Reprinted from the Health District's quarterly publication mailed to district residents (Winter 2009)
TOPIC: Handling Headaches
Getting inside a common ailment
by chryss cada

Spend some time inside Christine Robinson’s head and you’ll never use the phrase “just a headache” again.

The 42-year-old Fort Collins resident has endured chronic headaches since she was 8.

“For a long time the message I was getting was, ‘They’re headaches. It’s not like missing a leg or having a disease —just deal with it,’” she says.

For years she did just that — dealt with her frequent headaches by lying still in a dark, quiet room and taking over-the-counter medications. Then when she was in her 20s, her headaches could no longer be ignored.

“I’d have to wake my roommate up at 3 a.m. to take me to the ER for a Demerol shot for the pain,” she recalls. “Sitting under those bright lights amidst the waiting room noise, not able to get comfortable — that was torture.”

It wasn’t until several trips to the emergency room that Robinson was diagnosed with migraines.
“After being diagnosed, I looked back at all I’d been through and I got angry about my pain being belittled,” she says. “People tend to apply their own experience with headaches; but migraine sufferers know all too well that not all headaches are the same.”

Robinson is one of an estimated 28 million Americans who suffer from migraines, part of the larger population of 45 million Americans who suffer from chronic recurrent headache, according to the National Headache Foundation. In addition, about 20 percent of children and adolescents have significant headaches. And 3 percent to 5 percent of Americans have chronic daily headache (defined as more than 15 headaches a month).

Tamara Ann Miller, M.D., of Advanced Neurology of Colorado specializes in migraines. In the search for pain relief for chronic headache sufferers, Miller has overseen clinical trials evaluating a broad array of neurological agents.

“The rule of thumb is you should get help whenever headaches are interfering with your daily life,” she says.

Miller, who has been practicing in Fort Collins since 1992, has seen an increase in the number of people seeking treatment.

“Seventeen years ago people would ignore their headaches, but now there is help out there,” she says. “The medical field has addressed headache and said that people don’t have to live with the pain. More people are seeing doctors with the hope that they can improve their life.”

Robinson has learned that the first step to getting your headaches under control is to identify what type they are. Unfortunately she knows the five major types — tension, cluster, sinus, rebound and migraine — because she’s had them all.
When to call the doctor

Occasional headaches are common. But it’s important to take headaches seriously. Consult your doctor if:

  • You usually have three or more headaches a week
  • You take a pain reliever for your headaches every day or almost every day
  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches
  • Your headache pattern changes
  • Your headaches are getting worse
  • Is new headache pain in people 50 and older

Seek prompt medical care if your headache:

  • Is sudden and severe
  • Accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking
  • Follows a head injury
  • Gets worse despite rest and pain medication


Source: Mayo Clinic and Bruce Cooper, Medical Director, Health District

Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. They usually don’t interfere with participation in normal activity and can be treated with over-the-counter medicines. These headaches can be brought on by stress, which causes a tightening of the neck and scalp muscles.

Cluster headaches are one of the rarest yet most painful types and affect men more often than women. These recurrent headaches that occur in groups or cycles appear suddenly and are characterized by severe, debilitating pain on one side of the head.

Sinus headaches are caused when a sinus becomes swollen, usually through an infection. Treatment includes OTC pain relievers; non-antihistamine decongestants; and steam and warm compresses. (Antibiotics are usually not needed but sometimes required for bacterial infection of the sinuses.) Sinus headaches are often misdiagnosed by the sufferer.

“We have a lot of people coming in saying they have a sinus headache; but when we take a closer look they don’t actually have any congestion,” Miller says. “Often what they actually have is a migraine.”
One of the great ironies for headache suffers is rebound headaches, which are caused by overuse of painkillers. Culprits include over-the-counter medications as well as prescription drugs.

“Patients get into this cycle where they keep taking more drugs to get rid of the pain, and in the process they begin contributing to their own headaches,” Miller says. “If you’re taking 12 Excedrin a day, we need to look at alternatives to deal with your pain.”

Migraine headaches come from a neurological disorder that can run in families and are defined by background (at least five previous episodes of headache), duration (lasting between four and 72 hours) and symptoms (such as moderate to severe throbbing pain that is aggravated by daily activity, nausea and/or vomiting, and sensitivity to light and sound).

Ways to manage migraines vary from avoiding triggers (see sidebar) and getting regular sleep, to pain-relieving medication and non-medication treatments such as acupuncture and hypnotherapy.

Thomas Kirby, an acupuncturist with The Acupuncture Center in Fort Collins, urges his clients to look at the whole system of their body for the cause of headaches.

“You can’t just treat the symptoms. You have to get to the root cause,” he says. “If the ‘check engine’ light comes on in your car, you don’t just put a piece of tape over it.”

Migraine triggers

Physiological
Menses
Late hours
No breakfast
Too much sleep

Psychological
Anxiety
Depression
Anger
Fear

External Stimuli
 Diet
Alcohol
Weather
Bright light
Some medications

Source: Tamara Ann Miller, M.D.
Kirby believes headaches can stem from areas in life that need attention. “You have to start with things that help yourself, such as spending time with loved ones, doing things that inspire you and being in nature,” he says. “If that doesn’t work, you should definitely seek help.”

Those who do seek relief from migraine headaches with medication will choose from preventive treatments such as anticonvulsants and antidepressants or acute treatments that are taken at the onset of a headache.

Miller is a pioneer in the use of Botox for the treatment of chronic headaches. Known for its use in cosmetic procedures, Botox inhibits the release of neurotransmitters, which reduces the pain associated with migraine headaches. In a clinical trial conducted by Miller, 70 percent of the participants said the Botox treatment was good to very good in relieving their migraine pain.

As for Robinson, she’s found a medication that relieves the pain from the tension and menstrual migraines she gets once to twice a month — but she tries not to let her headaches get to the point that she has to take it.

“I’ve come to think of headaches as calls to action — messages from your body that you are being sent for a reason,” she says. “Pills won’t provide that reason; they will only provide relief from the symptoms until you figure out what’s triggering the message.”

She keeps notes on what causes each headache, is on the lookout for allergens and watches her caffeine intake. When dealing with particularly stressful situations in her life, she releases stress by talking with a friend or going on a long walk with her dogs.

“Realize that you are the expert on your headaches, and then partner with a doctor you trust to find the problem and solution,” Robinson says. “Know that your pain is real, and avoid feeling shame. While you may be doing something that adds to the triggers, you do not deserve to feel pain.”