Issue 3 Stories
Active Living

Making Heads or Tails of Headaches

What They Are and How to Treat Them

It’s one of those days. The pain in your head won’t let up. All you want to do is go home, lie down, close your eyes and go to sleep. You’re dealing with a nasty headache.

What actually is a headache, anyway? Why do we get them? And most important, how can we make them stop?

“Simply put, any pain in your head can be labeled a headache,” says Jason L. Asistores, MD, primary care physician at the Sentara RMH health centers in Luray and Mount Jackson.

Headaches afflict about half of all adults at least once a year. Due to hormonal differences, women tend to get about twice as many headaches as men do.

The International Headache Society defines a headache as “any pain above the orbiomeatal line,” an imaginary line that connects the outer corner of the eye to the outer part of the ear canal. If you were to connect those four points on each side of the head to create an invisible plane, any pain above that boundary technically could be called a headache.

Headaches fall into two broad categories. A primary headache is a disorder in itself, and is not caused by anything else. A secondary headache, on the other hand, has a separate cause, such as a bad cold, trauma or hormones—it’s a signal that something else is going on in the body.

Tension and Migraine Headaches

The most common primary headaches are tension-type headaches, followed by migraine headaches, according to Dr. Asistores. With tension headaches, he explains, the belief is that pain receptors located in the neck and around the muscle tissues that surround the cranium—the top portion of the skull that protects the brain—are likely the source of pain.

Sufferers often describe tension, or “regular,” headaches as a sensation of tightness or pressure. Tension headaches are usually felt in both sides of the head, and sometimes in the neck, and can last anywhere from 30 minutes to a week.

“Migraine headaches are a bit more complex,” says Dr. Asistores, “but current evidence suggests that migraine pain is the result of a chemical cascade caused by the dilation, or relaxation, of blood vessels in the brain.”

People with migraines often describe them as “throbbing” or “pulsating.” These headaches are commonly located on one side of the head, and tend to get worse with routine physical activity. Migraines are more likely to be accompanied by nausea, vomiting, and an increased sensitivity to light and sound.

“One often finds someone with a migraine locked up in a dark, quiet room, lying in bed,” Dr. Asistores notes.

Some people also get what is known as an aura before, or right at the start of, a migraine headache. Examples of auras include “seeing floaters or flashing lights, or having a funny taste in the mouth,” explains Dr. Asistores. “In extreme cases, people may even have symptoms that mimic a stroke, such as the sudden onset of speech difficulty.”

Migraines are documented to last anywhere from four hours to three days.

The third and least common type of primary headache is the cluster headache, which manifests as a series of relatively short but extremely painful headaches that people may experience daily for weeks or months at a time. Since they tend to occur at roughly the same time each year, people often mistake cluster headaches for symptoms of allergies or work stress.

Typically experienced more by men than women, cluster headaches involve a nerve in the face, and often create intense pain around one eye.

Cause and Effect

Lifestyle apparently plays a key role in primary headaches. Many people who are exposed to high levels of stress, for example, tend to develop headaches.

“Based on my own observations as a physician, a good number of patients who come in for headaches report being under a lot of strain at work, school or home,” says Dr. Asistores.

Thankfully, many people who suffer from migraines can find relief by making some lifestyle changes.

“Never underestimate the power of healthy living,” says Dr. Asistores. “Healthy sleeping habits, proper hydration and a well-balanced diet would always be at the top of my list of recommendations to help ward off migraines.”

Though they may sound like quackery to some people, a growing body of evidence suggests that relaxation techniques like yoga and meditation can be effective methods for coping with everyday stress, and can greatly reduce the incidence of migraines.

Consuming certain “trigger” foods also can be responsible for migraines in some people—a fact of which many sufferers are unaware. Foods that act as migraine triggers are highly variable from one person to another, according to Dr. Asistores.

“Something that may trigger a migraine in one person may have no effect on another person,” he says.

However, some foods, such as aged cheeses, alcohol, chocolate and high-carbohydrate meals, are commonly linked with migraines. Caffeine may be another culprit.

“Caffeine is tricky, though,” explains Dr. Asistores. “People with migraines may actually experience short-term improvement after taking some caffeine, but it often loses its efficacy with time. In the long run, some people may begin to develop headaches from caffeine withdrawal.”

Headache Treatment Options

To get relief from headaches, most people turn to over-the-counter pain relievers such as ibuprofen, acetaminophen, naproxen and aspirin, all of which are acceptable treatments that usually work. A physician may prescribe stronger doses of these medications, if needed. Patients taking these medications should use them only as directed by their care provider to avoid any serious side effects due to overuse.

In recent years, physical therapy has emerged as another option for relieving headaches. Some physical therapists, in fact, have even begun to specialize in treating patients for headaches. Raymond Moreland, a physical therapist at Sentara Martha Jefferson Hospital, is one of them.

“Headache patients make up about one-third to one-half of my caseload,” Moreland says.

Physical therapists base their treatment delivery on the idea that the most common type of headache, known as cervicogenic headaches, originate in the neck area. Although cervicogenic headaches are considered to be a secondary type, Moreland suspects that some migraine, tension and cluster headaches also may originate in the neck. Nerves that carry impulses from other parts of the body going to and from the neck often end up irritating the neck. From there, the pain can be referred to the head.

“The face gets a signal from the neck that it’s irritated, resulting in a headache,” Moreland explains.

To bring relief, Moreland works with the patient to find movements and/or positions to relieve the pain. He also uses dry needling, a technique that is relatively new to the physical therapy field but is growing in popularity and produces good results.

“Dry needling is similar to acupuncture, but it focuses on neck muscle tissue to treat referred pain,” he says.

Typically, Moreland sees his patients twice a week. He treats them with dry needling during one visit and then does mobilization and manipulation during the next visit. He also talks with his patients about what makes their headaches worse, what helps to relieve them and what they can do at home to help themselves.

Physical therapists tend to have different specialties, so not all treat headaches specifically. Those who do treat headaches may have different training, says Moreland. So if you’re looking for a physical therapist to help you, be sure to ask whether they specialize in treating headaches, and also about their approach and success rate.

Most of Moreland’s patients are referrals from primary care physicians and neurologists.

“Four out of five times I can do something to help with a patient’s headaches,” Moreland says. “I find it very gratifying to help people with headaches. I guess that’s why I do it.”

If Moreland can’t improve a patient’s headaches within two to three weeks, he sends the patient back to his or her doctor for follow-up evaluation.

When to See a Doctor

Overuse of over-the-counter and prescription pain medications, ironically, actually can lead to more headaches—a condition known as medication-overuse headaches.

“That being the case, if one’s symptoms continue to worsen despite taking pain medications, I would recommend seeing a doctor,” says Dr. Asistores.

People suffering from secondary headaches, which have an underlying cause, also should see a physician.

“Headaches from infections, bleeding or tumors in the brain, for instance, are serious conditions that should be treated in the hospital,” he adds.

Certain “red flag” symptoms should raise concerns, too. These include high fevers or a rash along with a headache; symptoms that suggest a stroke, such as speech difficulty, facial numbness/drooping or profound weakness of one side of the body; sudden onset of what seems like the worst headache of one’s life; and changes in personality or one’s level of consciousness.

“These kinds of symptoms should prompt immediate medical consultation when present with a headache,” Dr. Asistores says. “For people with cancer, HIV or Lyme disease who experience a severe headache, they also should seek prompt medical attention.”

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