Headaches (HA) are a common condition that many people suffer from. Headaches are sometimes the sign of a more serious medical condition, but often they are not serious in themselves. There are different classifications of headaches; the common ones are tension headaches, migraine headaches and cluster headaches. However, it is been postulated that headaches are on a continuum and perhaps more related than originally thought. Many believe that changes in the neurotransmitter serotonin are the basis for most headaches regardless of type. These changes may be triggered by food sensitivities, stress, hormones, medication or other chemical toxicities.
Differentiation of Headaches
Also called muscle contraction headache, tension headaches are a common type of headache. They are usually caused by tightening and strain of the muscles of the face and neck. The muscle tension and the decrease in blood flow contribute to the increased sensation of pain.
It is still not truly known what causes migraine headaches (MHA). Some theories are that they are caused by blood vessels changes in the head; another theory is that there is a change in the electrical function of the nervous system. There are 2 main classifications of MHA: a classic migraine with an aura, and a common migraine without an aura. MHA types that are more rare are ophthalmoplegic which can produce double vision and eye pain (also called ocular or retinal migraine), menstrual (also called catamenial) migraine, and basilar migraine which has symptoms of brainstem dysfunction similar to a stroke (also called hemiplegic). Over 50% of people with MHA have a family history of them. Most people develop MHA between the ages of 10-40 years old, and women suffer MHA more often than men. Estrogen is thought to play a role in migraines, and especially the use of oral contraceptives.
Cluster HAs are more commonly experienced in males, men are affected seven to eight times more often than women; and hereditary factors are usually absent. Many people with cluster headaches are heavy consumers of alcohol, and alcohol consumption has been reported to bring on cluster headache attacks. Cluster HAs are thought to be a vascular headache syndrome much like a migraine.
Stress is also a factor; it is the most frequent cause reported by migraine suffers to trigger a MHA. Certain foods can sometimes trigger MHA: Foods containing the amino acids tyramine or phenylalanine, aged cheese, wine, chocolate and cashew nuts; and monosodium glutamate. Changes in weather, especially barometric pressure, can also trigger a MHA.
Symptoms of Headaches
Tension headaches usually have a pulsating, type of pain that is generally felt on both sides of the head. Many people describe the pain as if it were a vise- like pressure sensation around the head like a band or a hat. The pain can last from half an hour to approximately a week, and is usually not associated with any digestive disturbance or sensitivities to light, sound or smell. Episodic tension headaches are defined as tension headaches occurring less than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months.
MHAs can start with small flashes of light, known as auras, on the periphery of vision. Sometimes in an aura the visual disturbance will appear as dark spots instead of light. Depression, irritability, restlessness or digestive disturbance may be present as well. MHA’s are typically one sided, with pain that can be described as throbbing, stabbing, and severe. The pain is worse with movement and exertion, and there is increased sensitivity to smells, noises and bright light. Most people will experience nausea and some also experience vomiting episodes. Other symptoms that are more uncommon include speech problems, numbness and paralysis. MHA’s usually last 4 hours and longer, sometimes 2-3 days.
In cluster HAs the pain comes on suddenly with intense severity on one side of the head by an eye or temple. The pain is usually short in duration, lasting 15 minutes to 2 hours, but can happen up to 8 times a day for several weeks, with periods of abatement in between. Frequently on the side of the HA there is also redness and tearing of the eye, with nasal stuffiness. Onset of pain is at night in about 50% of the cases, and then the pain usually awakens the patient within 2 hours of falling asleep.