Migraine, Cluster and Tension: Headache Misery May Yield to Treatment

by Food and Drug Administration (FDA)

"My headaches started when I was taking birth control pills. The pain was intense, first right above my eyes, then spreading below the eyes. It might start on one side and the next day switch to the other side. Nearly every week I'd be sick two or three days like I had the flu — vomiting, aching, and yawning all the time. All I wanted to do was sleep.

"After I went off the pill, the headaches were sporadic. I'd go for years with very little trouble. Surprisingly, during my pregnancies, they disappeared. But they returned with a vengeance at menopause, and I was sick more than I wasn't sick. I could hardly stand it."

Janice Bailey, of Tucson, Ariz., describes her decades-long battle with "sick headaches," the most common symptom of a disabling condition called migraine. Attacks often follow exposure to a trigger — such as birth control pills.

Migraine is only one of 12 headache types (with more than 60 sub-types) classified in 1988 by the International Headache Society for use in diagnosis. Migraine, cluster, and tension-type headaches are the main varieties. Numerous physical disorders underlie the nine other types.

Chronic headaches plague more than 45 million Americans, reports the National Headache Foundation, of Chicago.

Still, the vast majority of headaches are temporary, "requiring no more than an over-the-counter analgesic," says Russell Katz, M.D., deputy director of the Food and Drug Administration's division of neuropharmacological drugs, which reviews anti-migraine drugs. "Headaches from life-threatening conditions such as tumors are uncommon," he says.

An important tool in diagnosing headache is the patient's medical history, says Stuart Stark, M.D., director of the Headache Program for The Neurology Center in Alexandria, Va.

"The history usually is sufficient to determine the specific type of headache," he says. "But when headaches are debilitating, a diagnostic workup is warranted."

Workups often include taking pictures of the brain with a radiological procedure such as computed tomography or magnetic resonance imaging. To rule out certain causes, further procedures may be needed — blood tests, for instance. "We particularly look at the blood count," Stark says, "to see whether the blood is too thick or too thin. Blood that clots abnormally can be caused by disease, such as lupus (a rheumatic disease)."

Migraine

Migraine headaches affect 16 million to 18 million Americans, of whom nearly two-thirds are women, the National Headache Foundation says. Since migraine is believed to be mostly an inherited condition, children, even babies, may be "migraineurs," as victims of this headache are called.

"Abdominal colic could be a form of migraine," Stark says. "If the mother or father has had migraines, it's worth considering the colic as a possible prelude to a migraine condition. About all you can treat a baby with is liquid Tylenol, but the colic could alert you to watch for symptoms as the child grows."

The two main migraine sub-types are "migraine with aura" (formerly called "classic migraine") and "migraine without aura" (formerly called "common migraine"). Attacks can last from several hours to several days.

About 10 percent of migraine patients have auras — certain neurological (nerve-related) symptoms that precede the headache by 5 to 30 minutes but sometimes persist into the headache phase. Aura symptoms include visual disturbances such as flashing lights or zigzag lines or even temporary vision loss. Others are a pins-and-needles feeling on one side of the face or body followed by numbness, or numbness without the tingling. Less frequent signs are speech problems, confusion, and weakness on one side.

Migraines without auras may be accompanied by vague warning signs, including mood swings, mental fuzziness, and fluid retention.

Bailey says she often was very tired before an attack. "I'd yawn and yawn," she says. "But mainly it was just an overall feeling. I'd know I'd better not eat much if I had that feeling."

Patients describe their pain with words such as intense, throbbing, pounding. They feel it in the forehead, temple, ear, jaw, or, like Bailey, around the eye. Most migraines are one-sided. Some start on one side but spread to the other.

Besides headache, symptoms include nausea, vomiting, appetite loss, diarrhea, sensitivity to light and noise, fever, chills, flu-like achiness, and sweats. Attacks range in frequency from several times a week to once every few years.

About 5 percent of migraineurs don't have headaches. "They may have vomiting, dizziness, or ringing in the ears," Stark says. "Since migraine is a condition of the brain, literally any neurologic symptom can occur."

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