you can experience relief without medication.

How are headache problems treated?

There are two goals for the treatment of severe headaches: prevention and relief. One of the best ways to reduce the number or headache attacks is to eliminate those factors that seem to trigger your headache or bring it on. If allergies are present and seem to be a cause the headache, treatment of the allergy with avoidance and immunotherapy can be helpful.

Then, of course, there are medications. The medications your physician chooses will depend on the type and severity of your headache, how often it occurs, your overall health, etc. There are medications, which if taken regularly, can help prevent headache attacks. Some of these medications are rather strong and have some side effects and, therefore, are not used unless benefits outweigh the possible risks. Even as you are taking these preventive medications, you may still occasionally have a headache. Many medications for the relief of headaches are taken at the time of an attack. As each person responds differently to the medications and the size of the dosage your physician prescribes, it is necessary for your physician to know how well the medication is relieving your headaches.

How can headache problems be avoided?

The main way of preventing headaches is to be able to identify triggers and avoid them as well as treat any other source that has been shown to be a significant cause. For example, if you have sinus problems based on allergy, allergy avoidance and immunotherapy may be helpful. Some people find that certain chemicals in foods and certain emotional or hormonal situations are triggers and can be a target of treatment through avoidance. The following tables list some factor that patients have found to be triggers of headaches.

Food Triggers

• Cheese (especially cheddar)
• Chicken liver
• Canned figs
• Broad bean pods
• Herring
• Nitrates (found in bacon, bologna, salami, pastrami, sausage, pepperoni, etc.)
• Monosodium glutamate or MSG (found in Chinese food, dry roasted nuts, canned soups, potato chips, TV dinners, etc.)
• Caffeine (found in coffee, chocolate, tea, cola and some medications)
• Alcohol
• Medications, including oral contraceptives, Reserpine (for hypertension) and estrogen

Psychic and Psychological Triggers

• Emotional upset or release after concluding something important
• Tension (business and personal)
• Oversleeping or undersleeping
• Menstrual cycle
• Menopause
• Weather change
• Bright sunlight
• Exertion (though rare)

It should be emphasized that not everyone has identifiable triggers for their headaches. An exercise in understanding what they might be and keeping a headache calendar is an important step in finding out if you have identifiable triggers.

Helpful Links

• American College of Allergy Asthma & Immunology http://acaai.org/public