Headache Help (3 page)

However, treating headaches is both an art and a science, and often the first try doesn’t work. Each person is different: your headaches may be triggered by factors very different from someone else’s and your response to medications is also unique. You need to work patiently in partnership with your doctor, who may need to experiment with doses, monitor you for side effects, and recommend several changes in medication before getting the right balance. Even after you find the right medication and correct doses, over time the medication may become less effective and your doctor may have to experiment again. At times this trial-and-error process may be frustrating, but try not to give up: The hope for a higher quality of life with fewer headaches should make up for the setbacks and stumbling blocks you may encounter along the way.

NONHEADACHE MEDICINES

You may wonder why your doctor would prescribe an antidepressant, anticonvulsant, or perhaps a medication used for high blood pressure or heart disease for your headaches. This approach isn’t as odd as you may think. Certain medications commonly used to treat headaches are not always specifically approved or indicated by the Food and Drug Administration for this purpose. However, this practice is common. Medications often have several, sometimes a dozen, different effects. When drug companies develop and test a new medication—say, a drug with antidepressant, analgesic, sedative, and antiseizure effects—they focus on whatever property they think will be most marketable or profitable. In this case, they may focus their very costly research efforts on the drug’s ability to prevent seizures. Once the drug is approved by the Food and Drug Administration as a safe and effective anticonvulsant, doctors may then decide to use it for an altogether different purpose.

Since swollen blood vessels are a primary cause of head pain, many medications used for headaches have a beneficial effect on blood vessels. The medications either influence serotonin, which in turn helps control blood vessel constriction and dilation; constrict swollen blood vessels directly; or help prevent blood vessels from swelling in the first place. Other medications, however, such as narcotics, help headaches by dulling the pain signal to the brain.

WHAT KIND OF HEADACHE DO YOU GET?

One of the first steps to understanding your head pain is to identify what kinds of headaches you get. Although there are about a dozen major types and more than sixty subtypes of headaches, the vast majority are either migraines or tension headaches, which most people will get from time to time, and to a lesser extent, cluster headaches. Many headaches that are believed to be common, such as sinus headaches and allergy headaches, are, in fact, quite uncommon. Many other types of headaches are actually very rare and are caused by serious disorders, such as brain tumors or meningitis, and can be identified by certain high-risk factors. See Chapter 2, “Symptoms to Take Seriously.”

M
IGRAINES

Migraines may afflict up to 25 million Americans, two-thirds of them women, many of whom get menstrual headaches as well. Migraines, which are usually inherited, are characterized by throbbing or aching pain, usually on one side of the head, and are often coupled with nausea and sometimes vomiting, visual disturbances, or dizziness. Numbness in an arm or area of the face may also occur. Some sufferers get so-called classic migraines with aura—they see colors, shimmering lights, or experience other kinds of visual changes. Without auras, the headaches are called common migraines.

T
ENSION OR
M
USCLE
-C
ONTRACTION
H
EADACHES

More than three-quarters of all headaches are tension headaches, previously called muscle-contraction headaches. Typically, as muscles tighten in your head and neck and blood vessels in your head expand, you feel a throbbing forehead pain, a dull pain on both sides of the head, or a sensation that your head is being squeezed, tightened, or pressed, as if in a vise. Although the name is “tension headache,” stress and tension are not the major precipitating factors. Although we all get these headaches occasionally, some poor souls get them often, sometimes every day or every other day. When these headaches are chronic, they are, like migraines, often the result of a genetically inherited, predetermined condition. Although the pain may stem partly from the muscles over the head contracting, researchers now believe that the root causes of tension headaches are the same as those of migraines: serotonin imbalances and blood vessel changes. When chronic, these headaches often need something stronger than over-the-counter pain relievers. And as with migraines, the use of OTC pain relievers can backfire and make these headaches worse.

C
LUSTER
H
EADACHES

Afflicting about 1 out of 250 men and 1 out of 700 women, these agonizing headaches are among the most severe pains known to humankind. Their excruciating, debilitating pain, sometimes described as a red-hot iron being twisted around or through an eye or a temple, may last from fifteen minutes to three hours, sometimes longer. They’re called cluster headaches because they occur in waves, usually lasting several weeks to several months, once or twice a year. Symptoms that commonly occur with clusters include a runny or stuffed nose, a teary or red eye, or a drooping eyelid on the same side as the pain.

L
ESS
C
OMMON
H
EADACHES

P
OST-TRAUMATIC HEADACHES
are the result of injuries from an accident (especially a car accident) in which the head or neck is involved.

S
INUS HEADACHES
are linked to colds, a runny nose, or hay fever and are not as common as you think. Most people who believe (or have been told) that they have sinus headaches (and get relief from decongestants) actually experience tension headaches or migraines (for which the decongestants may help because they contain caffeine) that are causing pain in the sinus region.

Except as a result of a sinus infection, most people don’t get much of a headache from allergies or sinus congestion. However, migraines do engorge the sinus and create some stuffiness.

TMJ HEADACHES
are also much rarer than most people believe. Although TMJ (temporomandibular joint syndrome) causes face pain and sometimes a headache, most chronic headaches in TMJ sufferers are actually migraines or chronic tension headaches. The TMJ may aggravate the preexisting migraine or tension headache problem.

E
XERCISE AND SEXUAL HEADACHES
may occur at any age, especially after exercise such as weightlifting, soccer in which the head is used, aerobics, jogging, diving, and sex. These headaches are usually benign (although they can be serious in rare cases) and often last only about twenty minutes, but sometimes as long as a day. Consult a physician if you experience exercise or sexual headaches.

A
LLERGY HEADACHES
are, in fact, rare. Most so-called allergy headaches are reactions, but not true allergic responses, to certain chemicals in foods that commonly trigger headaches. A mild headache may occur due to nasal or sinus congestion because of the allergies.

And as you’ll see in later chapters, other factors, such as eyestrain, caffeine withdrawal, ear infections, an overactive thyroid, and dental problems, can also cause headaches. Certain medications can also give you a headache, such as nitrates (as in nitroglycerin) and hormones (estrogen or progesterone). Occasionally, people will get headaches from various medications for the heart, such as calcium blockers, nonsteroidal anti-inflammatories, medications for acid reflux or ulcers (such as Zantac), and from certain antidepressants (although, as we’ll see, antidepressants can also help headaches), such as Prozac, Zoloft, Paxil, Celexa, Remeron, Serzone, and Effexor. Serious problems are rare, but you should rule them out by consulting a physician.

HOW HEADACHES AFFECT COUPLES AND FAMILIES

Although headaches are a legitimate illness, many families and coworkers tend to be less sympathetic to headaches than to other illnesses. Yet the effects of headaches may ripple through a family profoundly. When you get headaches, you may fail to fulfill your commitments as a spouse or parent because of the pain. When you suffer, your mate suffers too, driving you to the emergency room, making midnight dashes to the pharmacy, calling the doctor at all hours, preparing ice packs in the middle of the night, breaking plans, feeling emotionally and physically drained, bearing the burden of additional medical bills, coping with added child care and home responsibilities, trying to stay sympathetic to your moodiness during and after the headache, working with you regarding drug overuse or abuse, and so on, all due to your severe head pain.

You may have feelings of guilt, shame, anger, isolation, and inadequacy. Although you certainly are suffering, try to understand how your illness affects those around you as well. Chronic headaches are often a source of strife between partners. Some mates don’t understand that the pain is the result of an inherited physical illness that is no more psychological than any other illness. Others fear that their partners take too much headache medication; although this may sometimes be true, it often is not. Yet it may appear to be a problem to a partner who doesn’t understand why there are so many pill bottles in the medicine chest. Many headache sufferers need an array of choices—not only a pain reliever and perhaps a preventive medication, but also choices among these medications, depending on whether the headache strikes at night or during the day and whether they need to go to work or not. They may also need an antinausea medication. In addition, they may get new prescriptions when the current medication isn’t strong enough but they keep the old prescription in case the new medication has too many side effects. The overwhelming majority of headache sufferers take medication simply for pain and nausea and do not abuse these medications for recreational use (although many do overuse them for pain).

Although headache sufferers are no more or less prone to addiction than others and simply wish to relieve their pain, family members may not understand and raise issues concerning medications and failed expectations. Your partner may need to suppress his or her own needs at times to care for you. This is tough when the headaches are chronic. Both of you need to try to understand each other’s lot.

QUALITY OF LIFE

Medical researchers have made great strides in treating headache. A wide array of relaxation techniques and medications are avail able. The choices are wide, and finding the right one may take some time and trial and error. With proper treatment, you can learn how to gain control over your life, and enjoy relief and a restored high quality of life. We offer rational and reasonable strategies for a range of headache situations.

The road isn’t straight, and often what seemed to be the right path becomes a dead end. You may have to backtrack, but it’s worth it. After all, your life—and whether head pain will interfere with it or not—is what’s at stake.

2

Helping Yourself

I
F YOU GET
frequent or severe headaches, you need to consult a physician. Nevertheless, you may want to know how to help yourself both with short-term techniques to get rid of a headache and long-term techniques to prevent future headaches.

Chances are, these self-help strategies won’t always work, but if they can ward off some of your headaches so much the better. Before you consider self-help methods, however, you should understand that there may be something more serious going on than just a headache. If the following symptoms occur, consult a doctor as soon as possible.

SYMPTOMS TO TAKE SERIOUSLY

• The headaches get progressively worse over days or weeks.
  
• The headaches have started suddenly; you’ve never had them before (especially important if you’re over fifty).
  
• The headache comes on suddenly after coughing, straining, or exertion, which has never happened before.
  
• You experience changes in memory, personality, behavior, or level of consciousness (that is, you become confused).
  
• You experience changes in vision or in your ability to walk, general weakness, numbness, or loss of senses.
  
• Your headache is associated with pain in the eye or ear.
  
• Your headache causes confusion or loss of consciousness.
  
• Your headaches are persistent, when previously you’ve never really had headaches.
  
• Your headaches interfere with your ability to function normally at work or in social situations.
  
• Your headaches are different from other headaches you’ve previously experienced.
  
• You have a stiff neck with a fever or a rash, or you experience a seizure.
  
• You have an unexplained fever or breathing problems, as well as the headache.
  
• There is a sudden or dramatic change in the severity of your headaches. If you get a very sudden and excruciating headache unlike any you’ve ever had, consult a doctor immediately.
  
• You get a headache after a head injury or accident, or after a sore throat or respiratory infection.
  
• You have a constant headache with no relief.
  

Assuming your physician rules out the possibility of a serious illness, here is a summary of the general guidelines for self-help methods to control headaches, which we’ll examine in detail in this chapter.

HOW TO GET RID OF A HEADACHE:
PRACTICAL STRATEGIES