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VOL. 4 • NO. 12
© August 2010
Headaches: A universal pain in the neck In the vast and ever-growing world of human pain and suffering, the headache gets little respect. Ask Dr. Brian McGeeney, a neurologist and pain specialist at Boston Medical Center. He and a group of other doctors — affectionately called Headache on the Hill — have travelled to Washington, D.C. to talk about the urgent need for more federal funding for headache research. Not many congressmen are listening these days — just too many other headaches on the political agenda. But McGeeney is not giving up the fight. For him it’s personal. “My mother had migraine,” he said, noting that he witnessed her discomfort as a young child. “And I have migraine as well. They are universal.” He’s right. Most everyone has experienced a headache in one form or another. According to the International Classification of Headache Disorders, there are roughly 300 different types and subtypes of headaches. Migraine alone has about 20. When one considers all the conditions associated with headaches — ice cream, exercise, hormones and even sex — it’s a wonder we are pain free at all. Adding to the confusion is that though the pain is lodged in the head, the brain itself does not have pain receptors. Rather, headaches are usually caused by faulty blood vessels or nerves in the neck and head. Whatever the cause, the National Headache Foundation reports that more than 45 million Americans suffer from chronic, recurring headaches. That means 45 million suffer from headaches more than 15 days a month for at least three months. It’s no wonder then that between 2004 and 2005 more than 11 million out-patient visits were for headaches alone, one third of which occurred in hospital emergency departments. Fortunately, the World Health Organization (WHO), the medical arm of the United Nations, is arguing the case for headache respect before the international community. The agency now ranks migraines — just one type of headache — as nineteenth among all causes of years lived with disability worldwide. But even those efforts are not gaining traction yet — much
to the dismay of WHO. “Headache,” WHO explains, “… continues to be underestimated in scope and scale, and … remains underrecognized and under-treated throughout the world.” What’s worse, it may be particularly under-recognized and under-treated among blacks. According to a report in a 2006 article in Headache: The Journal of Head and Face Pain, researchers found that roughly 46 percent of African Americans interviewed compared to 72 percent whites sought professional treatment for their migraines or were diagnosed with it even though the respondents complained of moderate to severe headache-related disability. Furthermore, only 14 percent of blacks were prescribed medication to treat migraine compared to 37 percent of whites. Yet, blacks respond very well to migraine treatment, as noted in a later study in the journal Cephalalgia. The researchers found that African Americans as well as whites reported significant reductions in headache frequency and disability as well Bennie Smith was forced to switch occupations — from mechanic to cab driver as improvements in quality of life over a — because of his cluster headaches. The pain from clusters has been called “the 6-month treatment period for migraines. worst that humans experience.” (Ernesto Arroyo photo) The problem starts at home. All too often, the victims themselves are nonchalant about what many believe are simply their place of work because of headaches and 40 percent said their minor annoyances. They still show up for work, for instance, condition restricted their career. headache and all. Bennie Smith, 54, is one of them. But there’s a cost for their loyalty to work. “Presenteeism” “It’s hard to keep a job,” Smith said. “You can’t suddenly take a break until the headache subsides. You’d be right — working while impaired — results in a hefty toll, and can exout the door.” ceed the cost of absenteeism or health and disability benefits. And that’s just for those who were able to keep their jobs. Smith said he recognizes that employers expect job performance, but the attacks impaired his ability to do the A survey conducted in Denmark in 2007 found that 29 percent of the respondents reported that they had changed Smith, continued to page 4
Chronic condition may need stronger relief Hazel Reese decided it was better to write about her headaches rather than complain about them. She published “I Will Not Complain” in 2004 and is working on a follow-up book. Smith suffers from mixed (tension-migraine) as well as chronic daily headaches. (Photo courtesy of Hazel Reese)
H
azel Reese, 66, knows a lot about headaches. She should. She has suffered them for the last 50 years. Her migraine was hormone-related and returned like clockwork every month. Her father gently massaged her temples before she went to sleep. “When I woke up, they’d [her headache] be gone,” she said. At the time she didn’t know she had migraines, a particularly painful type of headache. What’s worse, nor did her doctors.
They insisted she had sinus headaches. It wasn’t until 1982, when Reese was almost 40 years old, that she learned the nature of her headaches. By now, she knows exactly which type of headache she has. “Migraine with aura,” she proclaimed. Unfortunately for Reese, it’s not only migraines that attack. She also suffers from “mixed headaches,” or tension-migraine headaches. “It starts with pain on the left side of my head and a stabbing pain behind my left eye,” she said. All this is preceded by an aura. “I see flashing colored lights,” she said. The tension-type pain is then added to the mix. “That one begins in the back of the neck and moves to the shoulder,” she said. But Reese’s headaches fall under an even broader category — chronic daily headaches. Most people have headaches from time to time, but if a headache occurs 15 days or more a month for at least three months, it is considered a chronic daily headache. Reese says she is never completely without headache pain. “They never really go away completely,” Reese said.
“On a scale of 1 to 10, if I have a 5 or 6 headache, that’s like no headache at all.” Fortunately, most headaches can be treated at home. Overthe-counter (OTC) drugs, such as aspirin and ibuprofen and other NSAIDS (nonsteroidal anti-inflammatory drugs), are the first line of treatment. But overuse can be just as bad — in some cases worse — than the original headache. Internal bleeding or perforation of the lining of the intestines can result, according to the American College of Gastorenterology. Rebound headaches often occur when pain killers are taken more than three days a week or in a higher than recommended dose. Over-use is no trivial matter. Thousands — many of whom are elderly — die each year as a result. The good news is that with the advent of a class of drugs called triptans, many people suffering from migraines are living more comfortably with their condition. Often referred to as a “miracle drug” triptans do not prevent migraines, but instead are used to abort the symptoms of an attack. They are taken as needed. For those with more disabling chronic attacks, prescription drugs are taken daily as a preventive measure. “Many people take it for granted that a headache is something you can’t avoid,” said Dr. Eduard Vaynberg, an anesthesiologist who specializes in pain management at Boston Medical Center. “They view them as benign ailments.” Vaynberg understands that sort of fatalism. “Going to the doctor can be a hassle,” he admitted. “But when you can’t drive because you can’t move your Reese, continued to page 4