Total Health Systems of Macomb County
Dr. Bill Pohlen
What is a headache? By definition it is a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes. Since there are so many causes a classification system was put in place to distinguish between the many causes and allow healthcare practitioners to diagnose and treat the cause of the headache presenting at that time.
There are three main categories of headaches:
1. Primary Headaches
2. Secondary Headaches
3. Cranial Neuralgias, facial pain and other headaches
Primary headaches include migraine, tension and cluster headaches, as well as a variety of other less common types of headaches.
Tension headaches are the most common type of primary headache. Up to 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men. While tension headaches are the most frequently occurring type of headache, their cause is unknown. The most likely cause is the contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where the muscles that move the jaw are located, and the forehead.
There is little research that reveals the cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. The existing stresses can cause the muscles of the skull to clench the teeth and spasm. The physical stressors include very difficult manual work that occurs for long periods of time, sitting at a desk or computer for extended periods and situations that require intense concentration. Emotional stress may also be the cause of a tension headache.
- Pain begins in the back of the head and upper neck and is described as a band like pressure.
- Often described as pressure surrounding the head with the majority of the pressure being located over the eyebrows.
- Pain is usually mild, occurs on both sides of the head.
- There is no aura, nausea, vomiting of sensitivity to light or sound involved.
- Pain occurs sporadically but frequently and even daily in some individuals and the pain allows most people to function normally even though they have a headache.
Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience a migraine headache. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more woman than men are affected. It is estimated that 6% of men and up to 18% of women will experience a migraine headache in their lifetime.
Migraines without Aura- Not all migraines are the same. But there are certain symptoms that many experience. They include:
- Throbbing pain
- Sensitivity to light and/or sound
Migraines with Aura- About 1 in 5 people who get migraines have auras. An aura is a feeling or series of sensations that come about 10 to 30 minutes before a migraine attack. The aura may be followed by some or all of the of the symptoms of a migraine without aura. They include:
- Seeing flashing lights, zigzag lines, or blind spots
- Feeling numbness or tingling in the face or hands
- Having a disturbed sense of smell, taste, or touch
- Felling mentally “fuzzy”
Migraine triggers – Many health care professionals believe that certain factors or evens, often called triggers, can lead to a migraine. These triggers vary from person to person. Often it’s not just one trigger that sets off an attack, but a combination of triggers. Some common triggers are:
- Lack of or too much sleep
- Skipped meals
- Bright lights, loud noises, or strong odors
- Hormone changes during a woman’s menstrual cycle
- Stress and anxiety
- Weather changes
- Alcohol (often Red Wine)
- Caffeine (too much, or withdrawal)
- Foods that contain nitrates, such as hot dogs and lunch meats
- Foods that contain MSG, a flavor enhancer found in fast foods, broths, seasonings, and spices.
- Foods that contain tyramine, such as aged cheeses, soy products, fava beans, hard sausages, and smoked fish
Cluster headaches are a rare form of primary headache affecting 0.1% of the population (1 in 1000 people). It more commonly affects men in their late 20s though women and children can also suffer these types of headaches. Their cause is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus, an area located at the base of the brain is responsible for the body’s biologic clock and may be the part of the brain that is the source for the headaches. When brain scans are performed on patients who are in the midst of a cluster headache, there is abnormal activity in the hypothalamus.
Cluster headaches are known to:
- Have a hereditary presence and suggest there may be a genetic role involved.
- Triggers may be changes in sleep patterns.
- Medications have been suspect to also be triggers such as Nitroglycerin.
- Cigarette smoke, alcohol and some foods (for example Chocolate) can also be triggers.
Cluster headaches come in groups (Clusters) lasting weeks or months, separated by pain-free periods of months or years.
- When a Cluster headache is present pain typically occurs once or twice daily, but some patients may experience pain more than twice a day.
- Each episode of pain lasts from 30 to 90 minutes.
- Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
- The pain typically is excruciating and located around or behind one eye.
- Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.
- The nose on the affected side may become congested and runny.
Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall and can be driven to desperate measures. Cluster headaches are much more common in men than women.
Secondary headaches may be caused by problems elsewhere in the head or neck. Some of these are not harmful such as cervicogenic headache (pain arising from the neck muscles). Medication overuse headache may occur in those using excessive painkillers for headaches, paradoxically causing worsening headaches.
A number of characteristics make it more likely that the headache is due to potentially dangerous secondary causes; some of these may be life-threatening or cause long-term damage and a few of them are as follows which is not a complete list:
- Head and neck trauma – injuries to the head may cause bleeding in spaces surrounding the brain or within the brain itself.
- Symptoms of whiplash and neck injury
- Strokes or Transient ischemic attacks (TIA)
- Arteriovenous malformations (AVM) may cause headaches before they leak.
- Carotid artery inflammation
- Temporal arteritis (inflammation of the temporal artery)
- Brain tumors, either primary, originating in the brain, or metastatic from cancer that began in another organ.
- Idipatihic intracranial hypertension, where the pressure is too high in the cerebrospinal fluid within the spinal canal.
- Infection such as Meningitis, Encephalitis, HIV/AIDS
- Systemic infections such as pneumonia or influenza
- High Blood Pressure
- Renal dialysis
Seeking care for a headache should take place when the headache you have is “The worst headache of your life” according to the textbook definitions. The amount of pain will be taken into consideration in accordance to the patients appearance and other associated signs and symptoms like:
- Different than usual headache
- Starts suddenly or aggravated by exertion, coughing, bending over or sexual activity.
- Associated with persistent nausea and vomiting, fever or stiff neck, seizures, recent head traumas or fall, changes in vision, speech, or behavior, weakness or change in sensation, no response to treatment, more than normal recommended amount of OTC meds required for relief, interfering with work or quality of life.
As you can see by the few examples of headaches, signs and symptoms there can be more to your headache than you think. If you are unsure about the type of headache that you are experiencing call and make an appointment with either of our offices at Total Health Systems of Macomb County. Our Chiropractic Doctors and Physical Therapist’s, Medical Doctor’s and Nutriton Nurse are trained to diagnose and treat headaches and their causes.