What's Causing Your Headache

Dr. Arvind Bhateja, a leading neurosurgeon, and Medical Director, Sita Bhateja Specialty Hospital in Bangalore, answers some common questions on headache.

Interviewed by Wellness Team

Wellness Team (WT) - Do headaches run in families?

Arvind Bhateja (AB) - Most headaches don't but then headache is so common that one could easily have a family member suffering from a type of chronic headache. Some headaches do tend to run in families though. Migraine is especially common amongst the fairer sex and often mothers and daughters suffer together.

WT - There must be several causes or triggers for a headache. Can you name the most common ones?

AB - Yes indeed. The triggers are very variable from person to person but some common ones are stress, hunger, lack of sleep and certain chemicals like monosodium glutamate (used in Chinese cuisine) and red wine.

WT - Is migraine the most common form of headache?

AB - Tension type headaches and migraine are together the most common, but this varies according to geography and other factors.

WT - Can migraine headaches be prevented?

AB - Yes if a well-known trigger is identified, avoidance of the trigger can prevent headaches. It is easier said than done sometimes (try avoiding stress for example!). Some patients complain of headaches being brought about by certain foods and some may have headaches precipitated by exposure to bright sunlight. Exposure to these environmental agents can be avoided.

The other way in which we can prevent headaches is by using prophylactic medications in patients with frequent debilitating headaches. For these we normally use medications such as propranolol, flunarazine, topiramate and valproate.

WT - What is rebound headache?

AB - Rebound headaches usually occur in persons who abuse or overuse pain medication. It's also known as MOH (Medication Overuse Headache). Treatment is quite complex and involves careful withdrawal of medication and substitution of alternate medications. It takes a couple of months before the patient experiences relief of headaches with minimal or no medication.

WT - Are stress headaches and migraine the same?

AB - No they are not, although stress can trigger migraine headaches. In some patients the pattern of headaches may mimic features of both types of headaches (tension and migraine).

WT - Can hormonal changes cause headaches? Why do some women get a headache before or during their menstruation?

AB - Migraine and hormones are closely related and there are many endogenous chemicals in the body (neurotransmitters and hormones) which influence migraines. Trigger factors actually work via hormones. The female hormone, estrogen, is the culprit as far as menstrual migraines is concerned. Essentially these chemicals affect the blood vessels in the scalp and brain and cause them to narrow (constrict) and later widen (dilate). The phase when the blood vessels dilate is when patients experience a throbbing headache.

WT - What are the most common foods that trigger headaches?

AB - Foods containing tyramine are especially dangerous for migraineurs. There is a long list of foods that can potentially cause migraine but not all of these may be relevant to all patients. Common foods include bananas, various types of cheese, dates, figs, nuts, olives, some types of beans, papaya, peanut butter, raisins, tofu, tomatoes, yeast and yeast extracts. In addition, there are several food additives such as monosodium glutamate, nitrates, nitrites, aspartame, meat tenderizer and soy sauce which can trigger migraine headaches.

WT - Can a child outgrow headache?

AB - Yes, it is well documented. Some studies show up to a 40% reduction over 10 years.

WT - Is there a connection between body weight and headache?

AB - More and more evidence is accumulating in support of this statement. Although the reasons are not well known, obese children and adults tend to have a higher incidence of headaches as well as more frequent and more severe headaches.

WT - Monosodium glutamate (MSG) and artificial sweeteners are often blamed for headaches. What are the facts?

AB - They can trigger headaches in some patients but not in all. For example, if you are a migraine sufferer and you've not had a bad experience with these substances, it does not mean that you should avoid them altogether.

WT - Some people drink coffee for relief from headache. Does it really help or is it psychological?

AB - Many patients report good relief of headache after ingesting small amounts of caffeine (tea or coffee). In fact, some over the counter medications contain caffeine. However caffeine has also been implicated in CAUSING headaches especially when large quantities are consumed on a regular basis - this is also a rebound type of headache.

WT - How does tying a band around the head tightly when the headache is unbearable help?

AB - This is often useful in tension headaches, which are due to spasm of muscles in the scalp especially in the region of the temple and back of the head. Gently massaging these muscles or compressing them with a tight band can help alleviate the discomfort.

WT - Which are the relaxation techniques that prevent headaches or control them?

AB - Meditation, yoga, hypnosis can help. Rhythmic breathing, deep breathing, visualized breathing, progressive muscle relaxation and mental imagery relaxation are also useful.

WT - Some people who are able to cope with less sleep do not suffer from headache. What could be the reason?

AB - This is highly variable and depends on trigger factors from person to person. In some patients, lack of sleep could be a trigger but in some it may not. Reasons for this are not well known but probably based on genetics and the hormonal milieu.

WT - How effective are pain balms for headache relief?

AB - They are quite effective in tension headaches (headaches due to excessive muscle tension in the scalp). One good advantage is that use of oral medication is avoided and hence side-effects are also less.

WT - What is the best remedy for a headache - be it any kind?

AB - Headaches are best managed based on the type. The common headaches (tension headache and migraine) can easily be well controlled with a combination of stress reduction, relaxation techniques, avoidance of triggers and appropriate medication based on headache type and frequency.

Special thanks to -

Dr Arvind Bhateja

Consultant Neurosurgeon and Spine Surgeon

Medical Director, Sita Bhateja Speciality Hospital

9, O'Shaughnessy Road, Langford Gardens,

Bangalore 560025

Contact No. 40302700 / 93415 52700

Email: abhateja@gmail.com

Website: www.neuro-spine.com