The National Headache Foundation in Chicago
claims that over 45 million Americans, (more than the 33 million
sufferers of asthma, diabetes and coronary heart disease combined), get chronic,
recurring headaches. Of these, 28 million suffer from migraines annually,
and 90% of all headaches are tension headaches.
It is estimated
that industry loses $50 billion per year due to absenteeism and medical expenses
caused by headache, and migraine sufferers lose more than 157 million workdays
each year. According to a study published in the
April 1999 issue of the Archives of Internal Medicine, migraine costs
American employers $13 billion per year due to missed work and reduced
productivity.
The Foundation also reports that more than $4 billion is spent annually on
over-the-counter pain relievers for headache and that 70% of all migraine
sufferers are women.
Studies have reported that 5-10% of the population
seeks medical aid for the relief of disabling headaches. A 2003 Marketdata
Enterprises pain management programs study found that 8.6% of pain patients were
treated for this condition (vs. 9.5% in 2001).
Types of Headaches
Headaches fall into three main categories: muscle
contraction, vascular, and those organically caused.
Tension...
Stress, fatigue or hidden depression may act as catalysts. Some get tension
headaches occasionally, while others experience them daily. Doctors may treat
chronic tension headaches with anti-depressants or beta blockers.
Vascular headaches...
occur when blood vessels in the scalp expand and contract to produce a throbbing
pain, often synchronized to the pulse. Migraine and cluster headaches are the
most common type.
Migraine Headaches...
Currently, an estimated 28 million Americans suffer from migraine headaches
(compared with 17 million in 1997, 11 million in 1993 and 5.6 million in 1980),
and the rate of occurrence per 1,000 persons has risen, according to the
National Center for Health Statistics. The National Headache Foundation says
that 70% of migraine sufferers are women, aged 15-45 most often.
About 70% of migraine sufferers have a family history
of the condition. The majority of migraine sufferers are women in the stage of
life between their first menses and menopause, when flux in hormonal levels is
frequent. The prevalence of migraine decreases with age, beginning in the 30s
for males and in the late 40s for females. This appears to result from the fact
that new cases are not reported in later years.
This is a condition that is not only frequently
misdiagnosed as sinus headache or some psychological problem, but often lands
sufferers on a path of diagnostic testing, heavy medications, and folk remedies,
with little result. Even the criteria that physicians use to diagnose migraines
may miss many patients who have unusual types of migraine. Like back pain, the
condition arises for different reasons in different people: heat or cold,
changes in altitude, loud noises, bright lights, and menstrual periods are
powerful triggers, for example (which explains why 75% of sufferers are women).
A growing number of neurologists believe that migraine is an inherited
hypersensitivity in the brain to certain sights, sounds, smells, and other cues.
Black male migraine sufferers generally report more
frequent severe headaches, but less frequent disability from their severe
headaches than white males. Diet, stress, and other factors associated with low
income may also precipitate migraine attacks. Females between the ages of 30
and 49 years from lower income households are at an especially high risk of
having migraines and are more likely than other groups to use emergency care
services for their acute condition.
Cluster Headaches
Cluster
headaches — which involve a stabbing pain on one side of the head — are
relatively rare, affecting less than 1% of people, according to
the Mayo Clinic. 85% of those affected by cluster headaches are men. Cluster
headaches are much less common than migraines, but the pain is considerably
worse.
The National Headache Foundation reports that there
are an estimated one million cluster headache sufferers in the United States, of
whom 10 percent are afflicted with chronic cluster. About 90 percent of the
sufferers are male. Although cluster headaches produce some of the most severe
pain that a physician will see, they can go into long periods of remission. No
cause has been determined for this type of headache, but most can be controlled
with adequate treatment.
Although a
cluster headache can be temporarily debilitating, it causes no permanent harm.
The condition doesn't cause complications or lead to other disorders. Treatments
can't stop you from getting cluster headaches, but they can help decrease the
severity of pain and shorten the duration of the headache.
Although the
cause is unknown, research suggests that abnormal activity in the part of the
brain called the hypothalamus may be the source of cluster headaches. The
hypothalamus controls body functions such as eating, sleeping and sexual
behavior, maintains body temperature and chemical balance, and regulates many
hormones. The hypothalamus appears to be active during a cluster headache attack
on the side of your head in which the pain occurs.
For patients with chronic cluster headaches, lithium
or calcium channel blockers may be used. However, the medication of choice is
methysergide (Sansert). Histamine desensitization and surgical intervention may
be considered for chronic cluster headache patients who have not responded to
other forms of standard therapy.
Headache Causes
According to headache specialists, headaches may have
thousands of causes, the most common of which are tension and anxiety.
Migraines are generally hereditary conditions. Attacks last several minutes to
several days. People who suffer from them are unable to process a brain
chemical called serotonin, which then causes migraine pain. Other causes include
"trigger" foods and beverages, and erratic sleep and exercise patterns.
In addition, some types of aged foods such as cheese,
yogurt, and some cured meats have been known to cause headaches. Regular
exercise helps most people to maintain good health and to avoid chronic
headaches, but very strenuous physical exertion can actually have the opposite
effect.
Treatment ranges from relaxation to the use of ice
packs to analgesics and drugs that constrict blood vessels. To counter attacks,
sufferers can take prescription medications such as: ergotamine (Cafergot),
naproxen sodium (Anaprox), triptans, corticosteroids, and isometheptene (Midrin).
Other medications used include: propranolol (Inderal LA), beta-blockers,
antidepressants, anti-seizure drugs, and MAO-inhibitors, to prevent migraines
from happening in the first place. Some migraine sufferers may benefit from
using biofeedback, which trains a person to control the muscle contraction and
swelling of blood vessels that commonly cause the headaches.
According to the National Headache Foundation,
important elements of treatment are the non-drug general measures recommended
for the majority of migraine patients. The patient should be cautioned about a
diet restricting substances which may contribute to their headaches. (aged
cheese, chocolate, hot dogs).
For the acute migraine attacks, certain abortive
agents may be considered, such as the ergotamine preparations and sumatriptan.
The ergotamine preparations are available for several routes of administration
(oral, rectal, and sublingual). Dihydroergotamine (DHE) may be used for
self-injection.
