In this country, nine out of 10 people endure at least one headache every year. An estimated 40 million Americans suffer from chronic headaches. And the affliction is responsible for 150 million lost workdays a year.
“It’s a hidden epidemic,” says Dr. Fred Sheftell, co-director of the New England Center for Headache in Stamford, Conn.
Until recently, this epidemic was given short shrift by the medical community. Headaches were not regarded as real or serious problems, an attitude held over from their dubious heritage. For hundreds of years, headaches had been considered evidence of demons residing in the head or an excess of ill humors, and so were treated by exorcism and bleeding. More recently, Sigmund Freud regarded headaches as the frequent consequence of repressed emotions and feelings.
The legacy of such thinking, says Dr. Joseph Primavera, co-director of the Comprehensive Headache Center at Germantown Hospital and Medical Center in Philadelphia, “is that headaches are often thought to be the result of a weakness in character or a lack of mental health, something you bring on yourself.”
Recently, however, attitudes have begun to change. “Headache medicine has emerged from the Dark Ages,” says Primavera. “This is an exciting time.”
The excitement stems from discoveries about the causes and mechanisms of headaches and new approaches and medications to prevent and treat them. All of this confirms what headache specialists have believed for a long time: Headaches are the result of describable, traceable processes.
In most instances, but not all, headaches are neither dangerous nor life-threatening. In general, they can be separated into three broad categories: migraines, cluster headaches and tension headaches.
Migraines involve intense, throbbing pain that usually begins in the temple or one eye and may eventually spread down to the neck or even one arm. Bright lights can make a migraineur’s eyes water helplessly and send darts of pain into the head. The headache is often accompanied by nausea and vomiting.
At least 25 million people in the United States suffer migraines, 75 percent of them women.
What we already know about the mechanism of migraines is leading to new ways of treating them. For example, a collaborative study among a number of headache clinics suggests that the anti-seizure drug Depakote shows promise in warding off otherwise unresponsive migraines. Physicians are now prescribing the drug as a preventive measure. A new treatment, given after the onset of an attack, is the drug sumatriptan (Imitrex), which mimics the action of serotonin, not only by constricting swollen blood vessels but also by blocking the firing of the nerves that instigate migraines.
Although migraines may be the most notorious headaches, they are not the worst. That honor goes to cluster headaches, which afflict 1 percent of the population with excruciating pain.
“The pain is among the most severe that any human being can experience,” says Sheftell. “A cluster headache is often described as similar to a red-hot poker stuck with immense force through the eye and into the brain. If these people weren’t sure that the headache would end, they would surely kill themselves-which is why cluster headaches are often called `suicide headaches.’ “
One of the best treatments for cluster attacks is inhaling pure oxygen. For four out of five cluster patients, that stops the pain within minutes. The migraine drugs sumatriptan, DHE and ergotamine are also effective in stopping cluster attacks.
Yet, as dramatic as cluster headaches may be, neither they nor migraines constitute the bulk of headaches assailing the population. By far the most common are tension-type headaches. These are the ones that come with stress, that grow in intensity through a busy day and disappear after a night’s sleep. The pain usually is in the forehead and the back of the head and neck.
Many people get both tension headaches and migraines, while others get tension headaches that evolve into migraines. Stress may be the trigger that sets off the mechanism. Other tension headaches may actually come from excessive tensing of muscles around the head and neck.
Happily, many tension-type headaches can be treated without a doctor. If the headaches are occasional, for example a temporary reaction to a specific stressful situation, they most likely can be eliminated by an over-the-counter analgesic. Aspirin, acetaminophen or ibuprofen are the most commonly used. The sooner you take them after the headache strikes, the more effective they will be.
