HEADACHES

HEADACHES Result from biochemical changes in the brain.

Stress acting on the nervous system make headaches more likely to occur.

The stress may be biochemical emotional, biological or psychological

Types of HeadachesMigraineTensionMixedClusterSinusReboundMenstrual

MIGRAINEDisorder affecting the whole body.Has 5 distinct phases.

Phase I – Prodrome Phase II – Aura Phase III – Headache Phase IV – Resolution Phase V - Postdrome

MIGRAINE Phase I Prodrome

50% of Migraineurs experience a prodrome within 24 hrs prior to a headache.

Alteration in mood: irritability, depression, euphoria, high/low energy levels.

Alteration in sensory perception: overly sensitive to light, noise, touch, odors.

Food cravings: carbohydrates – candy, cakes Excessive yawning & speech/memory

problems.

MIGRAINE - Phase II Aura 15% experience aura within 1 hr. prior to

headache (discrete disruption of brain function). Flashing lights & shimmering zigzag lines

encircling a central dark blind spot. Decreased visual acuity. Numbness or the feeling of pins & needles

around the lip or hand. Occasionally profound with loss of speech &

vision or even hallucination.

MIGRAINEPhase III - Headache

Usually pulsating, occurring on one side of the head but may occur on both sides & alternate from side to side.

Lasts for 4 to 72 hrs.May feel sick to the stomach & does not

want to eat, move, see or hear.

MIGRAINEPhase IV - Resolution

Head pain subsides and the body regains normal homeostasis.

The process occurs over several hours during sleep or rest or may end abruptly during vomiting or after an intense emotional experience.

MIGRAINEPhase V - Postdrome

After head pain stops, most migraineurs experience a period lasting up to 24 hrs. when they feel drained, fatigued & tired.

They feel mentally dull & muscles ache.Emotions are frequently volatile, ranging

from depression to euphoria.

TENSION HEADACHE Common, accounting for nearly 90% of all

headaches. Frequently associated with fatigue &

stress. Usually bilateral (pain on both sides of the

head). Muscle tenderness may accompany a

tension headache like in a migraine headache but it is less severe.

Factors that Differentiate Tension from Migraine Headaches:

Disability is usually less, allowing individuals to continue to work with the headache.

Routine physical activity does not worsen the pain.

Nausea, vomiting & over sensitivity to lights & sounds do not generally accompany the headache.

Tension – type headache rarely awakens a person from sleep.

MIXED HEADACHESMixed or tension-vascular headache

shares features of both migraine and tension-type headaches.

A migraine is superimposed on a tension-type headache.

Frequently associated with analgesic overuse, depression, sleep disturbances & anxiety disorders.

CLUSTER HEADACHEPain is excruciating.Affects men 6X more frequently than

women & <50% of individuals.First attack strikes during the 2nd or 3rd

decade of life.Usually associated with heavy smokers.Do not appear in family members.

CLUSTER HEADACHESHeadaches lasts 15 minutes to 3 hours,

but these headaches “cluster” occurring up to several times a day for periods of 3 – 16 weeks.

The headache may resolve for months to years then strike again.

Occasionally it becomes chronic.

CLUSTER HEADACHES Cluster pain originates behind or around one eye

& generally awakens the person from sleep. Pain may radiate into the temple, jaw, nose,

teeth or chin. The eyelids droop, the eyes tear. The face flushes & the nose congests. There is usually no nausea or vomiting. During an attack the person is restless &

agitated. Alcohol, cold wind & heat blown into the face

may initiate an attack during a cluster period.

SINUS HEADACHE Associated with inflammation of the sinus

cavities, usually as a result of an infection or allergic reaction.

A deep dull ache, located around the nose, sometimes extending into the forehead and ears.

Frequently, there is a thick, purulent, colored nasal discharge & bad breath.

Last as long as the underlying condition exists.

REBOUND HEADACHE Occurs daily or almost daily even though the

person takes headache medication to counter the discomfort.

Typically, the medication brings relief, but as it wears off, the headache returns.

As the condition worsens, the medication becomes less effective.

Eventually the medications used to treat the headache perpetuate the headache cycle.

REBOUND HEADACHE Drugs capable of producing rebound

headache: Over the counter analgesics (Aspirin,

Tylenol, biogesic, alaxan, etc.) Caffeine Prescription pain medicine Sedatives Ergotamines (Avimigran)

REBOUND HEADACHES The head pain often persists to varying

degrees throughout the day, fluctuating in intensity from mild to moderately severe.

The ache is usually diffuse or dull, on both sides of the head but at times may be localized to a specific area of the head.

Symptoms characteristic of migraines may accompany the daily pain.

REBOUND HEADACHES The only effective treatment is to withdraw the

person from the medication responsible for the rebound phenomena.

Withdrawal symptoms are expected. The headache may intensify during the

withdrawal process. Once the medication is out of the system, an

alternative way to treat the headache will be prescribed.

MENSTRUAL MIGRAINEThe fluctuation of hormones, especially

estrogen, during the menstrual cycle is associated with migraines in 60% of female migraineurs.

14% suffer migraines only at the time of menses.

The headache begins just prior to the start of menstruation.

MENSTRUAL MIGRAINESEstrogen does not directly cause a

migraine. Instead, a rapid decrease in estrogen

levels is most likely to be associated with migraines, suggesting that stable levels may be migraine-protective.

More difficult to treat & last longer than other types of headaches.

DANGER SIGNALS Only 1 out of 25,000 acute headaches is a

symptom of a serious underlying disorder. Consult a physician if any of the following

symptoms appear.1. The head pain is severe & new, unlike past

headaches.2. The head pain becomes worse over time3. The head pain begins with physical exertion,

straining, coughing or sexual activity.

…DANGER SIGNALS4. With the head pain, the person feels

drowsy, confused, feverish or shows signs of physical decline.

5. The first headache occurs after the age of 40.

DIETARY TRIGGERSDietary Factors

Alcoholic Drinks (Red wine, champagne, beer).

Foods containing tyramine:

o Aged cheeseo Dried/smoked fisho Sour creamo Yeast extract

Substitutes White wine, clear

liquor. Cottage cheese,

ricotta Freshly prepared

fish Yogurt (not

homemade)

DIETARY TRIGGERSDietary Factors

Citrus fruits Aged, cured or

processed meats: hot dogs, luncheon meats, bacon.

Chocolate

Substitutes Other fruits Freshly prepared

meat

Carob

DIETARY TRIGGERSDietary Factors

Pickled, fermented / marinated foods: herring, sardines, anchovies, capers

Dairy products Onions Nuts, Beans

Substitutes Freshly prepared

fish

DIETARY TRIGGERSDietary Factors

Caffeine-containing beverages: colas, teas, coffee.

Aspartame (Nutrasweet, Equal)

Peanuts, peanut butter

Substitutes Herbal teas, fruit

juices (bottled or fresh but not citrus), water

Honey

Almond butter

DIETARY TRIGGERSDietary Factors

Food additives: meat tenderizers, MSG (Monosodium Glutamate – Vetsin), nitrates, soy sauce.

Homemade yeast breads & yogurt.

Substitutes Natural spices

Breads/foods without active yeast cultures

LIFESTYLE FACTORSStressDisrupted sleep patternsFrustrationsFatigue Irregular eating habitsCigarette smoking (Cigarette smoke

contains carbon monoxide – poisonous gas)

ENVIRONMENTAL TRIGGERS Bright light Flickering light source Fluorescent lighting Perfumes Strong odors Fumes from industrial complexes Air pollution Second-hand cigarette smoke Motion

ENVIRONMENTAL TRIGGERSWeather changes – change in

barometric pressure or in ionization of the air.

High HumidityDirect heat exposure from sunlightComplex visual factors – error in

refraction.

MEDICATIONSBlood vessel dilating drugs

(nitroglycerine)Drugs for blood pressure (Hydralazine,

reserpine, nifedipine)DiureticsAnti-asthma medicationsToo frequent use of analgesics,

ergotamines

ELIMINATION DIETDay I Eat your normal dietDay 2 Eliminate chemicals from diet,

such as food additives, over-the-counter drugs, nicotine, alcohol, caffeine.

Day 3 Begin diet of brown rice, fresh or boiled fruit (not citrus) & vegetables, noncaffeinated herbal teas & 8 glasses of water per day. Continue to 10 days.

ELIMINATION DIETDay 13 Add one type of food and

test the body’s response. Add bread, fruit or dairy products. Eat a moderate amount, such as 3-4 slices of bread, 4 oz. Of cheese or 8 oz. Of milk.

Day 17 Add meat, only one kind per day.

ELIMINATION DIETDay 18 You may choose to add

processed foods one at a time to test the body’s reaction.

Day 19 If the body acts negatively with headache, nausea, stomach upset or intestinal problems, avoid that substance for two weeks. Retest and if the same reaction occurs, eliminate that substance from your diet.

The Goal in Headache Management is to create

The Most Healthy, Restorative

Environment possible!

Simple measures, such asHealthy diet, clean smoke-free air,

Health-enhancing behaviors & Avoiding specific chemical & physical

Triggers, minimize Headache Frequency

HEADACHE FREE

BYROGER CADY, M.D.

KATHLEEN FARMER, Psy. D.

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