Actually, the answer to that question is True.  The real key to an accurate diagnosis is for your doctor to be able to identify specific characteristics of your headache in order to determine what kind it is and what may have caused it in the first place.  A critical step in reaching the diagnosis is to rule out any of the more serious conditions which may be the culprit. 
 
 

Headaches are serious business in this country.  There are at least 45 million Americans who complain of chronic headaches, and -- for at least half of these people -- the problem is serious and interferes with their activities of daily life.  The pain is also felt in our corporate pocketbooks in lost productivity and in skyrocketing healthcare costs.  Migraine victims miss almost 160 million workhours each year because of their headaches and headache sufferers in general make over 8 million visits to their doctors to find relief for the pain. 

There are a number of places a head can hurt -- the network of nerves in the scalp, the muscles of the head, and blood vessels that run along the surface and at the base of the brain.  The brain itself however, as well as the bones of the skull, cannot hurt, because there aren’t any pain-sensitive nerve fibers there. 

At the end of all these pain-sensitive nerves, there are tiny “messengers” (nociceptors) that get stimulated by stress, tension, lack of blood supply, or other headache “triggers.”  When this happens, they send off a signal -- with some help from unique body chemicals that transmit pain information -- to the brain. 

Some scientists suspect that people who have migraines or other forms of tormenting headaches have a lower than average level of endorphins (Greek for “the morphine within”) -- one of the body’s natural painkilling chemicals.  Most researchers agree that altered blood flow to the brain -- along with biochemical changes -- react in a domino-like effect to bring on the pain.   The nervous system responds to a signal -- like stress -- and starts a spasm which narrows arteries that supply blood to the brain, which causes the platelets in the blood to all clump together.  This releases serotonin -- which also constricts arteries, making the problem worse.  Hungry for oxygen, other brain arteries open wider to compensate for the reduced flow, which triggers the production of some nasty chemicals and pain producers like prostaglandins that cause inflammation and swelling and increased sensitivity to pain.  When the chain reaction is complete, the victim has one excruciating headache! 

Diagnosing a headache is not all that easy.  There are a number of different headache varieties and many of them have their own clear-cut symptoms and patterns.  The first challenge then, in getting to the root of the pain, is for the physician to take a complete medical history, to learn about any past head injuries or traumas, and to hear exactly what the patient’s headache involves.  Describing a headache calls for some careful choices of words.  The better the symptoms can be characterized and discussed, the better equipped the doctor will be to reach a diagnosis. 

While the physician will probably have a detailed list of questions for which answers are important, the headache victim should take some time before the office visit to be very precise in crafting a verbal description of the pain.  Are they agonizing, tormenting, throbbing, constricting, stabbing, vise-like, shooting, knifelike, dull, blinding, or debilitating?  Do they come on slowly and crescendo until you are driven to a dark room?  What makes the pain better?  How long do they last?  Are the headaches accompanied by other physical symptoms like weakness or numbness or dizziness?  Do they happen at the same time of day, or after eating a specific food, or only when you are stressed to the max?  If you are female, do they happen before, during or after your menstrual period?  Are there others in your immediate family who have similar headaches?  Think carefully...what information can you provide that will help give your doctor a good look “inside your head.” 

Obviously, not all headaches require a doctor’s care.  The important thing is to be alert to those that might signal a more serious condition so you can seek medical attention promptly.   While many people worry that their headache pain is the first symptom of a brain tumor, in reality this is true less than one percent of the time.  So, let’s get the worst-case scenarios out of the way first.

Headaches to be taken especially seriously include those that are severe and come on suddenly; those that are associated with convulsions or seizures, confusion, or loss of consciousness; those that result from a blow to the head; those associated with a pain in the eye or ear; and a severe headache in a person who was previously headache-free.  Headaches that accompany a high fever or recurring headaches in young children also call for prompt medical attention. 

To rule out more serious conditions, an electroencephalogram (EEG) to measure brain activity may be indicated if a malfunction is suspected.  The next level for patients with unusual headaches might be to undergo a computed tomographic (CT) scan or MRI (magnetic resonance imaging).  These sophisticated imaging devices take a look at structural variations, and may enable the physician to distinguish between a bleeding blood vessel and a brain tumor, for example.  An thorough eye exam may reveal unequal pupil size, which might suggest an aneurysm.  If appropriate, an angiogram might be ordered to take an enhanced X-ray look into the brain’s blood vessels.  Thermography -- or using an infrared camera to convert skin temperature into a color picture depicting the different degrees of heat -- is also being used experimentally to discover Cluster headache victims’ heat pattern in the area where their pain is centered. 

According to the National Institute of Neurological disorders and Stroke (NINDS), the migraine produces throbbing pain on one or both sides of the head, and symptoms -- besides pain -- can include nausea, vomiting, sensitivity to light and noise, fever, chills, flu-like achiness, and sweating. Some migraine sufferers experience visual disturbances (auras) before the onset of the pain.  Migraine attacks may last from a few hours to days, and may recur several times a week or as infrequently as once or twice a year.  Many migraine sufferers have a family history of the condition, perhaps due to an inherited abnormality in the regulation of blood vessels, although scientists are unsure.  The attacks can be brought on by eating seemingly harmless foods, too much or too little sleep, female hormones, stress, weather and temperature changes, or high altitude. 

Cluster headaches occur in a series of sudden, excruciating, one-sided episodes that begin as a minor pain around one eye, which may continue for 15 minutes or up to four hours.  Additional painful symptoms may include nasal congestion, drooping eyelid, and irritated watery eye on the side of the pain.  Victims complain that when the pain intensifies, they can’t lie down, they fidget, and have to pace the floor or rock in a chair.  Cluster headaches can strike at any age but usually start after age 20 and mainly affect men.  The attacks can strike several times a day or night, and continue for several weeks or months.  There are two kinds of cluster headaches -- episodic, in which there can be long, pain-free remissions; and chronic, when a person has only one week out of a year without a headache.  About 10 to 20 percent of cluster headache sufferers have the chronic condition. 

Tension-type headaches -- the most common of all headaches -- produce a dull, achy pain that feels like pressure is being applied to the head or neck.  This type of headache gets its name from the role of stress in triggering the attack, but also for the contraction of neck, face, and scalp muscles aggravated by stressful events.  The pain is temporary and described as mild to moderate and usually disappears after the period of stress is over.  The chronic version of this headache, on the other hand, can last for weeks, months and sometimes years.  The pain is described as steady, and on both sides like a tight band being tightened around the victim’s head.  Sometimes, even the scalp hurts -- making brushing or combing the hair almost impossible. 

Researchers believe that in many cases, chronic muscle-contraction headaches are caused by depression or anxiety. These tend to happen in the early morning or evening when conflicts at the office or at home are anticipated.  Physical postures that tense head and neck muscles -- like reading with your chin down, holding a phone between the shoulder and ear, or writing in poor light -- can also bring on a muscle-contraction headache.  Degenerative arthritis of the neck and TMJ (a disorder of the temporomandibular joint and the lower jaw) can also be some of the more serious causes behind these headaches. 

Treatments for headaches have come a long way since prehistoric times, when healers (who doubled as magicians and priests)-- and later the Egyptians -- performed a kind of brain surgery we called trephination today.  Researchers have found evidence that they used stone instruments to grind holes in the skull to allow demon spirits to depart.  Its hard to say if this technique cured or caused the headache.  By the time the Renaissance arrived, the medicine men had discovered some natural analgesics and medicines--like laudanum--were developed to stop or reduce pain. 

There has been a lot of progress during the past decade in finding new and more effective ways to treat migraine pain.  According to the American Medical Association, today most migraine sufferers are better able to control the pain and relieve its impact.  Individualized treatment plans are aimed at relieving migraine symptoms, preserving your ability to function at normal or near normal levels, and lessening the frequency or duration of future migraine attacks.  Sufferers may receive treatment to stop an attack in its tracks, treat the symptoms after the headache occurs, or   -- for the one in five migraine victims who have frequent, debilitating attacks -- a preventive treatment program might be recommended.  Fortunately, patients are not limited to a single treatment approach.  In developing your individualized headache therapy, your physician can choose among many medications available today that work well on their own or in combination with other drugs. 

In addition to drugs, there are a number of other therapies -- biofeedback training, stress management, diet modification, exercise and progressive relaxation therapy -- that many chronic headache sufferers find helpful in managing the pain or warding off attacks. 

Perhaps the most important thing to understand about headaches is that, while there may be generalized types of the disorder, each case is different.  There is no single magic formula to make the pain go away.  If headaches occur frequently, if there is a pattern in occurrence or in the progression of the pain, or if they begin to interfere with your daily routine get prompt medical attention.  Researchers have found that overuse of over-the-counter pain killers can sometimes actually cause the pain to continue.  An accurate diagnosis is the first step to a treatment program you can live with, and will hopefully minimize the impact of any headaches that do occur. 
 
 

QUIZ ANSWERS: 
1.  TRUE.  Exposure to nitrite compounds -- which are used as a chemical to preserve meat -- and foods prepared with monosodium glutamate (MSG) can result in a headache. 

2.  TRUE.  Scientists have found that “cluster” headaches not only happen more often in men, but the occur more often in men who are tall and muscular, who have what is described as a “rugged” face with a square, prominent or dimpled chin, whose skin is coarse in texture (like an orange peel).  They also occur more often in men who have hazel eyes who are heavy smokers and drinkers. 

3. TRUE. Ninety percent of all headaches can be classified as tension/muscle contraction headaches. 

4.   Unfortunately for the, this is TRUE.  Some people who suffer from episodic cluster headaches get a headache over and over again in the same pattern for as long as three months.  These people can have as many as four headaches a day during these periods. 

5.  FALSE.  Yes you can have headaches while you are sleeping.  In fact, cluster headache sufferers complain of headaches so severe they wake them from sound sleep. 

6.  FALSE.  While there are millions of Americans who suffer from headaches, according to the American Medical Association, recurring headache actually ranks seventh among complaints for which people see their doctors. 

7.  TRUE.  More than 26 million Americans suffer from migraine headaches which are believed to be hereditary.  The condition can strike at any age, but it is most common in young adult women. 

8.  FALSE.  Classic migraine sufferers report that they often see auras -- flashing lights, halos or experience temporary blindness -- before the pain strikes.  In reality, however, only 20 percent of people with migraine have auras. 

9.  FALSE.  There have been significant advances in the treatment of migraines.  Today, migraine sufferers -- in partnership with their physician -- can manage this condition much better and actually prevent or minimize attacks.  Experts generally agree that the more a migraine patient understands about what triggers the episodes and follows the prescribed regimen, the more likely he or she will be to reduce the incidence of attacks. 

10.  TRUE.  A migraine sufferer’s individualized treatment plan should: 1) identify and control factors that may trigger attacks, 2) include medications that will help prevent and treat the attacks, and, 3) involve modification of behaviors that have contributed to attacks in the past.  For some people, certain foods may bring on an attack; in others, not getting enough sleep -- or getting too much  -- brings on the pain. Getting plenty of regular exercise also helps people control stress, to relax, and generally to feel better -- and that goes for migraine sufferers, too.

DAVID S. COS, M.D. Diplomate, American Board of Internal Medicine Physicians Group of the Woodlands 1011 Medical Plaza Drive, Suite 120 The Woodlands, Texas  77381 (281) 296-8500

Dr. Cos received his Bachelor of Science Degree in Bioengineering at Texas A&M University and earned his Medical Degree from  University of Texas Southwestern Medical School in Dallas, Texas.  He completed his residency at Baylor College of Medicine in Houston.  Dr. Cos is a member of the Texas Medical Association, the Montgomery County Medical Society, and the American College of Physicians.  He and his wife have two children.