Help for the Headache from Hell
By June Rogers (Chatelaine)
“Y
ou worry at first that the pain
will kill you, and then you
wish it would.” Says Elizabeth
McKim, an assistant professor of English
at St. Thomas University in Fredericton.
The pain she speaks of is a migraine
headache. For McKim, something as
simple as glimpse of the sun’s bright
glinting off the Saint John River can trigger
it. Her only option is to cloister herself in a
dark room and wait—sometimes for up to
12 hours.
All of us have felt the pounding of a
headache. But for the millions of
Canadians who are flattened by migraines,
cluster headaches (like a hot poker piercing
the skull and tension headaches (like a tight
hand), that pain can sometimes mean days
off work.
There is good news, though. Fresh
research is opening up new ways to
overcome the pain. Headaches are no
longer understood simply as a vascular
problem in which blood vessels become
inflamed and then expand to cause that
familiar throbbing. New studies indicate
that headaches result from a complicated
series of interactions between nerves, body
chemistry and blood vessels.
Some scientists believe that tension
headaches and migraines are distinctly
different afflictions, while others believe
that they are in fact the same phenomenon,
differing only in intensity. Most headaches,
whether distinct or related, share common
triggers: eyestrain, excess stress, bright
lights or deafening sounds. Other common
causes include strenuous sex, ripe cheese,
red wine, or chocolate. Sensitivities to
internal and external triggers tend to run in
families.
Many headaches can literally by a
pain in the neck, the headache response
being triggered by the irritation of specific
nerves based in the neck.
Beverly Hann suffered for 13 years
with chronic headaches after a series of car
accidents damaged the joints between the
bones in her neck. “The headaches were
constant, and nothing could take the pain
away for any length of time,” she says.
Before her treatment at the Toronto pain
clinic of Dr. Peter Rothbart, where today
she is a nurse, she sometimes had to down
Tylenol with codeine every three to four
hours.
Rothbart uses a model of the human
skull to explain how neurologists now
believe headaches originate. Tracing the
route with a pen, he points out the control
centre for the pain: the trigeminal nerve
system, which lies within the brain with a
portion protruding below the skull. The
nerve branches up the neck and out on both
sides of the head to the eye, cheek, and
jaw.
Normally the trigeminal receives
information from the head and makes
minute chemical adjustments in response to
light, sound or tension. But if the
trigeminal becomes overwhelmed by
fatigue or stress, or if you are simply born
with a hypersensitive nerve, relatively
minor triggers can cause the nerve to
launch an all-out response.
This overreaction upsets the balance
of several chemicals in the brain, including
the neurotransmitter called serotonin.
Among its many functions, serotonin is
responsible for sending the message to
constrict your blood vessels. Another
chemical messenger called Substance P is
also released, causing irritation of the
surrounding nerves and blood vessels. That
irritation, in turn, is believed to cause
inflammation of the meninges, the sheaths
that cover the brain.
It’s at this point that you may start to
feel that familiar pounding in the back of
your neck, scalp, or forehead.
Rothbart believes neck trauma is the
root of the pain for many. Some 80 percent
of his patients with head pain, he says,
have back problems or have experienced
some injury such as whiplash.
This discovery offers the prospect of
eliminating the cause of the headache
rather than simply dealing with the
symptoms. One treatment to grow out of it
is a series of injections with a local
anesthetic, called nerve blocks. “Patients
receive enormous relief from pain by
blocking the C2 nerve, which feeds into the
trigeminal,” says Rothbart.
For a year, Beverly Hann received a
series of nerve blocks that alleviated her
pain. Then, in 1992, she opted for surgery
that permanently deadened those damaged
nerves in her neck do that they could no
longer transmit their pain-triggering
messages. “Now,” she says, “I get the odd
headache if it rains, but that’s about it.”
In the headache field, new drugs are
always being developed. One of the latest
is Imitrex, promoted as one of the most
effective so-called abortive headache
medications available. An abortive is drug
that stops a headache after it has started.
Stadol NS, a nasal spray, also offers
hope. Many headache sufferers experience
nausea during an attack and, as a result,
have difficulty keeping pills down. The
nasal spray offers an alternative way to
deliver the drug into the sufferer’s system.
There’s also an emergency-only
injectable treatment called DHE (dihydroergotamine). It has good relief
response with minimal side effects. And
one old herbal favourite—fever-few—is
now an over-the-counter medication called
Tanacet 125.
Of course, medication isn’t the only
answer, according to Dr. Gary Shapero,
who runs a headache and pain clinic in
Markham, Ont. Recently, some headache
patients have begun using moderate
aerobic exercise such as walking or
running to stem their attacks. If they can
manage to exercise through their pain for
30 minutes or more, the body releases
natural pain-relieving endorphins that can
help staunch the ache. In fact, people who
get migraines typically have lower resting
levels of endorphins than nonsufferers.
Rothbart stresses that while exercise
benefits those with migraine headaches, it
is not recommended for patients with
headaches originating in the neck as a
result of injury. Consult your physician
before beginning an exercise program.
It has taken Fredericton’s Elizabeth
McKim most of her life to find the right
strategy for dealing with her migraines.
Today she relies heavily on prevention.
That means avoiding her most powerful
trigger, light, as well as taking a beta
blocker, a drug that acts to regulate bloodvessel activity. Instead of disrupting her
life and sending her in search of a dark
quiet room two or three times a week, her
migraines are now milder and come only
two or three times a month. “I can almost
live normally now,” she says.
For more information, contact the
Migraine Association of Canada at
1-800-663-3557.