Headache pain isn’t all in your head
Not everyone who wears sunglasses does it to look cool. Some people wear shades to prevent glaring sunshine headaches. There are many paradoxes about migraine headaches, and one of them is the relationship to things — like hot weather and bright sunshine — that trigger an attack, according to Dr. Seymour Solomon, professor of neurology at Albert Einstein College of Medicine in New York.
“Most people who suffer with migraines discover that hot weather is a provoking factor, particularly hot or humid weather, or a combination of both,” Solomon said in an interview from his home in New York.
“Glaring heat — light reflecting off of water, for example — often is a very provoking factor. Many people who have migraines wear sunglasses almost all of the time to avoid that light stimulus.”
More than 40 million people in the United States suffer from recurring headaches, resulting in a loss of an estimated 150 million workdays and a cost of billions to the national economy, Solomon notes in “The Headache Book” (Consumer Reports Books; $14.95 paperback).
“Literally thousands of tons of aspirin are consumed every year, but it is only one of three painkillers that you can buy over the counter,” Solomon said. “The other two are acetaminophen and ibuprofen, sometimes mixed with caffeine, which has some slight analgesic action.”
Solomon, director of the headache unit at Montefiore Medical Center in New York City, cautioned against doubling — even tripling — doses of painkillers.
“What they are inadvertently doing is adding fuel to the fire rather than squelching it,” he said. “What happens then is a tendency for rebound headaches and a vicious cycle occurs until you finally wind up with a headache that is daily and lasts from morning ’til night.”
Painkillers that are sold over the counter are designed to stop or abort the episode of pain, he emphasized. They are not designed to treat daily or chronic pain.
Solomon, 66, has been a neurologist for 35 years. He is director of the headache unit at Montefiore Medical Center in New York City. He has had half-a-dozen or so migraine headaches in his life but can not explain their origin. However, Solomon said that a migraine headache, in most cases, is considered to be an inherited disorder.
He cites one report in his book where at least 60 percent of the patients screened disclosed a family history of migraines: 53 percent on the mother’s side, of the family and 17 percent on the father’s side. So it’s generally well-established that migraines are a genetically transmitted condition.
Migraines and tension headaches are the most common non-organic headaches, which account for more than 90 percent of the headaches, but why some people react to a certain stimulus — emotional stress, for instance — while others do not, is still a mystery.
Cluster headaches are another major type of non-organic headache but occur less frequently than migraine or tension headaches.
Organic headaches account for only 10 percent or less of the headaches.
They may be caused from such simple things as a bump on the head, a fever or a serious disease.
There are a number of migraine triggers, the most common association being emotional stress, excessive noise or overconsumption of alcohol, but not everyone readily associates headaches as the result of certain foods, changes in eating or sleeping habits, even strong odors.
“About 20 percent of the people who have migraines find that certain foods can cause not an allergy but a chemical sensitivity. And almost any food can do it in any one individual,” said Solomon. “The most commonly offending foods are chocolate, citrus fruits and hard cheeses.”
“In addition, alcoholic beverages are well known as triggering factors, and red wine is more of a factor than white wine, probably because of the amino acid tyramine content.”
“The most common headaches are tension-type headaches, and people who have them recognize that the headache increases in severity as the stress or tension builds,” Solomon said.
“Migraines, on the other hand, usually do not occur during the period of stress but immediately after when the person is trying to relax from the stressful event.
“In other words, it doesn’t occur while you’re having a fight with your wife but afterward when you’re trying to make up. And it doesn’t happen during a busy week but on the weekend when you’re trying to relax.
What, then, is Solomon’s advice on how to ward off job-related stress on weekends?
“That’s easier said than done,” he said. replied with obvious amusement. “You should not try to go from a stressful situation into a sudden relaxing situation. “If you find you’re tapering off too quickly emotionally, then try to engage in some physical activity to delay a sudden relaxation response.”
Although some people insist a migraine personality — a compulsive perfectionist — exists, a substantial number of migraine patients do not conform to this stereotype.
Moreover, there are no intellectual or racial barriers to headaches, according to Solomon.
“It used to be thought that headaches were an illness that only affected the cultured and highly educated in the 1800s,” Solomon said.
“But when they started doing epidemological studies in a more scientific way, they discovered that other populations, including natives of Africa who were not civilized, suffered from migraine headaches just as often as people who lived in so-called civilized western countries.”
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