In general, headache sufferers are more likely to be younger than older, and the average length of a headache is almost 6 hours for meals and 8 hours for females. Headaches trouble three out of every four people at least once a year and disrupt the lives of 45 million chronic headache sufferers. The most commonly experienced headache is the stress-included neuromuscular or "tension headache" which is generally the result of abnormally tightened or tensed facial and neck muscles. The well-known migraine falls into the other major category of headaches known as vascular headaches, so named because they are thought to involve abnormal function of the brain's blood vessels or vascular system. Migraines, which involve the cerebral arteries, are characterized by extreme throbbing pain and afflict between 16 and 18 million people - 70% of whom are women.

DIAGNOSIS

The diagnosis of headaches is usually made by taking a careful patient history. The frequency (how often the headache occurs) position (where the actual pain originates), length, and severity of the headaches are all important clues that help contribute to analyzing the condition correctly.

There are several different types of headaches:

Neuromuscular headache - The most common neuromuscular headache is the "tension headache," which is characterized by a bilateral, dull, non-throbbing constant pain and tightness of the neck or scalp. Tension headaches usually disappear after the period of stress is over. Headaches that are present when you wake up in the morning or get up from a nap may be caused by bruxism or clenching and grinding teeth during sleep. This headache is often confused with a migraine headache because the pain seems to reside on one side of the head only.

Sinus Headache- Sinus headaches tend to be seasonal and occur most commonly during the spring and fall when pollen is in the air. The sinus is often infected resulting in swollen soft tissues, blocked sinus ducts, increasing pressure, and intense pain. If sinus ducts become chronically infected, more serious complication can result.

Cluster Headache - Cluster headaches, named for their repeated occurrence in groups or clusters, cause excruciating pain around or behind one eye accompanied by tearing and reddening of the eye, a stuffed and runny nose and a flushing of the face. Pain frequently develops during sleep and lasts for several hours. Attacks can occur every day for weeks or months and then can disappear for periods up to a year.

Migraine Headache - Migraine headaches are characterized by severe, throbbing, one sided pain and can be accompanied by any of the following symptoms : visual disturbances, numbness in the arms of legs, the smell of strange odors, nausea, vomiting, cold hands, tremor, dizziness, or extreme sensitivity to sound and light. Migraines are the result of sudden vascular spasms of the arteries which nourish the brain. Then, the brain attempts to increase blood flow by dilating or enlarging the affected arteries. The dilation of the arteries causes the characteristic throbbing pain which corresponds to the heartbeat.

Menstrual Headache - Menstrual headaches are migraine headaches which occur shortly before, during, and after menstruation, or at the time of ovulation. Menstrual headaches are believed to be caused by fluctuating estrogen levels. Estrogens are known to fall immediately prior to a period, especially in women in their late thirties and forties. A drop in estrogen levels may also be responsible for mid-cycle headaches when the surge of estrogen associated with ovulation occurs, and the drop immediately following this surge may trigger a migraine. A sudden change in hormone levels during the final week of taking oral contraception (birth control pills), when estrogen is abruptly withdrawn, can also induce this type of headache. Frequently, the contraceptive pills are stopped in the mistaken belief that the pills have caused the migraine. However, it is often the withdrawal of the pill in the last week which caused the migraine to occur. The addition of a small amount of estrogen during this week may help to prevent such headaches.

TREATMENT

Neuromuscular Headache - Treatment for neuromuscular headaches varies according to the specific disorder causing the headache. For example, tension headaches are simply treated with aspirin or acetaminophen, while bruxism can be helped by corrective devices for the mouth and jaw. Non-drug therapy for chronic neuromuscular headaches includes biofeedback, relaxation training and counseling. Chronic neuromuscular headaches may also be helped by taking anti-depressants or MAO (monoamine oxidase) inhibitors. Anti-inflammatory drugs will control headaches related to arthritis of the jaw or neck.

Sinus Headache - Treatment of sinus headaches includes antibiotics, analgesics, and decongestants. If cysts, polyps, or chronic infection are suspected, soft tissue x-rays are recommended, and a surgeon may need to be consulted.

Cluster Headache - The sudden start and brief duration of cluster headaches make them difficult to treat. Often, by the time the medication is absorbed by the body, the attack is over. However, research has identified several effective drugs including the anti-migraine drug ergotamine tartarate, propranolol, calcium channel blockers and methysegide. Recently, Imitrex, an injectable seratonin, has provided dramatic relief to sufferers.

Migraine Headache - Drug therapies including beta blockers or calcium channel blockers with combinations of ergot and caffeine by mouth, suppository, or injection are often effective. Imitrex has proven to be a miracle drug for some suffers. Biofeedback training, stress reduction, and elimination of certain foods from the diet are also common methods of preventing and controlling migraines. In addition, regular exercise has proven effective in reducing the frequency and severity of migraine headaches.

Menstrual Headaches - Studies at the Yale University School of Medicine have shown that the administration of estrogen to patients suffering from migraines right before and during the period has been remarkably effective at relieving pain common with these headaches. (Estrogen has been shown to be a natural vasodilator and thus prevents initial arterial spasms.) In addition, estrogen therapy has reduced the number of headaches experienced by menopausal women undergoing hormone replacement therapy. Men with deficient male hormone levels are also prone to migraines which seem to be relieved by hormone therapy.

It is very important to screen patients carefully in order to be sure that chronic headaches are not symptomatic of more serious disorders. Careful evaluation and management of headaches can help to alleviate pain and improve the quality of life in all patients.