The Truth About Diagnosing Headaches

Headaches affect half of all adults each year. So why are they so hard to diagnose?

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Man suffering from headache
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Headaches: The Invisible Epidemic

Half of all adults have at least one headache a year. Many people, however, experience headaches on a weekly or daily basis, and with a degree of severity that interferes with work and sabotages social plans.

While headaches can be a sign of issues such as high blood pressure, primary headaches are a disorder in and of themselves. Tension headaches, the most common type, affect 70 per cent of us; sufferers complain of a sensation of tightness. Migraines, which are experienced by one in 10 Canadians, are the most likely to send us to a doctor, since the symptoms can be severe. Other variants include cluster headaches, which are brief but excruciating and can flare up several times a day.

The global impact of primary headaches is significant – they may be responsible for one-fifth of missed work worldwide. “It’s resulting in a lot of sick days and ER visits,” says neurologist Elizabeth Leroux, director of the University of Montreal Health Centre’s migraine clinic. In a 2013 study on the global burden of disease conducted by a consortium of international researchers, headache disorders were listed as having the third-highest impact on quality of life out of all medical conditions.

Women are three times as likely as men to have migraines. That’s partly due to hormonal fluctuations, but also because of sex-based structural and functional differences in the brain. A 2010 survey by Headache Network Canada found that 73 per cent of women with migraines experienced a loss of control over their lives; three-quarters of respondents reported feeling a lack of support from others.

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Woman with headache
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1. Name That Pain

Diagnosing a headache disorder can be perplexing: even two people with the same type may not share identical symptoms. The conditions can also change over a lifetime – for instance, migraines may become less severe after menopause.

“Primary headaches aren’t caused by anything you can identify on tests or x-rays. They’re part of a person’s genetics and chemistry,” says Werner Becker, neurologist and founder of the Calgary Headache Assessment and Management Program. As a result, these conditions can easily be misidentified as the wrong headache type (or something else, like sinusitis). It’s estimated that two-thirds of migraine patients aren’t diagnosed properly.

If you’re plagued by pain, consider going online. In 2013, the International Headache Society published a helpful set of clinical diagnostic criteria for different headache disorders, and it’s accessible to the public. “Patients can become active partners in their care,” says Becker.

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2. Experiment with Options

When it comes to treating headaches, especially migraines, it may take some puzzle work to tease out the best approach. “There is no quick fix,” says Leroux. “Often it’s some combination of things.” Those may include medication for attacks, as well as preventive measures and lifestyle adjustments. Certain dietary supplements may also help prevent headaches.

Habitually using the wrong drugs to treat your pain can lead to yet another cause of recurrent patterns: medication overuse. With repeated exposure, the brain becomes less responsive to painkillers, while the neural network grows more sensitized to pain as the frequency of headaches increases. Taking codeine 10 or more days a month for a migraine, for example, can set off a vicious cycle of rebound headaches.

A class of drugs called triptans, when taken early in an attack, are more effective for migraines than off-the-shelf analgesics because they stimulate the brain’s serotonin receptors rather than blocking pain. They can “change your life,” says Leroux, adding that there are seven kinds, with slight molecular differences, available. However, they may also not be safe to people with high blood pressure or vascular diseases.

Because people respond differently to these drugs, experts recommend testing various kinds until they find one that works. Those who suffer from chronic conditions (more than 15 days of headaches per month) typically take daily preventive medications. Calcium channel blocks are the go-to prophylactic for cluster headaches, while beta blockers and anticonvulsants can help migraines.

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Woman with notepad
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3. Rethink Your Habits

Although lifestyle adjustments can dramatically improve headaches, sufferers looking for instant relief may dismiss them. Triggers vary for different people (common ones include alcohol, poor sleep and weather changes), but they can often be minimized. Screens may have an especially powerful effect on migraine sufferers, who are often sensitive to light, says Becker.

Pinpointing triggers can be tricky because, as experts now understand, their effects are cumulative. “They might not cause a headache every time,” says Becker, “but if you have a storm system moving in when you’re premenstrual or unusually fatigued, that might stimulate a migraine.” To combat this, Leroux advises to fill out a headache diary and look for triggers you can control.

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