HEADACHE: IT'S NOT ALL IN YOUR HEAD

Mary Sue Underwood looked at a electro encephalo gram (EEG) monitor showing Ron Halter's brain waves at Saint Francis Medical Center.

Magnetic Resonance Imaging is used to see inside a person brain.

"I...went to school and later to work in spite of it... with involuntary tears running down the right side of my face, threw up in washrooms, stumbled home by instinct, emptied ice trays into my bead and tried to freeze the pain in my right temple, wished only for a neurosurgeon who would do a lobotomy on house call..." --from "In Bed" by Joan Didion.

Countless readers can relate to the desperate tone in Joan Didion's description of a migraine.

Others can sympathize, used to the familiar sight of a loved one fleeing to a darkened room, seeking sleep as an escape from headache agony.

Today, chronic headaches do not have to be suffered in silence, said Dr. Mohammed Shakil, of Cape Girardeau Neurology Associates.

Shakil has been practicing neurology for 17 years in Cape Girardeau.

He said people should be treated professionally for their chronic headaches and migraines, particularly if pain is affecting the quality of their lifestyle.

"If you miss work, or miss appointments or have to cancel social events because of the pain, you should get help. Why would anyone want to live like that?" Shakil said.

Chronic headaches may cause a deterioration in personal and professional relationships in addition to making the sufferer just plain miserable.

Untreated, Shakil said, the effects can lead to depression, which only quickens a downward slide of an individual's overall health.

Too often, people believe the recurring pain is just something they have to live with, he said, or sometimes, patients are reluctant to seek help, worried their problem won't be taken seriously.

But people who continue to treat their own headaches with continual, high doses of over-the-counter pain killers and caffeine may actually be adding to the problem by causing "rebound" headaches, and risking stomach ulcers and liver damage with excessive medication, Shakil said.

In the past, it was commonly thought that headaches not the result of direct head injury, were psychological -- caused by stress.

However, more recent research indicates that although stress may contribute to a headache's intensity, it's not the cause.

In recent years, scientists discovered that the most common headaches -- migraine and tension headaches -- were caused by real, physical events, and therefore treatable.

When a headache occurs, a "trigger" causes a wave of electrical activity to spread through the brain. Serotonin levels go up, but when it ebbs, blood vessels become irritated, and the pain hits.

Triggers include certain foods, environmental conditions (heat, cold, noise) bright lights, head trauma, motion, fatigue or other emotions.

Migraines are caused by the inability of the blood vessels in the membrane covering the brain to expand and contract regularly. Pressure on the smaller vessels causes painful stretching and the spasmodic stretching and constricting results in throbbing, pounding pain, often accompanied by nausea, distortions of speech, hearing and vision.

Migraines do seem to be hereditary, but haven't been isolated to a single gene, Shakil said. Women seem to be more prone to migraines than men, particularly during their menstrual cycles.

A typical migraine may also include an "aura" or visual blurring, wavy lines in front eyes, Shakil said.

The most critical part of treating headaches is diagnosis, finding the root of the patient's problem and treating it, said Shakil.

A doctor may be able to diagnose the problem in one or two visits by learning a patient's history, doing a physical exam, scans and bloodwork. Then treatment can begin.

Usually, severe brain trauma is ruled out, Shakil said.

Since headaches are extremely individualistic, so are treatments: Ranging from physical therapy, acupuncture and acupressure to antidepressants, beta blockers, calcium channel blockers, vitamin B3, or different combinations of medication.

Antidepressants are used, not for psychological reasons but because they affect serotonin levels, while beta blockers prevent blood vessel dilation.

Personally, Shakil said he gets an occasional tension headache, but has only experienced one migraine.

"It was when I was in eighth grade and lasted for four days. It was on my left side. Odd, because it came up with the sun and went away at nightfall," Shakil said.