mal de tete

Monday, April 18, 2011

Sport often gives celebrity to injury and illness, especially when a star player is forced from the lineup. Medical terms make headlines and fans who suffer the same disease can relate to the pains of their sports heroes. Headache sufferers can now relate to Dwayne Wade, the Miami Heat star, who and to miss a playoff game because of a migraine headache. Those in the know could not imagine trying to play in a brightly lit arena, filled with 20,000 fans. Most migraneurs want to crawl into bed in a dark, quiet room and hope that they can fall asleep and waken to the pain being gone.

Migraine headaches suffer from a language problem. People presume that bad headache equals migraine but that is the same thinking that presumes that bad chest pain equals a heart attack. While some bad headaches truly are migraine in nature, it is not always so, just like the heart does not cause all chest pain. Appreciating that there are many different causes of headache, commonly people experience tension headaches, migraines or a combination of the two. Think of the muscles of the scalp contracting to cause tension headaches. Irritation and spasm of the blood vessels supplying the brain can cause migraines. Headaches can begin as tension and progress to have migraine characteristics and vice versa.

Classic migraines begin with an aura where the patient knows that the headache might occur. Flashing lights, loss of vision or unusual smells can be a signal that the pain is about to occur. Add nausea and vomiting and perhaps a history of family members with bad headaches who would go to bed to sleep it off and the diagnosis is secure. History is the key in helping make the diagnosis and as long as the physical exam is normal, no other testing is needed. The hard part is the treatment.

The longer that the headache is established, the harder it is to relieve the pain. This is especially true since narcotics are not recommended for pain control because of the rebound phenomenon. When the narcotics wear off, the headache returns perhaps worse than before. But there are treatment philosophies that can be tailored to each patient. Often, a headache diary is an important tool to direct care. Knowing how frequent, how long and the circumstances of when the headaches occur can help find a therapy that can prevent the migraine from interfering with a normal life.

Philosophically, there are three options for migraine treatment: prevention, rescue and abortion. Prevention is important if headaches happen frequently and interfere with normal daily function. Trying to find the trigger and intervene may be helpful. For example, some women suffer monthly migraines associated with their menstrual cycle. Other people have food triggers, sleep deprivation or stress that can initiate a migraine. Medication alternatives may also be useful. If headaches happen rarely, it makes no sense to take a pill every day. Abortion may be the right thing to do, especially if the patient can identify an aura and take medication before the headache even starts. Finally, rescue occurs once the headache is fully established and pain control is needed. Ideally, the patient and care provider have a plan for rescue and the patient may have medication prescribed to take at home just in case. Sometimes the pain becomes intractable or is associated with uncontrolled nauseas vomiting and a visit to the ER or walk in clinic is appropriate. Intravenous medicat8ions can be used to rescue the patient but rarely are narcotics indicated.

Unfortunately, headaches like most other illnesses tend not to come at a convenient time. While Mr. Wade’s missing work in front of a packed stadium is a little more visible than the rest of the world of migraine sufferers, the goal remains the same. Provide the patient with information and tools to prevent the illness and should symptoms arise, allow the opportunity to treat themselves at home.

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