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Treatments can vary widely, from medication to surgery or herbs
By CINDY GEORGE Copyright 2008 Houston Chronicle

Constant shooting, stinging, throbbing and other painful head-pounding could ruin — or rule — your life.

Up to 35 million Americans suffer migraine and other forms of headache, according to the American Academy of Neurology.

• FOUR TYPES OF HEADACHES: The main types of headaches are tension, migraine, cluster and hormone.
Tension headaches, the most common, cause a band-like sensation or other pressure around the head. Most migraine headaches occur on one side of the head. Described as the most intense, cluster headaches attack in groups. Hormone headaches are associated with women’s menstrual cycles.

• OTHER TYPES OF HEADACHES: You might also experience over-medication rebound headaches, sinus headaches and those caused by brain abnormalities, including tumors.
• TRIGGERS: Stress, certain foods and sleeping patterns can trigger headaches.
“Eating meals regularly, staying well-hydrated and trying to minimize stress in life, sleeping well and getting exercise really do make a difference,” said Dr. Pamela Blake, a Houston neurologist at Memorial Hermann Northwest.

Changing weather that causes barometric pressure to spike or dip could be the culprit.

“When the fronts are coming in, primarily in the spring and fall, that will trigger headaches in the front of the head or face,”said Dr. Howard S. Derman, a neurologist at The Methodist Hospital. “People sometimes think those are sinus headaches because of spring flowers, but they’re really not.”

The same concept applies to people plagued with head pain while flying, hiking or mountain-climbing.

• FOOD AND DRINKS TO AVOID HEADACHE: “Red wine is at the top of the list,” Derman said.
Tyramine, found in chocolate, aged cheeses, vinegar, sour cream, soy sauce and yogurt can trigger headaches. So can nitrites, the preservatives found in smoked fish and many processed meats, and MSG — a flavor enhancer found in a wide variety of processed foods. Also watch your caffeine; too little or too much can bring on a headache.

• SLEEP: Evaluating your shut-eye might help, especially for migraines.
“If we can get them to sleep, their headaches generally do better,” said Derman, also director of the Headache Clinic at the Methodist Neurological Institute.

• STAY HYDRATED AND FED: Dehydration and long periods without eating are often-overlooked headache triggers.
• EYE STRAIN: The strain from reading in dim light, extended reading or driving sessions as well as an outdated prescription for contacts or glasses can hurt your head.
• IT MAY NOT BE A HEADACHE: If the pain in back of your head has been constant for five years, “that’s not a migraine, that’s a nerve problem” said Blake, director of the Headache Center of Northwest.

So, what to do about it?

New headache and migraine treatments, including a two-in-one pill, surgery and an implant, could take the pain away.

Medication:

• WHAT’S NEW: This spring, the U.S. Food and Drug Administration approved a new migraine pill called Treximet, which combines the active ingredient in the migraine medicine Imitrex with a painkiller.
“The drugs work together to treat the headache and if there is a recurrence, there’s a little medicine on board that may kick in later,” Derman said.

• PREVENTIVES: Several anti-seizure drugs and anti-depressants are bringing headache and migraine patients’ relief, including Topamax and Cymbalta.

Procedures

• NERVE BLOCK: The occipital nerve block, called ONB, is a 10-minute outpatient steroid injection around pinched nerves that stretch from the upper neck to the back of the eyes.
“That will help relieve chronic daily headaches and migraines,” Derman said.

The medication doesn’t go into the bloodstream and there are no side effects from the steroids, he said.

After 140 procedures in the last 18 months, Derman reports a 65 percent success rate.

• NERVE DECOMPRESSSION SURGERY: Involves an incision at the back of the head to remove thick tissue that squeezes occipital nerves.
“The decompression is very effective in relieving headaches that have been going on for years,” Blake said. She evaluates patients and determines which nerves need the operation.

A surgeon performs the decompression. Ideal candidates have had daily, constant headaches for more than 6 months and do not respond well to medications. About half of patients with insurance are covered for the procedure.

• NERVE STIMULATION IMPLANT: A device connected to a battery pack, similar to a pacemaker, is placed under the skin to stimulate occipital nerves and drown out pain.
“The theory is that your brain can only listen to one type of stimulation at a time,” Blake said. “If we can drive out painful stimulus with painless stimulus, the brain will listen to that.”

This is an option for people who did not respond to decompression surgery or whose insurance will not cover the surgery.

Alternative methods

Magnesium, CoQ10, the medicinal herb Feverfew and other over-the counter supplements may help. Some people find relief with acupuncture and biofeedback. “I’m supportive of all treatment regimens, if they work for you,” Derman said.
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Q. What’s the difference between a migraine and a headache?

A. A migraine is a form of headache that is typically more severe and debilitating. A migraine often feels like a throbbing or pulsating pain, whereas a headache is usually just mild discomfort in the head. When someone has a migraine, they often are sensitive to light, sensitive to sound and can become nauseated. There are two types of migraines: one with aura beforehand and one without. An “aura” typically consists of seeing flashes of light, a perception of zigzag lines in a person’s field of vision, blind spots or a feeling of tingling in an arm or leg. These symptoms might be noticed about 15 to 30 minutes before pain begins. The migraines that have no aura begin without warning and the pain gradually builds up.

Q. How is a migraine treated?

A. Migraines can be treated at two different times: once the person develops a migraine or before they develop one. Both treatments are done with medications that relieve the symptoms, though outcomes are usually better when the migraine is treated as early as possible.

Some women can get severe migraines around their time of menstruation. These types of migraines can be helped with the use of hormones or birth control pills.

Q. When should I get medical help for migraines?

A. You can take over-the-counter, pain-relieving drugs once you experience the first signs or symptoms of a migraine. However, if you are taking over-the-counter medications for them more than eight times a month you should look into seeing your doctor about a prescription treatment. These medications are preventive in nature, sometimes taken daily, and serve to reduce the frequency and severity of the person’s migraines. Your doctor may also discuss medications to take at the first sign of a migraine. These medicines help eliminate the migraine or make the symptoms much more tolerable.

Q. What about alternative medicines or home remedies?

A. Any activity you find relaxing might lessen the effects of a migraine, such as taking a hot bath or sitting quietly in a darkened room. If you are experiencing chronic headache pain, some alternative remedies like massage or even acupuncture might provide relief. Ideally, you should consult a physician before beginning any alternative medicines.

Derrick Williams, MD, is board certified as an internal medicine physician and practices at CHS Health and Diagnostic Center of Yorktown. For more information, call (765) 759-4069 or send an e-mail to info@chsmail.org.
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