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Headache: Hope Through Research
For 2 years, Jim suffered the excruciating pain of cluster
headaches. Night after night he paced the floor, the pain driving
him to constant motion. He was only 48 years old when the
clusters forced him to quit his job as a systems analyst. One
year later, his headaches are controlled. The credit for Jim's
recovery belongs to the medical staff of a headache clinic.
Physicians there applied the latest research findings on
headache, and prescribed for Jim a combination of new drugs.
Joan was a victim of frequent migraine. Her headaches
lasted 2 days. Nauseous and weak, she stayed in the dark until
each attack was over. Today, although migraine still interferes
with her life, she has fewer attacks and less severe headaches
than before. A specialist prescribed an antimigraine program for
Joan that included improved drug therapy, a new diet and
An avid reader, Peggy couldn't put down the new mystery
thriller. After 4 hours of reading slumped in bed, she knew she
had overdone it. Her tensed head and neck muscles felt as if they
were being squeezed between two giant hands. But for Peggy, the
muscle-contraction headache and neck pain were soon relieved by a
hot shower and aspirin.
An estimated 45 million Americans experience chronic
headaches. For at least half of these people, the problem is
severe and sometimes disabling. It can also be costly: headache
sufferers make over 8 million visits a year to doctor's offices.
Migraine victims alone lose over 157 million workdays because of
Understanding why headaches occur and improving headache
treatment are among the research goals of the National Institute
of Neurological Disorders and Stroke (NINDS). As the leading
supporter of brain research in the Federal Government, the NINDS
also supports and conducts studies to improve the diagnosis of
headaches and to find ways to prevent them.
Why Does it Hurt?
What hurts when you have a headache? Several areas of the head
can hurt, including a network of nerves which extends over the
scalp and certain nerves in the face, mouth, and throat. Also
sensitive to pain, because they contain delicate nerve fibers,
are the muscles of the head and blood vessels found along the
surface and at the base of the brain.
The bones of the skull and tissues of the brain itself,
however, never hurt, because they lack pain-sensitive nerve
The ends of these pain-sensitive nerves, called nociceptors,
can be stimulated by stress, muscular tension, dilated blood
vessels, and other triggers of headache. Once stimulated, a
nociceptor sends a message up the length of the nerve fiber to
the nerve cells in the brain, signaling that a part of the body
hurts. The message is determined by the location of the
nociceptor. A person who suddenly realizes "My toe
hurts," is responding to nociceptors in the foot that have
been stimulated by the stubbing of a toe.
A number of chemicals help transmit pain-related information
to the brain. Some of these chemicals are natural painkilling
proteins called endorphins, Greek for "the morphine
within." One theory suggests that people who suffer from
severe headache and other types of chronic pain have lower levels
of endorphins than people who are generally pain free.
When Should You See a Physician?
Not all headaches require medical attention. Some result from
missed meals or occasional muscle tension and are easily
remedied. But some types of headache are signals of more serious
disorders, and call for prompt medical care. These include:
- Sudden, severe headache
- Headache associated with convulsions
- Headache accompanied by confusion or loss of
- Headache following a blow on the head
- Headache associated with pain in the eye or ear
- Persistent headache in a person who was previously
- Recurring headache in children
- Headache associated with fever
- Headache which interferes with normal life
A headache sufferer usually seeks help from a family
practitioner. If the problem is not relieved by standard
treatments, the patient may then be referred to a
specialist--perhaps an internist or neurologist. Additional
referrals may be made to psychologists.
What Tests Are Used to Diagnose Headache?
Diagnosing a headache is like playing Twenty Questions.
Experts agree that a detailed question-and-answer session with a
patient can often produce enough information for a diagnosis.
Many types of headaches have clear-cut symptoms which fall into
an easily recognizable pattern.
Patients may be asked: How often do you have headaches? Where
is the pain? How long do the headaches last? When did you first
develop headaches? The patient's sleep habits and family and work
situations may also be probed.
Most physicians will also obtain a full medical history from
the patient, inquiring about past head trauma or surgery and
about the use of medications. A blood test may be ordered to
screen for thyroid disease, anemia, or infections which might
cause a headache. X-rays may be taken to rule out the possibility
of a brain tumor or blood clot.
A test called an electroencephalogram (EEG) may be given to
measure brain activity. EEG's can indicate a malfunction in the
brain, but they cannot usually pinpoint a problem that might be
causing a headache. A physician may suggest that a patient with
unusual headaches undergo a computed tomographic (CT) scan and/or
magnetic resonance imaging (MRI). The CT scan produces images of
the brain that show structures or variations in the density of
different types of tissue. The scan enables the physician to
distinguish, for example, between a bleeding blood vessel in the
brain and a brain tumor, and is an important diagnostic tool in
cases of headache associated with brain lesions or other serious
disease. MRI uses magnetic fields and radio waves to produce an
image that provides information about the structure and
biochemistry of the brain.
An eye exam is usually performed to check for weakness in the
eye muscle or unequal pupil size. Both of these symptoms are
evidence of an aneurysm--an abnormal ballooning of a blood
vessel. A physician who suspects that a headache patient has an
aneurysm may also order an angiogram. In this test, a special
fluid which can be seen on an X-ray is injected into the patient
and carried in the bloodstream to the brain to reveal any
abnormalities in the blood vessels there.
Thermography, an experimental technique for diagnosing
headache, promises to become a useful clinical tool. In
thermography, an infrared camera converts skin temperature into a
color picture or thermogram with different degrees of heat
appearing as different colors. Skin temperature is affected
primarily by blood flow. Research scientists have found that
thermograms of headache patients show strikingly different heat
patterns from those of people who never or rarely get headaches.
A physician analyzes the results of all these diagnostic tests
along with a patient's medical history in order to arrive at a
Headaches are diagnosed as
- Muscle contraction (tension)
Vascular headaches--a group that includes the well-known
migraine--are so named because they are thought to involve
abnormal function of the brain's blood vessels or vascular
system. Muscle contraction headaches appear to involve the
tightening or tensing of facial and neck muscles. Traction and
inflammatory headaches are symptoms of other disorders, ranging
from stroke to sinus infection. Some people have more than one
type of headache.
May 20, 1997
Information provided by NIH.