Headaches are ubiquitous. While they can be metaphorically caused by anything from lack of money to lack of romantic interest (“Not tonight, dear…”), in reality, most headaches have specific causes, and can often be treated, even avoided.
Pain in general is the result of pressure. Pressure, caused by swollen tissues, stimulates nerve endings, which is interpreted by the brain as pain. In the case of headaches, the pressure is usually in the facial skeleton, the neck, or within the head. The edema, or swollen tissue, may have a variety of causes, including infection or inflammation, allergy, or persistent tension. One of the most useful clues in headache diagnosis is to note the possible triggering event.
Patients commonly use the word “migraine” to convey the idea of severe headaches. Some years ago, one of my patients (not a singer!) stated that she didn’t just get headaches–she got real “mybrains!”
Migraines are not just bad headaches, but a specific condition that may be easy or difficult to diagnose. The common mechanism is the constriction of blood vessels, followed by swelling. When the vessel swells, it can become leaky and inflamed. Depending on which blood vessels are involved, the migraine can manifest itself in different ways.
Classic migraines begin with a visual aura–changes in vision, or spots in front of the eyes. This is followed by a severe, throbbing headache, painful light sensitivity (photophobia), and nausea. The sufferer needs to lie down in a dark room and stay there, often for hours.
Most migraines are not classic, however, and may involve only part of the head, or may involve other symptoms, such as double vision, severe pain behind the eyes, or nasal congestion. The term “vascular headache” probably better encompasses these conditions.
What causes migraines? Some patients are inherently prone. They may have a family history of migraines, or have the “migraine personality:” intelligent, controlling, and fastidious. Migraines may be related to the menstrual cycle, or to food allergies. This diagnosis is best made by a neurologist, and treatment is often successful, using dietary modification, oral medications, and most recently, a nasal spray. If caught early in the attack, migraines can often be aborted by simple measures, such as a strong cup of coffee.
Much more common are tension headaches. Here again the mechanism is edema, of the muscles and ligaments attached to the skull. These headaches commonly begin in the back of the neck as muscle tension, and progress toward the top of the head. They may encircle the head with pain causing a constricted feeling, or throbbing.
Treatment, here again, begins with identification of the cause. While the tension may be situational, it could also be due to poor neck posture, visual strain, etc. If you commonly experience tension headaches, you should consider Alexander training, as well as massage. Chiropractic treatments may be useful, if the manipulation is gentle and purposeful.
Infection–commonly sinus infection or dental problems–can also cause headache. The infection may be easy to localize, or vague and somewhat mysterious. For example, some forms of sinusitis can produce pain at the top or the back of the head, quite removed from the location of the actual sinus. Similarly, dental problems, including TMJ dysfunction, may be easy or difficult to pinpoint.
Headache remedies abound. Aspirin has potential hazards for singers prone to vocal fold hemorrhage, and other anti-inflammatories can also be hazardous, although to a lesser degree. If you take over-the-counter headache medications, beware of compounds, which often contain three or more medications. Know what you are putting into your body.
What can you do if you are prone to recurrent headaches? Before seeing a physician, you should analyze the pattern of the headaches, including frequency, severity, duration, as well as characteristics and possible triggering factors. Certain medications can trigger headaches. For example, antidepressants of the “MAO inhibitor” group, in combination with foods such as cheese, chocolate, or wine, can cause severe headaches. Monosodium glutamate (common in Chinese or Japanese food) can trigger severe headaches, even migraines in those who are prone. Foods should always be scrutinized, especially on tour in foreign countries, where you may be ingesting unknown ingredients.
If you do not have a headache history, and have begun to experience attacks only recently, make sure there is not an undiagnosed infection or inflammation in the nose, sinuses or teeth. Most importantly, if you seldom get headaches but have a sudden onset pain that grows more severe and unrelenting, see your doctor. Rarely, these can be due to serious intracranial problems that need urgent treatment.
In reality, however, most headaches are just that–a recurrent, bothersome symptom. Minimizing them is a collaborative effort between yourself and your physician, one that may involve changes in diet and life-style, as well as medications.
