By Barbara Isaacs, Kentucky Connect and the Lexington Herald-Leader
It's just a headache, right? It's sinus pain. It's back-to-school stress. It's all those deadlines.
People get them every day, pop a few over-the-counter pain relievers -- end of throbbing, end of story.
But for millions, headache is more than just a mere throbbing annoyance.
``Estimates are that as many as 20 percent of people with headaches could and should require medical attention in their lifetime,'' said Dr. Creed Pettigrew, a University of Kentucky neurologist and director of the stroke program at the Sanders-Brown Center on Aging. ``That means that millions of people within a given year in the U.S. should seek care.''
In a 1996 survey by the National Mental Health Association, 21 percent of the adults who were polled reported a bad headache at least once a week and 11 percent said they had serious headache pain several times a week.
``Headaches are probably a little more frequent these days,'' said Dr. W. Jeffrey Foxx, a Lexington family medicine physician. He estimates that about 10 percent of his patients list headache as their primary complaint. And some patients with long-term headaches have heard about new, more effective medications for migraine and other types of serious headache.
But before hitting the doctor's office, it's important to be able to spot serious headache symptoms:
Severe pain with a sudden onset. ``People might feel something like, `It's the worst headache of my life,' '' said Dr. Leland Irwin, an emergency medicine physician at Central Baptist. ``That's one to take notice of.''
Sometimes, extremely severe, sudden headache pain is an indication of a brain hemorrhage or aneurysm, which is a life-threatening emergency. Any new, different or worse type of headaches should be evaluated by a doctor.
Other symptoms with headache. Most serious are persistent fever, weakness or reduced function in the arms or legs, confusion or unconsciousness. Symptoms help doctors evaluate the headache's seriousness, so it's important to be able to describe when the headache started, how long it has lasted and other symptoms.
In cases in which serious underlying illnesses are suspected, CT scans, spinal taps and other methods of diagnosis are sometimes used.
Headache with visual disturbance. Visual disturbances, such as double vision, flashing lights and others can be part of the onset of a migraine or may indicate other headache-related problems.
Frequency. If the pain happens daily or doesn't respond to over-the-counter pain relievers, see a doctor.
``If you're taking more than 100 over-the-counter analgesics per month,'' you should see a doctor, said Dr. Robin Meek, a UK internal medicine physician who specializes in headache treatment. ``That's three or four a day. Some people just consume them, just eat them.''
If it's worse than usual. Irwin sees people with migraines daily at the emergency room. ``The people are there for relief, and they're happy to get it,'' Irwin said. ``We send people home more comfortable, but not always with complete relief. We tend to see the bad ones. For the regular, garden-variety headaches, they see their family doctor or go to the drugstore.''
If it changes your everyday life. Meek said headaches that cause people to miss work, make them unable to care for their children or interfere with family or social obligations should be checked out.
``Even if you get just one or two headaches a month, but if every time you're in bed two to three days, that's a severe disability,'' Meek said. Pettigrew notes that any severe headache that occurs more than once or twice a week warrants medical attention.
If headache pain awakens you. Cluster headaches, most common in middle-aged men, cause excruciating pain in the eye; often, the eye will water.
``It's so severe, often the person will pace around until it's over,'' Meek said. They only last about 45 minutes, but tend to recur nightly for a period of time.
Is it a tumor?
Experts say there's often an underlying fear factor with headaches.
``Some people simply want reassurance that they don't have a brain tumor,'' Foxx said.
The vast majority of headaches aren't an indicator of a more serious underlying illness.
``Only 5 percent of people with brain tumors actually have headaches,'' Meek said. ``But it's a common thought: `I must have a brain tumor. It keeps coming back.' But that's the nature of the headache condition. ... I think a lot of people are relieved when they see a doctor about headaches. It tells them: `There is something wrong with my head. I'm not making this up.' ''
``I don't think anyone should dismiss a bad headache,'' said Judi Jones, a Lexington graphic designer.
For Jones, life is an everyday headache.
``I notice the days when I don't have a headache,'' said Jones, 31. ``It's hard, because they affect your life so much. ... It just totally affects your daily life.''
For 10 years, ever since she had a severe electrical shock, Jones has had headaches. She has been diagnosed with several types of headaches, including migraine with visual disturbances and chronic daily headache.
She has tried biofeedback and massage therapy. She takes prescription medication to help prevent the attacks and to reduce the pain and nausea of the migraines and daily headaches. She has gotten some relief but still gets two to three migraines a month, and the nagging daily headaches continue.
That's no sinus headache
Jones is among 23 million Americans who experience migraine headaches, about 75 percent of them women. They last three hours to three days and cause the most absenteeism from among all kinds of serious headaches, according to the National Headache Foundation.
Even though the pain is severe, most people would be surprised to know it's a migraine, Meek said.
``Many people don't realize they have migraines,'' she said. If anything, they often mistake migraines and other headaches for the Kentucky catch-all of ``sinus pain.''
``Most headaches are not sinus-related,'' Meek said.
``And with sinus headaches, you typically almost never get throbbing headaches,'' Pettigrew said. ``It's more of a dull, bandlike pain.''
Some people with headaches either don't realize treatment is available or worry that doctors will dismiss their symptoms.
Meek, 43, has had severe headaches since age 6; hers are migraines with visual aura, meaning that just before the headache, she experiences visual disturbances. Her headaches interested her in treating people with headaches; about half of her patients are headache sufferers.
``If you don't have headaches, you're less sympathetic. You don't realize how bad and how disabling they are,'' Meek said. ``I think there's been better education; doctors are a little more aware.''
Herald-Leader news researcher Linda Niemi contributed to this report.
