What hurts when you have a headache? The bones of the skull and tissues of the brain itself never hurt, because they lack pain-sensitive nerve fibers. Several areas of the head can hurt, including a network of nerves which extends over the scalp and certain nerves in the face, mouth, and throat. Also sensitive to pain, because they contain delicate nerve fibers, are the muscles of the head and blood vessels found along the surface and at the base of the brain.
The ends of these pain-sensitive nerves, called nociceptors, can be stimulated by stress, muscular tension, dilated blood vessels, and other triggers of headache. Once stimulated, a nociceptor sends a message up the length of the nerve fiber to the nerve cells in the brain, signaling that a part of the body hurts. The message is determined by the location of the nociceptor. A person who suddenly realizes "My toe hurts," is responding to nociceptors in the foot that have been stimulated by the stubbing of a toe.
A number of chemicals help transmit pain-related information to the brain. Some of these chemicals are natural painkilling proteins called endorphins, Greek for "the morphine within." One theory suggests that people who suffer from severe headache and other types of chronic pain have lower levels of endorphins than people who are generally pain free.
What Are Migraine Headaches?
A migraine headache is a severe pain felt on one, and sometimes, both sides of the head. The pain is mostly in the front around the temples or behind one eye or ear. Besides pain, you may have nausea and vomiting, and be very sensitive to light and sound. Migraine can occur any time of the day, though it often starts in the morning. The pain can last a few hours or up to one or two days.
We don’t know what causes migraine headaches, but some things are more common in people who have them.
- Most often, migraine affects people between the ages of 15 and 55.
- Many people have a family history of migraine.
- They are more common in women.
- Migraine often becomes less severe and frequent with age.
What causes migraine?
One theory about the cause of migraine is the blood flow theory, which focuses on blood vessel activity in the brain. Blood vessels either narrow or expand. Narrowing can constrict blood flow, causing problems with sight or dizziness. When the blood vessels expand, they press on nerves nearby, which causes pain.
Another theory focuses on chemical changes in the brain. When chemicals in the brain that send messages from one cell to another, including the messages to blood vessels to get narrow or expand, are interrupted, migraines can occur.
More recently, genes have been linked to migraine. People who get migraines may inherit abnormal genes that control the functions of certain brain cells. And something the person’s body is sensitive to in some way triggers the actual headaches.
Headache triggers can vary from person to person. Most migraines are not caused by a single factor or event. Your response to triggers can also vary from headache to headache.Many women with migraine tend to have attacks brought on by:
- lack of food or sleep
- bright light or loud noise
- hormone changes during the menstrual cycle
- stress and anxiety
- weather changes
- chocolate, alcohol, or nicotine
- some foods and food additives, such as MSG or nitrates
To help pinpoint your headache triggers, it may be helpful to keep a headache “diary.” Each time you have a migraine, write down the time of day, point in your menstrual cycle, where you are at the time, and what you were doing when the migraine started. Talk with your doctor about what sets off your headaches to help find the right treatment for you.
When Should You See a Physician?
Not all headaches require medical attention. Some result from missed meals or occasional muscle tension and are easily remedied. But some types of headache are signals of more serious disorders, and call for prompt medical care. These include:
- Sudden, severe headache
- Sudden, severe headache associated with a stiff neck
- Headache associated with fever
- Headache associated with convulsions
- Headache accompanied by confusion or loss of consciousness
- Headache following a blow on the head
- Headache associated with pain in the eye or ear
- Persistent headache in a person who was previously headache free
- Recurring headache in children
- Headache which interferes with normal life
A headache sufferer usually seeks help from a family practitioner. If the problem is not relieved by standard treatments, the patient may then be referred to a specialist - perhaps an internist or neurologist. Additional referrals may be made to psychologists.
Are there different kinds of migraine?
Yes, there are many forms of migraine headache. But, the two forms seen most often are classic and common migraine.
With a classic migraine, a person has these visual symptoms (also called an “aura”) 10 to 30 minutes before an attack:
- sees flashing lights or zigzag lines
- has blind spots or loses vision for a short time
The aura can include seeing or hearing strange things. It can even disturb the senses of smell, taste, or touch. Women have this form of migraine less often than men.
With a common migraine, a person does not have an aura, but does have the other migraine symptoms, such as nausea and vomiting.
How does a migraine headache differ from a tension headache?
While migraine headaches affect millions of people, they are still less common than tension headaches. Tension headaches cause a more steady pain over the entire head rather than throbbing pain in one spot. Most of the time, migraine attacks happen once in awhile, but tension headaches can occur as often as every day. While fatigue and stress can bring on both tension and migraine headaches, migraines can be triggered by certain foods, changes in the body’s hormone levels, and even changes in the weather.
There are also differences in how these two types of headaches respond to treatment with medicines. While some over-the-counter drugs used to treat tension headaches sometimes help migraine headaches, the drugs used to treat migraine attacks do not work for tension headaches.
Diagnosing a headache is like playing Twenty Questions. Experts agree that a detailed question-and-answer session with a patient can often produce enough information for a diagnosis. Many types of headaches have clear-cut symptoms which fall into an easily recognizable pattern.
Patients may be asked: How often do you have headaches? Where is the pain? How long do the headaches last? When did you first develop headaches? The patient's sleep habits and family and work situations may also be probed.
Most physicians will also obtain a full medical history from the patient, inquiring about past head trauma or surgery, eye strain, sinus problems, dental problems, difficulties with opening and closing of the jaw, and the use of medications. This may be enough to suggest strongly that the patient has migraine or cluster headaches. A complete and careful physical and neurological examination will exclude many possibilities and the suspicion of aneurysm, meningitis, or certain brain tumors. A blood test may be ordered to screen for thyroid disease, anemia, or infections which might cause a headache.
A test called an electroencephalogram (EEG) may be given to measure brain activity. EEG's can indicate a malfunction in the brain, but they cannot usually pinpoint a problem that might be causing a headache. A physician may suggest that a patient with unusual headaches undergo a computed tomographic (CT) scan and/or a magnetic resonance imaging (MRI) scan. The scans enable the physician to distinguish, for example, between a bleeding blood vessel in the brain and a brain tumor, and are important diagnostic tools in cases of headache associated with brain lesions or other serious disease. CT scans produce X-ray images of the brain that show structures or variations in the density of different types of tissue. MRI scans use magnetic fields and radio waves to produce an image that provides information about the structure and biochemistry of the brain.
If an aneurysm-an abnormal ballooning of a blood vessel-is suspected, a physician may order a CT scan to examine for blood and then an angiogram. In this test, a special fluid which can be seen on an X-ray is injected into the patient and carried in the bloodstream to the brain to reveal any abnormalities in the blood vessels there.
A physician analyzes the results of all these diagnostic tests along with a patient's medical history and examination in order to arrive at a diagnosis.
Headaches are diagnosed as
- Muscle contraction (tension)
Vascular headaches - a group that includes the well-known migraine - are so named because they are thought to involve abnormal function of the brain's blood vessels or vascular system. Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles. Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Some people have more than one type of headache.
When headaches occur three or more times a month, preventive treatment is usually recommended. Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches. Drug therapy for migraine is often combined with biofeedback and relaxation training. One of the most commonly used drugs for the relief of migraine symptoms is sumatriptan. Drugs used to prevent migraine also include methysergide maleate, which counteracts blood vessel constriction; propranolol hydrochloride, which also reduces the frequency and severity of migraine headaches; ergotamine tartrate, a vasoconstrictor that helps counteract the painful dilation stage of the headache; amitriptyline, an antidepressant; valproic acid, an anticonvulsant; and verapamil, a calcium channel blocker.
Not all headaches require medical attention. But some types of headache are signals of more serious disorders and call for prompt medical care. These include: sudden, severe headache or sudden headache associated with a stiff neck; headaches associated with fever, convulsions, or accompanied by confusion or loss of consciousness; headaches following a blow to the head, or associated with pain in the eye or ear; persistent headache in a person who was previously headache free; and recurring headache in children. Migraine headaches may last a day or more and can strike as often as several times a week or as rarely as once every few years.
How are migraines treated?
Even though migraine has no cure, you can work with your doctor to come up with a treatment plan that meets your needs. Make sure your plan has ways to treat the headache symptoms when they happen, as well as ways to help make your headaches less frequent or severe. It may include all or some of these methods.
Finding and avoiding things that cause headache is one way to reduce how often attacks happen and how painful they are. Your diet, the amount of stress in your life, and other lifestyle habits may add to getting migraines. Eating a healthful diet, quitting smoking, and reducing your alcohol intake may help improve your headaches. Learn stress reduction techniques and find other positive ways to cope with stress. Try to get on a regular sleep pattern.
There are two ways to approach the treatment of migraine headache with drugs: prevent the attacks, or relieve the symptoms during the attacks. Many people with migraine use both forms of treatment. Some medicines used to help prevent attacks include drugs that were designed to treat epilepsy and depression. To relieve symptoms during attacks, your doctor may start by telling you to take over-the-counter drugs such as aspirin, acetaminophen, or NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen. If these drugs don’t work to give you relief, your doctor can prescribe types of drugs called ergotamines or triptans. Ergotamines narrow the blood vessels, which helps the migraine’s throbbing pain. Triptans are new types of drugs that relieve pain by both narrowing blood vessels and balancing the chemicals in the brain. Hormone therapy may help some women whose migraines seem to be linked to their menstrual cycle. Work with your doctor to choose the best medicine for you.
Biofeedback has been shown to help some people with migraine. It involves learning to control how your body reacts to stress to reduce its effects. Other methods, such as acupuncture and relaxation, may help relieve stress. Counseling can also help if you think your migraines may be related to depression or anxiety. Talk with your doctor about these treatment methods.
The best way to prevent migraine is to find out what events or lifestyle factors, such as stress or certain foods, set off your headaches. Try to avoid or limit these triggers as much as you can. Since migraine headaches are more common during stressful times, find healthy ways to cope with stress. Talk with your doctor about starting an exercise program or taking a class to learn relaxation skills.
If your doctor has prescribed medicine for you to help prevent migraine, take them exactly as prescribed. Ask what you should do if you miss a dose and how long should take the medicine. If you use headache medicines too often or more than what your doctor prescribes, the medicines can even start to cause a condition called “rebound headaches.” With this condition, your medicines stop helping your pain and actually begin to cause headaches. Talk with your doctor if the amount of medicine you are prescribed is not helping your headaches.