EDITOR'S NOTE: This weekly column by reporter Bill Kettler answers readers' questions about topics of general medical interest with information provided by doctors from PrimeCare, Jackson County's independent practice association.
I get headaches once in a while and I'm told they're not migraines. How is a headache determined to be a migraine? What medicines or other approaches can be used to get rid of a bad headache?
— Steve R., Medford
There is no test that can establish with certainty what kind of headache a person has, says Dr. Larry Maukonen, a Medford neurologist.
Physicians classify headaches by their symptoms. Migraines often announce themselves beforehand with a warning "aura" that people variously described as flashing lights or a kaleidoscope. Classic migraines are characterized by an aura followed by throbbing pain that lasts for four to 72 hours, and the pain is often limited to one side of the head. People with migraines frequently suffer stomach problems, nausea, vomiting, and confusion or disorientation, and they're often sensitive to light or sound.
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Migraines affect 12 to 20 percent of the population. Far more common is the tension headache, which is caused by tight muscles in the neck and head. Tense muscles aggravate nerves in the head, creating a sensation "like somebody's squeezing your head," he says.
There also are sinus headaches, which are the product of allergic reactions or infections in the sinus cavities in the skull. Pain is localized in the sinuses (above the eyes or below the eyes). Infection or allergens can cause the membranes in the sinuses to swell, creating pressure that produces pain.
Scientists are still trying to determine what causes migraines. Some believe they're caused by a tightening and sudden opening (dilation) of the blood vessels in the head. Others think they may be caused by a sudden release of neurochemicals such as serotonin in the brain.
Some foods seem to make people more likely to experience a migraine. Physicians encourage their migraine patients to limit their intake of foods such as red wine, chocolate and aged cheeses because they contain
chemicals that appear to trigger attacks.
"Things that make you feel warm and flush make it easier to have migraines," Maukonen says.
Physicians encourage people who get migraines to keep a diary to try to track the source of their attacks. Foods that trigger migraines usually cause symptoms within an hour, so a diary can sometimes quickly identify offending foods.
Stress also seems to play a role, but it's not always "bad" stress.
"Some people have migraines on their birthday," Maukonen says. "Some people have them on their days off, not on their work days. Different people have different patterns."
Lack of adequate sleep seems to trigger migraines in some people. Caffeine can cause migraines, but people who drink coffee and then stop can have caffeine-withdrawal migraines.
Physicians treat migraines with some of the same medicines that are used to treat high blood pressure, such as beta blockers and calcium blockers, but they do not work for everyone. Some people find that sleep will make their migraine fade away, but it's difficult to fall asleep while the pain persists. Some people retreat to a cool dark room and wait for the pain to fade, but that's not possible if, for example, a migraine occurs on the job.
Tension headaches can be treated by releasing the tension with muscle relaxants or stretching exercises. Applying gentle heat helps relax the muscles for some people. Over-the-counter drugs such as Advil, Aleve and Naprosyn work, too.
Physicians treat sinus headaches by addressing the source of the pain. Steroid nasal sprays can reduce inflammation, and antibiotics can halt bacterial infections. Drugs, however, have no effect on viruses that may infect the sinuses.
Maukonen says about 30 percent of us don't get headaches at all, and many have little sense of how debilitating they can be.
"They're not someone you'd want to be married to if you had migraines," he quipped.
Call Bill Kettler with your medical questions at 776-4492, or e-mail them to: bkettler@mailtribune.com or send them to: Mail Tribune, Ask Your Doctors, P.O. Box 1108, Medford OR 97501.
