Headaches
Overview
Headaches, particularly minor headaches, are a standard and honored facet of contemporary life. In all likelihood, though, every human being in the entire history of civilization has had a headache at some point. In every context, the claim of a headache is accepted social currency, making up the difference between what is expected and what is delivered. Conversely, the slight headache is so common that it's easy to affect a dismissive stance toward someone who has announced that they have one. The headache, as a cultural institution, has long since eclipsed the headache as a medical condition.
That a headache is a medical condition is hardly a revolutionary point; even a disappointed employer or a frustrated lover will generally concede that there is such a thing as a bad headache, and that at its worst, a headache can be debilitating. What makes pain of the gray matter such a gray area, however, is the spectacular diversity of this everyday phenomenon. A headache's intensity can range a dull irritation to an agonizing torment. A headache's cause can range from fleeting tension to a tumor of the brain. And wherever there are human beings, you will also find headaches.
Tension headaches
The medical community helpfully segregates headaches into two basic varieties. Primary headaches are symptoms unto themselves, and are not caused by or associated with other illnesses. Secondary headaches, on the other hand, are. (A headache, for example, could be diagnosed as "secondary to otitis.")
The most common type of primary headache is the ubiquitous and democratic tension headache. A tension headache is usually mild, and can be brought on by stress or anxiety. Tension headaches tend to diminish and disappear when the stress or anxiety abates, and they can also be effectively treated with common over-the-counter painkillers. Strictly speaking, around 90% of adults get them with some regularity, although they generally befall women more often than men. A tension headache often originates as a slight feeling of pressure either in the back of the head or over the eyebrows. The pain is usually bilateral (equally present on both sides of the head), and rarely is accompanied by other physical symptoms such as vomiting. Most people are able to function with a tension headache.
The truth about migraines
The second most common primary headache is the fearsome migraine. Culturally, the migraine is the monolithic idol of unholy suffering, and in conversation it invokes such profound respect that it has become a somewhat accepted colloquial description of any bad headache. In fact, though, there are many marked contrasts between true migraines and severe tension headaches.
First of all, one who suffers from migraine headaches is not experiencing the phenomenon once. Migraine is a chronic condition, and is experienced as a recurrent attack, most commonly manifested as a sharp, pounding pain in one temple. Migraine headaches can also be focused in the forehead, eyes, or the back of the head. The headaches associated with migraine are usually unilateral (on one side of the head), and usually switch sides from one attack to the next.
Unlike tension headaches, migraines are frequently accompanied by additional symptoms, such as nausea, vomiting, diarrhea, facial pallor, cold extremities, and an increased sensitivity to light and sound. Roughly half the time, migraine attacks are preceded by an overture of initial symptoms which can include fatigue, irritability, seemingly random mood swings, or specific cravings for sweet or salty foods. This period of "warning symptoms" can last for hours or days leading up to a migraine attack, and the subsequent attack itself can go on for a few hours or a few days as well.
Technically, migraine headaches are caused through the combined effects of vasodilatation (the enlargement of blood vessels), and the release of chemicals from nerve fibers that coil around the blood vessels. On the exterior of the human skull, just under the skin of the temple, is the temporal artery. During a migraine attack, the temporal artery enlarges, which stretches and stresses the surrounding nerves. The nerves, disturbed, release chemicals which cause discomfort, inflammation, and further arterial enlargement. The increasing enlargement of the temporal artery, of course, intensifies the pain.
Part of what makes migraine headaches so difficult to deal with is their tendency to activate what physicians refer to as "the sympathetic nervous system," which controls the body's basic, automatic responses to stress, anxiety, discomfort, and pain. It is believed that this increased activity in the nervous system is responsible for the common co-associated symptoms of migraines. Furthermore, it generally impedes the emptying of the stomach into the small intestine, with the result that medications taken orally are prevented from being absorbed. This explains the much-lamented ineffectiveness of medications taken to treat migraines.
About one quarter of migraine headaches are also associated with an aura, which in this case refers to the appearance of bright, zigzagging light patterns; flashing light; or a blind spot in the patient's visual field. Less commonly, some migraine sufferers will experience auras that are tactile (a persistent pins-and-needles sensation on the arms or face) or auditory (a persistent humming or ringing in the ears). These auras tend to be experienced during the period of warning symptoms, although they can sometimes continue throughout the headache attack too.
More complicated migraines can be accompanied by neurological dysfunction. Vertebrobasilar migraines are characterized by dysfunction of the brain stem (the lower part of the brain, responsible for automatic phenomena such as balance). The symptoms of vertebrobasilar migraines can be more markedly neurological, and may include fainting, vertigo, and double vision. Hemiplegic migraines are sometimes mistaken for the early moments of a stroke, as they can be accompanied by paralysis or weakness of one side of the body. These symptoms are almost temporary, but like other migraine symptoms, they can last for days.
Even after a migraine attack has ended, the migraine sufferer may feel lethargic, irritable, and sensitive to light and sound. This period of "coming out of it" can also last for a day or two, and it is not uncommon for a less intense headache to temporarily linger after the attack has subsided.
Around 12% of the population of the United States suffers from migraine headaches, although once again, the condition is about twice as common in women as in men. Migraine headaches can affect children, as well; interestingly, pre-pubescent boys and girls are equally affected.
More headaches to choose from
The rarest type of primary headache, cluster headaches, affect only 0.1% of the population. The usual gender slant does not apply here, as an estimated 85% of cluster headache sufferers are male. These headaches come in groups (clusters), and normally last weeks or months, separated by pain-free periods of months or even years. During the period in which the cluster headaches are active, pain typically occurs once or twice daily. Each episode generally lasts from 30 to 90 minutes, and attacks seem to happen at roughly the same time every day, frequently during sleep. When this happens, the patient is generally awakened, as typically the pain is excruciating. It tends to be focused unilaterally around or behind one eye, and the feeling has often been described as "a hot poker in the eye." The affected eye may become red, inflamed, and watery. The nose on the affected side may become runny and congested. There is no clear known cause of cluster headaches.
As for secondary headaches, they have a tremendous diversity of cause, ranging from truly serious conditions such as brain tumors, strokes, meningitis, and subarachnoid hemorrhages to more manageable conditions such as colds, influenza, withdrawal from minor addiction (i.e., caffeine) and the discontinuation of commonly-used analgesics.
If you are suffering from any kind of recurring headache, it is important to consult a healthcare provider. A particular cause for concern is the headache that occurs frequently and unilaterally, as this is true of headaches secondary to brain tumors and some serious neurological conditions.
Treating the five types of headaches
Beyond making the distinction between primary and secondary headaches, the medical community identifies headaches as falling into five more specific categories: acute, acute-recurrent, chronic-progressive, chronic-nonprogressive, and mixed.
Most acute headaches are non-traumatic and are the result of conditions such as upper respiratory tract infection, fever, or sinusitis. Often the best recourse for one suffering from a basic acute headache is to simply rest, preferably somewhere quiet and dark. An acute headache happens and is over.
Acute-recurrent headaches (migraine headaches, of course, fall into this category) are more serious, as they can in some cases be secondary to conditions of greater concern. A physician should be consulted, so as to determine whether the patient might be suffering from a neurological condition. If this proves not to be the case, a lessening of caffeine intake may be suggested, as large amounts of caffeine can somettimes be responsible for chronic headaches. Taken at the onset of a headache, over-the-counter painkillers can be effective in reducing the length and severity of the headache. Because of the sympathetic nervous system, particularly in the case of migraines, it is crucial that painkillers be taken in the early stages if they are to be effective.
Chronic-progressive headaches are characterized by a gradual increase in frequency and severity. Patients who notice chronic headaches which seem to grow increasingly painful from one onset to the next are encouraged by healthcare providers to undergo a neuroimaging process with MRI; the progressive headache is not necessarily secondary to a serious neurological disorder, but it can be, and thorough medical care in the warning stages could be important. Conversely, many chronic-depressive headache patterns are simply the result of tension headaches that worsen over time if the tension that brings them on intensifies.
The relatively rare chronic-nonprogressive headache keeps a much more regular schedule - temporarily. Typically, this variety of headache comes on quickly, and each instance usually lasts more than four days. The chronic-nonprogressive headache occurs several times a month (most sources place the number around fifteen), and are generally chronic for a period of a few months, after which they disappear. Although they may return at some later point, most cases show that years elapse between chronic-nonprogressive headache periods. A healthcare provider addressing the needs and concerns of someone experiencing this type of headache will evaluate sleeping patterns, exercise habits, and dietary choices. Because chronic-nonprogressive headaches are often associated with psychological conditions, it is common for those afflicted with them to relieve their causes, perhaps through counseling, stress management, therapy, or medication.
Finally, the mixed headache pattern is fairly self-explanatory. This last classification refers to cases where more than one type of headache is being experienced; for example, a migraine sufferer (acute-recurrent), may also be experiencing a chronic-nonprogressive tension headache.
The future of headaches
Because the headache, in its less extreme incarnations, is an occasional normalcy - fought with acceptable facility through the use of easily-attained painkillers - at least half its future is simply our future. The future of the common tension headache is the future of being human. We live lives whose unpredictibility can overwhelm us with beauty; on the other hand, it can also give us a headache.
More painful and recurring headaches cannot be shrugged off as a passing, small discomfort. Although many headaches are not yet fully understood, and although many forms of chronic and recurring headache persist beyond the present ability of medicine to cure them, strides are being made in the study of the neurological system, and there is great hope for advancement soon. Moreover, as our understanding of the head itself increases, so does our ability to treat its ails. Many people who suffer from ongoing headaches have found, through the guidance of physicians and therapists, that lifestyle changes and medication can significantly reduce their frequency and intensity.
Because headaches are often secondary and/or preliminary to other conditions, they can also sometimes be seen as useful signals that something must be investigated and addressed. This underlines the importance of consulting a halthcare provider if you are experiencing them frequently or if they are very painful. When experiencing a headache, always consider whether there may be obvious factors involved, like unusual or prolonged exposure to loud noise, or a particularly stressful day. But don't make the mistake of dismissing as unimportant what could be a cause for concern.
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