06 November 2011

like a hole in the head

it may surprise you to know that your brain actually has no nerve endings. no matter what you do to it [and i'll leave that decision up to you] you cannot make it hurt. i say that it may surprise you, because i think that the headache has to be the most common pain complaint in the world [generally a toss-up between that and lower back pain, -ed.] since dom has been laid low by some type of internal zombie devouring the tissues surrounding his brain [which do have pain sensors, lots of them, so that your body has plenty of warning that something's coming for the motherboard] and since i found out this year that i suffer from migraines [i'll explain later how i was unaware of this] and since i know lots of people who are suffer the tortures of hell from various forms of headache, i thought i'd share some of the wisdom i've accumulated on the subject...

the first rule of headaches is that you need to know who you're dealing with. saying you have a headache is like saying you have eyes. it doesn't really differentiate you from most other people. modern man would do well to emulate the myth of the number of eskimo-aleut words for snow and develop very specific ones rather than relying on a catch-all term. [to clarify, the "eskimo" people of northern canada, eastern siberia, alaska and greenland don't actually have that many words for snow, it just makes a logical-sounding argument about the development of language. on the other hand, the sami people of northern scandinavia do have hundreds of words for snow. which just goes to illustrate that geography really has very little effect on language. but i digress.]

in terms of identifying a headache, you need to determine whether or not the headache is the central problem. did you drink more than half your body weight in alcohol in the last forty-eight hours? congratulations, reprobate, your headache has a cause related to something else in your body and i'll see you next weekend. of course, there are lots of chemicals that you ingest aside from alcohol that can cause headaches [they just don't come with all the fun side effects]. so if your head's hurting, have a look at any medications you might be taking, particularly if you've just started them or changed dosages. google the hell out of them and find out the drug companies' dirty little secret: aside from somnolence [knocking you out], the most common side effect of pretty much any medication is headache. oh, and most prescription meds react badly with headache meds. because big pharma hates you and wants you to suffer.





show me where it hurts
one of the first things i do when i have a headache and haven't drunk more than half my own body weight in alcohol is do a quick assessment of how much water i've had to drink. people are too quick to dismiss the miracle that is water. it makes up more than three-quarters of your body and, when you aren't replenishing it fast enough, that body has ways of letting you know. sadly, much of the time, the thirst reflex in most people is so weak that they have trouble even identifying it until it becomes acute. because i'm aware of these things and because i'm still likely to forget about drinking water during the course of a normal day despite knowing these things, my first reaction to the early signs of a headache is to start drinking water like a camel at an oasis. and, unsurprisingly, that often does the trick. [note: drinking water means drinking water. not tea. not juice. not milk. certainly not coffee, no matter how much you need it to live. and not booze. water.]

so, now that you've determined that your head isn't reacting to chemicals or dehydration, we can move on to the causes of headaches that everyone knows about: tension and migraine. in my experience, these are divided along gender lines; women get headaches and men get migraines. no man in the history of the world has ever just gotten a headache. it's a migraine. or a brain tumour. or internal zombies. headaches are for girls. unfortunately, doctors [female doctors, one assumes] seem to disagree and claim that about 90% of all headaches are tension headaches and that they're about equally prevalent between men and women. 

there are, of course, many causes of tension headaches, but the key is that they're all related to the musculature of the head and neck. since most of us don't ever work the muscles that we have in our necks and head, it might come as an unpleasant surprise that we actually have a lot of them and that it's oh-so-easy to cause them to start aching. tension headaches are marked by a dull [sometimes not-so-dull] pain all over the head [that last part is important], a pain radiating from the neck, a feeling of pressure over the scalp or forehead and a general sense of wanting to smash in the face of anyone who even looks at you funny. they're a fairly common phenomenon and are generally relieved by one of the following methods:

how to cure a headache, medieval style
1. gritting teeth and bearing it [note: gritting teeth may worsen the condition]
2. analgesics such as ibuprofen or acetaminophen
3. tissue manipulation, also known as "massage therapy"
4. pounding the shit out of someone who annoys you [still in testing stage]

chronic tension headaches, ones that go on for months or occur at regular intervals, may point to a need for some further therapy [see #4], but generally, tension headaches should be alleviated by methods 1-3 above. of course, the one thing that gets left out is that, since you're dealing with muscle pain, what your body wants is not simply a painkiller [analgesic] but something to force the muscles to stop being angry, which means that what you really want is a painkiller + a muscle relaxant. the combination of the two is generally powerful enough to pummel any tension headache into submission. [of course, you might want to keep in mind that if you take these drugs too often, your body will come to expect them and when you don't oblige by scarfing down handfuls of pills, revenge will be taken by inflicting the mother of all tension headaches upon you.]

if you prefer a more natural method of approaching tension headaches, acupuncture and massage have both be shown to have beneficial effects. if you're looking for something a little more immediate, there are a number of herbal supplements and teas [try valerian- the granola's heroin, which also works as a substitute for catnip... a treat for the whole family]. it's not difficult to combat the immediate effects of tension headaches. the long-term problems associated with recurrent tension headaches, such as poor posture and sleeping position, inadequate rest, constant anxiety, depression and that douchebag at work who just insists on trying to make your life difficult are a little trickier to deal with. but in the meantime, drugs, acupuncture and massage can certainly help. [if not, please see #4, above.]

"migraines" that elusive category of aching head that everyone claims to have, are a little more specific. and by specific, i mean "just because it hurts, it doesn't mean it's a migraine". migraine is a condition characterised by acute pain in one side of the head. in fact, the word migraine is derived from the greek terms "hemi" [half] and "kranion" ["skull"], which means that the distinction should be pretty clear. if your whole head hurts, i don't care how much it feels like you're dying from it, it's not a migraine. [note- migraines can move from one side to the other, just to drive you that much crazier.]

for those who actually do suffer from migraines, the experience is generally pretty horrifying. the first time i had a migraine and was aware of it, my head hurt like someone had pounded a hole through my skull. a friend of mine described it as the ice cream headache that doesn't go away and that's pretty accurate. thing is, as most chronic migraine sufferers will tell you, the headache is generally the least of your problems. sure, it feels like your brain is trying to punch its way out of your head via your eye socket or the base of your skull [one or the other if you're lucky], but migraine is generally marked by nausea, moderate to extreme photo-sensitivity [imagine being a vampire at sunrise], edema [swelling] and even delirium.  sounds pleasant, no?

the premonition or "aura" of an imminent migraine
well, here's the tricky part. [i'd like to warn you that anyone reading this who actually suffers from migraines is probably going to want to hunt me down and smash my face in after reading this paragraph. so feel free to skip it.] migraines are a medical mystery and, as such, they can manifest in wildly different ways. the common perception is that they're a really bad headache, but 90% of cases report pronounced nausea as well. about 30% of sufferers report an "aura" a sort of visual, auditory or other sensory clue that a migraine is about to occur. [note, this is completely different than seeing an aura, as in the manifestation of the body of energy around a living being.] but the experience of migraine is often highly individual. for instance, a person could have migraines that involved waking up completely blind in one eye, but experiencing virtually no pain whatsoever. like me.

that's right. although i've had a couple of painful migraines in my life [which generally subside within an hour or so, just to piss you off more], the reason i never knew i had them was because mine are almost always pain-free. it took two doctors and a neurologist to convince me that what i was actually going through was a migraine. turns out that, while rare, it's not unheard of for migraines to manifest fairly painlessly. so go ahead and hate me, migraine sufferers. it still sucks to wake up in the middle of the night thinking you've gone blind.

because the cause of migraines is unknown, it's kind of difficult to pinpoint a cure. triptans- medications that affect serotonin receptors- have been shown to be effective in most patients if taken at or near the onset of a migraine. this, of course, assumes that your migraine has the decency to declare its intentions which, as noted above, only occurs in about 30% of cases. i was thrilled when my doctor prescribed maxalt, one of these meds, and told me to take them when i suspected a migraine was imminent. considering that my migraines consist of bring jerked out of sleep bolt upright and blind in the middle of the night, the medication is of limited use [and, indeed, sits in my medicine cabinet awaiting its expiry date].

other drugs that affect serotonin receptors, such as antidepressants, have shown some promise in combating migraines, but one of the most interesting fields of study is in the links between migraines and epilepsy. yes, it seems that migraines may actually be a very mild form of epilepsy, meaning that they would be best treated with mild anti-convulsant drugs. we have those. they're called benzodiazepines and i've written about them at length. valium, xanax, lorazepam, oxazepam... these are usually what i recommend to migraine sufferers. and wouldn't it just be the biggest piss-off in the world to drug companies if it turned out that the best treatment for migraines were drugs that had been around so long that they were all available in generic form already?

third on the headache hierarchy is the "new hotness": cluster headaches. after all, migraines are something that everyone has had and, more importantly, your parents probably had them [more likely your mother, since they're about three times more prevalent in women than in men, no matter how many men say they have them]. so migraines have undoubtedly lost their cool pain cred. cluster headaches are where it's at. they're nicknames "suicide headaches", so you just know that they're hardcore.

like migraines, they're unilateral, meaning they pick one side to attack. they're particularly associated with agonising pain around and/or behind the eyes. when asked to describe the pain, patients have come up with things like "having a limb amputated without anesthetic", which leads medical professionals to believe that they most likely hurt a lot. evidently, they hurt enough that you might as well be feeding patients breath mints as painkillers, because people in the throes of a cluster headache show pretty much no reaction whatsoever to analgesics. [throwing the aspirin back at the doctor and telling him/ her to go fuck themselves was apparently not considered a reaction for the purposes of these studies.]

mercifully, cluster headaches tend to be short-lived, lasting from fifteen minutes to three hours. on the other hand, three hours of a power drill being inserted behind your eye is probably more than most of us want to put up with. which leads to the question of a cure. yeah, about that.

turns out that medical science is as clueless about the cause of cluster headaches as they are about the causes of migraines. basically, it comes down to "sometimes stuff hurts". like migraines, they can respond to triptan drugs. giving patients access to oxygen [assuming you just have a tank of it lying around] may help. and there are several promising studies that ergot and ergot-derived treatments may be very helpful in the treatment of cluster headaches. you know what the chief "ergot-derived treatment" is? lsd. no word of a lie. the magic bullet for the "suicide headache" is to go play with the angels on a magic carpet made of rainbows. oh wait, now i get why more and more people i know are claiming to have cluster headaches.

in fact, cluster headaches are very rare, affecting about 0.1% of the population and that probably includes those who are faking it in order to get the trials of lsd. although cluster headaches have traditionally been seen as more prevalent in men than women [by anywhere from 4 to 7 times], that gap has been narrowing consistently, possibly proving that it just takes women a lot longer to realise that a pain is worth complaining about.

this is, of course, only a smattering of the types of headaches that one can have, because it doesn't take into account secondary headaches, which are those caused by other factors like malnutrition, blood pressure, disease or having an aneurysm. but i think that's enough for a sunday night. besides, staring at this computer screen is making my head hurt.

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