By Dr. Colin Michie FRCPCH University of Central Lancashire.
Headaches are frustrating and common, often sabotaging our ability to work or socialise. Most are relatively mild, but if severe or unexpected, they require careful consideration in a hospital emergency department.
A “typical” headache lasts 30 minutes to several hours. They often start with an upper respiratory infection, eyesight problems, musculoskeletal issues such as posture, drinking alcohol or following the repeated use of pain-killing medications. Dehydration can make the pain worse. Headaches may relate to hormone issues too: They are more common in women, during a period and during the time of menopause. We can treat the great majority of headaches at home – although they cause pain, they do not represent any underlying illness.
Headaches influence the quality of your life: documenting them in a diary is a useful exercise and might identify a pattern. However, many careful studies, including app-based surveys, suggest we rarely find what causes most headaches. Blood tests or brain scans have not helped either. One exception to this is referred to as the “red wine headache”, which is probably caused by its higher levels of tannins, histamines and flavonoids, including quercetin. This antioxidant typically protects the grape from ultraviolet light, but it interacts with alcohol in some to induce headache.
Rarely, problem headaches that come out of the blue can be the result of damage within the brain. Conditions that need to be ruled out include trauma, haemorrhages, strokes, infections or raised blood pressure inside the skull. Investigations in the hospital often include blood pressure, the retina, brain imaging and possibly a lumbar puncture to check the fluid around the brain. These help rule out any need for emergency neurosurgery or antibiotics.
Some headaches recur. Typically, they cause throbbing pain worse on one side of the head and they bring nausea too. They might start after sleep deprivation, alcohol use or specific dietary items such as cheese, chocolate or caffeine. They may start with an “aura” lasting about an hour – seeing zig-zag and flashing lights, smelling unusual scents, feeling pins and needles, or numbness and difficulty with vision or speaking are well known in migraines.
Caribbean studies have found these are rated as the most disabling common headaches; they can affect approximately 15% of a population. Migraines can last for days. Rapid, early treatments may be effective. In children, migraines typically have a distinct pattern, starting as recurrent abdominal pains that change into headaches over years. Migraines are most troublesome to young adults and tend to improve as we age.
Sufferers find a quiet dark room helps, together with acute pain-killers and sometimes agents to reduce nausea. Pharmacological treatments with triptans are the mainstay of many emergency room treatments in hospitals. Migraine pain leads to many thousands of Hospital reviews across the world.
Migraines are thought to be the result of a rapid dilation of blood vessels within the brain causing pain, in response to powerful messenger molecules. There are several strategies to tackle blood vessel dilation. Medications such as the triptans block the release of messenger molecules and contract dilated blood vessels in the brain. Recently the gepants have been specifically designed to block those messenger molecules in migraine. These too are effective for both preventing and treating migraines, and are being developed as a tablet that dissolves under the tongue, or as a nasal spray.
Another approach that has some success in headache clinics has been the use of botulinum toxin or “botox”. This medication is commonly used to remove facial wrinkles. Successive treatments injected into “trigger” points, where headaches typically start for a patient can reduce the frequency or severity of their migraines.
Allergic and migraine symptoms overlap. Some note that their headaches are brought on by allergies or perhaps if they have eaten foods high in histamine (such as fermented fruit, vinegar pickles, smoked fish or cured meats). Histamine is a neurotransmitter within several sets of nerve cells. High levels of histamine can dilate blood vessels causing flushing, anxiety and headache. This role varies between individuals, but checking this link may help some sufferers.
All those with headaches, including migraine, know that “stress” makes the pain worse. Severe headaches such as migraine are often linked to anxiety and an increased risk of depression too. Reducing stress levels is therefore a sensible method to reduce the need for pharmaceuticals. Triptans and gepants are not readily available to all medical systems internationally either, so this approach is clinically important.
Yoga, meditation and mindfulness exercises all reduce the impact of headaches. Massage and other lifestyle changes may work better for you. This is a valuable and universal message, even if you do not suffer with headaches. How do you reduce your stress levels?
Useful resources:
https://www.nhs.uk/conditions/migraine/
Dr. Colin Michie is currently the Associate Dean for Research and Knowledge Exchange at the School of Medicine in the University of Central Lancashire. He specializes in paediatrics, nutrition, and immunology. Michie has worked in the UK, southern Africa and Gaza as a paediatrician and educator and was the associate Academic Dean for the American University of the Caribbean Medical School in Sint Maarten a few years ago.
