To Your Health
December, 2012 (Vol. 06, Issue 12)
Understand Your Headache and Your Treatment Options
By K. Jeffrey Miller, DC, MBA and Danielle Vann, DC
According to the World Health Organization, an estimated 47 percent of the adult population have experienced a headache at least once in the past year. This fact makes it clear why headaches are one of the most common disorders and among the most common reasons people seek professional health care.
Unfortunately, when patients do seek help, unless it is with a health care provider who deals specifically with headaches, the headaches are often misdiagnosed. It seems that many headaches, especially so-called "bad" headaches, are often automatically diagnosed as migraine headaches. The truth is, there are many different types of headaches and not every "bad" headache is a migraine headache.
One of the primary problems with misdiagnosis of headaches is that once diagnosed, patients seeking additional opinions often refuse to accept a new and correct diagnosis. This is despite the fact the initial doctor who provided the misdiagnosis failed to be of help. Patients are typically only looking for a different treatment for the headache. Few give thought to the possibility that previous care did not help because the initial diagnosis was wrong. So, if you suffer from headaches, do you know which type they are – and the best way to relieve them?
One type of headache that exemplifies this concept is a cluster headache. The term cluster is utilized because the headaches occur is groups or clusters within specific time frames. The time frames vary from five minutes to several hours. Patients experience several headaches a day for many weeks followed by a period of time without headaches. Most people who suffer from this form of a headache will begin to experience symptoms at about 25 years of age. Men are affected five times more frequently than women.
Patients who experience a cluster headache usually describe the pain as one sided with stabbing eye pain. The headache usually begins just after the patient goes to sleep. The eye on the affected side will usually tear excessively during the headache. Constriction (narrowing) of the pupil is common, as is a drooping of the eyelid on the affected side. Some patients experience one-sided nasal stuffiness and runny nose.
Pain from the headache is carried through the trigiminal nerve, the nerve that provides sensation to the face. When the trigiminal nerve is activated it will trigger the severe eye pain. Patients may also experience pain in the forehead, temple, nose, cheek or upper gum on the affected side. The scalp may also become tender to the touch. Pain with cluster headaches can be so severe that some patients attempt suicide.
Like many migraine headaches, cluster headaches typically occur on one side of the head. This is one reason the two types of headaches are confused and misdiagnosed.
Cluster headaches can be classified as episodic or chronic. Episodic cluster headaches are more common (80 percent of cluster headaches), and usually result in two to three headaches per day for a two-month period. The headaches may then be absent for about a year. The pattern then repeats.
Chronic cluster headaches follow the same pain pattern, but they do not have long periods of relief. Patients with chronic cluster headaches may have as few as 14 headache-free days per year.
The cause of most cluster headaches is unknown. Many proposed theories focus on the autonomic nervous system and the nerve pathway at the base of the brain and nerves associated with the facial region. In some cases, the cause is a tumor of the brain or lungs.
Diagnosis and Treatment
Like most headaches, cluster headaches are usually diagnosed from the patient's health history. This is termed a clinical diagnosis. There is no specific "headache" test. Tests like CT and MRI scans of the head and thorax are usually only performed to look for rarer causes if conservative care fails.
Since the patient's history is the key component of diagnosis, the case history should be thorough. The doctor should take time to note the location, quality and severity of the headaches. Timing of the headaches, and factors that activate or relieve the headaches, should also be noted.
Medications like beta-blockers, anticonvulsants, and antidepressants are commonly given to patients who have been diagnosed correctly. Most patients frequently undergo several months of trial and error treatment with different medications in order to find the dosage cocktail that works for them. Even then, medication may not be successful, and of course, all medications have potential side effects that can make you feel even worse.
How Chiropractic Can Help
When medical methods fail to help, many people turn to chiropractic care for help. Chiropractic manipulation of the cervical and thoracic spinal areas has been shown to relieve signs and symptoms of cluster headaches. Since the cause of most cluster headaches is unknown, the reason manipulation helps is not completely clear. Still, manipulation may help the cluster patient by reducing signs and symptoms and decreasing the frequency of the headaches.
Doctors of chiropractic treat cluster and other types of headaches on a daily basis. In fact, headaches are among the three most common conditions treated by chiropractors nationwide. Chiropractors perform thorough health histories and physical examinations to help correctly identify the type of headache a patient is experiencing. In many cases, spinal X-rays are taken or ordered to help in the diagnostic process. Referral for additional testing is also an option. Chiropractors have access to outside laboratory and imaging facilities.
Patients suffering from "bad" headaches who have not benefited from care to date owe it to themselves to seek additional opinions to double check the accuracy of their diagnosis and investigate other treatment options. Only with an accurate diagnosis can accurate treatment be applied.
Patients suffering from "bad" headaches who have not benefited from their care to date owe it to themselves to seek the opinion of a chiropractor. Chiropractic care may provide relief and a better quality of life. It is safe, effective, affordable and always worth a try.
K. Jeffrey Miller, DC, MBA,is an assistant professor of chiropractic at the University of Missouri Orthopedic Institute, a branch of the University of Missouri Health System. He is a graduate of Palmer College of Chiropractic and the author of several practitioner and patient texts.
Danielle Vann, DC, is a graduate of Palmer College of Chiropractic Florida. She practices in Pulaski, Virginia with Tuck Chiropractic.