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.
Headaches: A universal pain in the neck
Bennie Smith was forced to switch occupations — from mechanic to cab driver — because of his cluster headaches. The pain from clusters has been called “the worst that humans experience.”
(Ernesto Arroyo photo)
Ask Dr. Brian McGeeney, a neurologist and pain specialist at Boston Medical Center. He and a group of other doctors — affectionately called Headache on the Hill — have travelled to Washington, D.C. to talk about the urgent need for more federal funding for headache research.
Not many congressmen are listening these days — just too many other headaches on the political agenda. But McGeeney is not giving up the fight. For him it’s personal. “My mother had migraine,” he said, noting that he witnessed her discomfort as a young child. “And I have migraine as well. They are universal.”
He’s right. Most everyone has experienced a headache in one form or another.
According to the International Classification of Headache Disorders, there are roughly 300 different types and subtypes of headaches. Migraine alone has about 20.
When one considers all the conditions associated with headaches — ice cream, exercise, hormones and even sex — it’s a wonder we are pain free at all.
Adding to the confusion is that though the pain is lodged in the head, the brain itself does not have pain receptors. Rather, headaches are usually caused by faulty blood vessels or nerves in the neck and head.
Whatever the cause, the National Headache Foundation reports that more than 45 million Americans suffer from chronic, recurring headaches. That means 45 million suffer from headaches more than 15 days a month for at least three months. It’s no wonder then that between 2004 and 2005 more than 11 million out-patient visits were for headaches alone, one third of which occurred in hospital emergency departments.
Fortunately, the World Health Organization (WHO), the medical arm of the United Nations, is arguing the case for headache respect before the international community.
The agency now ranks migraines — just one type of headache — as nineteenth among all causes of years lived with disability worldwide.
But even those efforts are not gaining traction yet — much to the dismay of WHO. “Headache,” WHO explains, “… continues to be underestimated in scope and scale, and … remains under-recognized and under-treated throughout the world.”
What’s worse, it may be particularly under-recognized and under-treated among blacks. According to a report in a 2006 article in Headache: The Journal of Head and Face Pain, researchers found that roughly 46 percent of African Americans interviewed compared to 72 percent whites sought professional treatment for their migraines or were diagnosed with it even though the respondents complained of moderate to severe headache-related disability. Furthermore, only 14 percent of blacks were prescribed medication to treat migraine compared to 37 percent of whites.
Yet, blacks respond very well to migraine treatment, as noted in a later study in the journal Cephalalgia. The researchers found that African Americans as well as whites reported significant reductions in headache frequency and disability as well as improvements in quality of life over a 6-month treatment period for migraines.
The problem starts at home. All too often, the victims themselves are nonchalant about what many believe are simply minor annoyances. They still show up for work, for instance, headache and all.
But there’s a cost for their loyalty to work. “Presenteeism” — working while impaired — results in a hefty toll, and can exceed the cost of absenteeism or health and disability benefits. And that’s just for those who were able to keep their jobs.
A survey conducted in Denmark in 2007 found that 29 percent of the respondents reported that they had changed their place of work because of headaches and 40 percent said their condition restricted their career.
Bennie Smith, 54, is one of them.
“It’s hard to keep a job,” Smith said. “You can’t suddenly take a break until the headache subsides. You’d be right out the door.”
Smith said he recognizes that employers expect job performance, but the attacks impaired his ability to do the simplest of tasks. Trained as a mechanic, Smith was forced to change careers. He now drives a cab during the day. “I’m basically my own boss,” said Smith. “If a headache comes I can stop a while.”
It’s a good thing he has some alone time. As Smith tells the story, migraines, from which he suffers periodically, are nothing in comparison to the headaches that have plagued him for nearly the last two decades.
Smith gets cluster headaches, a rare but painful headache that occurs more frequently in men and, according to mayoclinic.com, is more common in blacks.
The pain from clusters has been called “the worst that humans experience.” Some women have reported it as being more severe than childbirth.
“Migraine is nothing compared to cluster,” Smith said. “Migraines don’t come back.” But cluster headaches do. “I timed it once at one hour and 45 minutes,” Smith said.
Brian McGeeney, M.D.
Assistant Professor of Neurology
Boston University School of Medicine
Boston Medical Center
For Smith, the pain starts in the shoulder, travels to the neck and up to one side of the head. It then travels to the ear and only ends when it hits right behind an eye. Smith knows that alcohol and smoking are related to the attacks. He says the alcohol is out, but the smoking is still a challenge.
While cluster headaches are the least common of the major headaches, tension-type headaches are the most common. Up to 80 percent of the U.S. population suffer from this type of headache from time to time. They are triggered by fatigue, emotional stress, even faulty posture.
The pain from tension-type headaches is quite distinctive. By all accounts, it deserves the apt description “it feels like my head is in a vice.” Usually, the pain occurs on both sides of the head, is not associated with nausea, is not aggravated by exercise and is mild to moderate in intensity.
For the most part, tension headaches occur infrequently and are related to temporary stress, anger, anxiety or fatigue.
But it’s migraine headaches that have attracted the most attention and research.
The pain from migraines is typically a throbbing or pulsing of moderate to severe intensity on one side of the head. People complain of sensitivity to light, noise, sound, nausea and vomiting. Movement can exacerbate the pain. Migraneurs — those that suffer from migraines — get relief by resting quietly in a darkened room.
Certain factors can trigger a migraine — changes in the weather, odors, fatigue, tobacco, skipped meals, and certain foods.
Despite the existing knowledge on headaches, it’s ironic then that many sufferers are not diagnosed properly.
“I didn’t know what it was,” said Smith. Unfortunately, nor did many doctors. When asked how many doctors he had seen about his condition, he answered, “I can’t count them all.”
But then something good happened. Smith was referred to Dr. McGeeney, who finally diagnosed him with cluster headaches, and prescribed medication for his pain.
“On the second day the headache was completely gone,” said Smith. “You don’t know the relief.”
But Smith is not completely out of the woods — headaches generally cannot be cured, but they can be treated and often prevented. Smith is learning how to minimize the intensity and occurrence of his headaches. When he feels it coming on, he finds that exercising his shoulder and neck help.
And Smith said he has even more good news — he is ready for a full-time job.
So common and disabling are headaches that many hospitals have established pain management or headache clinics staffed by a variety of specialists and services, including biofeedback and stress reduction. Cases not easily managed by primary care are often referred to such clinics.
“It’s important to not blame yourself if you get headaches,” said McGeeney. “People aren’t giving it to themselves. There is a big genetic predisposition, but environmental factors are also very important.”
For more information:
The National Headache Foundation
American Headache Society