| Migraine attacks are usually preceded by a typical aura with flashing lights, lightning bolts in the head, numbness, etc.
I have a headache.” Everyone — from children, teenagers and adults to the elderly — has said this at some time or the other. The statement may be true, or it may simply be an excuse to avoid an unwelcome conversation, person or venture. After all, the pain is in the “head” (no pun intended) and it cannot be objectively verified or measured.
The brain itself is actually devoid of nerves and cannot feel pain. The sensations arise from receptors in the nerves in the surrounding structures such as the eyes, teeth, sinuses, facial muscles, scalp and the meninges (covering of the brain).
Acute pain may be due to an infection in any of these structures. If the headache is chronic and recurrent, it is probably due to tension or migraine, with an overlap between the two conditions.
During such a headache, biochemical analysis of the blood shows a drop in the levels of a neurochemical called serotonin and the trace element magnesium. This, in turn, stimulates the trigeminal nerve (one of the cranial nerves) and results in the release of substances called neuropeptides. Their action is dilatation and inflammation of the blood vessels of the covering of the brain. The result is a throbbing or dull, aching sensation in the head.
Tension headaches may not be confined to the head. There may be pain in the scalp, neck, jaw or shoulder. It may be associated with non-headache symptoms like insomnia, fatigue, irritability, loss of appetite or lack of concentration.
Migraines are the other type of recurrent headaches. They occur in 12 per cent of the population and are three times commoner in women. The headache may be familial, with many members of the family complaining of a similar indisposition. A typical migraine may be preceded for a few days by vague symptoms of drowsiness, irritability, depression, craving for sweets or increased thirst. A few hours before the onset of the headache, there is usually a typical aura with flashing lights, a feeling of lightening bolts in the head, tingling and numbness. (This differentiates migraines from tension headaches, which typically do not have an aura.) The headache that follows is throbbing and unbearable. It may last for a couple of hours or a whole day. It usually subsides with vomiting, leaving a physically and emotionally drained individual who has effectively lost a full working day.
Devastated by the ailment, most sufferers learn to recognise and avoid triggers which precipitate the headache. Migraine may be due to —
Hormones, especially fluctuating levels of oestrogen and progesterone. This is the reason why migraines are commoner in women. They are also aggravated at the time of hormonal surges and changes like menarche, pregnancy and menopause.
Foods containing monosodium glutamate (an additive in Chinese food) and tryptophan (found in chocolates, oats, bananas, poultry and red meat) and some preservatives. This has lead to the coining of the term “Chinese restaurant headache”.
Stress at home or at work, which can cause the release of chemicals.
Scents and perfumes or even the smell of paint.
Insomnia as well as excessive sleep.
Change in the weather.
Headaches are a source of anxiety, especially if they are severe and recurrent. There may also be the persistent nagging fear of a sinister diagnosis like a brain tumour. If you are worried,
Keep a “headache calendar”, so that when you consult the physician you have precise documentation of the type, frequency and duration of the ailment.
Have an ENT (ear, nose and throat) evaluation to rule out sinusitis and an eye check-up for refractory errors or glaucoma.
If these are normal and the headache is still worrying, you need to consult a physician. You may require further tests like a CT scan or an MRI, especially if the headache is non-typical.
A physician needs to be consulted if —
The onset of the headache is abrupt and severe,
If it is associated with fever, stiff neck, rash, mental confusion, seizures, double vision, weakness, numbness or speaking difficulties,
If it has occurred after a head injury or has suddenly appeared after the age of 50 years.
Most headaches respond well to a simple paracetamol or an NSAID (non-steroidal anti-inflammatory drug) like ibubrufen or tolfenamic acid preceded by an antiemetic like domperidone or stemetil. Lying in a darkened room also helps. Anecdotal evidence suggests that acupuncture or pressure are helpful.
Lifestyle modifications help to reduce the severity and frequency of attacks. Triggers should be avoided. Aerobic exercise for 40 minutes a day like walking, jogging, running or stair climbing releases protective mood-boosting chemicals from the calf muscles in the leg. Regular yoga, Tai-Chi, meditation and relaxation also lessen the levels of tension causing chemicals, thus reducing attacks and improving the quality of life.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at firstname.lastname@example.org