Most Common Headache Types

by Food and Drug Administration (FDA)

(Page 4 of 4)

Migraine headaches usually throb and affect one or both sides of the head. Physical activity tends to worsen the pain. Patients also may have nausea, vomiting, light and noise sensitivity, or other symptoms. Some sufferers have warnings, such as visual disturbances. Attacks last from a few hours to days, recurring from several times a week to once every few years. Women get migraines more frequently than men.

Cluster headaches occur as a series of one-sided headaches that are sudden and excruciating and continue for 15 minutes to 4 hours. Cluster attacks last 4 to 12 weeks, followed by remission as long as months or years. Other symptoms on the painful side include nasal congestion, drooping eyelid, and irritated, teary eye. Most cluster patients are men.

Tension-type headaches may last a few hours, a few days, or be chronic. The pain is described as a tight band around the head, but it can affect any scalp, face, neck, and shoulder muscles. Some patients, especially those with chronic tension headaches, also suffer from stress, anxiety or depression.

Danger Signals

Sometimes a headache can signal a serious condition requiring prompt medical attention. According to the National Institute of Neurological Disorders and Stroke in Bethesda, Md., a doctor should be consulted if a headache:

*is accompanied by confusion, unconsciousness or convulsions *involves pain in the eye or ear *is accompanied by fever *is accompanied by nausea *occurs after a blow to the head *is persistent in someone previously free of headaches *is recurrent, especially in children *interferes with normal life.

For more information, contact the Neurology Institute, P.O. Box 5801, Bethesda, MD 20824; telephone [phone]; or the National Headache Foundation, 5252 N. Western Ave., Chicago, IL 60625; telephone [phone]. (NHF offers a list of headache clinics and a state list of National Headache Foundation physician members interested in treating headache.)

Help for Headache Sufferers

In addition to over-the-counter products, a number of prescription drugs are available to treat headaches. Some migraine preparations also are approved to treat cluster headaches. One labeled as only "possibly" effective for migraine is approved for tension headache.

Anti-migraine drugs should be taken under medical supervision. Though they provide benefits, they can cause side effects, some of which are serious. Scientists don't know exactly how they work. The drugs' names, approved formulations and uses, and probable ways they achieve their effects are:

Ergotamine tartrate (Ergomar, Ergostat) tablets, dissolved under the tongue, are used short-term to prevent cluster headaches in some patients and to treat migraine and cluster. This drug constricts blood vessels and inhibits pain-causing fluid leakage from vessels in the brain's outer membrane. It interacts with brain "receptors" for serotonin (a chemical messenger that nerve cells use to tell each other what to do).

Ergotamine tartrate/caffeine (Cafergot, Cafermine, Ercaf, Ercatab, Ergo-Caff, Gotamine, Lanatrate, Migergot, Wigraine) tablets and/or suppositories are used to treat the same headaches as ergotamine alone. Caffeine increases ergotamine's effect, reducing the amount of ergotamine needed.

Dihydroergotamine mesylate injection (D.H.E. 45), an ergotamine derivative, is used like ergotamine. However, it can be injected in a muscle or given intravenously and may be more effective for a given attack.

Methysergide maleate (Sansert) tablets are used to prevent vascular headaches that occur once or more a week or are uncontrollable by other treatments. Thus, it is not used once an attack begins. It should not be taken continuously longer than six months. Sansert blocks serotonin transmission.

Isometheptene mucate/dichloralphenazone/acetaminophen (Amidrin, I.D.A., Iso-Acetazone, Isocom, Midrin, Migratine, Migrazone, Migrex, Mitride) capsules are used to treat tension headache and, the labeling says, "possibly" migraine. (FDA recognizes a potential benefit in migraine but requires more research to prove it is fully effective.) Isometheptene constricts vessels, dichloralphenazone mildly sedates, and acetaminophen relieves pain.

Propranolol hydrochloride (Inderal) tablets are used to prevent migraine. This drug may block communication between certain nerve cells.

FDA is reviewing data to support marketing of a migraine preparation called Imitrex (sumatriptan succinate), formulated as an injection patients can administer. The drug acts on serotonin receptors.

Last fall, an advisory panel to FDA on nervous system drugs recommended unanimously that Imitrex be considered approvable for treating migraine headaches. The panel concluded that more evidence was needed to prove safety and efficacy for use in cluster headaches.

Given the theory that most migraineurs are predisposed to their condition, migraine has been described as a cocked gun waiting to go off — except that this gun has many triggers.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.