Archive for November, 2009
Monday, November 30th, 2009
A migraine headache is a specific type of headache which is thought to be of vascular or neurologic origin. They are more common in women and in some patients can occur regularly, often following a particular part of the menstrual cycle. While they traditionally are described as causing pain on only one side of the head, they can occasionally cause pain on both sides of the head as well. In addition to the headache, other neurological symptoms usually accompany the headache.
For example, many patients describe having an “aura” prior to the onset of the headache. These can vary but the patient generally has some symptom that lets them know a headache is coming. They can even experience seemingly focal neurological symptoms such as a scatoma (a temporary blind spot in their field of vision) or other visual changes. Photophobia, avoiding bright lights, can occur as well. Finally, many patients experience nausea and even vomiting. All of these neurological effects do not occur in a typical tension headache and help to distinguish migraines. However, some of the symptoms of migraine, particularly the nausea and vomiting and photophobia, are similar to symptoms of more serious causes of headache such as subarachnoid hemorrhage or meningitis. Therefore, those more serious disorders should be ruled out before classifying a headache as a migraine.
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Friday, November 27th, 2009
The paranasal sinuses are mucosa-lined chambers in the bone of the skull and face. There are several of them surrounding the nasal passages. Normally, mucous secretions that are produced in the sinuses flow out of openings into the nasal passage. However, if a sinus is obstructed so that its contents cannot exit, the pressure inside the sinuses can build up. This can occur with mucosal swelling associated with allergy (allergic rhinitis or hay fever) or with infection such as a cold or sinus infection. When pressure builds up inside a sinus, it can cause pain. While some sinuses (such as the large maxillary sinuses) are in the face, most are associated with the base of the skull. This pain can be interpreted and described as headache. While these sinus headaches can occur in anyone with a “stuffed nose” of any cause, patients who have chronic sinus problems with recurrent sinus infections can often have quite severe pain associated with this condition.
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Wednesday, November 25th, 2009
By far the largest majority of headaches that most people experience are what is known as a Tension Headache, or some similar variant. While the exact cause of these headaches is not known and probably varies from patient to patient, this benign type of headache is usually associated with stress and muscle tension or spasm of the neck, facial or head muscles.
While their severity, location and characteristics can vary, they are almost always harmless and do not represent any more serious underlying problem. This is the typical headache most of us have experienced when you are over-tired, over-worked, or stressed. Tension headaches do not cause other neurological symptoms. If other symptoms are present, it should raise the question of another diagnosis.
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Monday, November 23rd, 2009
Headache is one of the most common medical complaints. Almost everyone experiences a headache from time to time. In the large majority of cases, it is a completely benign condition which is a nuisance and does not represent any significant or long-term medical problems. However, many people worry about a headache and are concerned that it could imply something much more serious. We all know the old “It’s not a too-mah!” line and joke about it, but what do headaches really mean? Can they mean something more serious?
The answer is a definitive yes. Some very serious medical conditions can be associated with headache. However, I must state again that the very large majority of headaches do not imply anything serious. While millions, if not billions, of people on this planet experience headache in their lifetime, only a small percentage will every have a more serious, related condition diagnosed.
So how do you know? What does that headache mean? That is not an easy question to answer. In fact, there are physicians who spend their whole career specializing specifically in headache, its causes and its treatments. While there is no easy answer that covers all possibilities, this article will supply you with a handful of the most common causes and types of headaches, from the most harmless and benign to the medical emergencies. It will explain some of the differences that help to distinguish one type of headache from another. This is not an exhaustive list of every possible cause of headache, there are certainly others. It starts with some of the more common causes and moves on to more rare causes.
This article is not intended to offer medical advice. Every patient and headache is different. Only your personal physician can help counsel you about what is best for your particular situation. If you are concerned about a headache or headaches you are having, consult your doctor.
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Friday, November 20th, 2009
When you think of Botox, what’s the first thing that comes to mind? For me it’s people who can’t stand to deal with aging, and seek Botox injections to chase away their facial wrinkles.
The next thing is that it’s poison, and how could anyone be so vain that they’d risk injecting poison into their bodies?
But researchers are finding that Botox is much more than a cosmetic tool. It has the potential to relieve migraine headaches and muscle pain. In fact, it has been approved by the FDA for the treatment of blepharospasm (eyelid spasm), strabismus (crossed eyes), cervical dystonia (painful neck spasms), as well as wrinkles between the eyebrows.
Although not yet FDA approved for headache and migraine treatment, it is now being legally prescribed “off label” for these treatments. “Off label” is the practice of prescribing medications for conditions other than those for which the drug has already received FDA approval. This common practice is one by which new purposes are often discovered.
Botox is a toxin produced by the bacterium Clostridium botulinum. Doctors inject a small amount of the purified toxin into muscle, which weakens the muscle and blocks the chemical which causes muscle contractions.
Research into its use in headache prevention has been ongoing for years and it is widely used in alleviating the pain of muscle spasms in the neck.
What is interesting is that migraine headache is not believed to be caused by muscle spasms. Researchers are finding that Botox works by blocking the protein that carries the message of pain to the brain. Relief is not instantaneous. In fact, it may take 2 to 3 weeks to see the results of treatment.
Not everyone benefits from this treatment – just as not everyone benefits from specific narcotic drugs. The good news is that once relief kicks in, it is more effective than traditional migraine treatment, and doesn’t carry the side-effects such as upset stomach, drowsiness and weight gain that are associated with narcotic drugs.
95% of those treated reported no side effects at all, with a few reporting such things as drooping eyelids and neck muscle weakness.
But this isn’t the whole story… Research is also being conducted into the use of Botox to reduce prostrate problems. While it is still too soon to rush to the doctor for treatment, the results look promising.
Researchers at the University Hospital in Rome reported that after 2 months, men taking Botox had a significant reduction in frequent and painful urination, a drop in PSA levels, and a reduction of almost half in prostrate size.
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Wednesday, November 18th, 2009
It used to be that Ted Willis could barely stand to get up in the morning, his head throbbing so much it felt as if his right eye would explode.
Even after a couple of surgeries, several consultations with specialists and a diagnosis of slipped disks in his spinal cord, the headaches subsisted. Then he took a recommendation from a local pain doctor: trigger point injections.
“It sounds so simple, but it’s such a dynamic thing. Instead of saying ‘these are drugs, go take them,’ they were telling me they could reroute that pain,” said Willis.
“It’s been a blessing to me.”
Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
In the procedure, a health care worker inserts a small needle into the patient’s trigger point and injects a local anesthetic. With the injection, the trigger point is made inactive and the pain is alleviated.
A brief course of treatment usually results in sustained relief. Injections are given in a doctor’s office and usually take just a few minutes.
Dr. Bradley Carpentier, a Salinas-based pain specialist, said the procedure can work for people such as Willis, who had experienced chronic pain with few options otherwise.
“It’s not for everyone,” said Carpentier, who said he offers it as an alternative treatment for patients with chronic pain who do not want to stay on regular pain medication.
Dr. Carpentier supplements Willis’ injections with steroids and numbing agents. The combination can sustain Willis’ pain for up to a few months at a time.
In Willis’ case, that pain was to the point where he couldn’t think straight on any given day. It nearly cost him his career as an insurance agent.
“I would have to leave the office and go home, lay down and tell everyone to leave me alone,” said Willis.
Willis suffered through a good portion of the 1990s with a dull, chronic tension headache that made its way to his right eye socket.
After years of medication and treatment, it was determined that two discs in his spinal cord had slipped. Surgery initially helped end the pain, but a 2003 rear-end accident brought them back even more intensely.
“I was dreading having more surgery, and Dr. Carpentier’s office came up with the procedure,” said Willis.
Carpentier explained the object of the injection was to scramble the nerve sensory. So when your brain goes to the place of the headache, it doesn’t know where to go.
For Willis, the result was immediate.
“As soon as he finished, he said how do you feel,” said Willis. “I just said ‘My god, I can’t believe this. For the first time in 15years, I absolutely have no pain.’”
The procedure was not permanent. Willis has returned to Dr. Carpentier’s office for follow up injections and Carpentier has cautioned Willis about prolonged treatment.
For now, Willis is back at work and living pain free. He still takes pain medication, but the trigger point injections have helped curb the amount.
“It’s not a miracle cure, but if you were taking five (doses) of something every day, and now you’re down to two or one, that’ s a big difference,” he said. “That’s what I was looking for”.
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Monday, November 16th, 2009
About 90% of headaches are caused by one of three conditions: migraines, cluster headaches and tension headaches. Today we’ll cover the last one.
What is it?
Tension headaches (or tension-type headaches) are the most common cause of headaches.
Who gets it?
Tension headaches can happen at any age, but it happens mostly in young adults. About 30-80% of the adult US population suffers from tension headaches from time to time. It happens twice as much in women.
What causes it?
The exact cause isn’t known. One of the theories behind tension headaches is that the pain is the result of muscle tension in the face, neck and scalp. Yet this hasn’t been proven. Other evidence shows that there is a change in chemicals in our brain which causes this type of headache.
Whatever the cause may be, there are certain triggers, or things which are believed to bring about the headache:
* Stress, such as problems at home or with family, around exam time, deadlines at work, etc.
* Depression and anxiety
* Not enough rest
* Poor posture
* Working in awkward positions or holding one position for a long time
* Jaw clenching
How does it feel?
The pain in tension headache is usually mild to moderate. It feels like pressure or tightness around both sides of the head or neck (people will say it feels like a vice). The muscles in the head, neck or shoulders may feel tender.
The pain is usually steady, and activity doesn’t make it worse. It lasts for anything from 30 minutes to several days. It typically starts several hours after waking and worsens as the day progresses.
Unlike migraine headaches, tension headaches usually don’t involve nausea or vomiting, sensitivity to light and sounds or auras (you can read our article about migraine headaches to see what aura means).
Tension headaches can be divided into three categories, according to how often they occur:
* Infrequent episodic. When it happens less than once per month
* Frequent episodic. When it occurs 1-14 times per month
* Chronic. When it happens 15 days or more in a month
Usually people can go on with their daily routine in spite of the headache.
How is it discovered?
The story and physical check are usually enough to diagnose tension headaches, and no special tests are needed. If the doctor suspects another cause, they may order other tests (such as a CT scan) to rule out other problems.
How is it treated?
A lot of people will just take over-the-counter painkillers for their tension headaches. This can be a problem, since taking too much of those can cause headaches by itself (these headaches are then called “medication-overuse headaches”).
There are a couple of drugs which can be used against tension headaches:
* Anti inflammatory drugs. These drugs can both take down inflammation and relieve pain. They are the first drugs used for tension headaches. Examples of such drugs include aspirin, ibuprofen, naproxen, indomethacin, and ketorlac. Acetaminophen may also help. Most of these drugs are over-the-counter drugs (OTC. meaning you don’t need a prescription for them). If OTC drugs don’t work, your doctor may write a prescription for something stronger.
* Behavioral and psychological interventions. Sometimes relaxation and stress management can help, especially when combined with drugs.
What happens after treatment?
Usually treatment provides relief from the headaches. As long as not too much of the medications is taken (which may cause headaches by itself) they can be controlled.
The bottom line – How do I avoid it?
If you tend to get tension headaches, there are medications which can be taken to prevent these headaches from occurring. These include drugs like antidepressants (those usually used to treat depression), blood pressure medications, and anti-seizure medications. You should consult your doctor about these drugs.
Another option is to deal with the stressors in your life that may bring about these headaches in the first place.
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Friday, November 13th, 2009
What is acupuncture?
Acupuncture is a therapy of traditional Chinese medicine that originated in China over 5,000 years ago. It is based on the belief that people have a vital energy, called “Qi,” that circulates through twelve invisible energy channels, known as “meridians,” on the body. These energy channels are like rivers flowing through the body to irrigate and nourish the tissues. Each meridian is associated with a different organ system. An imbalance in the flow of Qi throughout a meridian is how disease begins. An obstruction in the movement of these energy rivers is like a dam that backs up, causing stages of excess and deficiency in the body.
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Wednesday, November 11th, 2009
There seems to be a major shift taking place in the medical world when it comes to migraine. It’s actually been going on for many years, and it will probably continue for many years to come, but many people are still unaware of it.
At the heart of the shift is the question of just how widespread migraine is. It’s not going to come as a shock that this is confusing to many people. Some people still think of migraine as a bad headache. Others don’t realize that it’s possible to have a mild migraine attack. Others are still confused about basic terms, like cluster headache, migraine, sinus headache, and so on.
The “Common” Headache
Before we talk any more about migraine, probably the best thing to do is go back and talk about the common headache. Most people generally think of the most common type of headache as the tension headache (now more properly called the tension-type headache).
It might surprise you to know that we actually know very little about what a tension-type headache really is.
Wait a minute now – you just get tense, stressed, muscles get tense for one reason or another – you get a headache. What can be simpler than that?
It seemed that simple, until researchers actually started to investigate the actual muscle tension in the so-called tension headache. The surprise result was that a lot of people were getting the headache without any muscle tension at all!
Hence the name change
Is it psychological? Well, some psychological factors seem to influence some headaches, but there have been no consistent findings that show that the common headache is due to psychological factors. In other words, people with fewer anxiety or mood problems do not get fewer headaches.
So in the end, we know even less about tension-type headache (TTH) than migraine! And just like migraine, we don’t know what causes TTH.
So, could TTH be connected somehow to migraine? Currently we’re usually looking at symptoms and ruling out other causes before we put a headache and other symptoms into a category of migraine or TTH. But what if many of the migraine attacks and TTH attacks actually had the same root cause?
What if the common headache was actually migraine?
A shift of thought!
Many specialists are becoming convinced that most of the headaches out there are actually coming from migraine. And this changing opinion is showing up in popular literature about migraine. Take for example:
I was taught – as most doctors were taught, and still believe – that tension headache accounts for the vast majority of chronic headaches… migraine, not muscle contraction, is what causes headache ascribed to tension. These mild-to-moderate, nonspecific headaches stem from low-level activation of the mechanism of migraine…it arises from a single mechanism, but since the degree of activation fluctuates, it is expressed to varying extents and in many different ways.
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Monday, November 9th, 2009
It is but common nowadays to hear people saying that they get headache quite often due to pressure of work, and are inclined to carry a couple of tablets such as ibuprofen or paracetamol in their kit to counter this problem. Stress at the work spot, traffic jams at roads or anything of that sort might be the reason for this headache. Changing lifestyles and increasing pressure is taking a heavy toll on the people’s life and small issues like this are but inevitable of late.
One of the many varieties of headache is referred to as “tension headache”, which is caused due to excessive stress. Assume that you are in a hurry to attend a meeting and you are racing in a cab to the office. Unfortunately, you are caught in a traffic jam, had to wait for nearly an hour to come out of the traffic jam, and in the process, had to miss the meeting or if you were to speak at the meeting, the meeting was postponed due to your absence. This kind of stress waiting impatiently at the cab in the midst of a traffic jam might cause headache to you that is defined as tension headache. Technically, tension headache is caused due to contraction of muscles especially in the head and the neck portion, and is characterized by a dull and steadily increasing pressure. Instead of relying on instant medicines or resorting to doctor’s assistance, one can try out some simple things that can bring effective relief to your tension headache.
It might sound paradoxical at first, but has been proved effective in relieving tension headache. Try to soak your feet in hot water to get relief from tension headache. By drawing blood to your feet, the hot-water footbath will help in easing pressure on the blood vessels in the head. Pressure on the blood vessels in the head following a contraction of the muscles in the head and neck is the primary reason for tension headache, and this technique, without medication, might do just that – ease the pressure on the blood vessels.
If you cannot find hot water for soaking your feet, you might use a hot compress on your forehead or at the back of your neck. Since the contraction of muscles causes headache, this hot compress might help in relaxing the contracted muscles and provide instant relief to you from the tension headache. You can even try the other way round, as well. Contraction of the muscles causes the blood vessels to exert pressure on the sensitive nerves and this pressure causes headache. You can wrap a couple of ice cubes, and apply it as a cold compress on your forehead. Cold constricts the blood vessels, and, whey they shrink, they stop exerting pressure on the sensitive nerves, and, as such, you might get relief from the headache instantly.
One more thing one can try to get relieved from tension headache is to soak his or her hand in iced water for as long as one can bear it. When the hands are submerged in water, it is advisable to repeatedly open and close the fists. This simple trick will help in getting relief, as the cold dilates blood vessels and relieves the pressure on the nerves.
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