A closer look
A contradiction in terms
Do pain relievers treat a headache,
or cause a headache?
Regular use of pain relievers — including nonsteroidal anti-inflammatory drugs, such as aspirin and ibuprofen — can actually cause headaches. “Rebound” or medication-overuse headaches can occur when the medication is taken more than two to three days a week or more than the recommended dosage. For reasons not fully understood, a drop in the level of drugs in the blood precipitates another headache, which in turn precipitates another dose. The cycle continues resulting in chronic daily headaches with more severe and frequent pain. Rebound headaches can occur with prescription drugs as well.
Chronic condition may need stronger relief
Hazel Reese decided it was better to write about her headaches rather than complain about them. She published “I Will Not Complain” in 2004 and is working on a follow-up book. Smith suffers from mixed (tension-migraine) as well as chronic daily headaches. (Photo courtesy of Hazel Reese)
At the time she didn’t know she had migraines, a particularly painful type of headache. What’s worse, nor did her doctors.
They insisted she had sinus headaches. It wasn’t until 1982, when Reese was almost 40 years old, that she learned the nature of her headaches.
By now, she knows exactly which type of headache she has. “Migraine with aura,” she proclaimed.
Unfortunately for Reese, it’s not only migraines that attack. She also suffers from “mixed headaches,” or tension-migraine headaches.
“It starts with pain on the left side of my head and a stabbing pain behind my left eye,” she said.
All this is preceded by an aura. “I see flashing colored lights,” she said. The tension-type pain is then added to the mix. “That one begins in the back of the neck and moves to the shoulder,” she said.
But Reese’s headaches fall under an even broader category — chronic daily headaches. Most people have headaches from time to time, but if a headache occurs 15 days or more a month for at least three months, it is considered a chronic daily headache.
Reese says she is never completely without headache pain. “They never really go away completely,” Reese said. “On a scale of 1 to 10, if I have a 5 or 6 headache, that’s like no headache at all.”
Fortunately, most headaches can be treated at home. Over-the-counter (OTC) drugs, such as aspirin and ibuprofen and other NSAIDS (nonsteroidal anti-inflammatory drugs), are the first line of treatment. But overuse can be just as bad — in some cases worse — than the original headache.
Internal bleeding or perforation of the lining of the intestines can result, according to the American College of Gastorenterology. Rebound headaches often occur when pain killers are taken more than three days a week or in a higher than recommended dose. Over-use is no trivial matter. Thousands — many of whom are elderly — die each year as a result.
The good news is that with the advent of a class of drugs called triptans, many people suffering from migraines are living more comfortably with their condition.
Often referred to as a “miracle drug” triptans do not prevent migraines, but instead are used to abort the symptoms of an attack. They are taken as needed. For those with more disabling chronic attacks, prescription drugs are taken daily as a preventive measure.
“Many people take it for granted that a headache is something you can’t avoid,” said Dr. Eduard Vaynberg, an anesthesiologist who specializes in pain management at Boston Medical Center. “They view them as benign ailments.”
Eduard Vaynberg, M.D.
Boston Medical Center
Diagnosing headaches correctly is a challenge. “People can suffer from headaches for 10 years and no one has been able to diagnose it correctly,” he said.
Headaches are divided into two categories — primary and secondary. Primary headaches are not caused by a disease or condition — the headache itself is the problem. Migraine, tension and cluster headaches fall into the primary category. Secondary headaches, on the other hand, are symptoms of an underlying disorder, such as infections, tumors and neurological aberrations.
Cervicogenic, or neck-based headache, is a secondary headache. Although not as common as tension-type, they make up 20 percent of the patients with chronic pain treated in pain management clinics, according to a recent study published in the Journal of the American Osteopathic Association.
The pain from neck-related headaches is distinctive and is sometimes confused with migraine pain. It is characterized by moderate to severe pain on one or both sides of the head often triggered by neck movement. Some may experience nausea, vomiting and sensitivity to sound and light.
Some experts attribute this problem to overload — just two or three small bones in the neck bear the brunt of most of the movements of the head and neck, let alone the weight of the head itself. The head is roughly 12 percent of a person’s total body weight.
That’s an awful lot of repetitive stress and strain for two or three small bones. And it can come with a price. Eventually the bones show signs of wear and tear, the links between the bones become impaired and the pathway for the intricate system of nerves can narrow.
When conventional treatments fail, various interventions are offered, according to Vaynberg, who specializes in the treatment of cervicogenic headaches. Anesthesiologists can perform an anesthetic block to the nerve or muscle trigger points. Local anesthetics and steroids mixtures are commonly used. Botulinum toxin is sometimes used when local anesthetics give short term relief and in some cases has been successful. However, its use is considered experimental and it is not covered by insurance.
Radiofrequency is another technique, which cauterizes the nerve endings in the neck, thus providing a long-term relief of pain.
“Headaches are very challenging,” Vaynberg admits. “We often know what works, but don’t always know why they work.”
Either way, Reese is not complaining. Although the migraines precipitated her retirement 22 years ago — earlier than she had anticipated — she says she’s doing all right.
She knows her triggers. Perfume and loud noises can set it off. “The biggest trigger is the weather,” she offered. “Rain and warm temperatures in particular.” There are also foods she steers clear of — especially chocolates, hot spices or beans. “If I eat something I’m not supposed to, within the first 15 minutes, I can feel it,” she said.
Because of other serious medical problems, she is now on a “restrictive” medication for her headaches.
“Over the years you learn to live with it,” she said. “[But] I’m in control now.”