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Headaches •
Do you suffer from frequent headaches? If you answered “yes” to these questions, then you are one of the millions of Americans who suffer from severe Headaches. Like most headache sufferers, you have not yet found the best treatment of your headaches. The good news is that medical specialists have learned a great deal about the causes of headaches and how best to treat them. Now you can almost certainly gain at least an 80% relief from the pain and suffering of headaches. In this report I will tell you about our current medical understanding of the causes and treatments of headaches—and how you can reduce the severity and frequency of your headache pain and live a happier, more productive life. Both you and your family will benefit.
"I was having migraines at least once a month, and because of so much stress I had a hard time paying attention in school. Impairments Due to Headaches Like most
headache sufferers, you probably miss important activities. In fact,
Even between headaches, many persons with headaches suffer from more depression, anxiety, and various physical problems. In fact, headache patients, on average, suffer from as much general health disability as the average person who has had a heart attack within the past year! Studies show that headache patients, on average, suffer more health disability than do persons with arthritis, diabetes, depression, or back pain. The impact of headaches on our overall society is also huge. Billions of dollars are spent every year on headache remedies and prescriptions. Billions more dollars are lost in reduced work due to headaches. Most of this headache disability is now unnecessary. You can live with more freedom and more enjoyment. As you will read in this report, with proper treatment we can reduce your “life restrictions” due to headache pain by up to 90%. Lack of Good Headache Treatment In spite of the impact of headaches on both the individual and our society, doctors generally have not taken headaches very seriously. Most physicians receive no special training in evaluating or treating headaches. Even physicians who specialize in neurology usually have little interest in treating headaches. Doctors’ disinterest in headache treatment is somewhat understandable. Doctors are mainly trained to treat disorders that they can see or measure. They expect to see physical signs of disease, or laboratory findings that indicate which disorder to diagnose and treat. Headaches often have no physical signs and no abnormal laboratory findings. Therefore, doctors tend to regard headaches as a minor problem or “all in your head.” Patients with headaches are often labeled as “complainers,” and “drug-seekers.” Because of doctors’ disinterest in headaches, many headache patients are dissatisfied with their headache treatment. In fact, 38% of headache patients admit to being “turned off” by their doctor when it comes to treating their headaches. Also, 50% of headache patients are incorrectly diagnosed by their primary care physician—leading to improper treatment of their headaches. Many headache patients then try “alternative” treatments such as herbs, chiropractic, or acupuncture. Unfortunately, these treatments usually don’t provide much relief either. Fortunately, in recent years some physicians have taken a special interest in treating headaches. We understand that headaches are a serious disorder that interferes with leading a happy and fulfilling life. We take headache patients seriously, and we use every medical tool to reduce headache suffering. Symptoms of Severe Headaches Most severe
headaches have several of the following features: Usually, the headache pain begins gradually and builds to peak intensity over about a 2-hour period. The headache lasts from a few hours up to about 3 days, and then fades away. Sometimes vomiting or sleep will stop the headache. The headache sufferer may feel weakened, depressed, tired and have a reduced appetite for another day or so after the pain stops. Some patients will feel “odd” or “different” for a day or two before the headache begins. They may feel hyperactive, witty, elated, and irritable; or just the opposite: they may become sluggish, depressed, withdrawn, and mentally slowed down. When it occurs, this is called the “prodromal” phase of the headache. A few (about one in 10) headache sufferers will experience an “aura” a few minutes before their headache pain begins. This means they see odd flashes or lines in their vision, or have strange tingling and numbness in their hand or face. These symptoms pass away before the headache pain begins, and they cause no lasting problems. Some
headache sufferers notice that certain things bring on their headaches,
or make a headache more likely to occur. These things are called
headache “triggers.” Common headache triggers include Each of these triggers has the potential to destabilize the brain’s pain-control mechanisms. Now let’s discuss how these pain-control systems malfunction. The Underlying Cause of All Headaches Your headache pain is due to hypersensitivity of a group of pain-perceiving cells called the trigeminal brainstem nuclear complex, or TBNC for short. Your TBNC is a group of brain cells located in your brain stem (medulla oblongata) that receives input from most of the sensory nerves of the skin and muscles your face, head, neck, and even from the blood vessels inside your head. Your TBNC acts as a “switching station” and can either stop a pain signal (in which case you never feel it), or send it on up to the brain cortex where you feel the pain. Here is a very important point: your TBNC can increase or decrease the strength of any pain signal before it sends the pain signal on up to the conscious areas of your brain. In headache sufferers, their TBNC increases the strength of pain signals from the head or neck. This increase in the pain signal is called “central sensitization.” This means that, in headache, the main problem isn’t in the face, neck or head muscles, sinuses, or nerves. Instead, the main problem is that the TBNC of the brain is amplifying those pain signals before sending them up to conscious perception—this is what causes the headache. Once central sensitization begins it causes severe headache. The headache can continue until the pain-perceiving nerves cells exhaust themselves and can no longer transmit pain. Then the headache fades away—only to recur another day. Generally, the more frequent your headaches, the more severe is the central sensitization of your TBNC, and the more painful is each headache. The exact cause of central sensitization is unknown. There is probably a genetic predisposition in many headache patients—headaches often run in families. Problems with a normal brain biochemical called “serotonin” can cause central sensitization. This is probably why headaches are more common in persons with depression and anxiety, which also involve problems with serotonin. Estrogen affects serotonin function, as well as the function of several other important brain-stabilizing biochemicals. This is why menstruation, pregnancy, birth control pills, and hormone replacement therapy can trigger headaches. Many foods contain a biochemical called “tyramine,” which affects serotonin in the brain, and this is probably why certain foods trigger headache in some patients. (Many headache patients benefit by going on a “tyramine-free” diet.) Stress tends to reduce serotonin function, and thus can bring on or worsen headache. We think that pain itself can also lead to central sensitization. A vicious cycle can occur in which an initial pain (say, from muscle tension in the forehead or neck) leads to central sensitization of brain pain-perceiving cells, which then leads to more pain perception. In other words, pain leads to increasingly worse (and more frequent) pain in a vicious cycle that causes a severe headache. Another common cause of central sensitization is “pain-medication dependence.” Even pain medications that are “non-addictive” (Tylenol, aspirin, ibuprofen, Motrin, naproxen, Vioxx, Celebrex, etc.) can cause central sensitization if they are used frequently for long periods of time. Here’s how this works. The brain has circuits that are always active and reduce the strength of pain signals before we feel them in the conscious parts of our brain. If these circuits are not working well, then we have a heightened perception of pain. The daily use of pain-relieving medications tends to weaken these “natural” pain-reducing circuits. Then, whenever our blood-level of the pain-reliever medication falls to zero, we start to feel excess pain (“headache”). At that point, we’re trapped. Whenever we stop taking the pain-reliever medication we get a headache—so we naturally take another dose of the pain-reliever medication—which only increases our dependency on the pain-reliever. Not only that, but over time, the pain-reliever may work less and less well—so that we get a headache even when we do take the pain-reliever; but we get an even worse headache if we don’t take the pain-reliever. This is not a good situation. Fortunately, there is a way out of this trap, which I’ll discuss later. Myths About the Causes of Headaches Most persons—including most doctors—have never heard of central sensitization. Therefore, they have other “common sense” explanations of what causes headaches. Almost always, these are not correct. Let’s mention a couple of common misconceptions about the causes of headaches. Sinus
Headaches If there is no fever and if any nasal discharge is mostly clear, then the headache is almost certainly not due to a sinus problem—even if “sinus headache” medications help to relieve the pain. (“Sinus” medications are actually just non-specific pain relievers and decongestants that relief nasal stuffiness—again, which can be caused by any type of headache.) TMJ While there are many of types of headaches, most of them are rare. Only three types of headache are common: migraine type, tension type and pain medication induced. All three of these types of headaches involve central sensitization of the TBNC. They differ in the initial cause of central sensitization and in their headache symptoms. Migraine headaches usually have a pain that is throbbing, often there is nausea and vomiting, and painful sensitivity to light and sound. The pain is made much worse by activities or motion. There may or may not be an aura (as described above) before the headache pain starts. Tension headaches usually have a pain that is pressure-like and is less likely to be throbbing. The pain is less likely to be made worse by activity, and there is less likely to be nausea or vomiting. The skin and muscles may be tender to touch. Pain-medication induced headache can have either a migraine or tension type of pain. This headache is likely to be very frequent—sometimes even daily. Usually, this type of headache began as a typical migraine or tension headache pattern years earlier, and has changed into a near-daily headache due to progressive weakening of the brain’s own pain-reducing circuits by frequent use of pain-reliever medications. Fortunately, for all three types of headache we have good treatments that can usually provide great headache relief.
First, it is important for us to have a thorough understanding of the most likely causes of headaches in your particular case: Stress? Muscle tension? Hormone changes? Fully understanding the cause of your headaches will give you a better chance of controlling them. If hormone swings seem to be part of the cause of your headaches, then we stabilize your hormones to reduce your headaches. It is also important that you get adequate sleep, so we’ll treat insomnia if that has been a problem. If depression or anxiety is present, we’ll want to make sure that problem is reduced since it can worsen headache, too. Any other headache triggers should be avoided (dietary, etc.) For many patients with frequent headaches, learning special muscle relaxation techniques gives at least a 50% reduction in their headaches. These muscle relaxation techniques are quick and easy to learn—and unlike medications are always free of side effects or drug interactions. Massage of hard bands in muscles can also reduce headaches. For migraine and tension headaches there are two types of treatments, depending on how often the headaches occur. If the headaches occur only once a month or so, we use medications that treat the headache once it begins. If the headaches are frequent—say more than twice a month—we also use medications taken daily to prevent the headaches from starting. There
are numerous prescription medications that can stop the headache
attack once it begins. There all work to reverse the central sensitization
of the TBNC. Most of these medications fall into the classes of
If one single medication does not stop the headache, we can use combinations of medications. Overall, we can get good headache relief in 90% or more of headache patients. If
your headaches are very frequent, we will probably start
preventative medications. Again, there are several types
of preventative medications. Which one we try first, depends on
whether your headaches are more of the migraine type or the tension
type. Headache prevention medications include Again, if one preventative medication is not sufficient, we can try combination of medications. We are able to get greater than 50% improvement in almost all cases of very frequent headaches. If overuse of pain-reliever medications is causing nearly daily headache, we will start by stopping the offending pain-reliever medication. We will use other medications to control the headache while you “detox” off the pain-reliever. After about 8 weeks, the “medication induced” headaches will disappear, and we can then treat whatever type of headache remains. Other Types of Headaches Tension headaches, migraine headaches, and medication overuse headaches are the most common types of headaches. Together these account for over 90% of severe headaches. There are other, rare, causes of recurrent headaches: cluster headaches, trigeminal neuralgia, tumors, very high blood pressure, stroke, infections and inflammations of the tissues inside the skull. With most of these conditions there are other physical problems in addition to headache. Of course, we evaluate for these other causes of headache whenever we meet with a patient for the first time. Headache after head and neck trauma is not rare. This headache can be either of the migraine or tension pattern, and is treated accordingly as described above. Should You Seek Specialized Treatment for Your Headache? If you only have occasional headaches (less than one per week), that don’t significantly interfere with your daily activities, and that are improved by simple over-the-counter pain relief medications then you probably don’t need any further evaluation or treatment of your headaches. If, however, your headaches are severe and impair your daily activities; or if they are frequent (more than three per month), then you should be under the care of a specialist in headache treatment. Specialized treatment can get you maximum relief of headache pain—and make sure that your headache medications don’t cause harm. Over-the-counter headache medications can cause liver, stomach, and kidney disease; if used more than about three times per week, these medications can also cause medication-overuse headaches, as I discussed above. Treatment with a specialist can ensure, too, that headache-prevention medications are started if needed. This will minimize the number and severity of headaches you have, and help prevent medication-overuse headaches from developing. About Tate Healthcare Specialists We specialize in only a few medical conditions: Overweight, Attention Deficit Disorder, Clinical Depression, and Headaches. So, we are able to stay on the cutting edge of medical knowledge in these areas. You can be sure that our evaluation and treatment will be state-of-the-art, and will give you the best results. Most of the time a simple interview and brief exam will be all that is required for us to diagnose and begin treatment of your headache problem. Improvement is usually rapid. Health insurance will usually reimburse you a portion of your cost at our clinic. Don’t wait for your headaches to continue to worsen; don’t let yourself get into a cycle of overusing pain-relief medications. Get specialized headache treatment right away. Getting help at Tate Healthcare Specialists is easy. A good way to start is by completing our on-line Free Symptom Analysis. Then, I’ll get back to you with my initial impressions about your symptoms by e-mail—with no cost or obligation. Of course, you can also call our office to request information or to make an appointment. Simply call 800-889-4319. You can also e-mail me directly with any questions: jtate@tatehealthcare.com I’m looking forward to helping you live freer from headache pain! Thank you! Jeffrey L. Tate, MD
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