Headaches

Chronic daily headaches are exactly that — headaches that occur about 15 days a month over a period of at least three months. They are rare, affecting only about four percent of the population. The majority of people who experience chronic daily headaches are female.

Symptoms

Within chronic daily headaches are four types of headaches, which refer to the kind of actual pain you are experiencing. These include chronic migraines and chronic tension headaches. Also included are the chronic appearance of new daily persistent type headaches, which refer to mild to medium pressure headaches that come on suddenly in people that generally don’t experience headaches, and chronic hemicrania continua headaches, which are moderate to severe headaches that affect one side of the head and are accompanied by factors such as a red, teary eye on the affected side and nasal congestion.

Causes

Chronic daily headaches are associated with a variety of conditions and actions; whether these are cause or effect is as yet unclear. These conditions are anxiety, depression, disturbed sleep, snoring, other chronic pain conditions and overuse of caffeine.

Sometimes, chronic daily headaches are caused by the rebound effect of taking too much headache medication. If you have been taking headache medicine and are experiencing this kind of headache, talk to your physician. You will likely need to taper off under medical supervision, while still needing to treat the pain of the original headaches that started the spiral.

Prevention

• Time(s) of day or night that headache occurs
• Weather
• Environment (the presence of noise, smoke, crowds, or other)
• Response to light
• Foods eaten
• Hydration
• Alcohol consumption

Living better

Adopting a healthy lifestyle can help you ward off chronic headaches. That includes figuring out how to maximize sleep, nutrition and exercise, and minimize stress.

Make sure you get to bed every night in a dark and quiet room, and allow time for enough sleep. Eat meals that are regular, consistent and healthy. Exercise every day (walking outdoors is helpful) — taking short breaks from a demanding job to breathe and move around will help your head and your body. Do what you can to be aware of stressful factors in your life and reduce them, perhaps incorporating meditation or yoga into your day, as these are proven to be helpful in lowering stress. And reduce caffeine — even though caffeine might be included in certain headache medications, it can also aggravate them.

Exams and tests

Because of the persistence of these kinds of headaches, there are certain conditions that need to be ruled out as possible causes. These include infections, such as meningitis; an inflammation of the blood vessels around the brain, or a stroke; brain tumor; traumatic brain injury; and intracranial pressure that is too high or too low.

A complete physical exam is performed, and a complete medical history taken, to determine possible headache causes. The physicians at the St. Luke’s Headache Center can also perform imaging tests, such as CT scans or MRIs, to rule out some of these possibilities. A lumbar pressure test may be used to determine the presence of meningitis; this kind of test is also used to determine intracranial pressure.

Treatments

Treatments for chronic daily headaches vary, often depending on the type of headache it is and your individual response to medication.

The tricyclic class of antidepressants has proven effective, for example; it treats both the headaches and the conditions of depression, anxiety and sleep disruption that may go along with it. Beta blockers have been shown to work for chronic migraines and anti-seizure medicines have also proven helpful. Non-steroidal anti-inflammatory drugs work in some cases. And Botox — which acts to block the reception of neurotransmitter signals, thus, perhaps, intercepting pain — has been shown to be helpful in some cases as well.

Cluster headaches are intense, searing headaches that are so named because they come in a cluster — one or two a day for a few weeks or even months. The headaches themselves come on suddenly, and can last anywhere from 15 minutes to three hours. Since the clusters tend to occur in spring and fall, they are sometimes mistakenly associated with allergy symptoms.

This type of headache is rarer than most, with fewer than one in 1000 people experiencing them. Of that number, men are much more likely (90 percent of cluster headaches occur in men) to experience this syndrome.

Symptoms

You may feel a burning or piercing sensation right before the headache starts, or experience a migraine-like aura or nausea. Cluster headaches may cause red, teary eyes, (especially on the side of the pain) a runny or stuffed nostril, and nausea. Unlike during a migraine, when movement makes you feel worse, you will feel restless, and experience the need to walk or move.

Causes

Though the cause has not yet been determined, the hypothalamus — in charge of the body’s biological clock — is thought to be related. These headaches are sometimes known as “alarm clock” headaches because they tend to occur at the same time each day, often an hour or two after you fall asleep.

It is the trigeminal nerve that is affected and causing the pain. This is the largest of the cranial nerves, with branches that extend from inside your head to run up and down each side of your face, reaching your forehead, eyes, and jaw; in a cluster headache, only one side of the nerve is generally affected.

Prevention

Though there are no proven non-medical ways to prevent cluster headaches, not smoking is a basic rule for good health. It is one important to follow for those who experience cluster headaches, because the risk of these painful episodes is higher for smokers. Those who have sleep apnea are also more likely to develop this condition, as are those who have had a head injury.

There are several medical treatments that can help decrease the severity of these cluster headaches once they start, and there are also treatments available that may help reduce the number of headaches that occur in a cycle.

Living better

There are no known cures for cluster headaches. These suggestions, however, may set you on a path to feeling better.

• If you smoke, stop. That also means that if you are around those who smoke frequently, be wary; you are breathing in that smoke as well, and it may contribute to this debilitating condition. Stopping smoking may not stop your headaches, but your general health will improve, enabling you to more quickly recover.
• Ask your doctor if you can be tested for sleep apnea, if sleeping is fitful or interrupted. The special equipment that is worn by those with sleep apnea may prevent that condition — and reduce the number of cluster headaches you get as well.
• If you have had a head injury, consult with your doctor about any lasting effects you may be experiencing. Events that seem unrelated to your injury may actually be both connected and treatable.
• Avoid alcohol, particularly red wine, during a cluster phase. Alcohol has been shown to intensify symptoms or provoke an attack.
• Another trigger might be nitroglycerin, which is a medicine sometimes given for heart conditions. If you are taking medication, discuss it with your physician to make sure that there is not a relationship between your medicine and your headaches.

There are medical treatments available that can help you manage your headaches during the times that they occur.

Exams and tests

Although the symptoms of cluster headaches are not usually similar to those of a tumor or an aneurysm, the range of effects is large enough that a physician may want to perform imaging tests, such as a CT scan or an MRI, to rule these out. Once the expert physicians at the St. Luke’s Headache Center have performed a physical and taken your medical history, they will know if further tests are indicated.

Treatments

Treatments for cluster headaches include those that lessen the impact of the headaches when they occur, and those that control the number of actual occurrences. It may take time to find the medicine or medicines that work best for you, including weighing any possible side effects.

One of the fast-acting treatments that can be used for cluster headaches sounds simple: oxygen. At the onset of one of these headaches, breathing 100% oxygen at a certain rate over a short amount of time can provide dramatic relief. The downside to this treatment is that you need to have an oxygen tank, calibration regulator, and a mask available. The up side is that if your attacks generally occur at night, you can keep this equipment bedside.

Another treatment is called non-invasive vagus nerve stimulation. Here, a handheld device held to a certain point on the neck provides electrical stimulation to the vagus nerve — the longest cranial nerve, which also passes through the neck and thorax to the abdomen — through the skin. Unlike the stimulators that are used for migraines, this device is not implanted under the skin, but is administered externally instead.

More invasive, but also fast-acting, are triptans. These injectables are generally used for migraines, but can be effective for cluster headaches. The first injection is given under medical supervision.

Additionally, there are several types of preventive treatments available for cluster headaches, including a few classes of medication: anti-psychotics; calcium-channel blockers; and anticonvulsants. These types of medicines are generally administered at the start of a cluster cycle; you continue to take them during the length of time that the cycle generally occurs. Each of these types of medicines has its own benefits and risks; your physician at the St. Luke’s Headache Center will advise you as to which course of action is best for you.

Alternative medicines are being looked at for their effectiveness in controlling cluster headaches as well. Of these, melatonin — which is a sleep regulator — has shown promise in small studies. Capsaicin — an extract of chili peppers — has also shown effectiveness when administered through the nose.

Migraines are among the most severe kind of headache. More prevalent in females, you’re at risk for migraines if someone in your family history gets them, if you tend to be under stress, and if you suffer from other conditions, including allergies, epilepsy, and asthma.

These kinds of headaches, which affect more than 10 percent of people worldwide — including 28 million Americans — can be crippling, leaving people unable to leave their beds or go to work. The disabling pain can last for a few hours to a few days.

Symptoms

People with migraines experience a severe, throbbing pain, often on one side of the head. Nausea, vomiting, and extreme sensitivity to light and sound often accompany the pain. Migraines have a certain arc, going through a few phases, and can be experienced anywhere from rarely to several times a month.

• Warning signs: About two days before, there are changes in behavior, mood, energy, and/or appetite.
• Beginning symptoms: There are changes in vision, hearing, or smell. About one-third of migraine sufferers experience a warning symptom known as an “aura” just before the headache appears. This is characterized by seeing flashes of light, having blind spots, or feeling a tingling sensation on one side of the face, leg, or arm. Sometimes your speech can be affected, or you might have the sensation of being touched, or hear music or noises. This stage can last between 20 and 60 minutes.
• Headache: The headache is experienced as dull pain in the temple and side of the head that becomes throbbing, and can cause nausea, blurred vision, and sensitivity to light and sound.
• Pain ends: Headaches can last anywhere from a few hours to three days.
• Fatigue: After an attack, many sufferers feel fatigue that may last for hours or days. Others become elated. Moodiness, confusion, and continued sensitivity to light and sound are also part of this syndrome.

Causes

No cause has yet been attributed to migraines, but migraines tend to run in families. Researchers are investigating the possibility of genetic mutations that result in neurological differences. Understanding the causes will allow for the development of specifically targeted treatment and preventive medicines.

While these factors are being determined, we know this: migraines are associated with certain trigger factors. These include stress, changes in the weather, bright or glaring lights, altitude, and certain foods and medications.

Prevention

There is no way of preventing a first migraine, since the cause is as yet unknown. However, once you have experienced one, there are things you can do to be prepared.

Writing a list of the events that surrounded your migraine is very important. Were you under stress? Eating certain foods, such as cheese, alcohol, chocolate, or those that contained nitrates or MSG? (All of these have been associated with migraines.) Had you experienced a change in weather or altitude?

If you’re a woman, there is an additional factor: were you about to have your period? Migraines have been associated with changes in estrogen levels. If you notice a relationship between the appearance of migraines and your menstrual cycle, talk to your physician about estrogen management.

There are types of medical preventive treatment that involve rounds of medicines or injections. See Treatments section below. Your doctor at the St. Luke’s Headache Center can review these with you to determine the best solution for you.

Living better

Healthy living is important for everyone; for migraine sufferers, it is critical. Proper sleep, nutrition, hydration, and exercise can help keep these kinds of headaches at bay. Stress reduction is also vital.

Sleep: Consistent wake and sleep times are to your benefit. Sleep in a cool, dark room, and resist using your cellphone or computer for at least an hour before bed.

Nutrition: Know your triggers, and stay away from them. You can supplement your diet with vitamin B2 (riboflavin) and magnesium, as these have been shown to be helpful in lessening the symptoms of migraines.

Hydration: Drink plenty of water, and avoid alcohol and caffeine. Caffeine can be both a trigger and a cure, so it is best to keep your intake low or at least consistent.

Exercise: Work out at least three times a week for at least a half-hour each time. Walking is perfect for both relaxation and headache prevention, say the experts at St. Luke’s Headache Center.

Stress reduction: Meditation, yoga, and massage can help you manage stress. You can also do simple muscle relaxation exercises, such as slowly tensing, then releasing, the muscles in your body individually before you go to sleep at night.

Incorporate massage and acupuncture into your schedule. Another easy way to ease stress? Hug a friend or family member, and pet your dog: both of these actions release endorphins into your blood stream, which helps to lower stress. Of course, if you are taking medication for your migraines, always remember to take it on schedule.

Exams and tests

At the St. Luke’s Headache Center, your physician will be sure to take a complete medical history, including a family history, as well as performing a physical. Certain tests may be administered on a “rule out” basis. For example, based on what your history or exam shows, your doctor may want to do blood tests to see if there are any blood vessel problems, toxins, or infections.

Other tests include imaging tests such as an MRI or CT scan, to determine whether there are any brain bleeds or tumors, or the evidence of stroke or brain damage. A spinal tap (lumbar puncture) may also be found necessary, if there is a suspicion of low or high intracranial pressure.

Treatments

Treatment for migraine headaches can be categorized into two types. One is pain relieving, and the other is preventive.

Pain Relief

Pain relief medication includes over-the-counter medicines like aspirin, ibuprofen, and acetaminophen, which can relieve mild migraines. These kinds of medicines are not advisable for the long term, because they can cause both overuse, or rebound, headaches, and, with prolonged use, can cause gastrointestinal issues and ulcers.

Other kinds of pain-relieving medicines include triptans, which make blood vessels constrict to block pain, and ergots, which seem to be effective for sufferers whose headaches last longer than two days. These medicines require prescriptions, and your doctor at the St. Luke’s Headache Center will advise you as to their efficacy for your condition.

A homeopathic over-the-counter medicine to try is a severe headache and migraine nasal spray called Ausanil. Once a headache starts, this spray, which uses capsicum annum — the raw extract of the chili pepper plant — can help stop the pain with no adverse drug interactions in under 10 minutes, according to some patients who have used it. Methods of pain relief include icing your neck or the part of your head that’s affected, if you can. Even pulling your hair — gently — can help, as it improves blood circulation to the scalp and may alleviate tension in your head.

Preventive Treatments

The other type of treatment is preventive. You might want to consider this kind of treatment or medication if you get four or more migraines a month, your symptoms include protracted auras and weakness, and pain relievers are not working.

Cognitive behavior therapy (CBT) has had success with migraine patients, especially children. This practical, goal-oriented therapy helps patients find the attitudes, thinking, and behavior behind their difficulties, change those patterns, and so change the way they feel. With migraines, CBT strives to lessen the sphere of influence of a migraine. Often, patients who have migraines experience great stress, for example, in just making plans, because they don’t know when an attack will strike. This therapy can help modify that fear and anxiety, making it easier to participate in social commitments, work, and special occasions.

Classes of medications in the preventive category include beta blockers and calcium channel blockers, both of which are more commonly used to treat high blood pressure and coronary artery disease; one medication from the tricyclic class of antidepressants; and anti-seizure medicines. Botox has also proven effective for migraines; the treatment involves an injection into the neck about every three months.

Tension headaches, sometimes described as having a tight band of pressure around your head, are the most common type of headache. In fact, up to 80 percent of Americans experience them from time to time, with over three million a year reported. Headaches can bring about quality of life issues, because you are unable to participate in your daily routine, and can also raise work problems, if your productivity is affected.

These headaches can come from time to time, and last anywhere from a half-hour to a week. Sometimes, they can become continuous or chronic, occurring more than 15 days in a month for more than three months.

Symptoms

Tension headaches often present with a dull, steady, moderate to severe pain on both sides of your head. You may have trouble focusing and sleeping, feel fatigued or seem irritable, and be mildly sensitive to light and noise. Having a headache can make you distressed over minor issues and lead to impatience and frustration.

If your headache is severe, it may seem like a migraine. However, tension headaches are not generally accompanied with nausea, vomiting, or visual disturbances the way migraines often are.

Causes

The primary causes for tension headaches appear to be stress — whether from work, school, or family — and fatigue, whether mental or physical. Certain foods can act as triggers; caffeine withdrawal can also give you a headache. Bad posture — when, for example, you are cradling a phone between your shoulder and your neck, or hunched over reading too long with your neck lowered — positions that strain your head and neck muscles — can result in a headache. Eye strain can also be a cause.

There is also a theory that people who get tension headaches have a heightened sensitivity to pain. So, for example, increased muscle tenderness can cause a headache.

Prevention

The first step in preventing tension headaches is to isolate what causes them for you. Avoid foods that seem to trigger them, or environments that provoke them. (Maybe having a piece of dense chocolate cheesecake with a strong cup of coffee in a noisy pub isn’t the best idea for you.) Above all, learn to breathe through stress and come up with coping mechanisms for it. Make sure you get enough sleep.

Isolate possible physical causes. Observe your posture and your habits: how do you hold your phone? How do you sit in your desk chair? Get your vision checked to find out if you need glasses for the first time or a change in prescription if you already wear them.

If headaches persist despite controlling what you can for stress, fatigue, and physical causes, there are medical and alternative medicine treatments that can help prevent headaches or relieve your pain. See the Treatments section below. Your physician at the St. Luke’s Headache Center can advise you on the best method for you.

Living better

Some methods of handling stress that work for tension headache patients include the consistent practice of yoga or meditation, and taking long walks outdoors on a regular schedule. “Clean” sleep — where you have a regularly scheduled bedtime in a dark, quiet room, avoiding cellphone and computer use for at least an hour beforehand — is also recommended, to avoid both mental and physical fatigue.

Deep breathing exercises can be helpful. Start by paying attention to your breathing pattern. Then slowly, take a deep breath in through your nostrils, exhaling slowly through your mouth. Make sure you allow your stomach to expand through the inhalation so that you know you are taking a deep a breath as possible. Do this three to five times regularly a day — and whenever stress or tension becomes overwhelming. It gives you a “time out,” to slow down and think, calms your nerves, and lowers your blood pressure. All of this can act to prevent a headache coming on.

Massage, especially for your neck, head, and shoulders, is a powerful tool against tension and stress buildup. If you view it as pampering, stop — think of it as a medical aid. (And if you feel that you don’t have enough time in your schedule for a massage, well, that may be part of the problem.) A licensed massage therapist can provide muscle and tendon relief that will help stop headaches before they start.

Exams and tests

At the St. Luke’s Headache Center, the first step is to perform a physical evaluation and take a thorough medical history. Your doctor might ask you a series of questions to pinpoint the exact kind of pain you are feeling, and also ask for information about your life in general to see what stress level you are carrying.

Depending on what your physical exam shows and what answers are given about your life style, imaging tests such as an MRI or a CT scan may be performed to rule out underlying conditions.

Treatments

Treatments for tension headaches can include over-the-counter medicines such as aspirin, ibuprofen, acetaminophen and naproxen. Combination medicines — those that combine aspirin, for example, with caffeine — are often more effective than a single medicine. Too much of these kinds of medicines, however, can cause a rebound effect that produces more headaches or can cause gastrointestinal problems.

Triptans are sometimes prescribed for those who suffer from both tension headaches and migraines. If you have frequent or chronic tension headaches, tricyclic antidepressants are sometimes effective, and anticonvulsants and muscle relaxants are being studied for effectiveness.

For persistent tension headaches, injections of Botox can also be helpful; the drug interferes with the transmission of pain along the receptor’s path.

Alternative medicine routes that have proven effective include acupuncture and deep breathing exercises. Biofeedback — where you learn, through electrodes attached at various points to your body what your skin temperature, brain waves, and muscle tension, among others, are — and then how to control these — can also be helpful. Behavior therapy that teaches you how to find your triggers and react to them in a different way has been shown to work for some patients, as well.