Headaches for four days: Battling a “brain storm” – Harvard Health
Battling a “brain storm” – Harvard Health
Official statistics indicate nearly 40 million Americans cope with migraines — throbbing headaches so disruptive that those stricken often retreat to a dark, quiet room. But the real numbers affected by this “brain storm” are likely about 50% higher, Harvard experts say, meaning tens of millions haven’t formally been diagnosed and aren’t benefiting from ever-improving treatments.
Migraines aren’t just bad headaches. Pulsing pain, typically centered behind an eye or ear, can join nausea, vomiting, fatigue, brain fog, and increased sensitivity to light or sound that lasts for hours or days.
“We know migraine is underdiagnosed, so that implies it’s undertreated,” says Dr. Paul Rizzoli, clinical director of Graham Headache Center at Harvard-affiliated Brigham and Women’s Faulkner Hospital. “Those who haven’t been diagnosed aren’t people with no symptoms—they have active symptoms but aren’t seeking care or recognizing they should.
“
Fresh approaches with fewer side effects — including a newer medication targeting migraines’ apparent underlying mechanisms — should encourage those delaying a diagnosis to seek help. “There’s no need to continue pushing through without investigating all forms of possible relief,” Dr. Rizzoli says.
Hormonal triggers
Scientists still don’t understand all the reasons migraines happen. But it’s clear they often run in families and can be triggered by factors such as stress, disrupted sleep patterns, hunger or dehydration, certain foods or medications, and bright lights or loud noise. And for women — affected three times as often as men — hormones appear to play a major role in how and when these headaches start — and cease.
“The change in hormone levels that’s part of the menstrual cycle is often a trigger, but there may be other reasons why just the presence of hormones increases migraine frequency in women,” Dr. Rizzoli says.
Midlife, in particular, is often a tipping point.
Some women begin having migraines for the first time, while others with longtime headaches — booming through several days or more every month — notice they worsen, says Dr. Amanda Macone, a neurologist and headache medicine specialist at Harvard-affiliated Beth Israel Deaconess Medical Center.
Treatment advances
Even among people who help manage their migraines by avoiding triggers, medications are fundamental. Drugs either stop headaches in progress or prevent them from starting.
Traditional options to abort migraine episodes include triptans such as sumatriptan (Imitrex, Treximent) and ergot alkaloids such as dihydroergotamine mesylate (Trudhesa), which halt migraine attacks by stimulating the brain serotonin receptors. Others include over-the-counter pain relievers such as aspirin, ibuprofen (Advil), naproxen (Aleve), or acetaminophen (Tylenol).
For headache prevention, doctors often prescribe certain antiseizure medications, such as topiramate (Topamax) and sodium valproate (Depakote), or beta blockers, such as nadolol (Corgard) metoprolol (Lopressor, Toprol XL).
Botulinum toxin (Botox) injections offer a potential option for people with chronic migraine (15 or more headaches per month).
But recent years have seen the advent of targeted therapies that work better with fewer side effects. “We need to turn down the headache at its source,” Dr. Rizzoli says, “and the usual medications we have don’t work for everyone.” Here are the most promising fresh options:
CGRP blockers. These drugs interfere with a protein called calcitonin gene-related peptide (CGRP) that can trigger inflammation and pain around the covering of the brain. Formulations include atogepant (Qulipta) and Rimegepant (Nurtec), a daily pill; erenumab (Aimovig) or fremanezumab (Ajovy), a shot you give yourself once a month; and eptinezumab (Vyepti) or galcanezumab (Emgality), given at a health care facility as an infusion every three months. “They all work on the same principle,” Dr. Rizzoli says. “CGRP is part of the sequence of events that starts a headache.
If we can block CGRP, we can block the development of a headache.” Side effects are rare, he adds, and “that’s a big advance.”
Nasal sprays. Delivering migraine medications through the nose isn’t new. But Trudhesa is available in a new nasal formulation of the well-established ergot alkaloid drug dihydroergotamine mesylate, which is still available in an earlier nasal spray version (Migranal). It stands out for its rapid absorption into the brain, making it a useful therapy to stop a migraine in progress.
Green light therapy. Exposure to green light — unlike red, blue, or other colors — can shorten or avert a migraine. It’s not a standalone approach, but Harvard research has suggested green light is the most soothing on the spectrum, Dr. Rizzoli says. Green light lamps and glasses are commercially available.
Image: © Christopher Robbins/Getty Images
What type of headache do you have?
Headaches are familiar to nearly everyone: in any given year, almost 90% of men and 95% of women have at least one.
In the vast majority of cases, however, the pain isn’t an omen of some terrible disease. The three most common types of headaches are tension, sinus, and migraine. The most common headache triggers are stress, fatigue, lack of sleep, hunger, and caffeine withdrawal.
Mixed headaches
As understanding of the different types of headaches has evolved, researchers have altered some of their beliefs about migraine and tension headaches and the relationship between the two. This is largely because of the realization that some headaches don’t neatly fit either category. “Mixed” headaches have characteristics of both types, and because they’re hard to classify, treatment can be challenging.
For instance, the more intense a tension headache gets, the more it resembles the sharp, throbbing pain of a migraine headache. Likewise, when a migraine headache becomes more frequent, its pain begins to feel like that of a tension headache. Symptoms of headaches fall along a continuum ordered by their characteristics: the occasional tension headache is at one end and the classic migraine headache is at the other.
In between are chronic daily headaches, which can start with features typical of either tension or migraine headache.
Headache caused by a medication or illness
Some headaches are actually symptoms of another health problem. Many non-life-threatening medical conditions, such as a head cold, the flu, or a sinus infection, can cause headache. Some less common but serious causes include bleeding, infection, or a tumor. A headache can also be the only warning signal of high blood pressure (hypertension). In addition, certain medications, such as nitroglycerin and female hormones (prescribed for a contraception or menopausal symptoms) are notorious causes of headache.
Because the following symptoms could indicate a significant medical problem, seek medical care promptly if you experience:
- a sudden headache that feels like a blow to the head (with or without a stiff neck)
- headache with fever
- convulsions
- persistent headache following a blow to the head
- confusion or loss of consciousness
- headache along with pain in the eye or ear
- relentless headache when you were previously headache-free
- headache that interferes with routine activities.
Always take children who have recurring headaches to the doctor, especially when the pain occurs at night or is present when the child wakes in the morning.
Common types of headaches | |||
Headache Type | What it feels like | Who gets it | How often and for how long |
Tension | Mild to moderate steady pain throughout the head, but commonly felt across the forehead or in the back of the head. Generally not accompanied by other symptoms. | Can affect children, but is most common in adults. | Frequency varies. Generally hours in length. |
Sinus | Mild to moderate steady pain that typically occurs in the face, at the bridge of the nose, or in the cheeks. May be accompanied by nasal congestion and postnasal drip. | Affects people of all ages. People with allergies seem most vulnerable. | Frequency varies. Generally hours in length. Often seasonal. |
Migraine | Moderate to severe throbbing pain, often accompanied by nausea and sensitivity to light and sound. The pain may be localized to the temple, eye, or back of the head, often on one side only. In migraine with aura, visual disturbance precedes the pain. | Typically occurs from childhood to middle age. In children, migraine is slightly more common among males, but after puberty, it’s much more common in females. | Attacks last a day or longer. They tend to occur less often during pregnancy and with advancing age. |
Image: m-imagephotography/Getty Images
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Headaches every day – take analgesics?
Many people have occasional headaches. If this problem bothers more than 15 days a month, then we are talking about a chronic headache. Definitely, this is a serious reason to go to the doctor. Constantly experienced headaches reduce the ability to work. Timely diagnosis, adequate treatment and constant monitoring by a specialist cephalologist will help you in the future.
Often the causes of chronic headaches are not fully understood. Often, excessive use of painkillers forms a drug-induced headache, because. analgesics destroy the functioning of the brain’s own anti-pain system.
If you use painkillers more than 2-3 times a week (or more than 10 times a month) to stop a headache, then there is a serious risk of developing a drug-induced headache.
Chronic headaches are often associated with anxiety, depression, sleep disturbances, weight gain, chronic fatigue or overwork, long-term tension in the neck muscles, and especially the abuse of caffeine, energy drinks, nicotine and analgesics.
Clinical manifestations of chronic headaches
A condition in which headaches occur more than 15 days a month for at least 3 consecutive months is called chronic daily headache (CDAH), its forms are chronic migraine and chronic tension headache. Organic causes of CEHD are less common.
It is necessary to eliminate the factors contributing to the occurrence of CEHD: prolonged stress, obesity, abuse of painkillers (taking more than 10 days a month), persistent sleep disorders and emotional disorders (anxiety, depression), frequent cephalalgia (headache attacks more than 1 time per week).
When should I see a doctor?
1. Headache increased significantly.
2. The nature of the pain has changed.
3. Need to increase the usual dose of analgesic.
4. Taking analgesics more often, once a week.
5. More than one episode of pain per week.
Attention! Seek immediate medical attention if:
• sudden and unbearable headache;
• pain worsens despite taking analgesics;
• pain after a head injury, even if several hours have passed;
• headache along with fever, stiffness in the neck, clouding of consciousness, double vision, numbness of the body, weakness in the limbs, impaired speech.
Diagnosis of CEHD is based on neurological examination findings, sometimes blood and urine tests, MRI of the head and neck are required.
In the treatment of patients with CEHD:
treatment should be complex and individual;
a combination of non-drug and drug methods is needed;
therapy should be long
The first steps in the treatment of CEHD: explaining the need to cancel the “favorite” pain medication, keeping a diary of headaches and selecting adequate therapy.
For prophylactic treatment of CEHD (by prescription only) use:
1. Antidepressants, which also help with depression, anxiety, insomnia.
2. Anticonvulsants to prevent migraine attacks used for prophylactic treatment of CEHD.
3. Non-steroidal anti-inflammatory drugs (NSAIDs) with minimal risk of overuse cephalalgia.
4. Botulinum protein type A, its injections according to a special technology are effective, safe, and give a pleasant bonus – facial rejuvenation. A single injection avoids the daily use of “traditional” medicines.
Non-drug therapies:
1. Acupuncture
2. Massage to relax the muscles of the back, shoulders, neck and back of the head.
3. Meditation to achieve relaxation.
4. A biofeedback method that teaches pain control, pulse and muscle tone.
5. Transcutaneous electrical stimulation of the branches of the trigeminal or occipital nerve with a special device that contributes to a significant reduction and relief of pain.