Headache: Diagnostic Tests And Treatments (Part 2)

In part 1 of this series we learned about the impact of headaches on individuals and on society, looked at the causes of headaches and gained some understanding of the physiology underlying the headache process. Part 2 provides an overview of diagnostics tests and various treatments for headaches.

Tests Used To Diagnose Headaches

Most physicians will obtain a full medical history from the patient, inquiring about past head trauma or surgery and about the use of medications and may suggest that a patient undergo a computer tomographic (CT) scan and/or magnetic resonance imaging (MRI). These scans produce images of the brain that show structures or variations in the density of different types of tissue. A physician analyzes the results of all these diagnostic tests along with a patient's medical history to arrive at a diagnosis. Headaches are diagnosed and classified as either vascular, muscle contraction (tension), traction or inflammatory.

Vascular headaches--a group that includes migraine headaches--are so named because they are thought to involve abnormal function of the brain's blood vessels or vascular system.

Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles.

Traction and inflammatory headaches are symptoms of other disorders, ranging from stroke to sinus infection. Some people have more than one type of headache.

The most common type of vascular headache is the migraine headache. Migraine headaches are often characterized by severe pain on one or both sides of the head, nausea and at times disturbed vision.

Symptoms of migraine: Sensitivity to light is a very commonly described symptom of the two most prevalent types of migraine headaches: classic and common.

The major difference between the two types is the appearance of neurological symptoms 10 to 30 minutes before a classic migraine attack. These symptoms are called an aura. The person may see flashing lights or zigzag lines or may temporarily lose vision. The pain of a classic migraine headache is described as intense, throbbing or pounding pain and is felt in the forehead, temple, ear, jaw and the eye. Classic migraines may last for several days.

The common migraine--a term that reflects the disorder's greater occurrence in the general population--is not preceded by an aura. Both classic and common migraine can strike as often as several times a week or as rarely as once every few years.

The migraine process: Research scientists are unclear about the precise cause of migraine headaches. There seems to be general agreement, however, that a key element is blood flow changes in the brain. People who get migraine headaches appear to have blood vessels that overreact to various triggers.

It's believed that the nervous system responds to a trigger such as stress by creating a spasm in the nerve-rich arteries at the base of the brain. The spasm closes down or constricts several arteries supplying blood to the brain, including the scalp artery and the carotid or the neck arteries.

Migraine Headache Treatment

Drug therapy, biofeedback training, stress reduction and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches.

Drug Therapy: There are two ways to approach the treatment of migraine headaches with drugs: prevent the attacks or relieve symptoms after the headache occurs.

One of the most commonly used drugs for the relief of migraine symptoms is ergotamine tartrate, a vasoconstrictor which helps counteract the painful dilation stage of the headache. For optimal benefit, the drug is taken during the early stages of an attack. If a migraine has been in progress for about an hour and has passed into the final throbbing stage, ergotamine tartrate will probably not help.

For headaches that occur three or more times a month, preventive treatment is usually recommended. Drugs used to prevent classic and common migraine include methysergide maleate, which counteracts blood vessel constriction, propranolol hydrochloride, which stops blood vessel dilation and amitriptyline, an antidepressant.

Scientists estimate that a small percentage of migraine sufferers will benefit from a treatment program focused solely on eliminating headache-provoking foods and beverages.

Cluster Headaches: Cluster headaches, named for their repeated occurrence in groups or clusters, begin as a minor pain around one eye, eventually spreading to that side of the face. Cluster headaches last between 30 and 45 minutes. But the relief people feel at the end of an attack is usually mixed with fear as they wait for a recurrence. Clusters can strike several times a day or night for several weeks or months. Then, mysteriously, they may disappear for months or years. Many people have cluster bouts during the spring and fall. At their worst, chronic cluster headaches can last continuously for years.

What Are Muscle-Contraction Headaches?

Tension headache is named not only for the role of stress in triggering the pain, but also for the contraction of neck, face and scalp muscles brought on by stressful events. Tension headache is a severe but temporary form of muscle-contraction headache. The pain is mild to moderate and feels like pressure is being applied to the head or neck. The headache usually disappears after the period of stress is over. Ninety percent of all headaches are classified as tension / muscle contraction headaches.

By contrast, chronic muscle-contraction headaches can last for weeks, months and sometimes years. The pain of these headaches is often described as a tight band around the head or a feeling that the head and neck are in a cast. The pain is steady and is usually felt on both sides of the head. Many scientists believe that the primary cause of the pain of muscle-contraction headache is sustained muscle tension. Other studies suggest that restricted blood flow may cause or contribute to the pain.

Certain physical postures that tense head and neck muscles--such as holding one's chin down while reading--can lead to head and neck pain. So can prolonged writing under poor light or holding a phone between the shoulder and ear or even gum chewing.

Treatment for muscle-contraction headache varies. The first consideration is to treat any specific disorder or disease that may be causing the headache. For example, arthritis of the neck is treated with anti-inflammatory medication. Acute tension headaches not associated with a disease are treated with muscle relaxants and analgesics like aspirin, ibuprofen and acetaminophen.

People who suffer infrequent muscle-contraction headaches may benefit from a hot shower or moist heat applied to the back of the neck. Cervical collars are sometimes recommended as an aid to good posture. Physical therapy, massage and gentle exercise of the neck may also be helpful.

Finding the solution to your headache problems is usually a lengthy and involved process, especially since making an accurate diagnosis of the type and cause of the headaches must come before the proper treatment regimen can be found.

When Should You See a Physician?
Sudden, severe headache; Headache associated with convulsions; Headache accompanied by confusion or loss of consciousness; Headache following a blow on the head; Headache with pain in the eye or ear; Persistent headache in a person who was previously headache free; Recurring headache in children; Headache associated with fever; Headache which interferes with normal life.

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