Headache Disorders by Wayne Anderson, D.O.
Headaches are common. More than 45 million Americans experience recurring headaches. The most common primary headache disorders are tension-type headache and migraine. Chronic migraine, which is an almost daily chronic headache disorder, affects about 1 percent of the population (See references 1 & 2).
There are many different types of headache, but migraine is perhaps best known.
Many migraine patients assume that a migraine begins when the headache pain begins. But there are up to four phases of a migraine (See reference 3). The first phase, called the premonitory phase, can begin up to 48 hours prior to migraine. The premonitory phase can have symptoms such as frequent urination and yawning. The second phase, called the aura phase, involves visual changes or other symptoms. During the third phase, called the headache phase, patients experience a severe headache, often occurring on one side of the head. In the final and fourth phase, called the postdrome, patients may experience potentially disabling fatigue and changes in mood (See reference 3). Not every patient will have each of the four phases.
In the past, patients and physicians were taught that migraines occur when blood vessels expand and contract in the brain. But modern research has proven that migraines can occur in the absence of blood vessel changes. Migraines appear to be initiated by changes occurring in the trigeminal nerve cells involving many different brain chemicals (See reference 4). The headache-generating system is called the trigeminovascular system.
Treating Headache Disorders
Two types of treatments are available for headache disorders: prophylactic treatments (done regularly to help prevent headaches) and abortive treatments (done to stop a headache when a headache occurs). Some of the treatments commonly used just a few years ago have been found not effective, and others have been found very effective. In fact, some of the common headache treatments have been shown to worsen headache (See reference 5). Recent research has helped physicians choose the evidence-based treatments for specific headache types. Headache is one of very few disorders with scientific evidence for specific supplements and alternative therapies. Several vitamins, minerals and supplements have evidence in reducing the frequency, severity or duration of headache attacks (See reference 6).
United Council for Neurologic Subspecialties
The United Council for Neurologic Subspecialties (UCNS) has established a subspecialty certification for headache specialists. Because migraines and other headache disorders are common and potentially disabling, and are associated with other health conditions, such as depression, stroke, and epilepsy, the neurologic community believed that headache medicine represents a true neurologic subspecialty. According to the UCNS, “Headache Medicine is a subspecialty concerned with the diagnosis and treatment of head and face pain. Its scope includes the diseases or categories of disease causing central and peripheral disturbance of structures or functions causing head and face pain and includes both primary and secondary disturbances of these structures or functions.”
- Buse DC, Manack AN, Fanning KM, Serrano D, Reed ML, Turkel CC, Lipton RB. Chronic Migraine Prevalence, Disability, and Sociodemographic Factors: Results From the American Migraine Prevalence and Prevention Study. Headache. 2012 Jun 22.
- Bigal ME, Lipton RB. The Epidemiology and Burden of Headaches. In Comprehensive Review of Headache Medicine. Levin M, ed. Oxford University Press, New York. 2008.
- Ng-Mak DS, Fitzgerald KA, Norquist JM, Banderas BF, Nelsen LM, Evans CJ, Healy CG, Ho TW, Bigal M. Key concepts of migraine postdrome: a qualitative study to develop a post-migraine questionnaire. Headache. 2011 Jan;51(1):105-17.
- Bernstein C, Burstein R. Sensitization of the trigeminovascular pathway: perspective and implications to migraine pathophysiology. J Clin Neurol. 2012 Jun;8(2):89-99.
- Russell MB, Lundqvist C. Prevention and management of medication overuse headache. Curr Opin Neurol. 2012 Jun;25(3):290-5.
- Holland S, Silberstein SD, Freitag F, Dodick DW, Argoff C, Ashman E; Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2012 Apr 24;78(17):1346-53.
California Pacific Medical Center
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The California Pacific Neuroscience Institute in San Francisco features some of the top-rated neurology physicians and neurosurgeons in the San Francisco Bay Area. This issue of the CPNI Bulletin features our wide array of general neurology consultative services, physicians and programs, neurology research, and the new Brain Health Center at CPMC.