| "Just a Headache" by Robert Hamel, P.A.-C, Michigan Head*Pain & Neurological Institute, Ann Arbor, USA Headache, though a common problem that does not in most cases indicate a life threatening illness, nonetheless remains a complicated problem for many people. Why is this so? Though there are many answers to this question, it generally all boils down to one thing. Each headache and each person with headache requires an individualized approach. For instance, particular attention is required because there is no clear way to determine which medication is most appropriate for each individual before trying it. There are no lab tests or other tests that indicate which medication is going to be the most helpful with the least side effects for any individual. Moreover, because headaches often are associated with other problematic symptoms, medications must be chosen that do not aggravate symptoms such as nausea, cognitive difficulties or cold hands and feet which are just some of the symptoms that may accompany a typical migraine headache. So "just" a headache becomes a Pandora's box once opened. In addition, it is becoming increasingly clear from research that emotions play a role in how pain is experienced. Strong emotions tend to aggravate headache and/or complicate the perception of headache. This means that depression, fear and anxiety can all make a headache seem much worse. In the developed west, we have thought of pain since the 1600's as a simple stimulus and response. In othe words, if you touch a hot stove you will feel pain and you therefore remove your hand. This theory does translate well to headache. In the case of acute headache that is relatively infrequent, head pain is followed by a response that is often simple, direct and effective. However, in situations where pain is more chronic, complicated by life stressors, associated with medical problems, or occurs in the context of failure to respond to past treatment, the simple response to pain is inadequate and can become dangerous. For instance, taking more pills for a headache that occurs each day will lead to rebound headache and other problems such as gastritis or peptic ulcer disease. The treatment of pain is covered in medical and nursing schools but typically not the extent necessary to deal with the complicated problems of acute and chronic pain in its various manifestations. Until recently, there has been little attention paid to the need for individualized attention required to assess chronic head pain and other types of pain. Perhaps this is in part due to the fact that pain is difficult to measure. There are no objective "pain meters". Physicians and other clinicians must rely on the history to understand how pain is a problem for any one particular person. It is not simply a matter of choosing the right antibiotic, titrating the appropriate does of insulin, or choosing the right blood pressure medication. While blood pressure can be measured, blood sugars can be checked and infections can be cured, pain may continue despite all appropriate treatment. This brings us to one of the major issues confronting both patients and physicians regarding the treatment of chronic and acute pain, the amount of time required to understand a person's symptoms and choose the appropriate treatment. Time is often in short supply. Physicians are very busy and patients sometimes want quick and reliable cures. Fortunately, when time is spent on the history, and there is a willingness to understand the variety and types of treatment available to patients, headaches can be helped. There can be a happy marriage between the headache sufferer who is willing to be patient and a physician who is willing to spend the time necessary to find the most safe, tolerable and effective treatment. In summary, headache is a much more complicated problem that it appears on the surface in many cases. The more complicated the headache history, the more time is required to find the most appropriate treatment. Medical schools can certainly help by addressing the complicated nature of pain. Patients can help by educating themselves. |
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Published on the Help For Headaches Web Site |