Sunday, June 01, 2008

Health & Wellness: Headaches

From the Grace Church Health and Wellness Committee, June 2008

In acknowledgement of National Headache Awareness Week (6/1 to 6/8), this Committee Offering focuses on headaches.

In December, we directed our attention, in part, to the notion of helplessness, observing that having pervasive feelings of helplessness can become a habit and even generalize from one arena of our lives to other arenas. Headaches tend to be one of the areas where many of us fall victim to dispirited helplessness. We think that we just have to suffer through them. Growing medical evidence suggests, however, that headaches can often be successfully managed through a combination of two techniques: (a) keeping a calendar to record headache occurrences and the circumstances (e.g., food consumed or activities participated in) that precede these episodes and (b) timely use of new therapies.

First, we will examine common types of headaches (e.g., tension, cluster and migraine). Then we will turn our attention to risk factors that have been assumed to be linked with headaches, but for which there is no sound evidence supporting these links.

Common Types of Headaches:

  • · Tension Headaches are the most common headache. Such headaches are usually associated with diffuse, often mild to moderate pain on top of your head. Some suffers describe tension headaches as akin to having their heads squeezed in a tourniquet. Physicians acknowledge that while tension headache pain is occasionally severe, most often it is not a symptom of underlying disease. No spectrum of clear causes has been associated with tension headaches. Managing these headaches requires a balance of prevention informed by avoiding foods or activities that seem to trigger these headaches (identified as a result of good record keeping) and appropriate use of over the counter medications.
  • · Cluster headaches, more common among men, are one of the most painful types of headache. People who experience this type of headache report that they occur in clusters or patterns. Such headaches may last as little as a few days to as much as several months. In between these clusters, suffers are generally headache free. This type of headache is fortunately uncommon, and not life-threatening. Aggressive management techniques, usually involving prescription medications, can often shorten the duration and lessen the pain.
  • · Many sufferers regard migraine headaches as completely debilitating. Some times lasting from several hours to multiple days, and more common among women, when migraines strike going to a dark and very quite place to lie down can be the only respite. For some people, visual auras (flashes of light or blind spots) signal the onset of a migraine. A migraine may also be accompanied by other signs and symptoms, such as nausea, vomiting, and extreme sensitivity to light and sound. While there is still no cure, migraine management options have improved over the past few decades. The primary management techniques involve identifying and then avoiding triggers and taking appropriate medications early in the onset of the symptoms. Medications can help reduce the frequency of migraine and stop the pain once it has started.

In summary, with each of these types of headaches, the combination of careful self-monitoring, the right medicines and appropriate changes in lifestyle may make a tremendous difference for sufferers.

So far, we have focused on three types of headaches: Tension, Migraine and Cluster. The combination of careful self-monitoring, the right medicines and appropriate changes in lifestyle may make a tremendous difference for headache sufferers.

Now we will examine scientific evidence linking certain triggers to headache pain. Such scientific evidence generally comes from epidemiologic studies. These studies are great at linking risk factors to disease (e.g., confirming that high blood pressure is associated with an increased risk of heart disease). These types of studies generally don’t tell us why such links exist. The same general statements apply to headache research; the epidemiologic data may tell us, for instance, that certain dietary choices are associated with certain types of headaches but not what the mechanism is that is responsible for the headache.

Past medical beliefs linked hypertension to an increased risk of headaches. Recent studies, however, found no association. In fact, evidence has emerged suggesting that the relationship may be the opposite of what was first believed. It turns out that people with the highest measured pulse pressure (the difference between the systolic and diastolic blood pressure) had significantly fewer headaches than people who didn’t have high pulse pressures.

A recent national epidemiologic study of adolescents found that migraine headaches are more common in low-income families, more common among girls than in boys and among white teenagers than among black teenagers when there was no family history of such headaches. However, when one parent suffered from migraines, there was no association with family income. But when neither parent was afflicted with migraines, the likelihood that their teens would experience migraines went up as the family income went down. Trying to make sense of these findings, researchers observed that the correlations reported may not have been due to low income but to some other factors (not measured) that may also be associated with low family income. Moreover, the researchers acknowledged that migraines are a biological disease irrespective of family income. Stress has long been considered a risk factor for headaches and stress management techniques, such as those we have discussed in these newsletters in the past, should be helpful in managing migraines.

Finally, strong evidence suggests that for some people, physical exertion may be linked to headaches. Medical experts tell us that headaches that begin during physical exertion (e.g., exercise) and go away when you take a break could sometimes be a sign of heart disease, even if the person had no other symptoms of heart trouble. Such conditions are rare but should be paid attention to since the consequences could be life threatening if the problem is not recognized. Proper diagnosis and treatment is especially important in people 50 years or older and among any persons with risk factors for heart disease. The good news is that when such people with exertion-related headaches are found to have heart disease and are properly treated, the headaches abate.

Should you have concerns or want additional information about the material presented above, please contact your local health care provider, the Public Library, the Rector, or someone on the Grace Church Health and Wellness Ministry Committee (Chaired by Mrs. Florence Poyer, R.N.)

Prepared by: Walter S. Handy, Ph.D., member, Grace Church Health and Wellness Ministry Committee,

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