Take Pains to Treat Headaches
It’s a valid excuse to avoid work or stuffy parties. It provides grist for sexist jokes about why some women refuse romantic overtures. But when the headache belongs to you, it’s not funny.
Doctors typically have put headaches into three categories: migraine, tension type and cluster. But discoveries about the underlying mechanisms of headaches have made the terms less meaningful. As a result, patients’ complaints are being taken more seriously and better treatments are being developed, says Dr. Neil H. Raskin, UC San Francisco professor of neurology and a specialist in headache treatment.
“The same mechanism seems to present itself in (all) headaches,” he says. The traditional explanation for headaches--that the dilation and constriction of blood vessels are the primary problem--is not accepted by most specialists now, say Raskin and other experts.
“Biological changes in the brain are believed to be the starting point,” says Dr. Joel Saper, director of the Michigan Head Pain and Neurological Institute in Ann Arbor and past president of the American Assn. for the Study of Headache. Those biological changes, in turn, lead to a cascade of events, he says, including the dilation and constriction of the blood vessels.
(According to traditional--and many say outdated--definitions: migraines are characterized by intense, throbbing pain that can last for days; tension-type headaches are marked by dull, non-throbbing but constant pain; cluster headaches, excruciatingly painful, occur once or many times over a concentrated period.)
“There is growing awareness that headache is not a psychological or stress problem,” says Saper. “You feel pain through the brain.”
For instance, doctors have long debated the concept that migraine sufferers have a “migraine personality,” tending to be ambitious, perfectionists, resentful and aggressive. But a recent study, published in the journal Pain, compared 69 migraine sufferers with 69 control subjects and found no support for the concept.
At the moment, the drug sumatriptan is considered most exciting by headache specialists. It has been shown to relieve a headache in as quickly as 10 minutes. It’s not yet available in the United States, but it’s expected to be soon.
Sumatriptan is administered via an under-the-skin injection, says Rick Sluder, spokesman for Glaxo Inc., the manufacturer. It works by mimicking the action of a brain neurotransmitter called serotonin, thus temporarily correcting the negative biological changes believed to have sparked the headache, Saper says.
In clinical trials, 70% of patients with migraines showed significant relief one hour after taking the drug, Sluder says; 80% reported relief two hours after taking it. An oral form of the drug is also expected to be approved. Experts say sumatriptan use isn’t accompanied by side effects such as nausea.
Meanwhile, at a recent annual meeting of the American Assn. for the Study of Headache, Saper proposed that doctors use a staging system when treating headaches.
“Headaches should be staged based on complexity, just as cancer and other illnesses are,” Saper says. A very mild headache, for instance would be Stage 1A, best relieved by taking a couple of aspirin. A severe Stage 4D headache would perhaps even require hospitalization.
Knowing when to seek professional help for headaches is vital. Anyone who uses over-the-counter headache remedies more than once a week, week in and week out, should consider professional medical help, Raskin says.
