MEDICAL SURFARI: HEADACHES COME IN 150 DIFFERENT TYPES

Headache sufferers have existed ever since the earliest recorded history and probably well before that time.

In ancient times relentless headaches were treated by trepanation or opening the skull, reportedly to let out evil humors (fluids). These operations were performed without anesthesia and generally while the patient was intoxicated with alcohol or after chewing cocoa leaves to become intoxicated with cocaine. The diagnosis and treatment of headaches have come a long way since those days. There is now an international headache society, and in the late 1980s they composed a system that standardized headache diagnoses and treatment as well as research.

In this system there are 150 different headache diagnostic categories. Many of these are very uncommon and some are exceedingly rare. The most commonly occurring headache syndromes include tension-type migraine, cluster, sinus, rebound, menstrual and migraine. Headaches do not always remain within one category, as it is not uncommon for a headache to transform from one type to another over time or even during a single episode.

Migraine is a neurological disorder that is often hereditary. It typically results in recurrent attacks of headache and associated nausea, vomiting and sensitivity to light and sound. This type of headache generally occurs on one side of the head and it may radiate down to the neck and shoulders. The attack may last for anywhere from hours to days. It is not unusual for the scalp to be tender in this area during or after the headache. Migraines often leave people feeling drained of energy and irritable. About 20 percent of patients who have migraine headaches have associated flashing lights, small floating dark spots or numbness on one side of the head and this is referred as an "aura."

The precise cause of migraine is not entirely clear although there are some theories that are favored by researchers. Some feel that migraine sufferers have inherited a more sensitive nervous system response to environmental stimuli, thereby rendering the nervous system more vulnerable to these attacks that cause changes in brain activity and produce inflamed blood vessels and nerves around the brain. Migraine sufferers know that there are certain "triggers or provokers" that may trigger their headache. Although there are some common triggers, not all migraine sufferers have the same provoking factors but most learn to identify these and avoid them as much as possible. These provoking factors include certain type of foods, especially those that contain monosodium glutamate and those containing nitrates. Disruption in sleep patterns resulting in too much or too little sleep can precipitate a migraine. Fluctuation in hormones, especially those linked to menstrual cycles, may do the same. Stress and anxiety as well as environmental factors, including changes in weather, strong odors, glaring lights and high altitude, may precipitate a migraine attack.

Fortunately, through much research and development a variety of good medications have been developed to treat migraine headaches. However, before the appropriate type of treatment can be selected it is helpful for your physician to have a thorough understanding of the features of the headache. You may record this by keeping a headache diary. This means noting the time of day at onset, the headache location, the quality of the pain and any other associated symptoms including nausea, vomiting, sensitivity to light, muscle tenderness and relationship to activity. Also note the duration of the headache and the treatments that you have tried as well as their effectiveness. A complete medical evaluation for headache may require more than one visit and more than one trial of medication. With proper medical care, headaches can be managed but not cured.

Migraine headaches do cause a lot of personal suffering with resultant feelings of loss of self-control and sometimes may result in a sense of isolation, embarrassment and, or helplessness. Your physician can help you reduce your discomfort and better understand the precipitating factors. Optimal migraine headache management almost always involves a close partnership between the patient and physician.

World Wide Web Resources

Migraine Information Center

www.ama-assn.org/special/migraine/migraine.htm

www.ninds.nih.gov/HEALINFO/DISORDER/Headache/head2.htm

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may E-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.