Headache disorders are the Rodney Dangerfield of disease. They do not get the respect they deserve for two reasons. First, they are common. More than 90% of people have had at least one significant headache in their lifetime, 50% within the past year. Around 20% have problematic headaches and 4% have more days of headache than not. The World Health Organization has listed headaches as the sixth most common reason for “years lost due to disability.”
Secondly, unlike other maladies, there are no simple tests that reveal the underlying cause of most headache problems, leaving some to imagine that they are not real or important. This has led to headache disorders being the most under-diagnosed and treated of all medical problems. They should be respected because they cause more disability than all other neurological illnesses combined.
For more than 40 years, there has been a rigorous scientific search for the cause and cure for headaches and the fruit of that labor is starting to be realized. We are now on the threshold of a major game-changer in treatments that prevent a headache from starting. Additionally, some of our old ideas have been challenged and I will describe those changes below.
Out with the Old, In with the New
The International Headache Society (the major research community) no longer believes in headaches attributed to tension, sinus, stress, allergy or eye-strain. The headaches we use to call tension headaches, have nothing to do with stress or tight muscles and are often a form of migraine.
Migraine is not caused by blood vessels dilating or constricting.
Most things previously believed to be triggers for headaches; such as MSG, cheese, chocolate, red wine, sugar, artificial sweeteners or stress, haven’t been shown to be triggers when studied objectively. Real triggers can be estrogen-changing, over or under sleeping and dehydration. Most patients have no specific triggers but the headaches come randomly.
Migraines are most likely caused by genetic errors which allow subtle electrical storms to spread on the outer surface of the brain, which triggers the brain’s headache alarm system. Injuries and other life experiences can exacerbate them.
Triptans, medicines designed to turn off headaches, appear to be safer than we thought and probably don’t cause rebound headaches like painkillers or decongestants can.
The very first, of five, designer migraine-prevention treatments was recently approved and will be available early next year. This treatment uses a natural antibody to block the key chemical (CGRP), which the brain uses to form headaches. After 10 years of research the treatment has been shown to be effective and virtually side-effect free. Even now we have effective treatments for most patients. These treatments range from natural supplements, to hands-on treatments such as nerve blocks and Botox, to a cache of over 25 prevention medications that are quite effective and safe when used skillfully.
by J. Michael Jones MPAS-C, Center for Pain Management
J. Michael Jones MPAS-C sees patients Monday – Thursday from 8:30 a.m. to 4:30 p.m. in the Center for Pain Management, 2511 M Ave., Suite C, Anacortes. For more information or to make an appointment call (360) 299-4929.