The Painful Truth
Sydney Morning Herald
Thursday April 20, 2006
Scientists are building an arsenal of treatments to fight the common headache, writes Jane-Anne Lee.
You've just had great sex, but you can feel a dull ache coming on. Welcome to the coital headache. You may have swum a few laps before work, leaving you with a goggle headache from excessive nerve stimulation. You may have just started licking your gelato when the ice-cream headache kicks in. There are many other headaches, too. There's the Chinese restaurant syndrome from an MSG reaction, a fasting headache from detoxing, a hot dog headache from a food reaction, a cough headache and, of course, the hangover. Headaches come in all shapes, sizes and strengths. All of the above are classed as normal headaches while tension, migraine and cluster headaches are classified as recurring. The tension headache is the most widespread, affecting 7 million Australians. It usually strikes in the teenage years, peaks in the fourth decade, then declines, according to Headache Australia. Symptoms may include persistent, dull pain on both sides of the head that can vary in intensity, a tight sensation around the head and restricted neck movements.They may be known as tension headaches, but stress may not necessarily be the cause. Triggers can include poor posture, bright lights, depression, fatigue and medication overuse. They can be treated by making lifestyle changes, such as more sleep, relaxation and regular exercise and with over-the-counter medications such as aspirin. A much more painful headache is the cluster, which affects an estimated 14,000 Australians. It strikes five times as many men as women. Headache Australia says cluster headaches usually develop between the ages of 20 and 40. The cause is believed to be a disorder of the hypothalamus, part of the brain linked with the body's internal clock.The pain is more excruciating than migraine and is usually localised around one eye, spreading to the forehead, cheek and upper gum. Attacks last between 15 and 180 minutes and can occur on consecutive days for up to eight weeks. Family history, smoking and excessive alcohol consumption can be risk factors. For sufferers, their enjoyment of life can be destroyed, says Professor James Lance, honorary consultant neurologist at Prince of Wales Hospital, Sydney. "Thankfully, an Italian team has confirmed the importance of the hypothalamus in switching on and off the headache in cluster headaches. The researchers have found that by planting electrodes into the hypothalamus of sufferers then stimulating that area, the cluster stops. This is a breakthrough in the treatment of chronic clusters that do not respond to conventional medication."Just as debilitating, migraine usually strikes people in their 20s and 30s, less frequently after 40. Pain may be one-sided, moderate to severe, throbbing, and aggravated by movement. Sufferers may be nauseated, sensitive to light or noise and may vomit. Migraines can last between four and 72 hours. Statistics indicate about 8 per cent of men and 18 per cent of women suffer from migraine at some time in their life, Lance says. Recent migraine research has shown that there is an area in the mid-brain that becomes active, an area important in pain control. "Even more recently, French research has found that there is a lighting up of the hypothalamus early in migraine. This is important because about 25 per cent of patients the night before a migraine attack have a craving to eat sweet foods, or feel drowsy or on top of the world. These are functions of the hypothalamus." Current migraine treatment involves taking triptans, beta blockers, tricyclics and anti-epileptic drugs. However, a new class of drugs to treat migraine and pain is in the recruitment phase at the James Lance GlaxoSmithKline Medicines Research Unit at Prince of Wales Hospital. The drug is based on the chilli pepper theory. Chillis contain the active substance capsaicin. The aim of the drug is to block the action of the body's capsaicin receptors so if you were to, say, eat heaps of chilli, you wouldn't feel the burn. If you have chronic pain that goes through these same receptors then you may be able to block out the pain, says the unit director, Dr Malcolm Handel. Further Australian research is focusing on the link between stroke and migraine sufferers, particularly those with migraine with aura, where visual changes, such as seeing white spots, occur."We have investigated a gene that has a mutation in it, resulting in an abnormal level of the biochemical homocysteine, which increases the risk of cardiovascular disease and stroke," says Professor Lyn Griffiths, director of the genomics research centre at Griffith University. "This particular mutation occurs more often in those with migraine. And this may explain the link between migraine and stroke." Sydney migraine sufferers can register for Dr Handel's clinical trial on 1800475475.TYPES OF HEADACHENORMAL Dull ache caused by factors including fatigue, cold, chemicals and alcohol.TENSION Ache on both sides of head, feeling of tightness, restricted neck movement.CLUSTER Excruciating pain usually localising around one eye, spreading to forehead, cheek and gum.MIGRAINE One-sided, mild to severe throbbing pain, made worse by movement and light.
© 2006 Sydney Morning Herald