Coming to a Head: Living with Chronic Headaches

Everyone is struck by the occasional headache. Non-chronic headaches can stem from any number of causes, including low blood sugar, poor eyesight, withdrawal from caffeine, alcohol or cigarettes, or even having slept funny the previous night. Headaches can also be secondary symptoms of several viruses and conditions, including the non-serious, such as sinus infection or flu, and more serious conditions such as stroke, meningitis, concussion or brain tumour.

Some of the conditions above can lead to temporary, treatable headaches. Some people, however, suffer from chronic headache conditions. The three types of primary headaches, which comprise 90% of chronic headache pain, are tension headaches, cluster headaches, and migraine headaches. Each type of primary headache has its associated symptoms and various (although somewhat overalalpping) treatments. Although the causes of each of these headaches remain largely hypothetical, western medicine and alternative healers have developed treatments with varying degrees of success for each type.

Tension Headache
Of the primary headaches, tension headaches are thought to be the most common, affecting 75 to 90 per cent of all individuals who complain of chronic headaches. Originally, tension headaches were thought to be brought on by excessive muscular tightness. Physicians now believe that the root is emotional, brought on by anxiety, depression and worry.

Tension headaches most commonly strike adults between the ages of 40 and 60, thought to be brought on by the stressors of that life stage: work, family, finances. While the tension headache shares some traits with migraines (and is, in fact, thought by some medical professionals to be on the same spectrum as migraines, just on the far end), the way in which the pain manifests itself is quite different from migraines. Patients suffering from tension headaches experience a dull, steady ache on both sides of the head. Many say it feels as though their head is being squeezed with increasing force, as if wrapped in an ever-tightening band or vice.

Tension headaches are not as debilitating as migraines, and do not hit as quickly, instead worsening over the space of a day. Because their cause is so closely linked to lifestyle and emotional well-being, treatment should involve a two-pronged approach. You can begin by treating the pain symptoms with over-the-counter analgesics or pain relief medication. You can also try treating your anxiety medically by taking prescription anti-anxiety or anti-depressant medication.

If you prefer to treat the source of your headaches without medication, certain non-medicinal approaches have proven to be effective stress-reducers. Many people find relief in massage therapy, meditation, yoga and biofeedback technology.

Cluster Headaches
Unlike migraines and tension headaches, which occur most frequently in women, cluster headaches affect primarily men between the ages of 20 and 40. Cluster headaches occur in groups, striking daily over a period of days, weeks, or even months. Each episode lasts, on average, 15 to 45 minutes, but can last even longer, with episodes striking up to eight times per day. Headaches are severe, usually centred around one eye and affecting one side of the head. Pain is likened to having a nail driven into the head, and, to make matters worse, lying down appears to exacerbate the headaches, leaving the sufferer to pace an excruciating path until the headache subsides.

While the cause of cluster headaches is unknown, alcohol or nitroglycerin have been known to exacerbate a flare-up. Since both of these cause blood vessels to open up or constrict, medical researchers have hypothesized that the headaches are linked somehow to changes in the vascular (circulatory) system.

Treatment of cluster headaches involves interrupting the cluster cycle. Narcotics are sometimes prescribed, but because cluster headaches come on so quickly, oral medications are often too slow-acting to really help alleviate the acute pain. There are two medications that can be taken as an oral spray for rapid absorption: sumatriptan and DHE (migranal). Keeping a tank of oxygen at home and breathing in 100% oxygen has been known to help some patients suffering from crippling cluster headaches.

There are also some medications that have been used as a preventative strategy. These include prednisone (a steroid), lithium carbonate, and verapamil. All of these medications have side effects, but often none nearly as daunting as the cluster headaches themselves.

Migraine Headaches
Migraine headaches affect 18 per cent of women in the US population and about 6 per cent of men. These moderate to severe headaches are localized on one side of the head and characterized by pulsating pain. They are also marked by the duration, lasting between 4 hours to 3 days. There are two primary types of migraines, migraine with aura and migraine without aura. Each have distinctive characteristics, but suffering from one type does not preclude suffering occasionally from both types.

Migraines without aura are the most common type. Its symptoms include a headache lasting 4 -72 hours, localization on one side of the head, inability to perform routine tasks, moderate to severe pain, nausea, vomiting, and sensitivity to light and/or sound. In order to be diagnosed, you must have suffered at least 5 attacks with these symptoms.

Migraines with aura are the second most common type of migraine. Sufferers of migraines with aura experience the same symptoms as without aura (minus the nausea and vomiting), but also suffer reversible focal neurological symptoms. The symptoms can include visual symptoms such as flickering lights, spots, temporary loss of vision; sensory symptoms such as tingling or numbness; and reversible dysphasia (garbled speech). (If any of these are accompanied by muscle weakness or paralysis, it may point to stroke and immediate medical assistance is required.) Aura also has at least two of the following characteristics: visual symptoms affecting one side of the body; symptoms lasting from 5-60 minutes; and the gradual occurrence of one aura symptom, emerging over more than 5 minutes, with other aura symptoms occurring one after the other, again, gradually emerging over more than 5 minutes.

While the causes of migraines are, again, unclear, there are triggers including allergic reactions, disruption of sleep patterns, caffeine or alcohol, smoking, stress, ingesting pesticides, perfumes or other strong odors, bright light, certain foods (including, but not limited to, chocolate, nuts, dairy, red wine, aged cheese, smoked fish, onions, fermented food or foods containing MSG or nitrates), and even changes in the weather.

Treatment for migraines is varied and often what works for one individual does work for another. Once you know your triggers, you can try to avoid them. Many people develop coping mechanisms in their own, and have their headache rituals that can include hot or cold compresses, sleeping in dark room, a warm bath, etc. Medical treatment is often most effective at the onset of the attack, and can include analgesics with caffeine, triptans, and ergot alkloids (although they are prescribed less often due to toxic build up called ergotism).

There are various cocktails of drugs to treat symptoms, but often doctors try preventive medicine such as beta blockers, anticonvulsants and anti-depressants. In alternative medicine, many people suffering from migraines find relief in acupuncture, massage therapy, biofeedback, diet adjustment (using an elimination diet to find if you have a dietary trigger).

Chronic headaches can affect, and be affected by, your daily routine, daily stressors, and ability to function at work and at home. While medical science has given us so many answers in the past decade, our ongoing struggle with chronic headaches reminds us that there is still so much we do not know about the brain and the human body. As we learn more, however, there is increasing hope that those who suffer the crippling effects of chronic headaches will one day get relief.

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