My first serious "clinical scare" was with a 15-year old boy who, during assessment for educational issues, rather wistfully commented how "nice it would be to just die and never have another headache". Headache? WHAT headache? It had never been mentioned. And, therein was the problem.
When I began to interview him about his symptoms and how they impacted his life, it was clear how he feared a headache coming on, how many times he could not do fun things with his friends, how his friends made fun of him, how they interfered with his schoolwork and how hopeless he felt because no one believed him. I believed him and easily saw the depression this chronic and uncontrollable situation was causing.
Parents didn't know what to do, so everyone ignored his crippling pain until I sounded the alarm and referred them to a headache clinic in Dallas. At that time, there was no internet to learn more or to find resources; now, there are a number of organizations and resources to learn about chronic headaches and find clinicians who can treat them.
1. Tension: no nausea/vomiting, caused by stress forcing the contraction of the muscles in the neck and scalp.
2. Sinus: Occurs usually during the course of allergies or sinus infections. Again, no nausea/vomiting, but pressure behind the sinuses/forehead.
3. Rebound: Results from overuse of painkillers for headaches. No nausea or vomiting is seen.
4. Cluster: This type of headache affects more men than women and occurs in cycles. They have a sudden onset. Severe and debilitating pain occurs on one side of the head, likely around the eye and co-occur with nasal congestion and watery eye on the same side of the face. Restlessness and difficulty getting comfortable does not allow them to lie down. There is typically no nausea or stomach upset.
5. Migraine: This is probably the most dreaded form of headache as it is typically debilitating and can last from 4 to 72 hours. The "misery index" is high as one-sided pain, throbbing pain, nausea and vomiting, sensitivity to light and sound, moderate-to-severe pain and pain that interferes with or is worsened by regular daily activities are expected symptoms. About 15%-20% of sufferers, known as migraineurs, experience visual distortions or hand numbness. Migraine headache pain can occur in other areas of the body including the abdomen.
It is unclear if frequent migraines cause structural damage to the brain or if the thickening of this sensory cortex was present in the first place. Research is currently exploring which comes first.
Since the somatosensory cortex is involved in migraines, it makes sense that the sensory sensitivities to light and sound are common symptoms.
Thickening of the somatosensory area is also associated with multiple sclerosis and Alzheimer's disease.
The Migraine Trust
The International Headache Society
The Migraine Research Foundation-this site has a Directory of Children's Headache Doctors...by location. GREAT.
Considering that the cost to American business in terms of loss of productivity or reduced productivity is a whopping $29 Billion a year, there's a lot of research seeking to reduce the more debilitating effects of this disorder. For every 1000 migraineurs, yearly medical costs are about $200K.