Everyone has experienced it a few times in his or her life: a headache. This annoying and
Dr. Howard Jacobs
sometimes excruciating pain can seriously impact our well-being and overall happiness.
Dr. Howard Jacobs, attending headache specialist and hospitalist at Nationwide Children’s Hospital, answers Healthy New Albany’s questions on managing headaches, what to look out for when a child has a headache and when it’s time to seek professional help or medication.
Bio: Dr. Howard Jacobs is an attending headache specialist and hospitalist at Nationwide Children’s Hospital and clinical associate professor of pediatrics at The Ohio State University. Jacobs has published numerous articles and book chapters on topics relating to pediatric headaches. He has a particular interest in the effect genetics play in migraine therapy and the relationship of weather and migraines. Jacobs and his wife reside in New Albany.
What are the differences between a headache and a migraine?
“Headache” is a general term to describe, obviously, pain in the head. Headaches can be primary, or caused by something else: secondary, in which they are caused by infection or trauma. The two major forms of primary headaches are migraine and tension-type headaches. In general, tension-type headaches tend to be less severe and less likely to interfere with daily activities than migraines.
Migraines tend to be more severe in nature; often, but not always, throbbing and associated with nausea/vomiting, light and/or sound sensitivity, and dizziness. A small number of people who suffer from migraines complain of an aura, a phenomenon that occurs before the headache, often a visual problem. But most people do not have auras.
Headache pain can be found in a variety of places around the head, including above the eyes, behind the head, ears, neck, etc. Does the location of your pain mean anything in terms of cause or prognosis?
In most cases, no. Doctors have long been taught that migraines tend to be one-sided pain, but in children and adolescents, the pain is more often on both sides and very often across the forehead or behind the eyes. As such, it is often misdiagnosed as sinus pain. Sinus infections can cause pain, but pain is not the only symptom. Sinus infections also cause fever and nasal drainage along with pain. People who state they get frequent sinus headaches likely have migraines.
We may get a bit more concerned about headaches in the back of the head. Headaches in this location are still most likely tension-type headaches or migraines, but can also rarely be a sign of increasing pressure in the back of the head that could be caused by a tumor or other abnormality in the area. Again, though, these are quite rare.
Lastly, a neck injury may cause headaches, something we call a cervicogenic headache. These patients will often complain of pain in the back of the neck going up the back of the head.
What about the characteristics of the pain? For example, does experiencing a dull ache as opposed to a throbbing pain mean anything?
Again, classic teaching is that a migraine is a throbbing headache. In adults, this is usually true, but in pediatric patients, the pain may be steadier in nature. So the nature of the pain is not a good diagnostic sign.
Many times headaches, especially minor ones, are perceived as harmless. But can it be a sign of an underlying health problem? How?
A mild headache in the absence of any other signs is likely to be of little concern. However, if there are other associated symptoms, it may warrant further evaluation. Fever, weight loss, lack of appetite, urinary changes, decreased activity, change in mood or behavior, or neurologic issues such as seizure, tremors, weakness or paralysis are all signs that the patient should be evaluated. Also, a headache that is progressively worsening over time, or a headache that is worse in the morning and worsened by straining, such as having a bowel movement, may suggest increased pressure in the head and should be evaluated.
At what point should someone seek medical attention for his or her pain?
A sudden severe headache or a change in the headache’s sensation should be evaluated. Another good rule of thumb is that if the headaches are interfering with your life, then it is time to get them evaluated so therapy can be instituted to return your (or your child’s) life to normal.
What are some of the causes of headaches that we might not consider?
People often overlook the obvious – what we call lifestyle issues. Lack of adequate sleep; skipping meals; not drinking enough fluids; lack of exercise; stress at home, work, school or all of the above contribute mightily to headache.
Caffeine use also is a major problem. Caffeine is a double-edged sword. It has long been used to treat migraines and, on an occasional basis, does have anti-migraine effects, but if taken too often (the daily cup of coffee), it can make headaches worse. This is what is called a medication-overuse headache, which we see in probably half of our patients.
Caffeine, acetaminophen and ibuprofen – in addition to stronger medicines such as morphine, codeine and barbiturates – are likely to worsen headaches if they are taken too often. Unfortunately, people who are suffering from frequent severe headaches often keep taking more and more of these medicines to try to get rid of the pain, without realizing that, in fact, they are making their situation worse. That is when seeking medical care becomes extremely important, to break the cycle and stop the overuse.
Foods are often blamed as being migraine triggers, something that in general seems overrated. I find it seldom makes a huge difference. That said, if tomatoes make your headache worse, don’t eat them.
About 50 percent of women with migraines will note that their headaches are much worse during their menstrual period.
Many people complain their headaches worsen with weather changes. The headache medicine literature goes back and forth as to whether weather-related migraines exist. Regardless of what the literature says, many of my patients tell me that when storms move in, or when it gets really hot, they know they are going to get a headache. In fact, I wrote an article a few years back on a way to treat weather-related headaches.
What are some natural ways to control headache pain?
Yoga, acupuncture, self-hypnosis and biofeedback have all been shown to help headache pain, but require a commitment and “buy-in” from the patient. If you say “That stuff will never work,” then you’re going to be right.
Eating three meals a day, every day; getting adequate sleep at night without napping during the day; drinking lots of liquids (a good gauge is if your urine is clear); getting exercise and dealing with and, if possible, removing the stresses in your life will go a long way toward improving the headache situation.
There are supplements that may also help. Magnesium has the best evidence, but riboflavin, coenzyme q-10 and the herbals, butterbur and feverfew, all appear to have some effect on migraines. They may take weeks or months to work, though.
What over-the-counter pain relievers do you recommend to your patients? What makes them superior to other medications?
For tension-type headaches, acetaminophen (Tylenol) is often adequate. Migraines, however, seldom respond to this. Many migraine sufferers get adequate relief from ibuprofen (Motrin or Advil) or naproxen (Aleve). The key is to take the medicine as soon as possible. The medicines all work best if taken at the onset of headache pain. However, do not take these medications more than two to three days per week or you may develop a medication-overuse headache.
At what point does someone need to turn to prescription medication for pain?
When the over-the-counter medicines are not successfully aborting the headache or the headaches recur. Or if the headaches occur more than once a week or last more than a few hours.
What should parents know about headaches in children? How does a child’s headache differ from an adult’s? What special treatment does the child need?
Unlike the classic adult migraine, which is one-sided and throbbing, migraines in the pediatric population may be bilateral and may not be described as pounding. Part of this may be the difficulty a child has in describing what is going on, but it also may represent a difference based on the maturity of the nervous system itself.
Every parent who brings a child to the headache clinic is worried to some extent, maybe only a bit or maybe profoundly, that the headache represents a brain tumor. Please be assured that this is rarely the case and that your doctor, a neurologist or a headache specialist understands your concern and will be able to rule it out for you, often without an MRI or CT scan.
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Hannah Bealer is an assistant editor. Feedback welcome at ssole@cityscenemediagroup.com.
