Headaches often under-diagnosed and undertreated

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Almost everyone has a transient “nuisance” headache once in a while and most find relief with rest or by taking an over-the-counter pain reliever.

But many people who have headaches, especially those who have recurrent headaches severe enough to interfere with work and other activities, may in fact have migraines and not know it, said Dr. Sheena Aurora, a neurologist and director of the Swedish Headache Center.

“I see patients all the time who say ‘I don’t have migraines because I’ve never had an aura’— well only about 20 percent of people with migraine have an aura. Aura is very rare,” said Dr. Aurora.

Such headaches are much more common than classic full-blown migraines and while they may not have a typical aura they often come with other migraine symptoms such as nausea and hypersensitivity to light and noise.

Milder headaches that are not too bothersome and don’t interfere with your daily life are probably simply “tension headaches,” said Dr. Aurora. “But a lot of headaches that people call tension headaches are probably migraines.”

This is good news because many of these milder migraines are treatable, often more treatable than the classic migraines, Dr. Aurora said. “If you have headaches that come and go and interfere with your social and work activities, you should probably see somebody about them.”

Dr. Sheena Aurora

The approach at the Swedish Headache Center is to get to know the person in order to understand why they are getting headaches, Dr. Aurora said.

“We probably talk about their headache for about five to 10 minutes, and we spend the rest of the time trying to understand who you are and what sorts of stresses you may be experiencing in life that could be behind your headaches.”

In some cases, patients’ lives are so fraught with family, work and financial pressures that it seems overwhelming. In that case, to address their headaches, patients need a strategy to help them address those pressures, Dr. Aurora said.

In other cases, a combination of medical issues need to be tackled one by one in order to end the headaches. A patient, for example, might be overweight, which makes her back pain worse, which in turn makes her neck pain worse that triggers the headaches.

Without addressing the lifestyle and medical issues triggering headaches, it is difficult to address the headaches, Dr. Aurora said. “There’s a tendency in America to think there’s a pill for every problem, but there isn’t.”

In many cases, though, small changes in lifestyle can make a big difference. Consider, she says, the case of a hard-charging tech worker who works long hours in the office, comes home late, eats a rushed meal of preservative-laden processed food and then tries to relax by watching television.

Such a person, Dr. Aurora said, might be able to avoid or at least reduce their headaches simply by taking time in the evening to prepare a meal with fresh food without preservatives and then, instead of watching television, take time to get at least 30 minutes or more exercise.

Keeping a headache “diary” to keep track of activities and foods that seem to set off headaches can help identify headache “triggers” to avoid, Dr. Aurora said.

A headache diary can often explain weekend headaches, Dr. Aurora said. “Sometimes people drink coffee Monday through Friday, and then they won’t have it on Saturday, triggering what’s called a coffee-withdrawal headache.”

Headache diaries often reveal that a change in sleep pattern, such as sleeping in on a Saturday morning, is triggering headaches. “In that case, if you need to catch up on your sleep, you could get up at your regular time in the morning and take a nap later in the day,” Dr. Aurora said.

Although Dr. Aurora is not convinced that specific cheeses, wines and other foods are responsible for headaches as many believe, “if you find a consistent pattern linking your headaches to certain foods, definitely avoid them.”

But she’s definitely a skeptic when it comes to “headache diets” promoted by some popular health books. “The headache diets probably don’t work and, in any case, they’re so strict they’re impossible to stick to,” she said.

For headaches that don’t respond to simple lifestyle changes, there is a range of medications that have been shown to be effective for preventing headaches, Dr. Aurora said.

Among some of the newer treatments for chronic migraines are injections of headache trigger points in the muscles of the head and neck with Botox, the muscle relaxing drug made famous by cosmetic surgeons as a treatment for facial wrinkles but also used for a number of neurological conditions, such as dystonia.

In a study conducted at Swedish and due to appear soon in the medical journal Cephalgia, Dr. Aurora and her co-workers got good results with this approach. Other approaches available at the Swedish Headache Center include physical therapy, biofeedback, and, when necessary, psychological counseling.

Recently a number of genes have been linked to specific headache syndromes. These discoveries may help us to better understand the mechanisms behind headaches and lead to drugs that specifically target those mechanisms.

In the not too distant future, Dr. Aurora said, “instead of shooting in the dark” we may be able to use the patient’s genetic profile to design a treatment regimen that targets the specific mechanism behind his or her headache.

MRI scan of the brain

Headache Hygiene

Headache hygiene is the practice of taking care of yourself in a way that will reduce the likelihood, frequency, intensity and severity of headaches.

Lifestyle Changes

Migraine is not a predictable disorder for all people. Simple things like changes to a normal routine can lead to a severely disabling migraine attack.

Understanding how lifestyle affects the severity and frequency of attacks can be a large part of successful migraine prevention.

It is unrealistic to expect anyone to completely change a certain life style. However, certain things are relatively easy to do. For example:

Maintain regular sleep patterns.

Go to sleep and wake up at the same time each day.

Exercise regularly.

For example, aerobic exercise for at least 30 minutes three times a week will help reduce frequency or severity of migraine.

Exercise on a regular basis, even if your daily routine changes (such as when traveling, when you have house guests, or when your workload increases).

Eat regular meals.

Do not skip meals, and eat a good, healthy breakfast.

Reduce stress.

Limit stress by avoiding conflicts and resolving disputes calmly. Some people find it helpful to take a daily “stress break.”

Avoid known triggers.

Establishing daily routines that help reduce migraine attacks is important for long-term migraine prevention. For example:

Schedule a relaxation period that includes relaxation strategies such as:

Take slow, deep breaths

Focus the mind on a relaxing image or scene

Try soft relaxing lighting and sounds

Maintain your treatment plan:

Maintain the medication treatment plan designed by you and your physician. Early intervention may help prevent the migraine from progressing into a severe, disabling attack.

To learn more visit the Swedish Headache Center’s webpage.

To learn more about Swedish read other articles from the supplement:

• Brain Cancer: An Orphan Disease No Longer

Category: Brain & Nervous System, Pain Medicine, Swedish Today