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Headache: Extracts

Introduction

This book is all about headache. It is not about the medical emergencies, often referred to as "secondary" headaches, that present in the emergency department. It is about the headaches that the family doctor sees every day. It is about the headaches that rob individuals of quality of life, and the nation of time lost from work. We regard such headaches as "primary" headaches.

The spectrum of who gets headaches is not easy to predict. At one extreme are the hardy souls - by no means few in number - who can barely remember ever having had a headache. The US National Institute of Neurological Disorders and Stroke have evidence that 10 per cent of men and 5 per cent of women don't have a single headache during their entire lives. At the other extreme are those whose lives are dominated by headache. And in between there is a lot of variation concerning who gets headaches and how often they get them. Clearly headache is more than one illness, and afflicts more than one personality type.

What we do know is that the size of the problem is growing. In this, the second decade of the millennium, it is estimated that approximately 45 million Americans get chronic headache. That's about one in six people. Of these headaches, 28 million are classified as 'migraine'. The rest are due to the other causes. In the United Kingdom, about 6 million adults suffer migraine. On any one day in the United Kingdom, 200,000 people experience a migraine. Half of them will miss school or work. The cost to the National Health Service for medications and visits to the doctor is estimated at £150 million a year. In terms of time lost from work, the estimate is £2.25 billion, with 5 million working weeks lost each year. Added to this of course are the days lost to work as the result of headaches not classified as 'migraine'. In Australia, while no major studies have been undertaken, it is estimated that there are more than 3 million migraine sufferers and more than 7 million sufferers of tension headaches. Twenty three percent of households contain at least one migraine-sufferer, and the direct and indirect costs of migraine are estimated to be around $1 billion annually.

The World Health Organization has placed migraine among the world's 20 leading causes of disability. Chronic headaches from other causes simply add to this.

Why are headaches growing in number? Is it that we are exposed to more chemicals than in the past, or that we are eating more processed foods, or that we are working longer hours - or a combination of all of these things? We do not yet know the answer, but we do know that it will continue to cost individuals, doctors, and even nations both time and money as people continue to suffer.

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In this book I identify some of the events or actions that can set us, unknowingly, on the path to the headaches that dominate lives. And I present some ideas I have gathered, both from the science and from the patients I have seen along the way.

But this is not a neurology textbook. It is aimed at readers afflicted by headaches, who want options to deal with them. I will look at some of the basic science of headaches, and discuss ways of getting relief beyond, but not necessarily excluding, prescription medicines. Medication has its part to play, but I think it is a mistake to see it as our only weapon. I am writing for those people who feel that something might be contributing to their headaches, but they just can't nail what. Some of the simple things I will explore are practices an individual can undertake for themselves. Others are more a matter of how our society goes about daily life.

First, a word of warning. In all cases, I would exhort any headache sufferer to first get a diagnosis from a fully qualified medical practitioner - more than one, if necessary. There is no protocol that stops you from getting a second opinion or asking for a specialist opinion. It may be that you have had such a diagnosis, and are happy that the medications you are on control your symptoms satisfactorily. You may be reading this book simply to find out more about your condition. In contrast, you may be tired of always taking pills, and feel that they don't help a lot anyway, and you may be reading this book in order to find some treatment strategies to put into practice. But it would be foolhardy to try to treat yourself without first ensuring that the 'migraines' you are suffering from is not in fact a brain tumour.

In addition, recent assessment is important. Just because you have been diagnosed with migraine or stress headaches in the past, it does not mean that you cannot develop a second pathology, such as a stroke or a brain tumour. Any change in the nature, frequency, or severity of your headaches should ring alarm bells.

Throughout this book, I refer to the many factors that relate to the problem of headache. As a doctor who wants to understand the disease process, I am always drawn to scientific data. Sometimes I am able to infect my patients with my enthusiasm. More often, I suspect, they wish I would just get on with the business of finding an answer to their problem. So I have written the book with this in mind. Some people will get all they need from Part II, which focuses on treatment methods - and find themselves reading a much shorter book. But because most people seem to want to know the reasons for their headaches, I did not start with treatments. Many individuals are trying to piece the story together, and learn about the other health implications their headaches have for them and their families. For that reason, I have started by outlining what headaches are, what causes them, and why, giving as much detail as I think I can get away with as I proceed. I do not want any reader to feel intimidated by anatomy and chemistry. Even the very words scare some. So I primarily concentrate on the hard science in Part III.

We all learn in different ways. The way I learn best is to understand the scientific basics first. So if I were a young doctor just starting to go beyond the pharmacotherapy of headache, I would probably start at Chapter 10. If I were a headache sufferer or their friend or family member, I would start at Chapter 1.

I hope the science you meet as you read will help answer the question every headache sufferer asks at some time: 'Why me?' And I hope it will give you some new information and strategies when it comes to treating and preventing headaches

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