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What Are the Different Types of Headaches?

Posted Aug 24 2008 1:49pm
ANNOUNCER: They happen at any time. They can ruin your day. They can ruin your life.

The problem? You have a headache, and over 90 percent of us suffer from them at one time or another. For some people, it is a way of life.

RICHARD LIPTON, MD: People not only live with recurrent episodes of severe pain and temporary disability, but they live with an ongoing fear of when they may be struck by lightning out of the blue unpredictably.

ANNOUNCER: And it seems everyone has a different way to describe their headache: "It feels like I'm being hit with a hammer." "It's like my head is in a vice."

Just phrases, but those vivid descriptions can help figure out what type of headache you're having.

RICHARD LIPTON, MD: If we look at the primary headaches, there are four major kinds: migraine, tension-type headache, cluster headache and then the fourth group is a miscellaneous group of other, usually uncommon headache types.

ANNOUNCER: So what's the difference? For that, you need to ask yourself some key questions.

RICHARD LIPTON, MD: One issue is the quality of the pain. Is it throbbing? Is it a steady ache? Is it boring? Another feature is the location of the pain. Is it in the eye? On one side of the head? On both sides of the head? Another feature of the pain, again, is the frequency and duration. Do attacks last ten minutes? Do they last ten days? Do they occur every day? Do they occur only occasionally?

And then the features that go along with headache are very, very important.

ANNOUNCER: In fact each type of headache has a distinctive profile.

RICHARD LIPTON, MD: Individual clusters attacks last typically from fifteen to ninety minutes. Cluster periods, where you may have one or more attacks per day, in the average person, will last a month to several months.

Cluster attacks tend to be triggered by REM sleep. People with cluster quite often will awaken at a characteristic time every night with a full-blown attack. Three am is really quite typical.

ANNOUNCER: And, oh yes, they are extremely painful.

RICHARD LIPTON, MD: They're always one-sided. The pain is usually in or around one eye and the pain is accompanied by redness or tearing of the eye, drooping of the lid, nasal stuffiness and features of that kind.

Cluster affects perhaps two in every 100,000 people. And, given the severity of cluster attacks, that's a good thing. So patients who've had cluster and passed kidney stones will almost inevitably say, "Well, God, let me pass a kidney stone, the pain is much less severe than cluster."

ANNOUNCER: Treating cluster headaches is part preventative, part damage control.

RICHARD LIPTON, MD: The usual initial treatment for cluster headache is prednisone, and usually people would also be started on a calcium channel blocker. The two most important acute medications are injectable sumatriptan and high-flow oxygen.

ANNOUNCER: The headache that gets the most press is the dreaded migraine, which affects about 12 percent of Americans each year. Migraines tend to be one-sided with throbbing pain that can range from mild to excruciating.

RICHARD LIPTON, MD: Migraine is characterized usually by at least one or two of nausea, vomiting, sensitivity to light, sensitivity to sound or aura, those visual displays that usually precede but may accompany headache.

ANNOUNCER: What sets off a migraine? It may be diet, changing weather or for women, certain times of the month.

RICHARD LIPTON, MD: Hormonal factors are important triggers, so many women find that they get headaches the day before menstrual flow begins or the day that flow actually begins. And that effect, we believe, is an effect of estrogen withdrawal.

ANNOUNCER: There are a range of medications that can ward off attacks. And when it hits, there are some new approaches.

RICHARD LIPTON, MD: The sea change of the last ten years has been the development of a class of compounds called triptans. And triptans are migraine-specific drugs, meaning that they are drugs that were designed to relieve migraine attacks.

ANNOUNCER: And while migraines or cluster headache are disabling conditions, so too are run-of-the-mill tension headaches which can still ruin your day.

RICHARD LIPTON, MD: Tension-type headaches typically will begin at the end of a stressful day, three or four or five in the afternoon, and they typically last from one hour to six hours, though they may last even longer.

Tension headache pain tends to be on both sides of the head. Tension-type headache pain tends to be mild or moderate. Tension-type headache pain is a steady ache or a pressure or some people describe a hatband of pain.

ANNOUNCER: Usually the remedy for a tension headache is as close as your nearest pharmacy.

RICHARD LIPTON, MD: Most people with tension-type headache do fine treating with over-the-counter medications and there's a broad range of over-the-counter analgesics that have been shown to work for tension-type headache.

ANNOUNCER: And although stress doesn't cause headache, it can make it worse, and for that there are calming activities.

RICHARD LIPTON, MD: There are a wide range of stress management techniques that are used, everything from systemic relaxation that you do at home to biofeedback to cognitive-behavioral therapy, where you essentially learn about the ideas that you have that make your life more stressful and how to manage those ideas better.

ANNOUNCER: But when is it more that just a headache?

RICHARD LIPTON, MD: Sometimes headache is symptomatic of a serious underlying disorder. So one red flag is new onset of headache after the age of 55. If you start out having mild headaches and your headaches increase in frequency or severity over time. Headaches associated with a fever or a stiff neck may reflect an infection that requires medical attention.

Weakness, difficulty moving one side of the body, double vision, if you go from having no pain at all to having very severe pain, that may be a first manifestation of stroke, and if that happens, that's a good reason to seek medical care.

ANNOUNCER: Headaches aren't usually a serious health threat, but they can, if untreated, be a threat to our well-being. The message to take away is: There's help for your splitting head.

RICHARD LIPTON, MD: It's important for people to recognize that, if they're suffering from headaches, that they've got an extraordinarily common problem and an extraordinarily treatable problem.

Headache is not a problem that you need to learn to live with. It's a problem that you need to learn to manage and live without.

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