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Health Matters

By Virginia Lester,
RN, MSN, ARNP

A recent survey done by the National Ambulatory Care Medical Society found that headache was the eighth most common reason for patients wishing to visit primary care providers. The overall prevalence of migraine headaches is between 12 and 16 percent and tension headaches account for more than 4 percent. Both migraine and tension type headaches affect women more than men. Another type called a cluster headache is experienced more often by men and affects less than 0.1 percent of the population.

Most headaches are not serious and are not associated with a potentially life-threatening illness such as meningitis, brain tumors or brain hemorrhages. Systemic disorders such as fever, uncontrolled hypertension, sinusitis, and post injury may be the underlying cause for headache.

Headache complaints are of importance to the general population because, as with many other chronic disorders, headache changes the quality of life of the person who is suffering and also causes an economic burden to society at large. In 1993, headache was determined to be the primary cause of 150 million lost workdays and 329,000 lost school days per year.

This article will be limited to a discussion of migraine and tension-type headaches that dominate approximately 90 percent of all headaches that are not considered serious. 

The migraine headache is described as usually on one side of the head, but may be on both sides, with the forehead or total head eventually involved. The onset is gradual; pulsating; moderate to severe; aggravated by routine physical activity. The duration is from four to 72 hours and is accompanied with nausea, vomiting, eye pain from bright lights and occasionally a pre-headache visual disturbance. The tension headache is on both sides of the head with symptoms of pressure and tightness that waxes and wanes. Normal activities can usually be continued and the duration is varied. 

The idea that these two types of headaches have a specific symptom profile is no longer believed to be true. Many people have both types occurring at different times or a mixed headache with both types at the same time. 

Treatment of either type of headache is prevention if possible. Many foods such as chocolate, alcohol, caffeine, aged cheeses and smoked or preserved foods (partial list) can be triggers. Strong, flickering lights, odors or changes in environment can also be triggers. Stress, intense activity or major crises can be an underlying problem that will help to develop a headache. Determining a personal trigger and avoiding it is first line treatment. Many medications can also be prescribed that act to prevent the onset of headaches. Behavioral counseling is also thought to be a preventative treatment.

The use of over-the-counter (OTC) medications is discouraged because repeated use of analgesics (Tylenol, Advil) can actually make headaches worse. The idea is that taking a pain reliever will initially reduce the pain, however when it is no longer effective, the pain is worse, setting up a syndrome known as rebound headache. Daily or frequent use of OTC medications is discouraged. 

Headaches that are unusual in intensity occur in people who do not usually experience headaches, have sudden, very severe onset or cause change in vision or mental status should be evaluated by a primary care provider immediately. If you have a concern or are worried about having a headache, seek advice quickly. It is better to err on the side of caution.