Many scientists are abandoning the traditional notions that migraine headaches stem mainly from disturbed blood flow to the brain, and that tension headaches stem from tense muscles.
Migraines, tension-type headaches and possibly cluster headaches may stem from neurologic and chemical disturbances within the brain-- involving some of the same neurotransmitters, that cause depression and other mood disorders.
ALLERGY DIAGNOSTIC & TREATMENT CENTER
New view of migraines
According to the new view, migraines (and possibly cluster headaches) start when certain environmental, hormonal, or behavioral events cause nerve cells in the back of the brain to fire uncontrollably. That chaotic discharge spreads across the brain, depressing brain function and sparking the neurologic problems associated with some migraines. Moreover, that electrical flood tends to change the levels of certain brain chemicals--including the key neurotransmitter serotonin---that can dilate and painfully inflame the blood vessels in the skull; they also make the nerves extra sensitive to that pain as well as light and sound. While scientists had long assumed “tension” headaches, (the most common kind) were caused by contraction of muscles in the neck and head, a number of studies that actually recorded muscle activity during headaches found no convincing link between the two. As a result, headache specialists have now switched to the term “tension-type” headache.
Many experts now look to migraines for at least part of the explanation, citing several similarities. The same events often trigger them; they can often be treated or prevented by the same drugs; both types are more common in females; and frequent sufferers from either type are more likely to experience other problems linked with serotonin abnormalities, including depression and bipolar disorder (formerly called manic-depression).
Those experts suspect that the same basic neurochemical mechanism may cause both types of headache, but in susceptible individuals, that mechanism may be more likely to spark the potentially disabling symptoms usually associated with migraines: neurological disturbances, nausea, and extreme pain. (Migraines also differ from tension-type headache in a few subtler ways: They’re more likely to throb, to affect just one side of the head, and to worsen during physical activity.) In contrast, the primary symptom of tension-type headache is usually milder pain, without throbbing, on both sides of the head. But even symptoms sometimes fail to separate the two types. There’s a gray zone where the different headache types overlap or even become indistinguishable. For example, some headaches throb but have no neurological symptoms; others are only mildly painful but do produce neurologic symptoms; still others may be nauseating or throbbing but affect both sides of the head.
Frequently Asked Questions
In rare cases, headaches can indicate a serious underlying problem in the brain, for example:
Although headaches can also mean a brain tumor, other signs, such as seizures or partial paralysis, are usually apparent long before the headache starts. Seek prompt medical attention if you experience headaches that:
The improved understanding of the physiologic mechanism behind migraine has led to the development of drugs that target the chemicals implicated in those attacks. And the growing realization that all headaches have real neurological mechanisms has prompted headache experts to urge that patients and doctors alike take the condition more seriously and treat it more aggressively. Unfortunately, many people who suffer frequent, debilitating headaches still fail to tell their doctor, while many doctors still fail to prescribe the new treatments-- and in many cases, any effective treatment at all.
The new notion that tension-type headaches, migraines, and possibly cluster headaches are different manifestations of the same basic cause-and that many headaches are hard to classify even based on symptoms-has encouraged doctors to choose treatments based more on severity than on the supposed type. It has also encouraged them to take a more pragmatic, “whatever works” approach than they did before. Many of the same basic treatment options are appropriate for all headache sufferers, however, the overuse of any of those medications can cause dependency, in which chronic headaches persist despite the drugs and worsen when the drugs wear off.
The electrochemical changes within the brain that cause headaches are usually precipitated by some outside event, or trigger. Each individual is particularly susceptible to certain triggers. Identifying your own culprits and then trying to avoid them can be a particularly safe, effective way to prevent headaches. Even when the triggers can’t be avoided, knowing them allows you to take a timely dose of medication to abort or minimize the likely attack. The best way to identify your triggers is to keep a headache diary, when you note the time of the attack and the surrounding circumstances. Analyzing the diary with your doctor or a headache specialist can help eliminate unlikely candidates and identify the likely ones. To help focus your trigger-spotting efforts, here’s a list of the most common factors.
In some people, frequent headaches are so unbearable-and so difficult to treat without causing rebound-that these people are better off taking daily drugs to prevent the attacks. Such medications include certain drugs better known for treating heart problems, depression, or convulsions though they’re usually taken at lower doses for headaches, with generally less chance of side effects. Last year, a consortium of medical groups led by the American Academy of Neurology issued guidelines that defined who should receive such medicine: Preventive therapy is appropriate for people who say recurring headaches significantly interfere with their daily lives despite treatment of the individual attacks, as well as for people who find the side effects of such treatment unacceptable. But non-drug measures can be even more important. In particular, people should try to identify the factors that trigger the recurring attacks and, if possible, to avoid them. Headache sufferers should also consider certain other preventive steps-though they need to consider such options with care, since the supporting evidence ranges from reasonably solid to practically nonexistent.
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