By JUDD MATSUNAGA, Esq.
Years ago, my wife was complaining of a real bad migraine headache. She asked me to sit with her, saying that just being there for her would help. So, I made her a cup of tea, sat down and listened as she whined and complained about her previous headaches and her problems at work.
About an hour and a half later she smiled and said that the headache was gone. “No,” I said sadly. “Now I have it.”
Do you sometimes suffer from headaches? Did you know that headaches are among the most common ailments that people experience? Headaches inflict their misery in a variety of ways, from a dull, steady ache to a blinding, throbbing pain. While many headaches are fleeting and manageable, others can be intense, persistent, and debilitating.
There’s still a lot that doctors don’t know about why headaches occur and why certain people are susceptible. However, the creation of a headache classification system has significantly advanced our understanding. Drawing on insights from Harvard Medical School’s Special Health Report, “Relieving Headache Pain,” this article offers information on the most common kinds of headaches and the treatment strategies that work best for each.
Doctors categorize headaches into two main types: primary headaches and secondary headaches. When the headache pain itself is the main affliction, it’s called a primary headache. About 95% of headaches are primary headaches and are triggered by common conditions, such as stress, fatigue, and lack of sleep. When the headache is caused by another underlying medical problem, such as an injury, infection, or disease, it’s called a secondary headache.
The three most common types of primary headaches are tension headaches, sinus headaches, and migraine headaches (but there are others).
Tension headaches, also called stress headaches, are the most common type for adults. When someone complains of a headache, they’re likely suffering from a tension-type headache. Up to 80% of adults in the U.S. get them from time to time. About 3% have chronic daily tension headaches. Women are twice as likely to get them as men.(Source: www.webmd.com, “Tension Headaches,” Feb. 1, 2023)
Tension headaches often come on gradually and typically occur in the middle of the day. They generally produce a dull, squeezing pain often described as a band around the head. These headaches produce pressure that can feel like a clamp squeezing your skull. They can last from 30 minutes to a few days. Although your head hurts, tension headaches usually don’t keep you from your daily activities, and they don’t affect your vision, balance, or strength.
Tension headaches do not originate in the brain. Even though scientists aren’t 100% sure what’s causing that splitting sensation in our heads, recent studies point to overactive or problematic nociceptors as the possible cause. Nociceptors are found in the muscles of the head and neck, as well as in the sensitive membrane called the meninges surrounding the brain and spinal cord.
Modern life is stressful. Anything causing stress can trigger a tension headache. From the moment your alarm clock jolts you out of bed until you’re finally done for the day, you are likely to experience some amount of stress. Whether it’s due to an overpacked to-do list, a demanding job, personal issues or a growing pile of bills, stress is a likely cause behind the tension headache.
To effectively manage tension headaches, it’s advisable to begin treatment promptly when symptoms are mild. The goal is to ease your pain and minimize future occurrences. According to www.webmd.com, over-the-counter (OTC) pain relievers, such as Tylenol, Excedrin, aspirin, and ibuprofen are commonly recommended as initial treatments for these headaches.
If OTC pain relievers don’t help, or you suffer from the chronic kind of tension headaches, talk with your doctor about prescribing a stronger medicine, as well as the pros and cons. If you take too many painkillers, it can lead to what’s called a medication overuse or rebound headache.
Sinus headaches are most likely to occur as a result of allergies, when grass, pollen, ragweed counts are high, or following exposure to other allergens. An allergy or allergic response is generally not a direct cause of a sinus headache but can contribute to its occurrence. Allergies cause symptoms such as sinus congestion, which can lead to headache pain.
Sinuses are air-filled cavities (spaces) located in the forehead, cheekbones, and behind the bridge of the nose. The sinuses produce a thin mucus that drains out of the channels of the nose. When a sinus becomes inflamed, usually as the result of allergies or an infection, the inflammation will prevent the outflow of mucus and cause a pain similar to that of a headache.
What are the symptoms of sinus headaches? Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining. The pain is usually accompanied by other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, facial swelling, sinus pressure and sinus congestion.
Sinus headache treatment is usually directed toward pain relief and treating the infection. Treatment might include antibiotics for the infection, as well as a short period of pain and fever reliever (such as Tylenol or aspirin), decongestants (such as Sudafed), a vasoconstrictor to decrease nasal congestion, or antihistamines (such as Benadryl) to treat the sinus headache symptoms and provide sinus headache relief.
If the sinus headache pain continues after using pain relievers, consult your doctor to see if corticosteroids may be prescribed to further decrease the inflammation. When an allergen is causing the sinus flare-ups, preventive allergy therapy is often needed. If you have questions or concerns about your sinus headache pain and how to treat sinus headaches, consult your doctor.
If you suffer from migraine headaches, you’re not alone. Migraine headaches are a widespread condition affecting about 12% of adults in the U.S. This means that one out of every four households includes someone who experiences migraines. Despite its prevalence, migraine is a complex illness that affects people in very different ways. You may get migraine headaches once or twice a week, or once or twice a year. Untreated migraine attacks can last several hours, or a few days.
Some typical characteristics of migraine headaches include: (1) The pain is throbbing or pounding and feels worse when you move around; (2) You feel it mostly on one side of your head (the word “migraine” is the French derivation of the Greek word hemikrania, meaning “half a head”); and (3) You also have at least one of these symptoms: sensitivity to light and/or sound, nausea, and vomiting.
Both the frequency and the duration of migraine headaches vary from person to person. While migraine headaches are almost three times more common among women, 6% of men suffer from them. Migraine headaches usually last at least four hours and no longer than 24 hours, although they can leave a lingering pain that persists for days or even longer, e.g., women before or during menstruation.
Doctors don’t know exactly what causes migraines, though they seem to be related to your genes, as well as to changes in your brain. Research indicates that if you have a family member who suffers from migraines, your likelihood of experiencing them increases. If one parent has a history of these types of headaches, you have a 50% chance of getting them. If both parents have them, the risk jumps to 75%.
While no definitive cure exists for migraines, a variety of treatments are available to manage them. Some treatments stop attacks after they start, some prevent them, and some can do both. OTC pain relievers, typically containing acetaminophen, aspirin, caffeine, and ibuprofen, are commonly effective for headache relief. But when migraines occur on a regular basis and you’re taking them more than two days a week, it’s time to speak with your doctor about prescription drugs that may work better.
Your doctor will probably want some basic laboratory tests. He or she will perform a physical exam, including a blood pressure check and a careful look inside your eyes with an ophthalmoscope. Increased pressure in the head, which can be a sign of a brain tumor, can cause swelling of the optic nerve; the ophthalmoscope examination can reveal such swelling.
However, due to limited physical evidence headaches provide, medical tests aren’t likely to turn up much in the way of helpful information. Instead, your doctor will rely on the information you provide about your pain. To prepare before an appointment, you may find it useful to jot down the answers to these questions:
• When did your headaches begin?
• Does anything seem related to their onset?
• How often do they occur and how long do they last?
• Where is the pain located?
• How severe is it?
• What does it feel like?
• Do you notice any other symptoms before or during the headaches?
• Does anything trigger or worsen the headaches?
• Does anything ease the pain?
• Does anyone in your family have a history of headaches?
• How have the headaches affected your life?
In conclusion, your doctor will try to determine the causes of your headaches and design a treatment plan. However, if your doctor visit is in two weeks, but you’re in pain NOW, the Harvard Special Report gives the following self-help suggestions to ease symptoms:
• Lie down, preferably in a dark, quiet room.
• Place a cold compress (an ice pack or bag of frozen vegetables wrapped in a towel) on your head and a heating pad or warm towel on the back of the neck and shoulders.
• Sip ginger ale to ease nausea and replace any fluids lost from vomiting.
• If your headache is especially bad, take a medication that makes you drowsy, i.e, a sleeping pill or the non-prescription allergy drug Benadryl.
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Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.