Headache Help (35 page)

EYESTRAIN HEADACHES

When we overuse our eyes or do not have the proper corrective lenses, we overwork the muscles around our eyes, which can cause a tension headache. A headache from eyestrain is usually a dull, frontal ache or pain behind the eyes.

Of course, the same medications that help tension headaches will relieve eyestrain headaches, but an eye exam and improved corrective lenses would probably go further in preventing them in the future! Contact lenses do not usually offer an advantage over glasses in regard to headache. Computer screens may exacerbate eyestrain. Taking frequent breaks and using an anti-glare screen may help.

HANGOVER HEADACHES

Alcohol can cause throbbing headaches (with or without nausea) by dilating and irritating blood vessels, wreaking havoc on the blood sugar-insulin balance, causing dehydration, or introducing chemicals to which the body is sensitive. The most effective way to treat a hangover headache is to drink as much water as possible as well as some fruit juice or to eat some honey on crackers and take two aspirin. These strategies are most effective if taken before bed and upon awakening. People who experience migraines may be more susceptible to hangover headaches.

“ICE CREAM” HEADACHES

Some people are particularly sensitive to very cold foods, such as ice cream, and coldness may trigger sudden and severe pain in the forehead, nose, temples, or cheeks. The pain usually lasts less than a minute. It helps to eat the cold food slowly. These headaches are caused because of stimulating a nerve in the back of the throat.

TIGHT-HAT HEADACHES

As most people know, a tight hat, swimming cap, headband, or swimming goggles may cause pressure or irritate the nerves around the head and trigger a headache. In the vast majority of cases, these headaches can be simply treated with the over-the- counter analgesics described in Chapter 2. People who get tension or migraine headaches are particularly susceptible.

WEEKEND AND TRAVEL HEADACHES

If you drink a lot of coffee and tea at work and don’t continue this pattern on the weekend, you may get weekend headaches, which are very common. So-called caffeine withdrawal usually occurs some eighteen to thirty-six hours after the last cup of coffee or tea. Travel can wreak the same kind of havoc on your normal caffeine consumption.

These headaches can be decreased by gradually diminishing the amount of caffeine you regularly ingest so your body is not so de. pendent on it. Or you can be more careful in maintaining a constant level of caffeine consumption on weekends or trips. Going to bed and awakening at the same time as on the weekday may also help.

If you get headaches after a stressful week and get a so-called Saturday morning migraine, you may need to remember to incorporate stress-reducing techniques in your week, such as physical exercise or relaxation exercises to relieve the build-up of stress and how your body holds it. These weekend stress-letdown headaches are often exceedingly difficult to treat and eliminate. It may help to remain busy on weekends, rather than going from a period of high activity to doing nothing. At times, preventive medication may be used on Friday and Saturday only (for example, taking two Aleve on Friday night and Saturday morning).

HOLIDAY HEADACHES

Some people complain that their headaches flare up during the holiday season. A combination of factors, such as the stress and frustration of getting all their holiday shopping and chores done in time, fighting crowds and traffic, and the extra strain of attending numerous social events with coworkers or relatives, is probably responsible. Also, people tend to drink more alcohol and disrupt their routines during the holidays, which can contribute to triggering headaches. Headache sufferers are particularly susceptible to disruptions in their sleeping and eating schedules. The strategies in Chapter 2 (relaxation and stress-reduction exercises and perhaps an over-the-counter pain reliever) will help keep the holidays headache-free.

AFTER-SURGERY HEADACHES

Doctors have noticed for years that patients often experience headaches after surgery. Recent studies suggest that these are actually caffeine-withdrawal headaches because of the requirement that you not eat or drink anything twelve hours prior to the surgery. Discuss this possibility with your doctor prior to surgery.

After surgery, eating and having a cup of tea or coffee and a mild over-the-counter painkiller (aspirin, acetaminophen, or ibuprofen) will probably relieve these headaches. In any case, they resolve themselves quickly.

There is anecdotal evidence that some people actually experience a
decrease
in migraines for several months after surgery. The reason for this is not known.

HEMICRANIA CONTINUA

Hemicrania continua are rare one-sided headaches of dull, throbbing pain. Severe pain may occur, lasting from five to sixty minutes, three to five times per twenty-four hours. The pain is usually pulsating, with several minutes of intensely painful ice-pick jabs. Men and women of all ages suffer equally. Alcohol or physical exertion often intensifies the pain. Some people may experience other symptoms similar to migraines, such as sensitivity to light and nausea.

The anti-inflammatory indomethacin is the drug of choice for hemicrania continua headaches and will relieve them in 80 percent of cases. If you can’t tolerate it, or if it isn’t helpful, then your doctor will probably follow the strategies for migraine prevention, suggesting amitriptyline, naproxen, or calcium blockers.

CHRONIC PAROXYSMAL HEMICRANIA (CPH)

These very rare chronic cluster headaches are treated differently from other clusters. Most common among young women between twenty-five and thirty-five, these headaches are usually one-sided and focused around an eye, temple, or the forehead. Typically, the pain lasts up to fifteen minutes and may strike anywhere from five to twenty times a day. Like other types of cluster headaches, the pain is extremely severe and often associated with a tearing eye and a stuffy or runny nose.

Such severe headaches should be assessed by a doctor to exclude the rare possibility of a tumor or an aneurysm. Once diagnosed properly, CPH headaches are almost always relieved by the anti-inflammatory indomethacin (Indocin), though the effective dose varies greatly, from as little as 25 mg to 250 mg per day. The medication should always be taken with food to avoid gastrointestinal upset. Other side effects of the medication include fatigue, lightheadedness, and mood swings. Liver and kidney blood tests need to be checked regularly to rule out any organ dysfunction.

BACK-OF-THE-HEAD SHARP PAIN (OCCIPITAL NEURALGIA)

About 20 percent of migraine sufferers, as well as other headache sufferers, sometimes experience a sharp, burning, ice-pick or stabbing pain in the back of the head (occipital neuralgia). It may be accompanied by tenderness around the nerve in that area.

If severe, the pain can be relieved with a nerve-block injection of an anesthetic (Marcaine or lidocaine) just under the skin. The pro cedure is easy, with minimal discomfort and low risk. The injection may be done once or twice but usually not more than several times a year. If effective, the pain may be relieved for weeks or months. These so-called occipital nerve blockades are also helpful for cluster headaches and their variants, such as chronic paroxysmal hemicrania. Cortisone injections in the area of the nerve are sometimes more effective.

Back-of-the-head pain may also stem from injury, such as whiplash, or from shingles (herpes zoster). While antidepressants, anti-inflammatories, or the anticonvulsants carbamazepine (Tegretol) or gabapentin (Neurontin) relieve such pain, many people with occipital neuralgia respond better to injections. Physical therapy to the neck occasionally is helpful.

NECK PROBLEMS CAUSING HEADACHE (CERVICOGENIC HEADACHE)

It’s controversial whether neck headache (cervicogenic headache) is a distinct type of headache or is a type of migraine or tension headache. These headaches consist of one-sided back-of-the-head pain, usually accompanied by tension in the neck muscles and muscle spasm. Moving the neck often brings on the pain. Symptoms of migraines may also occur, such as blurred vision or nausea. Other symptoms may include arm pain, tearing of the eye, difficulty swallowing, numbness, and ringing of the ears. An MRI (magnetic resonance imaging) of the neck and other tests usually do not reveal problems. A doctor will probably treat these headaches as migraine or tension headaches. Injections of Novocain or cortisone (trigger-point injections) in the back of the head area or the back of the neck area may also be helpful.

MEDICATION-INDUCED HEADACHES

Almost all medication labels list headache as a possible side effect. Even patients who take a placebo sometimes report headaches. The
Physicians’ Desk Reference
and other medication reference books often list headaches as a side effect or adverse reaction to many medications.

In susceptible individuals, almost any medication may bring on a headache, even acetaminophen, aspirin, or ibuprofen. A few medications, however, that are commonly linked to headaches include atenolol, captropril, cimetidine, cocaine, danazol, diclofenac, nitroglycerin, hormones (estrogen or progesterone), oral contraceptives, and ranitidine (Zantac). In addition, calcium blockers, such as verapamil, can produce a chronic daily low-grade headache, and antidepressants, such as amitriptyline or SSRIs, can increase the frequency of headaches in some people. Ironically, these medications are often prescribed for headaches because they help decrease headaches in more than half of patients who take them and aggravate headaches in only about 5 percent. Likewise, anti-inflammatories, such as ibuprofen, aspirin, and naproxen, also prescribed for headaches, occasionally aggravate a headache situation.

As we’ve mentioned in previous chapters, many analgesics produce rebound headaches when patients overuse them, especially medications with caffeine, which include many of the over-the-counter pain relievers. Although caffeine helps headaches when taken in small amounts, too much caffeine on a daily basis may increase headaches. Ergotamine preparations, which temporarily shrink the arteries, also often produce rebound headaches in daily dosers.

Many medications used to protect the heart or to lower blood pressure will help headaches while others induce more headaches. Nitroglycerin, for example, a medication prescribed for heart problems, often produces a headache. Antibiotics and cold preparations may also bring on headaches in some people.

Fact: Almost any medication can increase headaches in a susceptible individual.

HEADACHES CAUSED BY MEDICAL CONDITIONS

Many other factors can cause headaches, such as too much sun, high blood pressure, and a host of medical disorders.

I
NFECTIONS

In a headache-prone person, any infection may induce headaches. A migraine sufferer with a sinus infection or the flu will probably experience a more severe and prolonged headache than a nonmigraine sufferer. Yet infections can also induce moderate to severe headaches in people who have never had a migraine or tension headache.

Headaches are also common with fevers, which are an indication of an infection. Fevers tend to bring on general head pain that’s caused by the blood vessels in the head expanding. Treatment involves aspirin, acetaminophen, and antibiotics.

Meningitis (an infection involving the covering of the brain) usually produces a fever, headache, and stiff neck. HIV headache can cause severe pain, is often related to light sensitivity, and almost always occurs in conjunction with advanced infection. Any headache associated with a fever should be reported to a physician. While people with HIV may experience headaches for a number of reasons, pre-existing migraines may actually diminish with the onset of AIDS.

C
IRCULATORY
P
ROBLEMS

Although most migraine sufferers experience cold feet or hands, true circulatory problems do not occur more often in headache patients than among the general population.

Stroke may produce headaches in some people, but the pain is usually minimal. Heart disease and artery disease in the arms or legs (peripheral vascular disease) do not usually cause headaches, although medications used to treat these conditions occasionally exacerbate or induce a headache.

H
IGH
B
LOOD
P
RESSURE

Uncontrolled high blood pressure on a moderate to severe level may cause or exacerbate headaches. Usually, these headaches are felt around the head or at the “hatband.” They tend to be worse in the morning and get better as the day goes on. They occur in people with severe hypertension, with over 180 systolic and no diastolic pressure. Treatment involves medication to keep the blood pressure in check.
Mild
elevations in blood pressure, however, do
not
usually increase the severity or frequency of headaches. On the other hand, during the day of a migraine or cluster headache, many people will experience a rise in blood pressure.

C
ANCER

Brain tumors may cause or aggravate headaches, but cancer in other parts of the body usually does not significantly affect head pain. Brain tumors are rare and usually coupled with progressively worse vomiting and increased head pain upon coughing and sneezing. Cancer patients should report any new neurologic symptom, such as vision changes or numbness, to a doctor. Certain medications used to treat cancer or associated medical complications may increase headaches in some people.