Headaches: The Painful Facts

By Michael K. Sowell, M.D.

How common are headaches?

Significant headaches occur in as many as 45 million Americans. Migraines, the most common, recurrent, disabling form of headaches, occur in 28 to 30 million Americans or 12 percent of the population. Approximately 6 percent of men and 18 percent of women suffer from migraines. Fifty percent of all migraine sufferers begin to have their attacks before the age of 20. About five percent of children suffer from migraines (ranging from 3.2 percent to 10.6 percent). The gender ratio for children is about 1:1 under the age of 12 years, with a slight preponderance of boys. However, after the age of 12 years, the incidence of migraine in females increases to an approximate 3:1 ratio of female to male adults. This may be related to the cyclical hormonal effects of estrogen and progesterone.

What impact do migraines have on the workplace?

A migraine exerts a significant impact on an individual's productivity. This may take several forms including: absenteeism, reduced productivity while at work, individuals working at a level below their capacity (underemployment) and unemployment. The best estimates suggest that migraine costs U.S. employers $13 billion per year in lost productivity.

When should you see your doctor for headaches?

There are no absolutes; however, some general guidelines are that you should consult a doctor if the headaches are moderate to severe, recurrent, of new onset, associated with light or sound sensitivity or result in attack-related impairment. This impairment may mean that you have to go to a dark room to lie down or miss work, school or family-related activities.

How is a diagnosis of a migraine made?

In the simplest of terms, a migraine is a headache with gastrointestinal symptoms, neurological symptoms and disability, in various combinations. A physician makes a diagnosis of a migraine by applying clinical criteria recently revised by the International Headache Society (ICHD-II) and applying them to the individual. Care must be taken to exclude secondary causes.

If a physician makes a diagnosis of a migraine, what are the options for treatment?

Essentially two therapeutic strategies are employed - acute treatment and preventive or prophylactic treatment. The most common among the acute treatment options is the use of triptans, a class of medications that are thought to be "migraine-specific" in their mechanism of action. The patient must be assessed for the possibility of any risk factors for coronary artery disease or uncontrolled hypertension. These would be contraindications to the use of triptans. Prophylactic or preventive treatment is for those patients who have frequent, severe, disabling migraines. Also, the preventive medication may make the attacks more responsive to the acute treatment.

Are there non-pharmacological approaches to therapy?

Education is essential to every patient with migraines. The goal is self-management within parameters established by a physician. Exercise has important benefits for a wide variety of medical conditions - migraines included. Relaxation training has been shown to be beneficial. Biofeedback has been shown to be of benefit, particularly in frequent, disabling migraine headaches. Certain dietary triggers can worsen migraines in some situations; perhaps the most notable troublemakers being chocolate, caffeine, aged cheese and alcoholic beverages. Since there are so many possible dietary triggers, it is best for the individual with migraines to identify their individual problem foods and beverages and avoid them.

Where can I learn more?

The American Council for Headache Education sponsors a patient-oriented website, www.achenet.org . A Kentucky support group chapter is needed.

Michael K. Sowell, M.D., assistant professor of Neurology and Pediatrics, is the director, University of Louisville Comprehensive Headache Program, the only academic program of its kind in Kentucky to serve the needs of patient care, teaching and research with headache as a specialty. Dr. Sowell is Board-certified in Neurology with special qualifications in child neurology. Appointments for children, adolescents or adults with headache or facial pain disorders may be arranged by calling 589-0802.