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Off With Your Headache 

With proper medical attention, Chronic headaches don't have to be part of life

For most people, headaches are merely a nuisance that hampers their ability to concentrate and interferes with the day-to-day business of life. For others, a headache can be debilitating. Yet, many who suffer with chronic headaches live with them for years by self-medicating.

  The most common headache types are tension and migraine. Although sinus headaches are a common complaint, particularly in south Louisiana, they are much less common than people think. "Everyone thinks they have a sinus headache, but more often than not, they are experiencing a tension headache," says East Jefferson General Hospital internist Dr. David St. Germain.

  In the rare instances that a sinus headache occurs, the pain is located in the face around the eyes, nose and cheeks and is usually the result of congestion or a sinus infection. If you are not suffering from other symptoms associated with allergies or a cold, it's more likely that you are experiencing a tension headache or a migraine.

  Tension headaches are far and away the most common variety. Typical tension headaches originate at the back of the head and are felt on both sides. The pain often is described as a viselike pressure that feels like a band around the head. They can be disruptive but are not usually incapacitating. To say a tension headache is purely the result of muscular tension oversimplifies a complex physiological response to stress. However, treatment does not have to be complicated. Counseling, exercise, adequate sleep and a healthy diet with plenty of water can help to curb tension headaches. There also are muscle relaxers, anti-anxiety medications and anti-inflammatory medications that can be very effective. Usually, if the stress can be eliminated, the headaches will disappear.

  What can complicate the situation is chronic self-medicating. When a patient forms a pattern of taking headache medicine more than twice a week or in larger-than-prescribed doses, they may experience a rebound headache. The overuse of over-the-counter or prescription medications can cause the medication to perpetuate headaches instead of relieving them. This is referred to as rebound because the pain subsides briefly after taking the medicine and then returns, creating a cycle of chronic headaches. Rebound headaches can be difficult to treat because the patient may have to suffer through a few headaches without medication in order for the rebound effect to subside.

  Compared to tension headaches, migraines can be much more severe. Pain tends to be located on one side of the head and usually is described as throbbing or even stabbing. During a migraine, which can last anywhere from a couple hours to a couple of days, sufferers may experience extreme sensitivity to light and sound, dizziness, nausea and vomiting.

  Although it is a less common symptom, some migraineurs (people who experience migraine headaches) notice an aura at the onset of the headache. Auras are visual disturbances like blurred vision, blind spots, flashing lights or loss of vision on one side. These usually indicate a migraine is imminent and fade as the pain of the headache sets in.

  The cause of migraines is complex, involving vascular restriction as well as chemical interactions in the brain that possibly are linked to serotonin. As of yet, there is no hard-and-fast explanation as to why some people suffer from them and others do not or why women between 15 and 40 experience migraines more than any other demographic. According to the National Headache Foundation, one theory suggests "migraines arise from an inflammatory process resulting from an interaction between the trigeminal nerve and the blood vessels surrounding the brain."

  There is no magic bullet for migraines, but some medications can prevent them from occurring as frequently, and other medications offer immediate relief. For mild migraines, your doctor may suggest an over-the-counter drug like Tylenol, Advil or Aleve.

  For more severe migraines, two types of medications are commonly prescribed, sometimes in combination: preventive and abortive. Abortive medications called triptans are migraine-specific and can be dramatically effective in treating a migraine when it occurs. Imitrex is the prototype for abortive medications, and other commonly prescribed medications include Maxalt and Frova.

  Preventive medications are generally prescribed for someone who suffers from migraines more than two or three times a month. Some first-line therapies for preventive care include Topomax, Depakote and Inderal.

  "There is very good medication available both for prevention and treatment of headaches," St. Germain says. " Yet people see it as a part of living, part of life that they've lived with for so long they just learn to deal with it. If you have any severe headache that interferes with your quality of life, if you have to stop what you're doing and lay down with a headache, you ought to consider seeing a doctor for treatment. We can help."

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