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Recognize, get help for chronic headaches
by Dr. Jonathan Spivack
Sep 12, 2010 | 2129 views | 0 0 comments | 8 8 recommendations | email to a friend | print
Dr. Jonathan Spivak
Dr. Jonathan Spivak
While the occasional headache is not uncommon, if you have headaches almost every day and for weeks or months at a time, then you suffer from chronic headaches.

Headache pain often begins as less frequent, episodic attacks, though the pain can be mild or severe. Over time, the frequency and duration of attacks increase until meaningful, more sustained incapacity results. With a migraine headache, the pain is invariably severe and incapacitating, regardless of the frequency or duration of attacks.

If you have a migraine, you are not alone. More than 30 million people in the United States suffer migraines (more common than the number of people with diabetes and asthma combined). One in four households has a migraine sufferer, and three out of four sufferers are women.

The World Health Organization considers a migraine to be one of the top five most disabling conditions. A 2002 study published in the Journal of Occupational and Environmental Medicine estimated that migraines cost our economy about $24 billion in lost productivity annually.

Migraines are hereditary in nine out of 10 cases. Just because a parent or sibling suffers from migraines, however, does not mean that you should consider them normal or a condition that you must tolerate.

A migraine checklist

If you have any two of these four symptoms:

• Pain that affects only one side of your head

• Throbbing or pulsating pain

• Pain severity that results in partial or complete incapacity

• Pain that worsens when you engage in simple activities such as walking, bending or stretching

… and, if you have one of these associated symptoms:

• Nausea or vomiting

• Heightened sensitivity to lights or sounds

… then your headaches are very likely migraines.

Finding the right treatment

Physicians who have studied headaches have developed a range of treatment options. They also have organized clinics, or headache centers, that specialize in diagnosing and treating headache disorders.

At the Headache Center of Northern Nevada, we provide a comprehensive, patient-specific treatment approach for all headache disorders. The evaluation involves a full assessment by a trained physician to establish a correct diagnosis and, when indicated, a work-up to rule out headaches due to other medical conditions. Only then can we design an effective, patient-specific treatment regimen.

Drug therapy is the mainstay for migraine treatment. Sometimes patients need a mix of medications (a “cocktail”) both to prevent migraines and to stop attacks. Finding an effective regimen of drugs for each patient can take time. At the Headache Center, our combined 35-plus years of experience enable Dr. Stephen Raps and me to choose the appropriate medications for a given patient.

Among our other therapies, biobehavioral (or biofeedback) therapy teaches patients to recognize the onset of stress as a cause of headaches. By learning to relax in these circumstances, the patient can ward off a headache. Physical therapy can help reduce neck pain and stiffness, which occur in 70 percent of migraines. By relieving pain over the long term, physical therapy reduces the likelihood of recurring headaches.

Combinations of vitamin, mineral and antioxidant supplements also have been proven safe and successful. While patients usually take them only as supplements to other therapies, in certain patients, such as pregnant women and others who cannot take standard medications, these can prove quite helpful. They include melatonin, riboflavin (B2), niacin (B3), magnesium and homeopathic remedies such as butterbur and feverfew.

Additional mildly invasive treatments include trigger point injections, occipital nerve blocks and Botox injections.

When to seek treatment

I do not have a “one size fits all” rule for deciding when to seek medical care for your headaches. If, because of your headaches, you cannot enjoy life, simply feel chronically miserable or depressed, or if your headaches have prevented you from working or enjoying your family, then you might consider seeking care.

The Headache Center of Northern Nevada is located at 2345 E. Prater Way, Suite #107, Sparks, NV, 89434. Call 352-5350.

Dr. Jonathan W. Spivack is a neurologist at Northern Nevada Medical Group. He earned his medical degree from Hahnemann University, School of Medicine, in Philadelphia. He completed his neurology residency at Mount Sinai University Hospital, New York City, in 1991. Spivack has been studying and treating headache disorders for almost 20 years.
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