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.