Headache pain is both common and complex. Learn the symptoms and treatments.

Almost everyone gets a headache now and then, but they sometimes require specialised treatment, which is available at the CU Headache/Pain Medicine Clinic.

If you were looking for a common experience, headaches would be an unappealing standout candidate. Indeed, the government declares headaches to be the “most common form of pain” in the country, accounting for a significant number of missed work and clinic appointments.

However, the severity and complexity of headaches, as well as the approaches to treating them, vary greatly. The most severe, such as migraines, can be extremely disabling and expensive. UCHealth Today spoke with Dr. Danielle Wilhour, an assistant professor of Neurology and headache specialist at the University of Colorado School of Medicine who practises at the UCHealth Neurosciences Center – Anschutz Medical Campus, to learn more about the nature of headaches. Dr. Wilhour also serves as the programme director for the University of Colorado Headache Medicine Fellowship.

Is there a clinical definition for the term “headache”?

 

“We define a headache as any kind of painful sensation in the head,” Wilhour explained. “There are numerous varieties.”

What kinds of headaches exist?

 

Wilhour differentiated between two types of headaches: primary and secondary. Primary headache pain is caused by the headache itself, rather than by an external cause. Migraines, cluster headaches, and tension headaches are a few examples.

According to Wilhour, pain from secondary headaches is caused by an underlying condition such as dehydration, infection, high blood pressure, meningitis, aneurysms, brain tumours and blood clots, and artery tears in the neck or head.

“Fortunately, the vast majority of headaches are primary,” she continues. “However, it is our job as health care providers to evaluate and rule out secondary causes and more serious conditions.”

What are some of the factors that frequently contribute to headaches?

 

Genetics may be involved. According to Wilhour, scores of genes have been identified that predispose people to migraines. “I tell patients that if one of their parents has migraines, there is a 50% risk that their child will have it. There is a 75% chance that their child will have migraines if both parents have them.”

Injuries, such as concussions and traumatic brain injury, can also increase the risk of headaches, according to Wilhour. Stress, insufficient or insufficient sleep, skipping meals, consuming alcohol or caffeine, hormonal changes, abrupt changes in weather, and physical activity can all “trigger” headaches.

Is diet a factor in headaches?

 

It can. Foods processed with additives such as nitrates and monosodium glutamate (MSG), for example, can flip the headache switch, according to Wilhour.

“In general, I advise people to eat as much natural food as possible, including fruits and vegetables, whole grains, lean protein, and healthy fats.” People should also be aware that gluten and dairy sensitivities can cause headaches, according to her.

When should I seek medical attention because of the frequency of my headaches?

 

“It’s reasonable to see a health care provider if you have more than one or two headaches per week,” Wilhour said. Individuals should also seek medical attention if their headaches are unusually severe or incapacitating, cause nausea and vomiting, or do not respond to over-the-counter medications. Changes in vision, loss of sight, and numbness or weakness on one side of the body lasting minutes to an hour, known as a “aura,” can also be symptoms of migraine.

A brain aneurysm, blood clot, or haemorrhage are the most serious causes of “thunderclap” headaches, which cause severe pain suddenly. “The pain level in these headaches can go from zero to ten in a matter of seconds,” Wilhour explained. They require immediate medical attention.

How does the CU Headache/Pain Medicine Clinic determine the cause of headaches?

 

Wilhour stated that providers gather as much information from patients as possible and use it to tailor their care. The steps are as follows:

• Examining the patient’s headache history and how it has progressed.
• Examining medications and how the patient reacted to them.
• Screening for more serious diseases.
• Identifying and treating comorbid diseases such as cancer.
• Recommending imaging, referral to other specialists, and other tests as needed.
• Procedures such as nerve blocks and trigger point injections are available.
• Developing a personalised treatment plan that may include prescription medications and vitamins.

“I also inquire whether the headache is positional in nature,” Wilhour added. “Does it hurt more standing up or lying down?” The changes in either case may indicate an excess or deficiency of fluid in the sac that protects the brain and spinal cord.

Migraines, cluster headaches, and tension headaches all have distinct symptoms that the clinic considers when making a diagnosis.

Let’s start with migraines. What are they, and how do they differ from other types of headaches?

 

“Migraines are frequently misunderstood as just another headache,” Wilhour explained. “They are, in fact, a complex neurological disease characterised by severe light and sound sensitivity, as well as nausea and vomiting.” They can last from four hours to three days, depending on their severity.” Migraines are characterised by throbbing pain on one side of the head, she adds.

What is the prevalence of migraines?

 

According to Wilhour, migraine is the most common neurological disease in the world, with one in every four people having “some sort of ongoing or prior migraine history.” Migraine is also the world’s second most disabling disease. “It has a high toll rate, with peaks in people’s 30s and 40s, when they are in the prime of life,” she explained.

“Many people mistake a mild or tolerable headache for a migraine, but this ignores the disabling features and impacts that a migraine can have on quality of life,” Wilhour added. “In addition to the pain of migraines, there is an element of stigma. We need to inform people about how many people are affected by the disease and raise awareness about it.”

Are some people more prone to migraines than others?

 

Yes. According to Wilhour, they are three times more common in women than in men, most likely due to post-puberty hormonal changes. Among ethnic groups, American Indians and Alaska Natives have the highest prevalence of migraines, but there are also disparities in diagnosis and treatment for Black and Latino people.

What do we know about migraine causes?

 

The trigeminal nerve, a major component of the body’s pain pathway, is the primary culprit, according to Wilhour. Changes in the brainstem activate the nerve and signal it to release inflammatory substances, most notably CGRP (calcitonin gene-related peptide), which cause blood vessels to swell and pain to be produced. As previously stated, genetics is a significant risk factor for migraines.

What is the treatment for migraines?

 

Over-the-counter medications such as Tylenol and ibuprofen, as well as caffeine, are the first-line treatments, according to Wilhour. Triptans, which are prescription medications, can also be used to treat migraines. Migraine attacks can be prevented by taking blood pressure, antidepressant, and seizure medications. These medications include topiramate and propranolol, both of which have been shown to be effective, according to Wilhour. Botox injections are also permitted for the treatment of chronic migraines (15 or more days a month).

Another migraine treatment is “neuromodulation devices” that have been approved by the FDA. To deter attacks, they use electrical stimulation. Cefaly, for example, is a headband that sends electrical impulses that both stimulate and calm the trigeminal nerve. The Nerivio device is attached to the arm. It sends an electrical signal to the brainstem, causing it to release pain-blocking neurotransmitters.

According to Wilhour, more recent medications are specifically designed to treat migraines. They target the CGRP molecule, which causes migraines. Among these medications are:

• Aimovig, Emgality, and Ajovy are three characters. These are medications that must be injected.
• Vyepti is administered via infusion.
• Nurtec, Ubrelvy, and Qulipta are a few examples. These oral medications are CGRP “antagonists,” according to Wilhour. They alleviate pain by blocking the molecule’s nerve receptors.
• Wilhour stated that Nurtec is the only medication approved to both prevent and treat migraines. Qulipta can be taken on a daily basis.

How effective are the new drugs?

 

Wilhour concurred. “We aim for a success rate of 50%. These new ones have a 75% to 100% success rate. When compared to older medications, that is remarkable.”

Are there any disadvantages?

 

Wilhour claims that the side effects are generally minor. They are, however, costly, and patients are usually required to try more established medications before being approved for the new ones.

What exactly are cluster headaches?

 

These are uncommon headaches that affect approximately one in every thousand people. Men are twice as likely as women to be affected. Cluster headaches, on the other hand, can be severely debilitating for sufferers, according to Wilhour.

“Cluster headaches are considered one of the most painful conditions that mankind has ever experienced,” she said. They appear in “cyclical patterns,” sometimes seasonally, and can last from a few weeks to several months. Wilhour added that patients can have up to eight attacks per day.

What are the signs and symptoms of a cluster headache?

 

Cluster headaches, unlike migraine headaches, do not usually have a trigger. They frequently cause stabbing pain over or behind one eye, which can spread to other areas of the face. They may also cause swelling and drooping around the eyes, as well as pupil changes. The attacks, which may occur at night, have been compared to “an ice pick to the head,” according to Wilhour.

Restlessness and agitation may signal the onset of a cluster headache attack, she adds. The cyclical attacks can be followed by periods of remission, only to be followed by another round of headaches.

What is the cause of cluster headaches?

 

According to Wilhour, there is a link between head trauma and tobacco and alcohol use. She believes that changes in the hypothalamus, the part of the brain that regulates our sleep and sense of time, are also involved in cluster headaches.

What treatments are available for cluster headaches?

 

“I try to get people on preventive medications so that the cycle can be broken sooner,” Wilhour said. She used the blood pressure medication verapamil as an example. Short treatments with high-flow oxygen, as well as nasal sprays containing zolmitriptan, have been shown to be effective in ending an attack.

Emgality, a migraine injection treatment, recently received FDA approval to reduce the frequency of cluster headaches.

Is it possible for me to use self-management techniques and/or make lifestyle changes to reduce my risk of headaches or lessen their severity?
Yes. “If done consistently, lifestyle measures in general have a modest protective effect,” Wilhour said. She emphasised several:

• Drink 64-96 ounces of water per day.
• Four times a week, do 30 minutes of moderate aerobic exercise.
• You should not skip meals.
• Caffeine consumption should be kept to a minimum.
• Sleep for 7 to 8 hours per night.
• Stress can be reduced by using techniques such as mindfulness, yoga, and meditation.

Can I get assistance in dealing with the stress of headaches?

 

Yes. Wilhour said she works with psychologists and psychiatrists who can help patients manage stress and cope with headache pain and unpredictability.

“Patients may experience anxiety about not knowing when an attack will occur,” she said. “That can be an important part of the treatment.”

Talking about stress brings up the topic of tension headaches. What exactly are they?

Tension headaches are a common occurrence. According to Wilhour, they frequently occur as a result of stressful mental and physical environments and our reactions to them.

“A lot of people don’t realise how much they hunch their shoulders and clench their teeth when they’re stressed,” she said. People can reduce stress by consciously improving their posture and, as previously mentioned, developing relaxation techniques. According to her, physical therapy and massage can also help reduce stress and the risk of tension headaches.

Is there collaboration between the CU Headache/Pain Medicine Clinic and other specialists?

Yes. Aside from the previously mentioned psychology and psychiatry, the clinic refers headache patients to other specialists, such as:

• Physical Therapy for Interventional Pain
• Neuro-Ophthalmology and Ophthalmology
• Dentistry
• Sleep Disorders
• Integrative Health Care
• Neuroradiology
• Neurosurgery of the Ear, Nose, and Throat

What is the University of Colorado Headache Medicine Fellowship programme all about?

 

According to Wilhour, according to an American Headache Society study, an additional 3,700 headache medicine specialists are needed to care for migraine sufferers, with the gap expected to grow to 4,500 by 2040.

“Because of the nationwide shortage of headache specialists, it is critical that we train fellows who will know the cutting-edge treatments and options that we have,” Wilhour said. “We need to increase patient access, keep them out of the emergency department, and provide them with treatment options other than narcotics.”