Examing The Causes And Cures Of Headaches

By Jan Howard

Dr John Murphy of Newtown presented a program on “Headaches—what causes them and what cures them,” on September 17 at St Rose of Lima School, sponsored by the Parish Nurse Ministry.

Dr Murphy is a member of Associated Neurologists PC in Danbury. He discussed the various types of headaches and how to treat them.

Headaches can range in severity, from a benign and transient discomfort to severe pain that can be incapacitating. Treatment varies.

Headaches are one of the ten most common symptoms treated by physicians, Dr Murphy said. Seventy-eight percent of women and 64 percent of men suffer from headaches.

He said that in a population of 100,000 people, 80,000 will have headaches. Out of these, 24,000 would take analgesics; 9,100 would suffer almost unbearable headaches; 1,600 would see a doctor; 272 would be referred to a neurologist; and ten brain tumors would be discovered.

Headaches have plagued mankind for centuries, Dr Murphy said. “They can be disabling.”

Six thousand years ago a Babylonian poem described symptoms of migraines, noting “flashes like lightening.” Shakespeare also referred to headaches in his writing.

When taking a person’s history, a physician asks the following questions: a patient’s age at onset of headaches, duration, severity and quality, location, frequency, family history, precipitating factors, and associated features. “We ask people what brings them on,” Dr Murphy said.

During an examination, the physician determines whether the patient looks ill, is alert, has a stiff neck, or has any focal abnormality that would require further examination.

Danger signals would include sudden onset of a headache, onset over 50 years old, focal neurological symptoms or signs, progressively worsening headaches, systemic illness, and onset after strenuous activities.

Migraines and tension headaches are slow in appearing, Dr Murphy said.

Tension headaches are the most common. They are dull, aching headaches with a hatband effect. There is no sensitivity to light, they are mild to moderate in severity, and there is no nausea or vomiting. Stress or muscle contraction may play a role.

Treatment includes reassurance, biofeedback, stress management, physical therapy, and pharmacotherapy, but medicines are used as a last resort, he said.

“As a society, we reach too quickly for headache meds,” Dr Murphy said.

Medicines include Motrin, Tylenol, and muscle relaxants. Caffeine in medicines accelerates the absorption of the analgesic, he noted. If tension headaches occur often, tricyclic antidepressants might be prescribed.

Twenty-three million people get migraines, one out of five women and one out of 20 men, Dr Murphy said. “They can be severe and disabling. Most are not diagnosed, including 60 percent of women and 75 percent of men.

“Some people just put up with bad headaches,” he said. Even children can get headaches, he said, noting that four percent of four and five year olds may have migraines.

Dr Murphy said a great majority of migraine sufferers report a family history of migraines, which suggests a genetic link.

Migraine symptoms last from four to 72 hours. They may have two of the following: unilateral location, pulsating quality, moderate or severe in intensity, and aggravated by routine physical activities, and one of the following: nausea, sensitivity to light or sound, vomiting, and recurring with no evidence of organic disease. The patient must have had at least five attacks.

Migraines, while usually one sided, can be both sides, Dr Murphy said. “It can start on one side and move to the other side.”

Migraine headache sufferers will experience either a visual or sensory aura. With a visual aura, there may be a blind spot. When it recedes, the headache begins, Dr Murphy said. Sensory aura begins with numbness, weakness, and speech disturbance.

Migraines can cause a person to feel drained for days, he said. Migraines caused by menstrual cycles are difficult to treat, he noted. “They are related to falling estrogen levels.” Most women do not experience migraines during pregnancy. Also, women experiencing menopause do not have migraines or headaches, but if they have estrogen therapy, the headaches return.

Dr Murphy suggests regular exercise, sleep, and meals. “Avoid chocolate, cheese, alcohol, and MSG and limit caffeine,” he said. Stress management and biofeedback may be used in treatment.

“Keep a diary of attacks,” he said. “Figure out what happens.”

Medication can consist of mixed analgesics for mild migraines and mixed analgesics, oral narcotics, triptans, or nasal sprays for moderate to severe cases. Drugs that rapidly reduce pain and symptoms are available in tablets, nasal sprays, and by injection. “They are patient friendly,” Dr Murphy said.

These drugs are not used for pregnant women and are used carefully for patients who have risk factors for coronary heart disease, he noted.

Cluster headaches are uncommon and are rarely seen in women, Dr Murphy said. With these, patients suffer excruciating pain around the eyes. They can last for 15 minutes, and occur every night for three to 16 weeks.

In treatment, “Oxygen works almost immediately,” Dr Murphy said.

Exertional headaches are usually benign, and occur when the heart rate and blood pressure increase markedly, he said. Motrin can be an effective treatment.

Analgesic rebound headache is the result of overuse of narcotics, Dr Murphy said. “Medicine overuse often produces chronic daily headache. It is five to ten times more common in women, with the majority in their 30s and 40s,” he said. “Migraine usually precipitates the pattern.”

What is overuse? Dr Murphy said there is overuse if three or more simple analgesics are taken per day for more than five days per week or narcotics or ergots more than three days a week. Some people take up to 36 aspirin a day, he noted.

People taking narcotic medicines more than three days a week are headed for trouble, Dr Murphy said.

Treatment includes withdrawal of analgesics. In the case of narcotic analgesics, they are withdrawn slowly. Headaches will temporarily worsen, he noted. Occasionally, patients will need inpatient treatment.

Muscle contraction headaches occur in the back of the head and are mostly because of tension or stress, Dr Murphy said. They are bilaterial, and are treated by physical therapy or neck exercises.

Headaches suffered only on Saturday or Sunday may be because of changes in caffeine consumption.

Dr Murphy said it is very uncommon to have headaches as a result of sinus disease or allergies.

The Parish Nurse Ministry will sponsor a program on “The Thyroid Gland” on October 1 at 7:30 pm in the Msgr Conroy Room of St Rose School.