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The Nagging Headache Life is one big headache! When you hear this statement do you think of the many and varied problems one has to go through as we move on through this life or is it about a pain in the Head. If you are taking medication to control that pain in your cranium perhaps you should find out just why you do have a headache instead of just throwing pills at it. As I have talked to doctors and read articles on this symptom the older crowd appear to have headaches due to about four reasons. Muscular skeletal conditions and degenerative processes, structural/postural conditions, medical reasons, and rebound headaches. The accompanying article by Dr. J. Griffin Steel, Neurologist, provides information on the medical treatment for headache. Dr. Chris Carraway, Chiropractic Neurologist, provided information on the Chiropractic treatment for headache and Robin Beilby L.Ac provided information on Oriental Medicine and acupuncture. Misalignment of the spine causes tension in the muscles near the spinal cord and pressure on nerves causes radiated pain. Old injuries and the aging process contribute greatly to some of the misalignment problems which lead to headaches. This condition can be lessened by tension therapy or manipulation. Today most often the small hand-held instrument called an Activator is used instead of Chiropractic adjustments done by hand on a specialized table. According to Jirout J (1985) “Comments Regarding the Diagnosis and Treatment of the C2-3 Segment” out of 200 patients, 90% had headaches resulting from problems with vertebrae and 80% received complete relief through chiropractic manipulation. Structural/postural conditions are caused by osteoporosis and poor posture. As Osteoporosis develops and the person leans more forward, the weight of the head increases the strain on the muscles of the neck and can cause tension headaches. As we age we become sloppy about our posture. How many maintain good posture while they are watching TV? That old soft chair just encourages one to slouch, half lie, or curl up to get comfortable. Many spend hours at the computer. How many sit up straight while playing those video games or reading their e-mail? When you bought the computer table and accessories you probably bought a good chair to go with it. Do you really sit back in that chair or do you lean forward over the keyboard? In both these situations as with Osteoporosis the muscles of the neck are working overtime because the spine and head are not in good alignment. The medical reasons for headaches can be varied. There could be a clogged sinus, eye strain due to changing eye sight, side affects of heart medications, Temporal Arteritis (inflammation of an artery in the neck or head). All of these can cause moderate and intermittent headaches. There are also those headaches that are sudden and severe which are accompanied by confusion and loss of function of one side of the body. When a headache like this occurs one should immediately contact a physician or go to an emergency room. Likewise it is important to visit a doctor if a headache is accompanied by a fever and neck pain. Rebound headaches are those that result from taking medication for the headache. The instructions and warnings on some of the medications you may use for headache list a headache disorder as a side affect. When you take medication for a headache it may go away for a short time only to return. The returning headache could very well be a rebound headache caused by the medication or an allergy to the medication. Then what do you do? Take another pill and another which can lead to overmedication and addiction. Certain foods can trigger a headache. If this is the case, keeping a food diary can help to pinpoint the problem. Stress at work or within the family may also cause tension headaches. Reducing the stress and learning to slow down may help reduce some of these headaches. According to Robin Beilby, L.Ac headaches are caused by disharmony within the body. This is based on Ancient Chinese theories that the qi (chi) should evenly flow through the body. When qi is out of balance, pain and disorders occur. In order to rebalance the qi, a pattern of disharmony is identified allowing the acupuncturist to choose specific points and making a point prescription to treat the headache or other disorders portrayed by the client. The acupuncture needles are then placed at these points for treatment. Chinese herbal medicine may also be prescribed to augment the acupuncture treatments. The acupuncturist determines the pattern of disharmony by questioning one’s signs and symptoms, medical history and course of disease, inspecting the face, body and especially the tongue, listening to the voice and the sound of breathing, and palpating the pulse at both wrists. In this manner the practitioner can determine the pattern of disharmony. Three patients may present with a migraine but could have a different imbalance, which would require a different acupuncture treatment. The polarity or Yin & Yang of all major organs needs to be determined. The Yin represents cooling, moisture, earth, and winter. The Yang represents energy, heat, heaven and springtime. The Acupuncturist must balance the Yin & the Yang. Both the Chiropractor and Acupuncturist indicate that a long and in depth history is necessary to determine the proper treatment for a headache. Both refer a client to the emergency room or a medical doctor if the history and signs and symptoms indicate the headache may be due to tumors, bleeding, or disorders they can not treat.
Headaches Over Age 50
J.
Griffith Steel, MD Headaches are one of the most common pain problems. Headaches occur in all age groups but tend to lessen in people as they get older. New or worsening headaches in middle aged or older adult are often very worrisome. Occasional headaches of all types affect 69% of men and 88% of women every year. Doctors classify headaches into one of two broad categories, functional or secondary. Functional headaches are caused by abnormal behavior of the muscles, blood vessels, scalp, lining tissues of the brain, or the brain itself. Functional headaches include migraine and tension headaches, which together account for the vast majority of all headaches. Secondary headaches are those caused by diseases of pain sensitive structures of the neck, head, sinuses, or brain blood vessels. Systemic illnesses which affect the entire body may cause headaches as well as other symptoms. An example would be headache that accompanies flu and is caused by fever. In general, functional headaches decrease and secondary headaches increase with aging. Tension Headaches Tension headache, also called muscle contraction headache, is the most common headache throughout life. It is caused by sustained contraction of the neck and scalp muscles. The pain is moderate, steady, dull, tight, long-lasting and usually relieved by aspirin or acetaminophen. Tension headaches are often associated with fatigue, stress, worry, or over- work. Depression is also frequently accompanied by tension headaches. Tension headaches usually lessen with aging, unless some stressful event occurs such as financial worries, loss or grieving, or unaccustomed activity. Chronic tension headaches, more than 15 days per month, may be due to medications or depression. Migraine Headaches Migraine is the most common cause of intermittent severe headache. Migraines occur in 5% of men and 15% of women. Susceptibility to migraine is a genetic trait that often manifests first in youth. Migraines are typically abrupt in onset, one-sided, sharp or pounding, and accompanied by nausea, vomiting or visual disturbances. Migraines typically last one to three days, but some persons have longer or shorter attacks. Migraines may be triggered by external environmental factors such as heat, bright lights, movement, stress, sleep deprivation, alcohol, or strong odors. However, the changes in the brain which permit migraines to occur are “hard wired” and only diminish gradually with aging. Although migraines usually decrease slowly with aging, in the last twenty years many older persons continue to suffer migraines. Persistent or worsening migraine in older persons has become widely recognized by headache specialists and is called transformed migraine. These late-life migraines are less painful but last longer than youthful migraines and have a higher incidence of fatigue, mental confusion, short term depression and are less responsive to treatment. Transformed migraine that occurs every day is called chronic daily headache syndrome. Mid-Life Headaches Mid-Life headaches are new or distinctly different headaches which start for the first time over age 50. These headaches take many forms. Cluster headache is a very distinctive headache seen mainly in men over 50. These headaches are brief, repetitive attacks of sharp or boring pain in the forehead and one eye, usually at night, accompanied by eye tearing, runny nose and congestion. The pain is very intense but rarely lasts more than 30 minutes. Cluster headache occurs in groups or series of attacks, hence the name cluster. A similar disorder occurs in women, often beginning after age 65, called paroxysmal hemicrania. These headaches consist of multiple attacks of very brief stabbing pains in the scalp, usually in one small area. The pain may eventually spread to a wider area on the head. The pain is always on one side only and feels like knives stabbing. Paroxysmal hemicrania responds specifically to indomethacin (Indocin®). Hypnic headaches are sudden bilateral severe throbbing headaches that awaken a person from sound sleep. They may occur 3 times a night and the typical patient is a 65 year old woman. The cause is unknown. Secondary Headaches Many illness and medications can cause headaches. Strokes, head trauma, sinus or brain infections, anemia, dental disease, heart failure, kidney failure, sleep apnea, and arthritis may all trigger headaches. Brain tumors are rare but always worrisome. Depression is a common cause of headache in older persons. Many chemicals can cause headaches as side effects. These include aspartame, a common sugar substitute used in diet drinks, monosodium glutamate (used in Chinese cooking), nitrites (used as meat preservatives), carbon monoxide (from faulty heaters or leaking car exhaust systems), and solvents (used as nail polish or cleaning agents). Headaches caused by brain tumors usually begin slowly and worsen gradually. The pain is often vague and not severe at first. The headaches are often worse at night and present upon awakening in the morning. Coughing, sneezing, bending over or physical exertion may aggravate the pain. Brain tumors eventually cause other neurological symptoms such as confusion, visual or speech loss, inco-ordination, or imbalance. If a person suspects they may have a brain tumor they should see their doctor immediately. Medications Causing Headaches Many medications cause headache, including medications whose purpose is to relieve headaches. Older persons take, on average, 3 times more pills than younger persons. Medicines triggering headaches include SSRIs (antidepressants), nitroglycerine (heart), calcium channel blockers (heart, hypertension), beta-blockers (hypertension, heart), prednisone (steroid), Aggrenox (anti-platelet pill), and even aspirin-caffeine compounds taken for relief of headache! In fact, the presumed cause of transformed migraine in seniors is too much medication, especially some types of pain killers. Headache medication, especially pain killers, is the most common cause for unremitting tension and migraine headaches in middle or older age. Medicines especially linked to causing transformed migraine include butalbital compounds (Fioricet®, ESGIC®), ergot-containing drugs (Cafergot®), narcotics (Percocet®, Vicodin®)and even triptan products (Imitrex®, Maxalt®, Relpax®). Talk To Your Doctor About Headaches Physicians are like reporters; they want to know the 5 W’s: Who, What, When, Why and Where. Describe your headache symptoms and pattern to your doctor. Detail a typical single headache, and describe the associated features, such as blurred or distorted vision, nausea, and mental fatigue. When do your headaches begin and end? Do they have a pattern? Is there a family history of headaches? Have your headaches changed lately? What are your medications? What are your other health problems? Have you felt depressed or been under stress lately? Have you had tests or treatments in the past? Prepare a written record or calendar of your headaches for 6 weeks prior to your appointment. Beware of Easy Solutions If you are seriously troubled by frequent headaches, a five minute appointment with the doctor is not enough. Beware of the “quickie” appointment ending with a prescription for a narcotic. You may be worse off in the long run. Similarly, beware of the “one size fits all” solution. Some health care providers diagnose one condition and prescribe one treatment for everything. Not all headaches are caused by neck misalignment. Beware of well meaning persons who make casual recommendations based only on their own personal experience. When To See A Specialist Neurologists are Board Certified by the American Board of Psychiatry and Neurology. They specialize is disorders of the brain, spinal cord, peripheral nerves and muscles. Most neurologists are experienced in diagnosing and managing complex headache disorders. If you are having 3 or more severe headaches per month or if you have failed 2 or more treatments or if your headache pattern has changed recently, you should see a neurologist. |
