27 Tishri 5778
October 17 2017



Headaches, a Primer

A headache is defined as pain in the head that is located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. Headaches, like chest pain or dizziness have many causes. While painful and annoying, most headaches do not indicate a serious disorder and, in non-chronic cases, may be relieved by medicines and/or changes in lifestyle. There is no single cause of headaches; a number of causes have been identified; two of the major categories include tension headaches and migraines.

Tension headaches are the most common type of primary headache and account for 70% of headaches. As many as 90% of adults have had or will have tension headaches. Tension headaches occur from contraction of head and neck muscles and may feel like a ‘tight band’ across the area. It can occur in people of either sex and at any age but it is most common in adults and adolescents. It is of relatively short duration, if treated in time.

The tension headache usually occurs in isolated incidents but can become chronic for some people. Possible causes of muscle contraction associated with tension headaches are stress, fatigue, poor posture, eyestrain, tobacco and alcohol use, and, in women, hormonal changes before and after a menstrual period.

Treatment: Individuals with occasional tension headaches or mild migraine headaches that do not interfere with daily activities usually medicate themselves with over-the-counter (OTC, non-prescription) pain relievers (analgesics). Many OTC analgesics are available. OTC analgesics have been shown to be safe and effective for short-term relief of headaches (as well as muscle aches, pains, menstrual cramps, and fever) when used according to the instructions on their labels.

Finding an effective analgesic or analgesic combination often is a process of trial and error because individuals respond differently to different analgesics. In general, a person should use the analgesic that has worked in the past. This will increase the likelihood that an analgesic will be effective and decrease the risk of side effects.

Migraine headaches are the second most common type of primary headache and account for 20% of all headaches. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraines can affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.

With a migraine, blood vessels of the head and neck constrict, resulting in a decrease in blood flow to the vessels. Migraine is usually experienced as a throbbing pain on one side of the head with an associated feeling of sickness and sensitivity to light and sound. Pain may be dull or severe and often begins in the morning, gradually worsening in an hour or so and may be accompanied by other symptoms such as nausea, vomiting, vertigo-like feeling and visual disturbances. It commonly lasts from a few hours to one or two days in some cases.

Some of the factors that have been identified as being associated with migraines: family history, prolonged muscle tension and stress, alcohol use, smoking or exposure to tobacco smoke, lack of sleep, certain foods such as chocolate, nuts and fermented or pickled condiments, as well as foods containing the amino acid tyramine (aged cheese, red wine, smoked fish), foods containing preservatives and artificial sweeteners, and for women, menstrual periods and the use of oral contraceptives.

Many people suffer from “mixed” headache disorders in which tension headaches or secondary headaches trigger migraine headaches.

An estimated 40%-60% of migraine attacks are preceded by premonitory (warning) symptoms lasting hours to days. The symptoms may include sleepiness, irritability, fatigue, depression or euphoria, yawning, and cravings for sweet or salty foods. Patients and their family members usually know that when they observe these warning symptoms that a migraine attack is beginning.

An estimated 20% of migraine headaches are associated with an aura. Usually, the aura precedes the headache, although occasionally it may occur simultaneously with the headache. The most common auras are 1) flashing, brightly colored lights in a zigzag pattern (fortification spectra), usually starting in the middle of the visual field and progressing outward and 2) a hole (scotoma) in the visual field, also known as a blind spot. Some elderly migraine sufferers may experience only the visual aura without the headache. A less common aura consists of pins-and-needles sensations in the hand and the arm on one side or pins-and-needles sensations around the mouth and the nose on the same side. Other auras include auditory (hearing) hallucinations and abnormal tastes and smells.

For approximately 24 hours after a migraine attack, the migraine sufferer may feel drained of energy and may experience a low-grade headache along with sensitivity to light and sound. Unfortunately, some sufferers may have recurrences of the headache during this period.

Treatment for moderate to severe migraine headaches: Migraine-specific abortive medications usually are necessary for moderate to severe migraine headaches. The abortive medications for moderate or severe migraine headaches are different than OTC analgesics. Instead of relieving pain, they abort headaches by counteracting the cause of the headache, dilation of the temporal arteries. In fact, they cause narrowing of the arteries. Examples of migraine-specific abortive medications are the triptans and ergot preparations.

How are migraine headaches prevented?

There are two ways to prevent migraine headaches: 1) by avoiding factors (“triggers”) that cause the headaches, and 2) by preventing headaches with medications (prophylactic medications). Neither of these preventive strategies is 100% effective. The best one can hope for is to reduce the frequency of headaches.

What are migraine triggers?

A migraine trigger is any factor that causes a headache in individuals who are prone to develop headaches. Only a small proportion of migraine sufferers, however, clearly can identify triggers. Examples of triggers include stress, sleep disturbances, fasting, hormones, bright or flickering lights, odors, cigarette smoke, alcohol, aged cheeses, chocolate, monosodium glutamate, nitrites, aspartame, and caffeine. For some women, the decline in the blood level of estrogen during the onset of menstruation is a trigger for migraine headaches. The interval between exposure to a trigger and the onset of headache varies from hours to two days. Exposure to a trigger does not always lead to a headache. Conversely, avoidance of triggers cannot completely prevent headaches. Different migraine sufferers respond to different triggers, and any one trigger will not induce a headache in every person who has migraine headaches.

Alternative Treatments

A recent study at the Harvard Medical School has suggested that chiropractic treatments can decrease the frequency and length of headaches as well as the number of painkillers needed for relief. They have found that chiropractic treatment can work, but accurate diagnosis of the headache is key to efficacy. The method used by the chiropractor to treat headaches should be a combination of cervical manipulation and muscle relaxation techniques. After the initial treatments postural changes should be included to limit future headaches.

When should you consult a doctor? Most people with isolated tension headaches usually avail themselves to over-the-counter pain relievers and anti-inflammatories, or self-treatment such as relaxation and sleep. However, for chronic headaches contact your General Practitioner (GP) to discuss possible causes and prevention.
If any of the below symptoms are present your GP should be contacted immediately:

A sudden, severe headache accompanied by nausea and vomiting; persistent and recurring headaches accompanied by memory problems, difficulty concentrating and tiredness; a high fever with neck stiffness (unable to bend the chin down to the chest); convulsions (fits); persistent vision disturbances (light flashes); trouble controlling arms and legs; loss of feeling in the arms and legs; tiredness and apathy with difficulty communicating.

Dr. Eliezer Rosenblum is a NY State Licensed and Board Certified Chiropractor and Physiotherapist. He made aliya in July 06. He practices in Yerushalayim, Beit Shemesh and Ramat Beit Shemesh. For a free phone consultation call 052-662-4658.





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