Alcohol overuse has been associated with new daily persistent headache. On occasion, alcohol is used in an attempt to dull pain. This is not a good practice for a number of reasons, but it’s certainly not a great idea if it ends up giving you a chronic headache. This does not, of course, mean an occasional hangover headache, but is referring to general alcohol overuse and problem drinking.
What are the reasons headache sufferers might abuse alcohol? Is alcohol use associated with anxiety disorders? There is actually some evidence to suggest that alcohol dependence may be twice as high in people with anxiety disorders as in the general population.
Watch for these symptoms of a drinking problem:
More than three drinks per day or more than 7 drinks per week if you are a woman (or a man over age 65)
More than four drinks per day or more than 14 drinks per week if you are a man (under age 65)
Inability to stop drinking at a given time (binge drinking)
Failure to do what was expected of you because of drinking
“Blackouts” or memory loss because of drinking, like forgetting what happened the night before
Needing a drink first thing in the morning
Losing friends because of drinking
Feeling guilty about how much you drink
Feeling annoyed or angry when people talk about how much you drink, or when you read things like this list
If you think you might have a problem, talk to someone. Seek help for your problem drinking. Be smart, and get control of your drinking. And don’t use headache as an excuse to drink, because it’s not really a very good one. Who wants a daily headache?
Thunderclap headache is a sudden severe headache which reaches its peak intensity within one minute or less. It is sometimes described as “the worst headache of my life.” Once present, the headache can last from an hour to days.
Causes of Thunderclap Headache
Causes of thunderclap headache are subarachnoid hemorrhage, a syndrome called reversible cerebral vasoconstriction syndrome (RCVS), cerebral aneurysms (even unruptured), cerebral venous sinus thrombosis, cervical artery dissection, spontaneous intracranial hypotension, third ventricle colloid cyst, pituitary apoplexy, epidural cervical hematoma, and hypertensive crisis. Not all cases of thunderclap headache have one of these potentially serious underlying causes, and can be idiopathic, meaning there is no identifiable cause. Idiopathic thunderclap headache is what is known as a diagnosis of exclusion, which means that underlying problems with the blood vessels in the brain or neck should be ruled out first.
Unruptured aneurysms are present in 3.6-6% of the general population. It is thus unclear whether thunderclap headache is always due to an unruptured aneurysm in an individual who has both.
Primary cough headache, exertional headache, and headache associated with sexual activity can also present as thunderclap headache. As mentioned, idiopathic thunderclap headache, in which no underlying problem is identified, can occur. In the past, this has been referred to as “crash migraine.”
80% of those with primary thunderclap headache (with no underlying cause) have a triggering event, such as exertion, defecation, coughing, sexual activity, bathing, or emotional disturbance. Although it is not entirely clear why thunderclap headaches occur, it is thought that a sudden change in sympathetic tone of the blood vessels may cause sudden vasodilation resulting in the headache pain.
What Should You Do If You Have a Thunderclap Headache?
If you have a thunderclap headache, you should seek evaluation. You may simply have idiopathic thunderclap headache, or thunderclap headache associated with exertional headache, cough headache, or headache associated with sexual activity. However, no one will know whether there is a more serious and treatable underlying condition unless it is looked for.
Resources:
1. Schwedt TJ. Clinical spectrum of thunderclap headache. Expert Rev Neurother. 2007;7(9):1135–1144.
2. Linn FHH. Primary thunderclap headache. Handb Clin Neurol. 2010;97:473–481.
3. Dodick DW. Thunderclap headache. J Neurol Neurosurg Psychiatry. 2002;72(1):6–11.
4. Mistry N, Mathew L, Parry A. Thunderclap headache. Pract Neurol. 2009;9(5):294–297.
5. Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol. 2006;5(7):621–631.
6. Chen SP, Fuh JL, Lirng JF, Chang FC, Wang SJ. Recurrent primary thunderclap headache and benign CNS angiopathy: spectra of the same disorder? Neurology. 2006; 67(12), 2164—2169.
7. Liao YC, Fuh JL, Lirng JF, Lu SR, Wu ZA, Wang SJ. Bathing headache: a variant of idiopathic thunderclap headache. Cephalalgia. 2003; 23(9), 854—859.
Primary headaches—headaches that do not have a secondary underlying cause—affect almost one third of women in their child-bearing years. Migraine headaches affect women three times more frequently than men. We suspect this may be the case because of the influence of hormones on the underlying genetic tendency toward migraine. In fact, it has been recently discovered that there is a migraine gene that is on the X chromosome. (It is not yet known how many migraine sufferers possess this gene.)
Many myths about women and headaches persist in our culture, but it’s not fair to treat women with headache unfairly. Find out the truth about these common headache and migraine myths.
In addition to the way that hormones may affect your genetics to cause migraine, it’s also important to understand how a woman’s hormonal cycles affect headaches themselves. Sixty per cent of women with migraine headaches report that their worst headache each month occurs at the time of their menstrual cycle. Some women only experience menstrually related migraine headaches, and not at other times.
Migraines tend to affect women in a different fashion than men. Women report headaches that last longer and are associated with more accompanying symptoms. Their headaches tend to be more severe, more likely to require bedrest, and more likely to cause inability to attend work or social engagements.
According to the World Health Organization, migraine is the twelfth highest cause of disability in women worldwide.
Despite the heavy toll migraine takes on women, many have never seen a doctor about their headaches. A Canadian survey found that only 38% of women with migraine had sought medical care for their headaches. Although 40% of migraine sufferers experience weekly episodes, many self-treat rather than seek medical care. Historically, women have often been treated as if they were hysterical, crazy, up-tight, frigid, or in some other way blamed for having migraines. This is not the case. Migraine is a biochemical disorder of the brain – to understand it better, read our article on Pathophysiology.
If your doctor does not seem to understand migraine or your headaches, or treats you like it is in any way your fault, find another doctor. Both the National Headache Foundation and the American Headache Society (US), or Help for Headaches if you are in Canada, can direct you to a physician with an interest in headache. You can find information for all these organizations on our Resources page.
Almost everyone who has ever had a troublesome headache has worried at some point in time that they might have had a brain tumor. So let’s talk about what a brain tumor headache feels like.
Here are some reassuring facts: although up to 70% of people with various brain tumors have a headache at the time of diagnosis, only about 8% of tumor patients have headache as their first and only symptom. Many older sources have described a “classic” brain tumor headache as one that is worse in the morning, and is more likely to be a dull pain, but with nausea and vomiting. (There are other causes of morning headache, though.)
However, neurologist and cancer specialist Dr. Casilda Balmaceda, Assistant Professor of Neurology at Columbia University College of Physicians and Surgeons in New York, states that there is no typical brain tumor headache.
Symptoms for headaches associated with brain tumors
Nausea and vomiting do not usually show up until the tumor has gotten big enough to put pressure on the brain. This increased pressure phenomenon can also be the reason for morning headaches. However, morning headaches are far more likely to be due to sleep disorders like sleep apnea.
A brain tumor headache can link to the spot where the brain tumor is. So if you always get a headache in the same spot, there is a possibility that it could mean a brain tumor—but it’s not a big chance. If most of your headaches are on one side, but a few are on the other, your headaches are still most likely to be migraines.
Migraine patients who have had the misfortune to later develop a brain tumor report that the headaches due to the tumor are different from their migraine headaches. Do you always get a headache with a brain tumor? No—sometimes you get other symptoms instead, like weakness or a personality change.
Children with brain tumor are more likely to experience headaches than are adults.
Most people have no cause for worry, but it’s always best to see a doctor to be sure. A thorough history and a good neurologic examination can help to determine if you need diagnostic imaging studies like an MRI scan.
Migraine sufferers have always reported that the weather affects their headaches. Even the Greeks talked about “hot winds and cold winds”. Exactly how the weather affected headaches was not clear until formally studied. Canadian researchers looked at the effects of the chinook winds on migraines, and found a correlation. They reported that the most favorable “headache weather” was warm, dry, and with higher barometric pressure. You know, like a nice summer day.
Since then, several other studies have looked at weather and migraine but the results have been a little bit confusing. This may be partly because the early studies were small, and did not have very many people in them. It may also be partly because not all migraine sufferers are alike. And another study concludes that formal weather modelling may yield better information than patients’ observations.
A 2004 study conducted at the New England Center for Headache followed 77 migraine patients who kept headache diaries for 2 to 24 months. The headache diary data were compared to National Weather Service data. The most interesting thing about this study was that although 63% of migraine sufferers thought they were affected by the weather, only 51% of them were actually affected by the weather factors they thought influenced their migraines.
The weather factors most likely to influence migraines were temperature and humidity, high or low. The second most likely factor was any significant change in the weather, which affected 14% of migraine sufferers, and barometric pressure changes, again high or low, which affected 13%. Interestingly, 39% were sensitive to one weather factor, and 12% to two. So, in this study, no single weather change affected everyone the same way.
A 2009 study of weather conditions preceding emergency department visits for migraine found that the biggest trigger was higher ambient temperature, but that low barometric pressure was also a trigger. This was a large study, with over 7000 patients seen over a 7-year span.
Additional studies confirm the connection between both hot weather and drops in barometric pressure as triggers.
There isn’t much you can do to avoid the weather, but as our understanding of the biological effects of climate changes grows, you can at least predict these triggers a little better.
References:
1. Vaitl D, Propson N, Stark R, Walter B, Schienle A. Headache and Sferics. Headache: The Journal of Head and Face Pain. 2001;41(9):845-853.
2. Yang AC, Fuh J-L, Huang NE, et al. Temporal Associations between Weather and Headache: Analysis by Empirical Mode Decomposition Baylis M, ed. PLoS ONE. 2011;6(1):e14612.
3. Prince PB, Rapoport AM, Sheftell FD, Tepper SJ, Bigal ME. The Effect of Weather on Headache. Headache: The Journal of Head and Face Pain. 2004;44(6):596-602.
4. Mukamal KJ, Wellenius GA, Suh HH, Mittleman MA. Weather and air pollution as triggers of severe headaches. Neurology. 2009;72(10):922 -927.
5. Hoffmann J, Lo H, Neeb L, Martus P, Reuter U. Weather sensitivity in migraineurs. J Neurol. 2011;258(4):596-602.
What is complementary and alternative medicine (CAM), and how does it differ from “conventional” medicine? At the present time, conventional medicine is considered to be that delivered by MDs, DOs, and the allied health professionals they have customarily worked with in the past, such as psychologists, RNs, MSWs, registered dietitians, and physical and occupational therapists. CAM practitioners, however, work with conventional medical practitioners on an increasingly common basis. Therefore, the term “integrative medicine” is becoming favored over the term “complementary and alternative” medicine.
Complementary medicine has meant those forms of non-conventional medicine used in conjunction with conventional treatment; alternative medicine has meant those used instead of conventional medicine.
CAM includes chiropractic doctors, naturopathic doctors, acupuncture, homeopathic medicine, Ayurvedic medicine, mind-body techniques, bioelectromagnetic therapies, aromatherapy, Reiki, Qi gong, T’ai Chi, therapeutic touch, and herbal remedies. As some treatment modalities previously considered to be “CAM” have become more mainstream, and have received more scrutiny and research evidence, they have achieved “conventional” status, such as massage, biofeedback, and cognitive behavioral therapy.
Integrative Medicine and CAM for Migraine
Biofeedback, cognitive behavioral therapy, and other types of counseling or psychotherapy have been studied for headache sufferers, and can be effective. There have also been positive studies of acupuncture for migraine.
Formal studies of aromatherapy suggest benefit from lavender and peppermint oil for the treatment of headaches.
If you have mild migraine attacks, your migraine headaches may respond to over-the-counter medications. However, these should be taken in moderation as excess doses can increase headache frequency and severity. International Headache Society recommendations are to limit the use of over-the-counter medications to no more than 15 days a month, which averages out to three days a week.
The frequent use of over-the-counter medications can also result in other problems if used year over year. Acetaminophen (paracetamol) can cause liver damage if overused. Non-steroidal anti-inflammatories such as ibuprofen can result in stomach irritation, and can contribute to risk of heart disease. Long term excessive use of either type of over-the-counter medication can result in kidney damage.
Migraine Prescription Medications
Most migraine sufferers have attacks that are moderate or severe. These usually do not fully respond to over-the-counter medications. Fortunately, there are a variety of migraine-specfic medications designed to abort an acute migraine attack. If you have tried one or two, there may still be others that would work. Sometimes, pills do not work fast enough, as it takes at least 30 minutes for a pill to get from your stomach to your bloodstream. If this has happened to you, be aware that there are migraine-specific medications in both injectable and nasal spray forms.
Migraine and Medication: Prevention
Until we learn more about the primary prevention of headache disorders, medications remain the mainstay of treatment. Learn how to most effectively manage your headaches with medication when trigger management and lifestyle management are not adequate to keep your headaches at bay. At present, preventative medication therapy is under-utilized in the management of migraine headache. If you have three or more days of disabling headache per month, migraine prevention may be helpful for you, and you should discuss this with your physician. Even if you have as few as two disabling headache days a month, but cannot use triptan medications to abort them because of other medical conditions, you may be a candidate for migraine prevention medication.
There are many preventive medications. Even if you have tried three or four, there are likely to be other medication options available.
The question of whether a headache is a migraine may seem obvious if you are an experienced migraine sufferer, but not everyone knows this stuff inside out. There is still confusion out there, and it’s always worth reviewing. Some people, for example, think that a migraine is defined by how bad the headache is. While a migraine is defined by moderate or severe pain, among other things, it does require other features to be a migraine headache and is not just a severe headache. And there are other types of severe headache that are not migraines.
Eight Ways to Tell if a Headache is a Migraine
If your headache is one-sided, it is more likely to be a migraine.
Migraine pain is generally moderate or severe.
Most migraine pain is pounding or a throbbing sensation in head.
Migraine pain is often made worse by routine physical activity.
If you have nausea or vomiting with your headache, it is more likely to be a migraine.
If bright light or noises bother you during a headache or make your pain worse, it is likely that your headache is a migraine.
If your headache is preceded by an aura—a warning phase with flashing lights, colored shapes, lines, blind spots or any other kind of neurologic symptom like numbness, your headache is a migraine.
If you have headache at the back of the neck, it can still be a migraine, as long as you have other migraine symptoms. Neck pain associated with migraine is actually more common than nausea in migraine attacks.
What is harder for people is how to tell headache types apart when you happen to suffer from more than one kind of headache. It’s important to know which one is a migraine so you can take the right medication. If you only get so many migraine medications a month, you don’t want to “waste” one on a headache that isn’t a migraine. Plus, taking these too often can lead to more headaches.
It’s not always easy to tell various headaches apart, as they may start out the same. Remember, too, that not every migraine attack is going to be exactly the same. But keeping a headache diary can help you begin to sort your own headaches out, and this can help you and your physician figure out what is going on.
Apparently, it can, although that headache may not necessarily be a garden variety migraine.
Some licorice, especially many varieties manufactured in the US, is flavored primarily with anise seed, and carries little risk to your blood pressure. But true licorice comes from the root of the herb Glycyrrhyza gabra, and contains glycyrrhizin. Glycyrrhizin has many effects on the neuro-endocrine system, and increases blood pressure. Authentic licorice made with licorice root should be eaten in moderation to avoid elevations in blood pressure and other health issues.
There was a report made recently of a single case of licorice-associated thunderclap headache due to reversible cerebral vasoconstriction syndrome with PRES (posterior reversible encephalopathy syndrome). What does all that mean?
Reversible cerebral vasoconstriction syndrome (RCVS) is a cause of thunderclap headache–a type of suddenly occurring severe headache–that headache experts are working to understand better. It likely has multiple causes, and most likely affects susceptible individuals. We need to better understand what causes someone to be susceptible to suddenly and unpredictably having segments of their brain blood vessels constrict and then dilate.
PRES is a condition in which the posterior (back part) of the brain is affected by swelling, and the affected person suffers from headache, seizures, visual problems, and alterations in mental status. In this particular case, these two conditions were brought on by eating one pound of licorice a day over a four-month period. Thankfully, it was all reversible.
Should you avoid licorice? Probably not, but I wouldn’t advise eating a pound a day, especially if you have migraines, and definitely not if you have high blood pressure. Moderation is still a good thing.
While there has been a recognized association between bruxism (grinding) and temporomandibular disorders, this has not been well-studied with respect to headache disorders. One study found that 40% of patients presenting with TMD also had migraine. The authors of the study note that further research is necessary.
Clenching has been associated with anxiety disorders, and may be highly comorbid with migraine as well. Although formal studies of temporomandibular dysfunction in migraine are lacking, many headache experts note a correlation between TMD symptoms in their migraine patients.
Types of Temporomandibular Dysfunction
The American Academy of Orofacial Pain recognizes two types of temporomandibular dysfunction. These are called myogenous (related to muscles) and arthrogenous (related to joints). Myogenous TMD is due to bruxism, clenching, or both, and has no evidence of joint issues. Arthrogenous TMD is due to problems with the jaw joint itself, and may include degeneration of the disc in the jaw joint. Many people with TMD will have both types.
TMD occurs more frequently in women, with a 4:1 ratio reported. Not everyone with TMD is depressed. Some people with TMD have abnormalities in a gene called serotonin transporter gene, which has also been found in association with depression. Serotonin transporter gene changes have also been associated with the emotional processing of pain, and may cause an increase in migraine attacks as well as TMD pain.
Symptoms of arthrogenous TMD are popping or clicking of the jaw, inability to fully open the jaw, ear pain or a sense of fullness in the ear, ringing of the ear, dizziness, and hyperacusis (hypersensitivity to normal sound levels). Myogenous TMD causes pain in the jaw and muscles of the face.
Treatment of Tempormandibular Dysfunction
The TMJ Association recommends the following self-management measures for TMD: moist heat, cold packs, at least temporary avoidance of hard or chewy foods, or foods that make you open your jaw wide, like apples or corn on the cob, and good general dental care. In addition to maintaining a good posture in general, you should avoid sitting with your chin in your hand, and you should not sleep on your stomach. Also keep in mind the saying, “lips together, teeth apart.”
These measures are not a substitute for medical or dental evaluation. If they are minimally helpful, you may require physical therapy or dental treatment, which can include an oral device.Your physician or dentist will be able to determine whether you need referral to an oral surgeon or craniofacial specialist.
There is little evidence that either orthodontia or occlusal adjustment can prevent or treat temporomandibular dysfunction, according to the Cochrane Summaries.
References:
1. Palit S, Sheaff RJ, France CR, et al. Serotonin transporter gene (5-HTTLPR) polymorphisms are associated with emotional modulation of pain but not emotional modulation of spinal nociception. Biol Psychol. 2011;86(3):360-369.
2. Kotani K, Shimomura T, Shimomura F, Ikawa S, Nanba E. A Polymorphism in the Serotonin Transporter Gene Regulatory Region and Frequency of Migraine Attacks. Headache: The Journal of Head and Face Pain. 2002;42(9):893-895.
3. Esposito, CJ, Fanucci, PJ, Farman, AG. Associations in 425 patients having temporomandibular disorders. J Ky Med Assoc. 2000;98(5):213-215.
4. Gatchel, RJ, Stowell, AW, Buschang, P. The relationship among depression, pain, masticatory functioning in temporomandibular disorder patients. J Orofacial Pain. 2006;20(4):288-296.
5. Ojima, K, Watanabe, N, Narita, N, Narita, M. Temporomandibular disorder is associated with a serotonin transporter gene polymorphism in the Japanese population. Biopsychosoc Med. 2007;1:3. pub online 2007, Jan 10, doi: 10.1186/1751-0759-1-3.
6. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular joint (TMJ) disorders. In: The Cochrane Collaboration, McDonald F, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010. Available at: http://summaries.cochrane.org/CD006541/orthodontics-for-treating-temporomandibular-joint-tmj-disorders. Accessed January 10, 2012.
7. Koh H, Robinson P. Occlusal adjustment for treating and preventing temporomandibular joint disorders. In: The Cochrane Collaboration, Koh H, eds. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2003. Available at: http://summaries.cochrane.org/CD003812/occlusal-adjustment-for-treating-and-preventing-temporomandibular-joint-disorders. Accessed January 10, 2012.
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