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When Is a Headache a Migraine?
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What Are the Different Types of Headaches?
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Diet and lifestyle modifications
One measure that people can take to lower the risk of episodic tension headaches is to get enough sleep and eat nutritious meals at regular times. Skipping meals, using unbalanced fad diets to lose weight, and having insufficient or poor-quality sleep can bring on tension headaches. In fact, the common association of tension headaches with hunger, lack of sleep, heat, and sudden temperature extremes has led some researchers to suggest that headaches developed over the course of human evolution as an internal protective response to stress from the environment.
Changes in diet may be helpful to some patients with migraine, although some experts think that the role of foods in triggering migraines has been exaggerated. Women with migraines, however, often benefit by switching from oral contraceptives to another method of birth control or by discontinuing estrogen replacement therapy.
Patients with cluster headaches are advised to quit smoking and minimize their use of alcohol, because nicotine and alcohol appear to trigger cluster headaches. Currently, the precise connection between these chemicals and cluster attacks, however, is not completely understood.
Surgical
Headaches that are caused by brain tumors, post-injury hematomas, dental problems, or disorders affecting the spinal disks usually require surgical treatment. Surgery may also be used to treat cases of idiopathic intracranial hypertension that do not respond to treatment with steroids, repeated lumbar punctures, or weight reduction.
Some plastic surgeons have reported success in treating patients with chronic migraines by removing some muscle tissue near the eyebrows, cutting a branch of the trigeminal nerve, and repositioning the soft tissue around the temples.
Psychotherapy
Psychotherapy may be helpful to patients with chronic headaches by interrupting the "feedback loop" between emotional upset and the physical symptoms of headaches. One type of psychotherapy that has been shown to be effective is cognitive restructuring, an approach that teaches people to reframe the problems in their lives—that is, to change their conscious attitudes and responses to these stressors. Some psychotherapists teach relaxation techniques, biofeedback, or other approaches to stress management as well as cognitive restructuring.
Complementary and alternative (CAM) treatments
There are a number of different CAM treatments for headache, but most fall into two major groups: those intended as prophylaxis or pain relief, and those that reduce the patient's stress level.
CAM therapies intended to prevent headaches or relieve discomfort include:
- Feverfew (Tanacetum parthenium). Feverfew is an herb related to the daisy that is traditionally used in England to prevent migraines. Published studies indicate that feverfew can reduce the frequency and intensity of migraines. It does not, however, relieve pain once the headache has begun.
- Butterbur root (Petasites hybridus). Petadolex is a natural preparation made from butterbur root that has been sold in Germany since the 1970s as a migraine preventive. Petadolex has been available in the United States since December 1998.
- Brahmi (Bacopa monnieri). Brahmi is a herb used in Ayurvedic medicine to treat headaches related to anxiety.
- Acupuncture. Studies funded by the National Center for Complementary and Alternative Medicine (NCCAM) have found that acupuncture is an effective treatment for headache pain in many patients.
- Naturopathy. Naturopaths include dietary advice and nutritional therapy in their approach to treatment, which is often effective for patients with episodic or chronic tension headaches.
- Chiropractic. Some patients with tension or migraine headaches find spinal manipulation effective in relieving their pain; however, no controlled studies of the long-term effectiveness of chiropractic in treating headaches have been done as of 2003.
CAM therapies that are reported to be effective in reducing emotional stress related to headaches include:
- yoga and t'ai chi
- prayer and meditation
- aromatherapy
- hydrotherapy, particularly whirlpool baths
- Swedish massage and shiatsu
- pet therapy
- humor therapy
- music therapy
Clinical trials
As of late 2003, there were three National Institutes of Health (NIH) trials recruiting patients with headaches: a study evaluating a new intranasal drug (civamide) for cluster headaches; a study of the effectiveness of biofeedback and relaxation training in patients with chronic migraine or tension headaches; and a study of migraine headaches in children.
Prognosis
The prognosis of primary headaches varies. Episodic tension headaches usually resolve completely in less than a day without affecting the patient's overall health. According to NIH statistics, 90% of patients with chronic tension or cluster headaches can be helped. The prognosis for patients with migraines, however, depends on whether the patient has one or more of the other disorders that are associated with migraine. These disorders include Tourette's syndrome, epilepsy, ischemic stroke, hereditary essential tremor, depression, anxiety, and others. For example, migraine with aura increases a person's risk of ischemic stroke by a factor of six.
The prognosis of secondary headaches depends on the seriousness and severity of their cause.
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Author Info: Rebecca J. Frey PhD, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Neurological Disorders, 2005 |
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