What to do about chronic headaches

This article discusses chronic headaches and what you can do about them.

From drinking too much last night to stressing out about finances or family concerns, there are so many possible causes of the common headache. However, when headaches go from being few and far between to frequent and long-lasting, it may be time to make an appointment to see your primary care physician.

"Practical clinical criteria defines chronic migraine as a headache that occurs greater than 15 days a month with each headache episode lasting longer than four hours for at least three consecutive months," said Dr. Denis G. Patterson, medical director of the Northern Nevada Pain Center and founder of Nevada Advanced Pain Specialists. "It does not matter how severe the headaches are — the medical term for chronic headaches is migraine headache."

According to Patterson, who is board-certified in pain medicine and physical medicine and rehabilitation, common headache triggers include hormonal changes in women, stress and changes in sleep patterns. Certain foods, such as alcohol, aged cheeses, chocolate, aspartame, too much caffeine, monosodium glutamate, processed and salty items, also may set off headaches. Among other potential triggers are bright lights, loud sounds, unusual smells, changes in the weather or barometric pressure, intense physical exertion or sexual activity.

"The causes of chronic headaches are not well understood," Patterson said. "Medical experts believe that genetics and environmental factors seem to both play a role."

No matter the cause, if you find that you're hampered by headaches a little too often, experts suggest first making an appointment with your primary care physician. If unable to alleviate the headaches, this doctor may then refer you to a headache specialist, such as a neurologist or pain management physician.

"A physician trained in treating headaches will likely diagnose the condition on the basis of your medical history, a review of your symptoms, and a physical and neurological examination," said Patterson, who specializes in common and complex neurological disorders, as well as musculoskeletal issues. "Your doctor may also recommend a variety of tests to rule out other possible causes for your pain if your condition is unusual, complex or suddenly becomes severe."

As for treating chronic headaches, there are quite a few options for today's patients. Your doctor may advise starting with noninvasive and nonpharmacological solutions to see if the migraines can be reduced naturally. For example, you may be encouraged to engage in muscle relaxation exercises and commit to getting enough sleep. Other treatment options may involve alternative medicine, such as acupuncture or massage therapy.

Pain-relieving medications or preventive medications also might be prescribed to address chronic headaches. Finally, certain patients may need injections to ease or prevent the pain. This might involve the use of nerve blocks, nerve stimulators or Botox injections.

"Botox is the first and only preventive treatment approved by the FDA for adults with chronic migraine," Patterson said. "It may reduce the number of headache days a month and/or decrease the severity of headache episodes."

Without treatment, the frequent pain of chronic headaches can lead to decreased quality of life. If you find that your headaches go beyond the occasional hangover or tension-filled day, reach out for relief.

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Study: Complementary & Alternative Medicine Use In Youth With Recurrent Headaches

A new study published in Pediatrics claims that children with chronic recurring headaches, especially those with another chronic condition, are more likely to use complementary and alternative medicine.

OBJECTIVE: To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care.

METHODS: Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used.

RESULTS: Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care.

CONCLUSIONS: CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

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Long-term treatment for headache sufferers

Electric stimulation of the peripheral nerve has shown long-term effectiveness for reducing the intensity of headaches for chronic headache sufferers.

For the more than 45 million Americans who suffer from chronic headaches, relief may be on the way in the form of an electric pulse, according to a study presented at the ANESTHESIOLOGY™ 2013 annual meeting. Electric stimulation of the peripheral nerve reduced average headache intensity by more than 70 percent.

With electric stimulation of the peripheral nerve, a thin insulated wire is implanted in the back of the head (occipital nerve) or in the forehead above the eyebrow (supraorbital nerve) and delivers electric pulses to block pain. The study looked into the safety and long-term usefulness of this treatment.

"Despite advances in headache treatment over the past two decades, many people do not get adequate pain relief from current treatments, or they cannot tolerate the side effects of the medications," said Billy K. Huh, M.D., Ph.D., professor and medical director of the Department of Pain Medicine at The University of Texas MD Anderson Cancer Center, Houston, and adjunct professor of the Department of Anesthesiology at Duke University Medical Center, Durham, N.C. "This treatment offers hope to those patients and a chance for a major improvement in quality of life."

The study monitored 46 patients who received peripheral nerve stimulation between 2005 and 2012. Follow-up phone interviews were conducted to determine subsequent headache intensity, frequency of headaches per month, complications and overall satisfaction with the treatment.

The study found that both headache intensity and frequency decreased significantly. The average headache intensity was reduced by more than 70 percent. The average number of "headache days" decreased from 28 to 14 per month. Ninety percent of patients were satisfied with the treatment, with one reporting more than eight years of reduced headache intensity and frequency.

A drawback of the treatment is its relatively high level of complications, which include electrode migration, equipment problems and infection. The study authors state that as physicians gain experience with implantation techniques, complications will decrease.

"This is a real breakthrough for chronic headache sufferers," explained Dr. Huh. "For patients with no other options to relieve their pain and suffering, this treatment is a way for them to get their life back."

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Study claims acupuncture can treat headaches

A study shows that acupuncture can effectively reduce the intensity and duration of painful headaches and may be more effective than migraine medication.

A new study concludes that acupuncture is effective for relieving headaches. Investigators note that acupuncture reduces the intensity and duration of headaches. In addition, they suggest that acupuncture can reduce the need for “drug therapies and is a valuable option for patient suffering from CDH [chronic daily headache].”

In this controlled study, verum acupuncture was compared with sham acupuncture. The verum acupuncture group improved significantly over the control group. Verum acupuncture significantly reduced the frequency, intensity and duration of chronic daily headaches. The research notes that acupuncture is effective for reducing the intensity of pain for chronic tension headaches and migraines. In addition, patients suffering from nausea due to headaches and migraines showed a significant decrease in nausea levels.

In related recent research, acupuncture was found more effective and safer than a migraine medication. Researchers discovered that acupuncture effectively reduced migraine pain intensity levels and no adverse effects occurred. In the same study, patients receiving the medication valproic acid did not have the same level of clinical benefits as acupuncture and with nearly 50% of patients experiencing adverse side effects from the drug.The outcomes were measured six months after the study had been completed. This demonstrates that acupuncture has long term benefits for patients with migraines and that it is both safe and effective.

A massive meta-analysis study measuring patient outcomes of nearly 18,000 patients concurs with the researchers. The study finds that acupuncture effectively treats neck, back, osteoarthritis, headache and shoulder pain. Published in the Archives of Internal Medicine, the researchers concluded that, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.” US Navy sports medicine Dr. Stuessi concurs, “I’ve found phenomenal, off-the-charts results doing acupuncture for sleep, for dizziness and headaches.”

Acupuncture for pain control has received a great deal of attention in modern research. A study conducted at the University of California (San Francisco) discovered that acupuncture provides the same level of pain relief as morphine. The laboratory experiment revealed that needling ST36, an acupuncture point located on the lower leg, significantly reduces jaw pain. After one minute, the pain level reduced by over 20% and after thirty minutes of acupuncture treatment the pain level reduced by 30%. This acupuncture procedure provided the same level of pain relief that is made possible by one dose of morphine.

According to Traditional Chinese Medicine (TCM) theory, acupuncture point ST36 is located along a channel of other points starting in the head and terminating in the feet. ST36 is on the Stomach channel, which is also referred to as the Foot-Yangming Meridian. This acupuncture channel originates at another acupuncture point, LI20, runs to the inner canthus of the eye to an acupuncture point called UB1 and then descends to the gums and joins with yet another acupuncture point called DU26. The Foot-Yangming channel then circles around the mouth, meets with acupuncture point CV24 and then follows the angle of the jaw. Other details of Chinese medicine theory demonstrate that the various branches of the Foot-Yangming Stomach channel connect to the head, mouth, gums and jaw and therefore are consistent with the research demonstrating that acupuncture point ST36 relieves jaw pain.

The mounting evidence from both primary and secondary research demonstrates that acupuncture has significant effective actions in controlling pain. Acupuncture is a covered benefit in many health insurance plans, is used by the US military for the treatment of pain and PTSD and is supported by a deluge of research from prestigious universities. That, combined with publication of supportive research published in important medical journals, suggests that acupuncture is now entering a more mainstream branch of medicine.

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