Introduction to Headache
For 2 years, Jim suffered the excruciating pain of cluster headaches. Night after night he paced the floor, the pain driving him to constant motion. He was only 48 years old when the clusters forced him to quit his job as a systems analyst. One year later, his headaches are controlled. The credit for Jim's recovery belongs to the medical staff of a headache clinic. Physicians there applied the latest research findings on headache, and prescribed for Jim a combination of new drugs.
Joan was a victim of frequent migraine. Her headaches lasted 2 days. Nauseous and weak, she stayed in the dark until each attack was over. Today, although migraine still interferes with her life, she has fewer attacks and less severe headaches than before. A specialist prescribed an antimigraine program for Joan that included improved drug therapy, a new diet and relaxation training.
An avid reader, Peggy couldn't put down the new mystery thriller. After 4 hours of reading slumped in bed, she knew she had overdone it. Her tensed head and neck muscles felt as if they were being squeezed between two giant hands. But for Peggy, the muscle-contraction headache and neck pain were soon relieved by a hot shower and aspirin.
An estimated 45 million Americans experience chronic headaches. For at least half of these people, the problem is severe and sometimes disabling. It can also be costly: headache sufferers make over 8 million visits a year to doctor's offices. Migraine victims alone lose over 157 million workdays because of headache pain.
Understanding why headaches occur and improving headache treatment are among the research goals of the National Institute of Neurological Disorders and Stroke (NINDS). As the leading supporter of brain research in the Federal Government, the NINDS also supports and conducts studies to improve the diagnosis of headaches and to find ways to prevent them.
Why Does it Hurt?
What hurts when you have a headache? 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 bones of the skull and tissues of the brain itself, however, never hurt, because they lack pain-sensitive nerve fibers.
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.
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
- Change in usual headache pattern
A headache sufferer usually seeks help from a primary care provider. If the problem is not relieved by standard treatments, the patient may then be referred to a neurologist. Additional referrals may be made to psychologists.