Headache is among the 10 leading reasons patients seek physician help. Americans spend billions of dollars annually for overthecounter headache relief potions. In the search for relief, however, it’s important to realize not all headaches are alike. Headaches are characterized by their location, duration, reaction form, associated symptoms and causes:
Migraine headaches are usually one sided, having pulsing sensations, and may be accompanied by photophobia (light sensitivity) and nausea or vomiting.
Sinus headaches typically are constant pressure headaches in the cheek and forehead areas. The person may feel as if his head will blow off.
Tension headaches are caused by muscle tension, which may result from stress or from injuries to the muscles, the connective tissue and skeleton of the neck.
Cluster headaches are fortunately uncommon. People with cluster headaches may have six or more shortlived headache attacks daily. These headache cycles may continue for months. The pain, often totally incapacitating, is described as a hot poker being twisted in the skull.
Brain tumors are uncommon causes of headaches. These headaches are sharp and often associated with nausea. They appear upon awakening and generally disappear in the morning.
Headaches are often a side effect of medications. This type of headache is usually influenced by the medication’s basic actions, but can also be an allergic reaction to the medication. Aspirin may cause sinus headaches in aspirin-sensitive patients. The normal drug action of theophylline, which relaxes the smooth muscles of the lungs, causes a headache when administered in moderately high doses.
Allergic disease and allergic reactions are important causes of headaches. Sinus or nasosinus vacuum headaches and migraines are the headaches most clearly related to allergies.
The term sinus headache is, in part, a misnomer. Although the pressure and discomfort are felt in the area of the face above the sinus, the causative sites are actually in the nose. When the openings of the sinuses in the nose are blocked, pressure equilibrium is disturbed; i.e., pressure in the sinus becomes less than or more than atmospheric pressure. This pressure difference causes pain by forcing the mucus membrane against the bony skull or stretching the membrane away from its attachment. When the barometer falls before a storm, many sinus sufferers can predict the weather-but at a painful price. These same sinus pain symptoms can be reproduced by applying cold air or pressure to the sinus openings.
The sinuses can also become infected. In this case the pain is associated with fever, tooth pain and body symptoms. Sinus infections are less common than nasosinus vacuum headaches, although these two different problems are sometimes confused.
Congestion of the mucus membrane of the nose is the precipitating force in sinus headache and may be caused by medication or allergy. Nasal allergy is usually caused by airborne allergens, such as pollens, molds, dusts and dander. About 5 percent of nasal allergies may be due to food allergies.
To prevent nasal congestion and nasosinus headaches, chronic care may be needed. The choice of treatment is based upon collaboration and cooperation between patient and physician.
The first and safest method is to avoid allergenic factors. For example, room air filters can effectively reduce the levels of allergens and irritants.
Intranasal corticosteroids are a safe, practical means to reduce allergic-reaction-induced nasal congestion. These usually provide benefit within a week. Allergen immunotherapy (allergy shots) which decreases the allergic nasal response may benefit nasosinus headache sufferers.
Decongestants and Mild Pain Killers
For acute sinus headache pain, medications containing decongestants and mild pain killers (acetaminophen, aspirin or ibuprofen) generally suffice for relief. In more severe episodes, nasal spray with decongestant and topical numbing medicine is useful. Inhaling warm moist air also shrinks congested mucus membranes and moistens dry mucus. This shrinking unblocks sinus openings in the nose allowing the pressure to equalize, thus relieving the pain. If the problem does not improve with these treatments, doctors may prescribe oral anti-inflammatory steroids to provide relief.
Chronic use of decongestants is less desirable now that alternatives are available. Decongestants constrict nasal blood vessels. They also constrict peripheral blood vessels and may predispose or cause high blood pressure.
Migraine headaches or attacks are complex reactions. One way they are differentiated is whether or not the migraine attack is preceded by a sensation called an aura. This sensation may be a smell, sound or visual response. If the attack has an aura, it is called a classic migraine. Without this aura, it is a common migraine, so named because it is more commonly occurring.
In both classic and common migraines, pain is caused by blood vessels around the brain dilating, throbbing and pressing against the bone. The cause of the dilation was recently discovered to be an important difference between these two types of migraine. In classic migraine, the first phase is a constriction of a blood vessel within the brain. Some brain tissue receives inadequate oxygen detoxic forum. Special messages called reflexes, and special chemicals called vasodilators are released from the brain. The vasodilators open up blood vessels and along with the reflex messages cause the widened throbbing blood vessels around the brain. In common migraine, the disturbance in brain tissue oxygen does not occur. Instead chemicals or reactions outside the brain cause the blood vessels to dilate.
Allergies Can Trigger Migraine
Patients who have migraines often have other allergic problems or relatives with migraine. Although migraines may be provoked or worsened by seasonal airborne allergies, food allergies are the most important allergic cause of a migraine attack.
Nineteenth-century physicians recognized clinical association between migraine and eating certain foods. In the early twentieth century, there were many reports of food caused migraines. More recently, the role of food allergy in migraine attacks has been confirmed by careful double-blind placebo-controlled studies.
Nearly 40 percent of adults with migraine will have an attack after eating certain foods. Avoiding these foods will decrease attacks by more than 50 percent and will sometimes stop them completely. In children, the percent who can benefit appears higher.
Other people have migraines which may be provoked by the drug-like action of food components rather than specific foods detoxic kruidvat. For example, tyramine in cheese, phenols in red wine, monosodium glutamate, sodium nitrate, aspartame and alcohol may precipitate an attack.
Should an Avoidance Diet Be Considered?
The first step in determining if foods are causing migraines is to keep a careful diet diary and a record of migraine episodes including their severity. From this diary, a knowledgeable physician can help determine if a trial avoidance diet should be instituted.
It may take several months before an avoidance diet can be adequately assessed. If the migraine condition improves, the avoided foods are carefully reintroduced. When the introduction seems to cause migraine, the food can be deleted from the diet again. Finally, the foods that remain suspect can be evaluated in a double-blind challenge. In this test neither the physician nor the patient knows which is the food and which is the placebo.
Studies are currently under way to evaluate new diagnostic tests to determine if they can better identify foods implicated in an individual’s migraine. The tests presently used for diagnosing food allergy appear too imprecise to reliably predict the likely allergenic foods causing migraine. These tests can help, but are inadequate by themselves. The history, diet trial and challenge are the keys to finding the correct diagnosis and treatment.