HOW TRIGGER FACTORS SET OFF HEADACHES

Migraine

Change in temperature

Change in humidity        

Too much alcohol            

Allergy 

Menstrual cycle               

Emotional strain              

Dreams headache

In each case, the trigger factor in some way increases blood flow in the head, which, once disturbed, gets worse in a sort of  chain  reaction, producing the symptoms of a migraine

Muscle tension   

Emotional disturbance Fatigue prolonged poor posture (too much TV, etc., in an uncomfortable position)

Tobacco

Glaring light

Menstrual cycle

Sleeping in a bad position

Trigger factors of this kind produce muscle contraction (even   though  you  are unaware of them) This produces excess waste matter in the muscles, which irritate the nerves and produce an ache

Sinus

Allergies

Colds

Change of temperature

Change of humidity

Dust

Nasal and throat infections

Each of these trigger factors upsets the normal working of the sinuses, and in some way irritates the nerves of the sinuses.

In the chapters which follow, the most common types of headaches are discussed in some detail—including their nature, causes, trigger factors, and treatment.

CHAPTER 5

MIGRAINE THE TERRIBLE

Ask any migraine sufferer about his headaches and he'll almost invariably say they are “terrible.” No other word in the language seems to describe them so well. For this very reason, the name “migraine” has come to mean to many people terrible headaches of any kind.

This is unfortunate, because it tends to make diagnosis inexact, and to prevent a person with bad headache problems from seeking help because he thinks his case is hopeless. Of 100 people who think they have migraine, only about 10 actually do; the other 90 have some other type of headache problem.

If a person has true migraine, he can be helped—and rather simply in a majority of cases. If he does not have migraine, correct diagnosis may also lead to a cure or to real relief. So our number one job in helping the migraine sufferer is to describe true migraine as exactly as our knowledge will permit, and to lead the headache sufferer to a correct determination of the type of headache he really has.

What Is Migraine?

Migraine is that form of headache which is one sided, throbbing, associated with eye and stomach disturbances, preceded by warning signals, and generally, if untreated, lasts from 12to72 hours.

Migraine is ordinarily periodic in nature; that is, it occurs at more or less regular intervals of time. Once an attack is over, the patient is free from this type of pain until the next migraine attack. (It is possible to have other types of headaches between migraine attacks—but their nature is different.)

The occurrence of other types of headaches between migraine attacks may confuse the picture if distinctions are not drawn between the different types of pain involved. The present medical concept of migraine is that it is a constitutional abnormality (an abnormal functioning of the body) in which heredity plays an important part.

The importance of defining migraine in very specific terms is this: migraine, as defined here, is a specific illness for which treatment is known, and which, in most cases, can be effectively controlled.

If the definition is so broad as to include other types of headaches, the treatment for true migraine may not work, and the patient may undergo years of needless suffering.

The importance of correct diagnosis was pointed out by sharp-tongued George Bernard Shaw, who for years had severe migraine headaches, and who once commented to the famous Arctic explorer Nansen, “You have spent your life in trying to discover the North Pole which nobody on Earth cares tuppence about, and you have never attempted to discover a cure for the headache which every living person is crying aloud for.”

What Does “Migraine” Mean?

The word “migraine” is derived from the ancient name for this type of headache—“Hemicrania”—which means “half of the skull,” because the attacks are usually one-sided. The malady has been known so long that it was described in ancient medical writings.

While the name applies to the headache, migraine affects other parts of the body; in fact, some people are troubled with “migraine” without having headaches, for migraine disease involves much more than headache.

Throughout history, various other names have been given to migraine, and they occur frequently in our literature. For example, the vapours, sick headache, bilious headache, and nervous headache.

How Common Is Migraine?

Based on a widely accepted figure that some 13 million people in the United States are frequent sufferers from disabling headaches, and on clinical observations that some 10 to 15 per cent of serious headache sufferers have migraine, it is probable that at least 2 million Americans have migraine.

Dr. Henry Ogden has stated that when migraine is strictly defined, 3.3 per cent of the population (or about 5,500,000) people have migraine. Broader definitions put the figure much higher.

The importance of defining migraine in very specific terms goes far beyond the matter of statistics. Whatever the actual figure, migraine is a serious problem to many people. The loss in living time, in working time, in wages, and in productive work must be considerable.

Migraine—A Five Act Drama

There are five phases to the usual untreated migraine attack—although some people may not experience all of them all the time:

Phase 1—Warning signs—which are always present, and which precede the pain (5-30 minutes)

Phase 2—Throbbing—one-sided, intense headache (12-18 hours)

Phase 3—Steady—one-sided,   severe  pain—not  throbbing

(12-24hours)

Phase 4—Dull ache, all over the head (12-24 hours) Phase 5—Relief of pain, usually replaced by a tingling sensation in the scalp (uptol2 hours)

The duration of these phases is not the same for every-one; and the treatment required for relief depends on how far the attack has progressed when treatment is begun.

Phase 1—The Warning

If your migraine attacks come on while you are asleep— and this is not unusual—you will probably miss the warning signs. By the time you are aware of the attack, it is too late for preventive measures.

But if your attacks come on during your waking hours, you will experience one or more of the following warnings:

Visual Disturbances: Your eyes don't focus well—vision is blurred. You may see double. For a few minutes you may be partially blind in one or both eyes, then vision returns after what has been described as a “prairie fire” effect. Coloured zig-zag lights or dark spots before your eyes may be seen.

Often one eyelid droops—usually on the side where the headache will develop. You may be extremely sensitive to light or glare. You may see “snow falling” or “cobwebs forming.”

Nausea and Vomiting: Almost all people with migraine experience nausea and vomiting to some degree before the headache begins. This also may continue after the pain starts, or it may not occur until after pain has started.

Speech Difficulties: Some people notice numbness of the face and tongue, and an inability to talk properly. Trouble in concentration and in using the right words is not unusual.

Skin Sensations: These range from scalp sensitivity so acute that you cannot put your head on a pillow, to tingling of hands or feet and a feeling of thickness of the skin, as though it were swelling.

Restlessness, Irritability, Dizziness: Dizziness is, of course, a rather specific condition; restlessness and irritability, while they are often present, are not related to migraine alone.

Sensitivity to Noises and Odours: You may find that noise becomes almost unbearable. Some people become acutely sensitive to odours before or during an attack.

Other Warning Signs: Many people with migraine have reported other experiences which serve as warnings to them, but which are somewhat less common than those enumerated above. Such warnings include excessive urination, a feeling of more energy than usual, etc.

It will be recognized, however, that such experiences are not enough to warn specifically of a migraine attack, whereas nearly everyone with migraine has some visual, digestive, or skin disturbances which are therefore much more reliable indicators.

The warning period will last from 5 to 30 minutes—and it is during this time that treatment MUST be instituted to be most effective.

What Causes the Warnings?

Visual Disturbances

One of the principal characteristics of migraine is that there are alterations in the blood flow in various parts of your body—beginning just before the pain itself.

It is generally accepted in medical circles that certain blood vessels in a migrainous person don't function the way they do in a normal individual.

These blood vessels are mainly in the head—both inside and outside of the skull— and are controlled by the autonomic nervous system—the body's automatic control system.

At the back of the brain is a portion called the occipital lobe, whose job it is to register what your eyes see, and interpret this information to other portions of the brain. The theory is that in migrainous persons, the blood vessels which supply this portion of the brain become narrowed down just before the pain of the migraine begins.

This reduces the amount of oxygen supplied to the area, producing a variety of visual disturbances, which last for several minutes. After a few minutes, the blood flow returns to normal in this part of the brain, and the visual disturbances stop.

The reason that the cause of visual warnings is not known with certainty is that there is no practical way to study the blood flow within a single part of the brain.

Nausea and Vomiting

Whatever it is that upsets the body's control system—the autonomic nervous system—and produces the visual warn-ings likewise causes a spasm of the duodenum (that part of the intestine into which the stomach opens). This spasm (or tightening of the muscles) forces bile, which is normally in this part of the intestine, back into the stomach.

Bile does not belong in the stomach, and is an irritant to the stomach walls. The result is that the stomach quickly acts to get rid of this foreign material. The nausea occurs because of the bile's presence in the stomach; the vomiting is the stomach's way of freeing itself from this irritating material.

The fact that the bile is “thrown out” probably accounts for the old name “bilious headache” being applied to migraine.

Difficulties in Speech and Concentration

Just as there is a center for vision in the brain, so are there centers for speech and for thought—and for most other bodily functions. If the blood supply to these areas is affected at the beginning of the migraine attack, you will experience difficulty in concentrating or talking.

Skin Sensations

Tingling of the skin—which is very similar to the sensation when your foot “goes to sleep”—is caused by shortage of oxygen in the affected part. And once again, the disturb-ances in the autonomic nervous system can be blamed, since the blood supply to these areas is somehow reduced.

Increased Elimination

The effect of nerve stimulation of the intestine is to produce bowel movement, in some people. Likewise, stimulation of the bladder may bring about excessive urine output just preceding an attack.

Treatment During Phase 1

The most important fact to remember about treating migraine is that prompt action during Phase 1 can completely prevent development of pain—or modify it so that the pain which does develop is less severe, and of much shorter duration. Treatment consists of two kinds: what you do . . . and what you take.

What To Do

Most migraine patients agree on the following:

Don't “panic”—don't get into the frame of mind that says “here comes another on

Relax—and sit down; don't lie down Get into a darkened room if possible If you feel thirsty drink some black coffee Avoid noise if possible.

Some patients report that putting cold, wet towels around their heads and putting their feet in hot water will help to stop an attack. There may be some medical basis for this, because the cold may reduce blood flow to the scalp and the heat may increase blood flow away from the head.

What To Take

There are three types of medication that may be used to control migraine in Phase 1:

1.            Medicines that restrict blood flow to the external arteries

of the skull, where the pain develops (ergot derivatives)

2.            Medicines to relieve the initial pain—usually aspirin or

an aspirin compound

3.            Medicines to control the spasms of the duodenum and

the stomach, to prevent nausea and vomiting (Belladonna

or other similar medicines)

4.            Black coffee—the caffeine in which makes the ergot more

effective

The first of these—the use of ergot derivatives—is the most important, because this is the treatment to prevent the headache from advancing to Phase 2.

Ergot and How It Works

Ergot is a fungus that grows on the grain of cereals, and is obtained commercially from rye. The use of ergot to control headache was first recommended in 1898 by Thom¬son in a medical textbook. At that time, it was not known how or why ergot relieved certain types of headaches, but it had been observed to be of some value.

Ergot was originally used by doctors—and still is—to contract the womb after childbirth. It is possible that Dr. Thomson or someone else at about the same time observed that women who ordinarily suffered from migraine were relieved of their headaches during the period after childbirth when they were under treatment with ergot.

This, however, can only be surmised at this date. During these early days of the use of ergot, there were occasional cases of what is called ergot poisoning, possibly due to impurities, in the ergot then available.

As a result, researchers, in attempts to discover the cause of the occasional trouble, discovered that ergot actually consists of three main types, all of which were found in the original substance. They further discovered that each of these three types, used individually, has effects on different parts of the human system.

In 1932, ergotamine tartrate—one of the three ergot types—was made available to medicine in refined form. This compound has its principal effects on what are called involuntary muscles; that is, on muscles like those in the intestines and blood vessels which operate automatically.

Put simply, ergotamine tartrate causes these muscles to contract gently—that is, to become smaller. Because ergotamine tartrate produces this effect particularly on the blood vessels which supply the scalp (extracranial blood vessels), and since these are the blood vessels which are involved in migraine headaches, ergotamine tartrate is an extremely useful medicine in controlling migraine.

Specifically, when ergotamine is taken promptly during warning stages of a migraine attack, it can prevent excessive blood flow in the scalp and thus prevent development of the pain.

How To Take Ergot

Ergotamine tartrate is available in several forms, and your doctor will help you find out which is best for you. These include:

(a)          Tablets

(b)          Liquid

(c)          Injections

(d)          Suppositories

(e)          Mouth Sprays

The most effective way to take ergot is by injection, but it is inconvenient and not generally used. The most convenient way is tablets, but many people who have migraine find that because of the accompanying nausea, they are unable to keep the tablets down long enough to be effective.

For this reason, most headache specialists agree that rectal suppositories containing ergotamine tartrate are the best method for most migraine patients. The suppository is especially effective because it makes the ergotamine tartrate available for immediate absorption into the blood stream, and thus brings quick action in preventing the further development of the attack.

There are many commercial forms of ergotamine tartrate available, and your doctor will prescribe one for you; they are not ordinarily available without prescription.

Ergotamine tartrate is always more effective when combined with caffeine, and many of the ergot preparations are now compounded with caffeine and medicines to lessen nausea and vomiting. Many patients find that drinking black coffee at the time they take ergotamine tartrate makes it much more effective.

Side Effects From Ergot

In addition to the beneficial effects of ergot there may be “side effects” in some people which make its use inadvisable, or subject to limitation. The most usual side effects are nausea and vomiting—which are often present with migraine, and occasionally made worse by ergot preparations.

Cramps in the legs occur rarely; if you have such trouble, your doctor may restrict the amount of the medicine which you should take.

It is characteristic of migraine that it usually disappears during pregnancy, and therefore the use of ergot would not be required. However, because of its effect on the womb, it is ordinarily inadvisable for a pregnant woman to take any ergot preparation except under her doctor's orders.

One other caution: because ergot has an effect on in-voluntary muscles—including those blood vessels of the heart—it is not considered advisable for persons with any history of coronary heart disease to use ergot preparations.

Ergot should also be avoided by persons who have any blood vessel disease, such as Raynoud's Disease or Buerger's Disease. Ergot is not without its own set of old wives' tales, and it may be well to mention a couple of these.

Will ergot cause a woman to grow a mustache? No. This would occur only in the event of a hormone imbalance.

Will ergot cause fingers and toes to drop off? Again, no. There have been one or two cases reported over the years where early signs of gangrene have been noted— but in these cases, the condition developed after long continued daily use of excessive amounts of ergot preparations. In all cases reported the patients had pre-existing blood vessel disorders, and should not have been taking ergot at all, as noted above.

Can You Take Ergot Too Frequently?

Ergot, like any other medicine, must be used with good sense. The one pitfall that occasionally trips up an ergot user is that he (or she) may trick himself into using the drug too frequently.

If you follow your doctor's advice, and if you learn to recognize the warning symptoms of migraine positively—so you do not take the drug needlessly —ergot will be your servant, not your master.

Remember that ergotamine tartrate, for most migraine cases, is a specific remedy; but it will not relieve a tension headache, and may actually make it worse.

When NOT to Use Ergot

There are a few conditions during which ergot preparations should not be used:

1.            During pregnancy

2.            Overactive thyroid (unless approved by your doctor)

3.            Severe infection

4.            Jaundice, hepatitis, and other liver diseases

5.            Very high blood pressure

6.            Special diseases of the blood vessels (such as Buerger's disease)

7.            Coronary disease

Aspirin and Migraine

Occasionally a migraine patient finds that in the early stages of an attack, two or three aspirin tablets may afford some relief. However, aspirin has no effect on the basic condition which brings about migraine headaches.

Aspirin treats the symptom—ergotamine tartrate treats the under-lying process which brings on migraine. Use aspirin or aspirin compounds if you find that they help. Some ergot preparations include aspirin.

Anti-Spasmodics and Migraine

These are drugs which overcome spasm of the intestine which occurs during the first and second phases of migraine attacks—the warning, and the initial pain stages. The reason for their use is to stop the tightening up of the intestine at the exit of the stomach which forces bile back into the stomach and causes nausea and vomiting.

Taken in time, anti-spasmodics can be of considerable help in preventing or relieving nausea and vomiting. Your doctor will prescribe these medicines for you if they are needed.

Oxygen and Migraine

Aviators during World War II learned, to their surprise, that severe headaches (sometimes known as “hangover” headaches) could be quickly dispelled by a few minutes in an oxygen mask.

This same treatment—the use of oxygen—has been found effective in the relief of migraine and certain other types of headaches. Unfortunately, this is not a very convenient method of relief for most people.

Phase 2—Throbbing, One-Sided, Intense Headache

Migraine is most notorious for what happens during the second phase of an attack—the terrible, throbbing, pounding, one-sided pain which for some people is almost un-bearable. Phase 2 is the violent stage of migraine. Starting off soon after the warning signs stop, the pain quickly builds up to a peak—which, if untreated, may last 12 to 18 hours.

Anyone who has been through such an experience will appreciate the need for quick action when the warnings start.

The pain is usually, but not always, one-sided. Some people always have these pains on the same side of the head; others find that the pain may come on either side, in different attacks, but it does not shift during Phase 2 of a single attack.

The pain throbs in time with the heart beat. It is made more intense by coughing, bending over, straining, or motion of the head. It follows, or is located along, one or more of the major blood vessels in the scalp.

If the artery in the temple is involved, you may actually be able to see it stand out and change in size with the heart beat. Pressing on the artery may ease the pain somewhat.

Many people find that a quiet, dark room makes the pain more bearable—or at least keeps it from building up to maximum intensity. Light is very aggravating during Phase

2. You may feel chilly—or break into a sweat—or both. You may feel terribly depressed probably because you are going into another attack with the feeling “I can't do a thing about it.”

Some people find the pain so intense that they cry out or groan. Numbness or tingling in hands or feet is not unusual. The scalp may become so tender that you cannot put your head on a pillow. Nausea, cramps, vomiting, and frequent bowel movements are common occurrences. Some patients have to urinate frequently.

What Happens—Physically—During Phase 2?

You will recall that during Phase 1—the warning period— a number of symptoms occurred in the head, and that these were produced by changes of blood flow within the brain itself.

In Phase 2—the initial throbbing headache—the disturbances in blood flow occur outside the brain in the scalp area. In this stage of migraine, one or more of the major blood vessels which supply the scalp becomes greatly enlarged (dilated). All blood vessels have elastic walls which change in size with each heart beat.

As the blood vessels of the scalp increase in size, during a migraine attack, they finally reach a point where the nerves in the walls of the arteries are subjected to sufficient pressure with each heart beat that pain is felt.

For some reason—as yet unexplained—the body mechanism in migrainous individuals is not able to control the blood flow and the size of these scalp blood vessels, once an attack is under way. Something in the body goes wrong —and it may take many hours for the condition to clear up.

This pulsating pain goes on for several hours, and after perhaps four hours or more, the elasticity of the blood vessels begins to disappear, and the blood vessel walls become almost rigid. At this point, the pounding pain gives way to a steady, intense pain—still on the one side of the head. This is the beginning of Phase 3 of the typical migraine attack.

The nausea and vomiting which occur during Phase 2 are merely a carryover of the same conditions which began during Phase 1.

Sensitivity of the scalp is explained by the fact that when an area of the body is hurting, it is generally unusually sensitive to the touch.

Discomfort from light (photophobia) and from noise (audiophobia) during migraine is merely another evidence of the fact that the head and its organs are unusually sensitive during the pain of a headache. This is particularly true in migraine because the pain is so severe, and every additional irritation is unusually noticeable.

Treatment During Phase 2

If you are unable to start treatment during the warning stage of an attack, or if the treatment has not been effective, you will want to know how to get relief after the pain starts. The same steps described under “What To Do” for Phase 1 apply during Phase 2.

What To Take

Ergotamine tartrate should still be effective, even though taken after the pain begins, but it is of little use once the throbbing pain has changed to a steady pain. Ergot preparations fail in migraine treatment only when too little is taken, or it is taken too late.

Again, the speed with which you act is of the utmost importance. If you wake up with a throbbing migraine headache—don't wait to see if it will go away. Take ergotamine tartrate at once. It will do no harm to try aspirin or one of the aspirin compounds, but it is unlikely that you will get much relief.

Phase 3—Severe, Non-Throbbing Headache

By the time a migraine attack has been under way for a few hours, the throbbing pain gradually changes to a steady one—sharp, extremely painful, still on one side of the head. Nausea and vomiting are usually gone by this time . . . little remains but the headache.

What Happens During Phase 3?

The blood vessels by this time have become almost rigid,, and are still greatly enlarged. The vessel walls have become “water-logged” (edematous) and thickened—and the nerves are under a constant pressure. The throbbing is gone only because the vessel walls have ceased to expand with the heart beat, and have reached their rigid state.

Treatment During Phase 3

Once you understand migraine, there is little excuse for you to allow an attack to reach this third stage. You should certainly be able to recognize the warning signs, and you should never be more than a few minutes away from a supply of ergotamine tartrate in whatever form you use it.

But, if you do reach this stage, there is little point in taking ergot preparations, because blood vessels no longer respond to this treatment. The only thing left to do is to use power¬ful pain killers and sedatives—provided your doctor feels this is in order.

This steady severe pain lasts from 12 to 24 hours, in most cases. Sleep is the best relief, if you can manage it.

Phase 4—Dull, All-Over Headache

After Phase 3, the worst of the migraine pain is over, but the after-effects may last another day or more.

The pain of the second and third stages of migraine produces in most people a general muscle tension throughout the head and neck—particularly the forehead and the back of the neck.

This accounts for the dull, all-over head-ache which follows Phase 3. In effect, Phase 4 is just a plain, old-fashioned tension headache, brought on by the pain of migraine. Gradually, the pain eases, and disappears, over a period of several hours.

What To Do and Take

At this stage of migraine, your best bet is to try to relax, forget what you have been through, and find some way to keep busy.

1.            Take a hot bath

2.            Massage back of neck and forehead

3.            Take aspirin or aspirin compounds—either alone, or combined with muscle relaxants

4.            Keep busy . . . or get some sleep

Phase 5—The After-Effects

While there is little discomfort connected with the after-effects of migraine, there is no question but that many people are aware of them. Usual after-effects include:

1.            Tingling of the scalp

2.            ”Beat-up” feeling

3.            Emotional relief (“At last that's over!”)

No treatment is necessary in this stage, and it usually lasts for only a few hours. Some people find that Vitamin B1 helps restore their pep.

Who Gets Migraine?

No discussion of migraine would be complete without giving some attention to what is often called “Migraine Personality.” This term is generally meant to indicate a person who is high strung, precise, compulsive, domineering, self-centered, demanding, and perfectionistic.

If you were to meet a person with migraine who had these character traits, you would probably believe that there was a relationship between the personality and the migraine. But there are far more people with these traits who do not have migraine than who do—and there are many migraine sufferers who exhibit none of these characteristics.

Because the idea of Migraine Personality has been given so much attention over the years, and rather widely accepted, studies were made by Dr. Max Cooper and his associates of Montefiore Hospital to try to find a method of diagnosing various types of headaches by psychological tests.

They attempted to find personality traits which were common to specific types of headaches. They found that there were no psychological differences between people who have migraine and people who have tension headaches —or between people who have headaches and people who do not.

Thus, we must rule out “Migraine Personality” as a scientific term. Who, then, does get migraine?

Heredity

About 60 to 70 per cent of people who have migraine come from families in which either the parents or grandparents also had this malady. This fact, plus observation of thousands of cases of migraine, indicates very strongly that heredity is an important factor.

Age

Half of the migraine sufferers have their first attack be-between the ages of 20 and 30; about 9 out of 10 have their first attack between the ages of 16 and 35. Migraine can occur in young children, and has been found in children as young as 5.

It is unlikely that migraine will show itself first beyond the age of 45. The attacks usually become more severe and more frequent—if untreated—as age advances. But around the age of 50, in both men and women, it is not unusual for the attacks to become less painful and less frequent.

Often, particularly in women as they go through the change of life, migraine may stop completely.

Men vs. Women

A popular belief is that more women than men have migraine. Whether this is true is of very little importance, because both men and women do have migraine and the symptoms and treatment are the same for both.

City vs. Country People

It is generally believed that more city people than country people have migraine. But again, the statistics are unsatisfactory. This belief could come from the fact that headache clinics are in the larger cities, and draw their clientele primarily from nearby areas.

Epilepsy and Migraine

There may be a relationship between epilepsy and migraine, but opinions differ on this point. Both have been thought to have hereditary tendencies, and more families with a history of epilepsy have migraine victims than do families from the rest of the population.

However, the occurrence of migraine does not in any way indicate that there is an epileptic tendency in the family, or that epilepsy may develop.

Through recordings of “brain waves,” medical research men are able to establish the presence of epilepsy very easily. The brain wave patterns of epileptic persons are different from those of non-epileptic persons. Migraine sufferers, however, have normal brain-wave patterns—even during a migraine attack.

Migraine Is Non-Selective

No evidence developed by research so far has demonstrated that migraine is selective, except as to hereditary characteristics. It strikes rich and poor; men, women, and children; city dweller and farmer, without discrimination.

What Brings On Migraine Attacks?

You will recall that in the preceding chapter, the differences between the underlying cause of a headache and the trigger factors which set it off were discussed.

Every migraine sufferer has one or more trigger factors which sets off his or her attacks. The more triggers that affect you, the more attacks you may get. If you have migraine, it is important to determine what your trigger factors are, because if you can avoid the triggers, you will not get the headache.

No migraine attack comes on by itself—there is always a trigger, although it may take a long time to discover what it is.

Some trigger factors are very obscure. One thirty-year-old man with an eight-year history of migraine had noticed that his attacks would be brought on by chocolate or by fatigue after excessive work or loss of sleep. His headaches did not seem to be related to emotions. He had a fairly placid personality.

During the winter, he averaged about one attack per month, but during the last two summers, he had almost daily headaches.

This man had been a butcher for the past two years, and his headaches were more frequent on very hot days. The trigger was found to be sharp temperature change which he experienced when going from the hot store into the walk-in freezer and then back into the heat.

The heat differential was upwards of 60 degrees. The sudden changes were playing havoc with the sensitive scalp blood vessels. When he came from the freezer back into the hot room, the heat would dilate the scalp arteries, causing a rush of blood.

After several such trips, a violent headache would develop. By avoiding the freezer on hot days, he eliminated this trigger factor, and stopped his headaches.

Some of the more common trigger factors of migraine include:

fatigue  late sleeping

emotional upset              

worry

change of pace in living anger

bright lights       

hurry

noise    

frustration

pungent odours              

overwork

menstrual period            

underwork

sudden weather changes            

confusion

allergies              

crowds

hunger anxiety

side effects of medicines taken

change for other illnesses (such as anticipation

nitroglycerine  or  amyl  niitrite )

fear       

unexpected guests

long drives or train rides              

poor ventilation

excitement

There may be several others which you could add to the list, if you have migraine. The important thing is for you to learn to recognize what brings on your attacks— and then avoid those which can be avoided.

Significance of Migraine

Migraine is a very worrisome, painful illness—but it is not a cause of death, nor is it a sign of a fatal disease.

Diagnosis

From the description of migraine in this and previous chapters, it must be clear that your doctor, by taking a history of your headaches, can in most cases identify migraine when it is present.

On the other hand, a general physical examination will not ordinarily reveal any significant information that would help in the diagnosis of migraine.

If you experience the typical migraine warning signs, and get to your doctor within the first four hours of your headache, he can administer ergotamine tartrate by injection as part of his diagnosis. If the ergotamine tartrate stops the attack, it is practically certain that you have migraine.

The accuracy of this test is due to the fact that ergotamine tartrate does not relieve any other form of headache, with the exception of histamine headache. But in histamine cases, there are no warnings, and the headaches themselves do not last four hours.

“Artificial” Migraine Attacks

In rare cases, your doctor may wish to observe your condition during an attack, and may attempt to bring one on by the use of certain drugs, such as nitroglycerine, or nicotinic acid (not related to nicotine in cigarettes).

These drugs dilate the blood vessels of the scalp area, where migraine attacks occur, and in many cases will actually bring on a migraine attack if the patient is subject to migraine. They will not produce any headache in an individual who does not suffer from migraine. This is a further test for migraine.

Laboratory Tests

Your doctor may have you take a series of other tests— not to identify migraine, but to rule out other conditions which might be causing your headaches. These include “brain wave” tests (electro-encephalogram); X-rays of the skull, sinuses, and neck; blood count and blood chemistries; urinalysis; electro-cardiagram.

These tests are not necessary in most cases, and you need not fear your doctor is neglecting you if he does not make all of them.

Again, it should not be overlooked that the most important single factor in the diagnosis of migraine is the history.

Long-Range Treatment of Migraine

During our discussion of the migraine attack in its five phases, treatment for relief in each phase was discussed. But of far more importance are the steps that can be taken in between attacks, to prevent their coming on.

There is no “insulin” for migraine—that is, there is no drug or medicine which can be taken to avoid attacks in the manner that insulin can be taken daily by diabetic people to keep the disease under control. The migraine sufferer requires “custom made” remedies which may include no drugs or medicine at all.

The principal long-range treatment for the avoidance of migraine is the recognition of trigger factors which bring on attacks, and the avoidance of them.

You may be able to identify those which touch off your attacks—but if not, the simplest means to approach the problem is to keep a headache diary. Whenever an attack comes on, after you have overcome the attack, make as complete notes as possible about your activities, diet, etc., during the previous 18 hours.

Over a period of time, you will probably find the trigger factors that affect you.

You have then the problem of learning to avoid them. If your trigger factor is an allergy, your doctor may want to make tests and then administer desensitizing injections. If your problem is diet, you'll have to change your eating habits.

If emotional disturbances are the root of the trouble, your problem may be more difficult—and may require you to change your attitudes, living habits, or even your work.

Should You See a Psychiatrist?

In cases of migraine where emotional problems are the trigger factor, psychiatric help may be necessary. Your doctor can advise you on this point.

What About Tranquilizing Drugs?

These drugs at best produce a general state of relaxation— a sort of “don't give a hoot” attitude—which may help to control the emotional trigger factors that bring on migraine. Tranquilizers have no effect on migraine itself—nor on the other trigger factors which are found in migrainous people.

Much remains to be learned about the tranquilizers and their long-term effects. Tranquilizers will not solve your problems—but they may help you see them in better perspective. Let your doctor decide whether you should use them.

Tips on Avoiding Migraine

Poor living habits are probably the greatest factor in bringing on migraine attacks. And while no blanket rules can be set down, the following will apply to a large number of migraine sufferers:

1. Watch your eating habits. Eat regularly, moderately, and avoid pressure and unpleasantness    during meals.

2. Schedule your time to avoid overloading yourself. Take regular breaks during the day, if it helps you to relieve work pressure.

3. Get plenty of rest. Tired people are irritable people.

4. Avoid sharp changes in your routines. For example, if you lead a fast-paced life during the week, and get migraine on week-ends, plan your weekend schedule so you don't suffer from too great a let-down. Many patients complain of migraine attacks on week-ends, when they sleep late. Learn to look forward to your week-ends and to enjoy them.

5. Don't take on more than you can do. This applies to your regular work, your community activities—and even to your household chores.

6. Learn to ignore minor annoyances.

7. Learn how to relax . . . and don't feel guilty when you do.

8. Live a balanced life—with adequate exercise, work, relaxation, outside interests, etc.

9. Don't bottle up your troubles—blow your top if necessary to get things into perspective again.

Research in Migraine

Research has revealed what happens in migraine, and has brought about the development of drugs which help relieve it. But there is still much to be learned about the illness. We do not know why some people have it and others don't. We do not know why it goes away—during pregnancy, for example.

It is possible that migraine is related to glandular conditions or function—but we do not know.

If research in the next 15 years is as fruitful as that during the past 15 years, we could conceivably see an end to migraine problems.

CHAPTER 6

NERVOUS HEADACHE-ALIAS “TENSION” HEADACHE-OUR MOST POPULAR MODEL

It usually starts at the back of your neck, and you can feel it coming on. Not severe . . . not throbbing ... just a dull ache that gradually creeps “through” to your forehead and finally spreads out over your entire head. If it gets bad enough, and goes on for a few hours, you feel as though it were pushing in from all sides . . . pressing your head downward, and squeezing it in a giant noose that gets tighter and tighter.

Sometimes you know what brought it on—an argument ... a disagreement with a friend or fellow worker . . . too much to do and too little time to do it ... too many telephone calls . . . too much noise . . . too much television . . . too many bills and not enough money. But other times it comes on without any apparent cause.

It is this lack of cause that worries you . . . because eventually you decide something is physically wrong with you—and yet you hesitate to go to the doctor, because everything else seems to be all right. Aspirin, or one of the other headache remedies, usually helps—but it worries you to take so much.

What Causes Nervous Headache?

Tense muscles are the basic cause—and because the muscles are tense, and because you are emotionally tense, this type of headache is often called “tension” headache.

You may not realize it, but emotional upsets—even

Nervous Headache—Alias “Tension” Headache slight ones—cause you to tighten up certain muscles. If you will look back to page 12 (Headache Due to Muscle Tension), you will find a simple explanation of how this pain is produced.

Now let's take a look at some of the other characteristics of “muscle tension headaches” that will enable you to determine whether this is your problem.

When Does Nervous Headache Come On?

Like migraine, nervous headache may come on at any time of the day or night. You may wake up with it in the morning—perhaps due to dreams—but it will seldom wake you in the middle of the night.

You may get it every Monday or every Saturday—or even daily. It may be regular or not. You may go for months without one—and then have one every day.

How Long Does It Last?

Because muscle tension headache is largely emotional in origin, it will be related to your emotional state. It may last an hour—or it may go on continuously, night and day, for weeks.

Does It Give Warning?

Not in the sense that migraine gives warning. But nervous headaches usually come on gradually, and you may know in advance, from experience, that you are getting one. You won't get spots before your eyes, an upset stomach, or dizziness to warn you of a nervous headache—but you may be generally conscious that the back of your neck is beginning to feel tight.

Where Is the Pain?

Nervous headaches are usually all over the head, but most intense at the back of the neck, and in the center of the forehead. This is because the neck muscles tighten up first, producing more waste products than the blood can carry away, and the pull of the neck muscles eventually tightens up the muscles all over the scalp, which are an-chored to the forehead. This accounts for the movement of the pain and its spread over the entire head.

Other Symptoms

In severe cases of muscle tension, or nervous headache, you can actually feel “knots” in the neck muscles with your fingers. These are due to the muscles being involuntarily tightened. The neck seems stiff, and moving the head tends to make the pain more severe.

The tendency is to try to hold the head as steady as possible, and this increases the muscle tension, making matters worse instead of better.

Because you have the headache, you may be sensitive to noise and bright light—which is characteristic of nearly everyone who has a headache of any kind.

Can Anything Besides Nervousness Cause Muscle Tension Headache?

Yes-—arthritis, poor eyesight, bad lighting, drafts, poor posture, and other things which cause you to tense your neck and other head muscles for a prolonged period. But the vast majority of “tension” headaches are produced by nervousness, anxiety or worry.

Nervous Headache—Alias “Tension” Headache                53

Treatment of Tension Headache

As with other types of headaches, tension headache must be treated in two parts:

a)  relief of pain in an individual attack

b)  removal of the underlying cause of repeated attacks.

How to Stop the Pain

There are three types of treatment which singly or together are effective in relieving tension headaches:

1.            Reduction of the pain itself—usually with aspirin or other medications, most of which contain aspirin.

2.            Relaxing muscle tenseness—with medicines, massage, or heat.

3.            Increase of blood flow to the affected muscles—through the use of medicines or the application of heat.

Your doctor can advise you on the best means of relieving your headaches, and can prescribe special drugs when they are required.

Relaxing Muscle Tension

As indicated above, relaxing muscle tension during a head-ache attack can be achieved by use of medicines or by massage or heat. Some medicines relax the muscle tissue itself; other medicines are used to relieve nervousness which produces the muscle tension. In both cases, your doctor must prescribe for you.

Some people can get effective relief from massage of tense muscles—particularly at the back of the neck—or from the use of a hot-water bottle or heating pad at the back of the neck or on the forehead.

The use of various vibrating devices (chairs, etc.) may be helpful. In both cases, the effect is to relax the muscle and permit free circulation of the blood within the muscle, so that the waste products which have accumulated there can be carried away and the irritation relieved.

Increasing Blood Flow to Muscles

Because muscle tension headaches are produced by an accumulation of irritating waste products within the muscle, due to inadequate circulation, your doctor may prescribe medicines to increase circulation to these muscles.

The treatment may be either by injection of nicotinic acid at the time of the headache, or by tablets of the same medicine.

Nicotinic acid has no relation to nicotine, and heavy smoking cannot produce the same effect as proper ad-ministration of nicotinic acid. In fact, the action of nicotine from smoking is the opposite—that is, it cuts down on blood flow and may bring on a headache or make one worse.

Other means of increasing the blood flow, such as hot showers or hot baths, heating pads, hot water bottles or vibrating devices may also help relieve headache attacks.

Tension vs. Worry

“Tension”—like so many other words in our language— has many meanings. In the case of headache, “Tension” is a much abused and misunderstood term, which is sometimes confused with “worry.”

People speak of working “under tension.” Medically, we speak of muscles being “under tension”—but the words have different meanings. A tensed muscle is a contracted muscle. In this condition, it is working, and producing waste products.

These, as we have noted earlier, may be produced faster than the blood takes them away. When they are excessive, they cause irritation and pain. When the tensed muscles are in the region of the head and neck, they cause headache.

But a person working “under tension,” may react to it by getting a headache. Yet he (or she) may not be worried. Tense situations often cause tense muscles —and tense muscles often cause headache.

On the other hand, people in perfectly relaxed situations may find they have plenty of time to think about their problems, and to worry to the point that they produce a muscle tenseness, and finally a headache.

Less frequently, worry may cause other bodily reactions that bring on ulcers, heart palpitations, and even such diseases as high blood pressure and colitis. The important difference to note is this:

Some “nervous” or “tension” headaches are brought on by conditions outside of our bodies, and by our physical reactions to them. Other nervous or tension headaches are brought on by our own handling of our emotions under difficult or trying circumstances.

BUT IN EITHER CASE, our own emotional reactions to outside situations or inside thoughts are the real problem and the real cure for nervous or tension headaches must come from a change in habits of thinking within the patient himself.

Let us see what we can do to help isolate the cause of your nervous or tension headache—and to help you find relief.

Finding the Cause of Nervous Headaches

Over a period of years, during which many thousands of patients with nervous headaches have been observed, we find an amazingly small number of basic problems which bother most headache patients.

The questions which follow are designed to help you find just what type of problem is bothering you, so you may set about finding the way to correct it.

Home Life

1.            Is the atmosphere in your home one of constant bickering or hard feelings between members of the household? Does someone “nag” you all the time, or vice versa?

2.            Are your relations with those who should be closest to you strained?

3.            Are you having in-law trouble?

4.            Are you having trouble with your wife, husband, or children, or parent, or your boy friend or girl friend?

5.            Do you get the feeling that people in your family don't “understand” you?

6.            Are your marital relations unsatisfactory?

7.            Are you suffering with these problems in silence, rather than trying to do something constructive about them? Your Work

8.            Are you worried because “things aren't right” in your job? That is, is your progress too slow... are you afraid you'll lose your job ... do you feel as though you never get the breaks?

9.            Do you dislike your job or your boss? Financial Problems

10.          Do money problems constantly worry you?

11.          Do you have trouble managing the money you have?

12.          Is money management disturbing the family harmony? Managing Your Time

13.          Are you always running behind schedule? And worrying about it?

14.          Are you always in a hurry?

15.          Do you have too many things to do? Are you always getting talked into taking jobs that you can't handle? Your Children

16.          Do your children annoy you?

17.          Are you worried about your children's progress, or about the way they are turning out?

18.          Does it worry you that you can't do as much for your children as you would like to do? Are you worried that you are doing too much for them? Insecurity

19.          Are you always worried about what other people think about you or what you are doing?

20.          Do you feel you are a failure in almost anything you do?

21.          Do you feel better when you have had a drink or two. . . or three?

22.          Does your future look pretty dismal?

23.          Are you always making excuses when you don't get a job done when it is needed? Boredom

24.          Are you bored with life?

25.          Do you often have “nothing to do” and find time hanging heavy on your hands?

26.          Are you without a hobby to keep you busy and interested in something outside of your job and home chores? Health

27.          Are you worried about your health? Do you secretly fear you have a disease, and does it pray on your mind?

28.          Do you smoke excessively (more than 3 cigars or 15 cigarettes per day)?

29.          When you are nervous or tense, do you find yourself eating all the time? or starving yourself?  or eating irregularly?

 58          Help For Your Headaches

30.          Have  you  sometimes  thought  you  should  consult  apsychiatrist? General Worries

31.          Do you worry about “every little thing”?

32.          Are you constantly tidying up your house or office or store?

33.          Are you always trying to keep up with the Joneses?

34.          Are other people always “messing up” your carefully made plans?

35.          Does “everything happen to you”?

36.          Are you doing something you are trying to conceal from other people?

After you have checked yes or no to the questions above, go back over the ones marked yes, and think about each one. For example, if you answered ”yes” to the question “Are you constantly tidying up your house,” ask yourself WHY are you always tidying up. Is it because . . .

. . .    you are afraid of what your neighbour might think of an untidy house?

. . .    you grew up in a house that was always spotless?

. . .   your husband (or wife) is extremely critical and you are afraid of criticism from him (or her)?

. . .    you associate cleanliness with health and you are afraid an untidy or dirty house may bring illness? And then ask yourself . . .

. . .    are you attaching too much importance to what you think your neighbour thinks?

. . .          will your husband (or wife) love you any less if you do not spend all your time cleaning house?

. . .          whether you must apply the same standards to your house that your mother or grandmother did? (This may have given them headaches, too.)

 . . . whether you are being too fussy about this health business . . . maybe it hurts your health more to be fussy than it would to be a little messy.

Now—lest you get the idea that cleanliness is NOT recommended, let us make this point clear:

The fault is not in tidiness or untidiness—it is in OVER-DOING the job of keeping things neat and clean.

This is also true of any fetish you may have that keeps you upset or edgy ... if you give anything TOO MUCH importance, and let it bother you constantly, you may find it at the root of your headache problem.

IN ALL THINGS BE MODERATE is mighty good advice for anyone suffering from tension or nervous headaches.

How Do You Remove the Cause of Your Worry or Tensions?

Whole books have been written about methods of relieving nervous tension—and whole lives devoted to helping people to solve their emotional problems that result in—or from— tension.

Our purpose in this chapter must be to point out what you can do, rather than to go into detail about how you can do it. There is a saying to the effect:

“Lord, give me the patience to bear what I cannot change, the courage to change that which can be changed—and the wisdom to know the difference.”

Solving your problems that result in nervous or tension headaches must be somewhat along this line. If you are in a situation which makes you nervous and tense, you must either:

 a)           change the situation, or

b)            learn to live with it, and learn to avoid being upset over things you cannot change.

You must understand, however, that it is your emotional reactions which in most cases bring on tension or nervous headache. If you are so constituted that you become unhappy in every situation, then changing your situation will be of only temporary help.

The real problem, in almost every case, is an emotional readjustment within you. This may be hard to face up to—but it is nevertheless the real answer to getting rid of tension headache.

What About Tranquilizers?

For many years, doctors have prescribed various drugs as a temporary measure to “calm down” tense or nervous people. In the past few years, a new form of drug, com-monly known as “tranquilizers” has been very widely used for this purpose.

The tranquilizers act on certain centers within the brain which are commonly connected with anxiety, and reduce the reaction to factors which normally produce anxiety or tension. These drugs are not sleeping pills—although some people become drowsy from them.

Millions of people have used tranquilizers during their first few years of general use. As yet, relatively little is known about their possible harmful effects, but a study reported in the Journal of the American Medical Association, by Drs. Herman A. Dickel and Henry H. Dixon, of the University of Oregon Medical School, indicates that in some 1,700 people out of 8,200 studied, “tranquilizers seriously aggravated the mildly distressing problems for which they had originally been prescribed.”

What the final verdict on tranquilizers will be, if there is one, is hard to predict. The safe course to pursue, in the authors' opinion, is to treat the tranquilizers as you would any other medicine—let your doctor advise you on their proper use, and do not expect them to cure every problem that may come along.

Tranquilizers, sedatives, or other medicines should be considered for temporary relief only—while you are finding and working out the real problem. Tranquilizers will not solve your problems for you—but they may assist you in looking at the problems more objectively, and in this way help you to get long-range relief from your headaches.

Where Can You Look for Help for Your Emotional Problems?

Most people who are seriously enough upset to suffer from nervous or tension headaches will find that outside help will be the quickest and surest way to relief. There are many people to whom you can turn for help. Personal friends in whom you have confidence, of course.

And your family doctor, or your minister. But you may be surprised to find how many other sources of help there are. In many communities there are mental health clinics, marriage counselors, and other social service agencies which are devoted to helping people in trouble.

Your county medical society or your doctor can give you a list of such agencies in your area.

If your trouble stems from your children, your local school will probably have access to child guidance clinic or counselor who will take a personal interest in helping you. Much of this help is available to you at little cost, other than the effort you must put forth to take advantage of it.

Again it must be emphasized, however, that the correction of an emotional problem is one which must take place within you, yourself—and that regardless of where you go for help, in the long run it will all lead back to one central point, and that is your own thought habits.

CHAPTER 7

HISTAMINE HEADACHE-OR HEADACHES BY THE BUNCH

Sometimes confused with migraine, histamine headaches are one-sided, throbbing, extremely painful and often seasonal. For many years doctors thought that they were a variant of migraine.

But there are important differences, and at the beginning of our discussion of histamine headaches, let us again take note of the fact that accurate diagnosis can make the differences between continued attacks and relief. It is only in the past few years that a distinction has been drawn between histamine headaches and migraine.

What Is “Histarnine”?

Histamine is a natural substance that occurs throughout the body. Without going into detail, it is sufficient, here, to know that it is part of the automatic control system of the body that helps protect it against abnormal conditions.

Under ordinary circumstances, the body maintains a proper balance of histamine. But if some part of the body is injured, or perhaps attacked by an irritant (for example, poison ivy), the affected area develops an increased amount of histamine locally.

The reason for this is that one of histamine's jobs is to open up (dilate) blood vessels, and thus permit additional blood to flow to and away from the affected part. This provides blood to fight the irritation, and to carry away foreign substances for disposal elsewhere in the body, or to provide extra blood for other purposes.

Histamine has become most widely known in recent years because of the part it plays in allergic reactions. For example, a person who suffers from hay fever reacts violently to certain irritating substances (usually pollens) which cause the body to release excessive amounts of histamine in the upper respiratory passages. This increases the blood flow, causing swelling and blocking of the nasal passages.

The discomforts of hay fever are well-known.

Medical researchers analyzed the chemical composition of histamine and developed medicines called “anti-histamines” which neutralize the effects of histamine and usually provide quick relief from the symptoms of hay fever.

As will be covered later in this chapter, however, anti-histamines will not be of any help in the relief of histamine headaches.

Why Histamine Headaches?

In some people, an imbalance of histamine opens up some of the blood vessels of the head, and brings about severe, throbbing, one-sided headaches very much like those in migraine.

We do not know, yet, just why this occurs, why it affects only one side of the head, or why it affects only some people. But it has been shown that an injection of histamine into people who suffer from histamine headaches will produce attacks just like those they experience naturally.

Doctor Bayard T. Horton of the Mayo Clinic was the first to demonstrate the relationship between histamine and this peculiar type of headache, and to distinguish it from migraine.

Because of his work, these headaches are often called “Horton's Headaches,” and the several symptoms and signs of these headaches are called “Horton's Syndrome.”

Histamine Headache—or Headaches by the Bunch         

Histamine headache is one of the rarest types, and is still easily mistaken for migraine.

Typical Attack

Histamine headaches come on without warning at any time of the day or night. Normally, an attack starts with a sudden burning sensation on one side of the head, which rapidly changes to a severe, throbbing pain.

Usually it affects the forehead, temple, eyeball, cheek, behind the ear, and the neck. It builds up to its full intensity in about 5 minutes. The pain usually stops as suddenly as it starts, and may last from 10to60 minutes.

Along with the headache comes heavy watering of the eye on the affected side. The area around the eye often swells, and the eye becomes bloodshot. The nose on the same side becomes blocked, and waters profusely. The back of the throat feels scratchy, and the mouth waters.

After each individual headache, the patient is completely free from pain, and has no lingering symptoms, such as scalp sensitivity.

Histamine attacks come in bunches—as many as3or4 individual headaches occurring in one day for a month or so, usually about the same time every year. Following this, there may be no more histamine headaches for months —even for years—before another series of attacks occurs.

Some patients get a histamine siege once a year, some twice a year, others may go for years without any. They tend to occur less often as a patient ages. Rarely, a patient will get them many times during the year.

The severity of the headaches and their arrival without warning can be a disturbing experience to a person who does not know the cause. Unlike migraine and tension headaches, histamine headaches do not seem to have any particular relation to worry or nervous tension.

What Does Histamine Headache Mean?

Histamine headaches have not been found to be related to any disease or other condition in the body. Because of the fact that histamine is involved in these headaches, and the fact that they often occur at the same time each year, it is natural to suspect that allergy may play a role somewhere. But no such connection has been established up to this time.

No hereditary factor has been found. So even though histamine headaches are violent and unnerving, there is no reason to fear that they mean some hidden illness.

What Sets the Headache in Motion?

Although it is clear that the release of histamine within the body under certain conditions brings on histamine headaches, we do not know what causes the histamine to be released in just this way.

Thus, it is not yet known what the “trigger factors” for histamine headache are, or what can be done to avoid them. If you have histamine headaches and can find your trigger, you may be well on the way to relief.

As indicated in the Table and the description of these headaches earlier in this chapter, the characteristics of histamine headaches are rather clearly defined. If the pitfall of classifying them as migraine headaches is avoided, there should be little difficulty in identifying histamine headaches.

However, in those cases where verification of a diagnosis is needed, your doctor can, by injecting histamine, determine whether this is your trouble. If you are subject to histamine headaches, the injection will bring on an attack similar to those you usually experience.

It should be noted, however, that this test is only dependable during the period when you are suffering a siege of headaches of this type. If you get your attacks in May, and the test is made in October, such a test may fail to bring on an attack.

Treatment

There are three types of treatment to be considered for relief of histamine headaches:

1.            Relief for a single attack.

2.            Prevention of further headaches during a particular “siege.”

3.            Desensitization to prevent another series of attacks from occurring.

Treatment of a Single Attack

Because histamine headaches are caused by dilation of blood vessels (as in the case of migraine), the treatment of an acute attack is similar to the treatment of Phases 1 and 2 of migraine.

Most people find that sitting upright, avoiding strong light and noise, and relaxing will help minimize the pain of an attack.

If your histamine headaches are very short—perhaps 10 minutes or less in duration—there is no point in taking any medicine, because it cannot act fast enough to be of any help. However, if your attacks tend to last longer, you may get considerable relief from the immediate use of ergotamine tartrate—preferably as a rectal suppository for quickest action. Your doctor can prescribe this for you.

Because speed is so important, the ordinary aspirin-type medicines will probably be of little help in histamine cases.

Some patients have found relief from inhaling oxygen for brief periods, and even keep a small tank of oxygen at hand during the season when they get their attacks. Your doctor can advise you on this.

Prevention of Further Headaches During a Particular Siege

If you are in the middle of a histamine “season” when you discover this to be your problem, it will be too late for desensitization (see below). But you may be able to diminish much of the pain of additional individual headaches—or even avoid them completely—by one of the following methods:

By use of aspirin or an aspirin compound—10 grains every 6 hours—whether you have a headache or not, during the period when you would normally be having headaches. This will dull the pain considerably, but will not prevent it.

By use of ergotamine tartrate—which is recommended by some doctors—to be taken daily forl0tol4 days as a preventive measure. This will ordinarily limit excessive dilation of the blood vessels of the head and avoid the sudden severe attacks that are characteristic of histamine headache.

Histamine Desensitization

The most satisfactory treatment of histamine headaches— in the long run—is histamine desensitization. This process will prevent the periodic “siege” completely, if started soon enough. Some patients find that the treatment must be repeated every year; others can go for long periods without additional treatment.

The purpose of desensitization is to make the body less responsive to its own histamine. The method used is to give the patient daily injections of histamine, in gradually increasing doses, for 10 days.

During the first 2 or 3 days of treatment, the patient will experience considerable flushing of the face, and some headache after each injection. The flushing gradually disappears, and the headaches following the injections no longer occur.

If the injections are com¬pleted before the usual series of attacks, they are generally effective in completely preventing the attacks. Usually, no further treatment is necessary, after the injections. However, if headaches do occur, ergotamine tartrate should bring relief.

Contrary to what you might expect, taking anti-hista-mines during the period of histamine headaches has been found to be of no help. Nor will taking anti-histamines in advance of the usual onset of histamine headache attacks prevent them from developing.

Relief From Nasal Stoppage

During histamine headache attacks, nasal stuffiness may cause considerable discomfort. This can be relieved fairly easily by the use of various nose drops or inhalers.

CHAPTER 8

ALLERGY AND HEADACHE

Long before “allergy” was an everyday word, many people were aware that they were “sensitive” to substances that did not trouble most people.

For example, you may have had a maiden aunt who broke out in a rash when she ate strawberries ... or a neighbor who spent weeks in sneezing discomfort every year with hay fever or rose fever. Now we know that these, and many similar symptoms, are due to a type of body reaction called “allergy.”

What Is An “Allergy”?

Allergy is an abnormal body response to a substance which does not produce the same response in most other people. Such abnormal responses might include: rash . . . runny nose . . . watery eyes . . . quickened pulse . . . asthma . . . coughing or sneezing . . . itching . . . hives . . . burning of the eyes or skin.

The substance which causes an allergic reaction is called an allergen. An allergen can affect you in one of three ways—sometimes by touch (poison ivy)...by inhalation (house dust, pollen, etc.) ... or by eating (strawberries or chocolate or eggs or meat).

What Happens In An Allergic Reaction?

When you come in contact with a substance to which you are allergic, your body releases a natural substance called histamine. This histamine acts on your body tissue—either locally (as in poison ivy) or all over (as in a case of hives from eating).

But it can produce many different effects. Two people allergic to the same substance may react in different ways.

How Do Allergic Reactions Cause Headaches?

An allergen does not produce a headache directly, but only by affecting those tissues which are capable of causing headache.

For example—it can trigger a migraine headache because the histamine released opens up blood vessels in the head. Or, it can produce a sinus headache—the most common “allergic headache” as described in the next chapter.

Prevention and Treatment of “Allergic Headache”

Since all types of headaches caused by allergy are covered in other chapters, it is sufficient here to point out that to prevent these headaches, it is well to:

1.            identify the substance or substances which produce your allergy

2.            determine whether you can avoid them (this is easiest in the case of foods, and plants like poison ivy)

3.            obtain treatment to desensitize your body to the allergen.

Sometimes, however, prevention is difficult or impossible —and in such cases, various anti-histamine drugs are often effective in overcoming the effects of the allergy. The treatment of the pain from the headache depends on what type of headache the allergy produces. For suggestions on pain relief, see the chapters which apply to the type of headache you experience.

Can Emotional Upset Bring on Allergic Headaches?

It is an interesting fact that some people who are troubled with allergies can get identical reactions from actual exposure to an allergen or from fear of exposure to the same material even though it is not present.

One doctor, suspecting that his patient's allergy to roses was more imaginary than real, brought the patient into a room where a large bouquet of roses was on the table. The patient immediately went into a sneezing spell—and was surprised when he was told that the roses were ar¬tificial.

The doctor had set up this demonstration to prove to his patient that much of his problem was in his imagination. In this case, the patient saw what he believed to be roses, and his fear of his allergy brought on his sneezing spell.

By using hypnosis, it is possible to make a patient imagine that he sees something to which he is allergic, and this will often bring on allergic reactions. Thus it is actually possible for some people to have allergic reactions without an allergen being present. This is particularly true in patients with allergic asthma.

Some asthmatic attacks can be brought on by emotional upset—such as fear or anxiety— and these attacks can be just as severe as those brought on by the allergen itself.

If you are subject to allergic headaches, it is possible for you to develop a headache attack when you have not actually been exposed to your particular allergen. The attack is real, but the cause, in this case, is imaginary rather than real. The knowledge that there is such a thing as a “psychological” allergy may help you be on guard against it.

CHAPTER 9

SINUS TROUBLE AND HEADACHE

The sinuses are the root of many of our discom-forts and some of our headaches. A sinus is a cavity con-taining air within the bone tissue of the head. It may be completely open, or like a honeycomb in structure.

There are many sinuses in the head, but usually only those in the front of the head are involved in headache. In the front of the head there are eight sinuses—four on each side. They are:

Maxillary              on each side of the nose, in the cheek bones Frontal in the  forehead, just above the eyes

Sphenoid             behind the bridge of the nose on each side

Ethmoid               beneath the eyes.

Each sinus is connected to the nasal cavity either directly or through other sinuses. When the sinuses are normal and healthy, they are continuously ventilated by air from the nasal passages. Infections of the nasal passages can spread to some or all of the sinuses. These infections often arise from a common cold.

Sinus headache is not always caused by infection. It may also be caused by allergy, bad teeth or occasionally by abnormal tissue growth. How sinus headaches are pro¬duced will be discussed later.

The location of the sinus headache will depend upon which sinuses are involved. Thus, one person with sinus headache may not experience the same kind or location of pain as another.

Typical Sinus Headache

Sinus headache is usually a dull, deep, boring pain, although in certain cases throbbing may develop. Ordinarily this is a mild type of headache—nagging, but seldom severe.

Depending on its cause, the headache may occur at any time of the year and at any time of the day or night. It is not unusual for a person suffering from sinus headache to wake up with it in the morning.

There are no warning signs of sinus headache in the sense that migraine gives warnings. One or more of the following associated symptoms may be present with sinus headache: congestion of the nose, watering or runny nose, sneezing, tenderness below or above the eyes, burning and itching of the eyes, “post nasal” drip (drip on the back of the throat), pain on biting or chewing.

Your first sinus headache may be short lived, if you are fortunate enough to get the infection cleared up promptly. But it is possible that the infection may linger for weeks or even months. Some people develop a continuous sinus condition which leaves them in constant discomfort.

These prolonged sinus conditions may eventually bring about permanent changes in the sinuses which make it difficult to clear up the sinus trouble. You may know people who have had to move to a dry climate to obtain relief from a sinus “condition.”

Who Gets Sinus Headache?

Just about anyone of any age can get sinus headache. But if the sinus headache is caused by allergy, certain conditions such as weather, temperature, high humidity, and high pollen count seem to aggravate the headaches. Allergic sinus headaches may in individual cases be related to hay fever, rose fever, asthma, or food allergies.

What Causes the Pain?

There are several conditions which bring about the pain. Within the lower bone structures of the nose are large spaces for blood vessels. When the lining of the nose becomes irritated, these spaces become filled with fluid and swell up. This blocks off the normally open air passage into the sinuses.

Gradually, the fluids produced in the sinuses which ordinarily drain slowly into the nose, accumulate, and build up pressure. Eventually, the pressure becomes great enough to create pain. It is a dull steady pain because the pressure is constant.

If the tissues of the sinuses become infected, they produce a thick fluid which tends to increase the difficulty of drainage, prolong the pain due to pressure, and also to irritate the nerve endings.

If the infection is severe enough to call for greatly increased blood supply to the area, the blood vessels may become involved too, and a throbbing pain may develop.

“Vacuum” Headaches

Another type of sinus headache is the so-called “vacuum” headache. This is caused by a swelling of the tissues in the nose because of sudden air pressure changes, or allergic reaction to food or airborne irritants such as pollen. The swollen tissues close off the air passages into the nose.

Gradually, the oxygen in the air trapped in the sinuses is “used up,” and a vacuum created. This produces a steady inward pull on the surrounding sinus wall—and irritates the nerve endings.

Sinus Tumors and Growths

Occasionally, sinus headaches may be the result of a growth within the sinuses or the nasal passages. Sinus tumors are rare, and they are usually not malignant. The commonest sinus tumor is called an osteoma—a simple overgrowth of bone like the stalactites and stalagmites in caves.

Tumors of the soft tissues around the sinuses do occur, but are very unusual. Sometimes simple growths called nasal polyps develop on the lining of the nasal passages and block off the sinus openings, causing a build-up of pressure and headache.

Any tumor or growth of the types just discussed will produce headache only on the same side of the head. Simple growths, such as polyps, can be removed very easily—usually in the doctor's office. The other types of tumors are very rare, but can be corrected by surgery.

Deformed Nose Structures

If the structure of your nose has at some time been de-formed or damaged (for example, if you broke your nose), the air passages might become clogged on one side causing difficulty in breathing, and possibly headache. Such defects can be readily corrected by surgery.

How Teeth Can Cause Sinus Headache

The three upper molars on each side have long roots which are anchored in the floor of the maxillary sinuses.

If these teeth become infected or decayed, the sinus may also be affected, and produce headache. This is a matter for your dentist's attention.

Diagnosing Sinus Headache

The best time to diagnose a sinus headache is while you have it. Your doctor will look for inflammation inside the nose, associated conditions as described on page 73, and type, location, and frequency of your pain. He may feel that an X-ray of your sinuses is needed to help in the diagnosis.

He will also be interested in anything you can tell him about the things which seem to bring on these headaches.

Treatment of Allergic Sinus Headache

As in other types of headaches, the treatment must be considered both from the standpoint of prevention, and of relief of a specific attack.

Prevention of allergic reactions calls for two steps:

a)            Identification of the substance to which you are allergic (the allergen),

b)            Treatment (desensitization) to prevent further re¬ action to the substance.

You can often avoid these allergens if you know what they are. Your doctor can give you simple “scratch tests” which will indicate the type of substance to which you are allergic. But if your allergy is more complex in nature, rather detailed tests may be required.

The scratch test merely involves a series of light scratches on your arm, and the application of known materials to each scratch. In a few minutes, those substances to which you are allergic will cause the skin to redden and a local swelling to develop around the scratch.

If your problem is an allergy to dog hair or pollen, you may require desensitizing treatments. If you are bothered by feathers, you may be able to avoid them by changing your pillow to foam rubber or kapok.

If your allergy is some type of food or drink you may avoid it by changing your diet.

In the case of seasonal allergies (such as tree or grass pollens, or rose fever), use of anti-histamine drugs may give you sufficient relief.

Your doctor can assist you in finding the best form of anti-histamine for you. Because some anti-histamines produce drowsiness, it is important to avoid driving or other activity if you are so affected.

If you do have an allergic attack, you can usually get relief by the use of nose drops, inhalers, sprays, or medicines which will “shrink” the swollen tissues and permit the sinuses to drain naturally. This relieves the pressure and the pain. Nose drops should not be used indiscriminately.

Aspirin and aspirin compounds will be helpful in relieving pain temporarily.

Many sinus sufferers also get relief by applying heat to the forehead or lower sinuses. This may be done at home with hot water bottles, heating pads, or infra-red lamps— or by your doctor with diathermy (“artificial fever”) machines.

Treatment of Infectious Sinus Headaches

Acute infections of the sinuses are easier to treat than allergies, if they are caught early enough. There are five steps in the treatment of headache caused by acute Sinus Trouble and Headache                             sinus infections:

a)            Killing the infection by the use of appropriate medicines.

b)            Relief of pressure in the sinuses by medicines which relieve the congestion. This includes nose drops, inhalers, tablets or liquid medicines

c)            Lying down may help the sinuses to drain, thus relieving the pressure.

d)            Relief of pain by the use of aspirin or aspirin compounds.

e)            Relief of pain by the use of heat.

Long-standing sinus infections are more troublesome and often require minor surgery to obtain relief.

Treatment of Vacuum Headache

Because vacuum headache starts with a swelling of the nasal tissues, simple relief can be obtained by the use of nose drops or inhalers which shrink the membranes and break the vacuum. Prevention of vacuum headache lies in finding the cause of the swelling—such as an allergy, or a sudden change in air pressure (altitude changes in an airplane or elevator). Aspirin or aspirin compounds will help relieve the pain.

CHAPTER 10

EARACHE OR HEADACHE

Because the ear is a part of the head, earache could be called a form of headache. When the ear becomes infected, it may produce either earache or headache—or both. There is little question that the ear is the source of pain when an ear infection is present, and because ear infections can be dangerous, immediate attention by a doctor is important.

While you may develop headache along with earache, the earache itself is the important symptom, and it is not within the scope of this book to go into ear infections and diseases, with the single exception of Ménière's Disease, as discussed below.

Ménière's Syndrome

The case of Gerald G. demonstrates the typical course of Ménière's syndrome—which often makes itself known first through headaches and dizziness.

Gerald, a 50-year old man, had been a stock clerk in a large department store for 20 years. He was a happy man who got along well with people, and did his work well. But then things began to go wrong with his job.

He began putting stock away in the wrong places. His supervisor thought he was getting lazy, because he often put stock which belonged on high shelves on lower shelves.           

The reason for this was that he was having dizzy spells, and was afraid to climb the ladder to put stock where it belonged. He was also troubled with a dull headache that  became more and more bothersome as the weeks went by. Next, he began to hear ringing noises in one ear— “violin,” he said.

And often on his way home he found the subway steps “coming up to meet him.” He had trouble walking in a straight line. It was at this point that he came for medical help. The combination of dizziness, headache, and ringing noises in the ear suggested Ménière's condition.

Ménière's syndrome is relatively rare. It is thought to be caused by abnormalities which develop in some of the blood vessels which supply the middle and inner ear.

The condition is, therefore, a slowly progressive one, ordinarily occurring on only one side of the head. Gen-erally it does not occur before age 45. As the condition progresses, the headache becomes continuous and more painful, the dizziness becomes worse, and the sensation of ringing noises “louder.”

Along with these symptoms, deaf-ness develops in the ear, but this is often unnoticed by the patient in the early stages.

The symptoms continue until the patient becomes nearly or completely deaf in the affected ear, and the headache and ringing noises finally disappear. The dizziness may diminish, but the patient never quite regains his normal sense of balance.

Cause—Unknown

It is not known what brings about the abnormalities which produce Ménière's syndrome, and there is no cure known at this writing.

Treatment

Some experimental work has been done to find a treatment for Ménière's, and some success has been reported using nicotinic acid to help improve the blood flow to the middle and inner ear, and anti-histamines to help control any allergic reaction which might be causing the difficulty.

Ordinarily, the headache associated with Ménière's may be treated with sedatives and standard headache remedies in the aspirin family. Since no cure is known, the disease must run its course.

And What About Gerald?

In the case of Gerald G., examination showed that he was losing his hearing in one ear, and that he did have Ménière's. His headaches were relieved by ordinary remedies, and he took a six-months' leave from work until his dizziness subsided—after which he was able to walk and work satisfactorily, although deaf in one ear.

CHAPTER 11

DO TEETH CAUSE HEADACHE?

Ordinarily, the teeth, like the ears, have easily identifiable pains of their own—but very occasionally in-fections of the teeth or gums can be responsible for pain outside of the immediate area of the teeth or jaws.

The most common headache associated with the teeth is what might be called “ice cream headache”—a sharp pain usually in the forehead at the bridge of the nose, lasting for only a few minutes.

The name, of course, comes from one of its most common causes—too much ice cream in too short a time. Either unusually cold or unusually hot foods can bring on such pain. Because these pains are over quickly, no treatment is required.

In rare cases, where a tooth has its roots imbedded in the “floor” of a sinus, an infection can produce a headache rather than a toothache. If such infections are serious, they usually affect the tooth, and your dentist would discover the condition in routine mouth X-ray examinations.

If you have not suffered from headaches in the past, and suddenly develop both headache and toothache, the chances are it will be your dentist who will help you solve the problem.

CHAPTER 12

THE EYES SELDOM HAVE IT

Why is it that most people, when they begin to develop frequent headaches, suspect eye trouble or eye-strain?

One explanation is that almost every form of headache does create sensitivity to light (photophobia), and may even affect vision. This then becomes a question like “Which came first—the chicken or the egg?”

A generation or two ago, the eyes were probably responsible for more headache than they are today. Why?

Because people take better care of their eyes today, and get glasses when they need them—before vision becomes bad enough to cause headache. Our children, today, are given regular eye examinations in school.

Most doctors give routine eye tests as part of a regular check-up. And so much of our work today demands good sight that we discover eye defects before they become troublesome enough to cause headache. In most states, an eye test is required to get a driver's license. So, all in all, the chances of eye defects causing headache are greatly reduced.

Actually, eyestrain and eye disease are among the least common causes of recurrent headaches. Of course, anyone who overworks his eyes may occasionally get a headache, but if you have frequent headaches, it is most unlikely that eyestrain is the sole cause or even a major cause.

A visit to your eye doctor is the first step when you suspect that your eyes are causing headaches.

The Eyes Seldom Have It             

How the Eyes Can Cause Headache

There are several types of eye ailments that can bring on headache:

I. Infections of the eye or eyelids: iritis and conjunctivitis (pink-eye)

II. Eye injuries

Any damage to the eye surface such as that caused by getting a foreign object in the eye may result in pain which could last until the injury is healed.

III.           Eye diseases other than simple infections

Glaucoma is a rare but very serious disease of the eyes in which headache is an early symptom. Usually it affects only one eye at a time. Glaucoma produces severe pain in the eyeball itself, as well as disturbance of the vision.

The eyeball usually feels as though it were “about to burst” because there is an actual build-up of pressure within the eyeball. The pain is continuous—and does not come and go during the day. Unless the disease is given immediate treatment, loss of vision may result.

IV.          Vision defects—far-  and near-sightedness,  and astigmatism

In all conditions which we describe as “vision defects,” the eye does not get a clear image. Without conscious effort, our eyes attempt to improve the image—and this involves a straining of the eye muscles. If the straining goes on long enough, headache may be the result, gen¬erally in the region of the eyes. The pain will be steady and dull, and will go away when the eyes have been rested adequately.

A sure test for eyestrain headache is that you will not wake up with it in the morning. If you have headaches when you waken, you can rule out eyestrain as the cause.

Eyestrain can also produce headache at the back of the neck, which may spread to the top of the head. This occurs because the person with eyestrain, in an effort to see better, may hold his head in an awkward position, thus keeping the neck muscles abnormally tight. Result -—muscle-tension headache.

You may be surprised to find that other people may notice that you are “straining to see” before you notice it yourself, if eyestrain is your problem.

You may also develop eyestrain headaches if you have been wearing glasses and they have gradually become inadequate before you are aware that you need new ones.

The only remedy for headaches from visual defects is to get correctly fitted glasses, and to have them checked periodically. You can get temporary relief of the pain with ordinary headache remedies—but if you have frequent eyestrain headaches, there is a danger of your having to take some pain remover almost continuously.

V. Lighting conditions

Some people get headaches because of poor lighting conditions. Too little light, too much light, glaring light, and even fluorescent light may bring on headaches. With¬out going into the reasons for all of these, it is sufficient to point out that if you suspect your headaches are re¬lated to your eyes, you should check the light where you live and work. This type of headache can of course be relieved by aspirin or other pain killer.

CHAPTER 13

TEMPORAL ARTERITIS-THE HEADACHE YOU CAN SEE

Temporal arteritis produces what might be called a type of “old age” headaches, for it rarely appears before the age of 60. It is one of the few headaches you can “see,” for it is always accompanied by the enlargement of main artery in the temple—usually on one side of the head.

A few months ago, a retired man, about 65, came in with a complaint of constant headaches—one sided—more severe in the morning than later in the day, but always present. The pain was throbbing when severe—and became “dull” as it tapered off.

He had first noticed the pain about six months earlier, when he began waking up with mild headaches in the morning. Gradually they became more severe, until they reached the stage which brought him in for help.

The headaches, interestingly enough, were his only symptom. He showed no nervousness, fatigue, or nausea; he was under no strain in his daily living . . . had enough to live on comfortably, a happy home life, and no serious illness in the past.

He had, at one time, minor trouble with high blood pressure, but this had been corrected. He assumed, how¬ever, that the high blood pressure might have returned, and might be causing the headaches.

He could locate the pain very accurately—in the region of the temple—and had noticed that the artery in his temple had become so enlarged that it was clearly visible under the skin. The pulsations of the artery (caused by his heart beat) came at the same instant as the throbbing pain.

And he noticed that by pressing on the artery, which temporarily cut off the blood flow, the pain was diminished.

Examination showed that this man was in excellent health other than the condition causing his headache. The absence of any other illness or symptom pointed to temporal arteritis.

Headache is often the only symptom of temporal arteritis, other than the visibly enlarged artery, but some patients experience a general feeling of weakness and sometimes sweating.

What Causes Temporal Arteritis?

While it is not yet established just what brings on this disease of the temporal artery, it is now known that this particular artery undergoes a change in the cellular structure of its wall. The result, over a period of time, is a thickening and stiffening of the artery wall, and the artery becomes enlarged.

The condition was first reported by the Mayo Clinic in 1932, and the disease did not attain “official standing” until 1946.

Treatment

Recent discoveries in drugs, such as ACTH and cortisone, have been found effective in many cases of temporal arteritis. Their effect is to reduce the swelling of the artery and the results are often dramatic.

The patient described earlier in this chapter was treated with ACTH, and within a week, the swelling was reduced and the pain eliminated. To keep the disease under control, he takes one tablet of a related drug each day, and has had no further trouble.

If the medication had not been successful, treatment would have been to tie-off the artery (a minor surgical operation). This procedure is very simple, because the artery is just below the skin. In a case like this, Nature has a wonderful way of supplying blood through alternate routes, and no harm is caused by the loss of the use of tied-off artery.

In the early stages of temporal arteritis, it is often difficult to determine that it is present, and aspirin or other simple headache remedies might be helpful. But as the disease progresses and is finally diagnosed, continued use of such remedies in the quantities required would be unwise—particularly when the disease is so easy to control.

CHAPTER 14

TRIGEMINAL NEURALGIA-OR ‘‘FACIAL HEADACHE”

Trigeminal neuralgia is so distinctive in its char-acter that it has been known as a specific type of illness for thousands of years. The present name is but one of its “aliases.” It has also been called tic douloureux . . . fifth-nerve tic . . . and, in ancient times, tortura facies (facial torture).

The present name—trigeminal neuralgia—indicates that the pain occurs only in areas served by the trigeminal (or fifth cranial) nerves (left and right). These two nerves start at the brain and pass through small holes in the skull at the back of the neck, after which they branch out into three main trunks—to supply the chewing muscles, cheeks, inside of the mouth, teeth, gums, and part of the tongue. This ailment occurs largely in adults—seldom in children.

How It Strikes

Trigeminal neuralgia strikes “like a bolt from the blue.” Without warning, it suddenly inflicts on its victims violent, piercing, intense pain. And in a few seconds, it stops as suddenly as it starts. During a day, however, these attacks may come onl5or20or30 times. And the siege may last for several weeks. Then—as suddenly as it started, it stops.

Individual attacks appear as a result of some outside stimulation or irritation, such as cold wind blowing on the face, sipping a cold drink, eating ice cream, brushing the teeth, etc., or as a result of local infection or injury in areas served by the trigeminal nerve. Other irritants that have been reported include nicotine, vibration and strong spices.

The first time the pain is experienced, the person affected may think he has a bad tooth, and it is not unusual for him to consult a dentist rather than a doctor. Most dentists will spot the trouble quickly, after an examination, and refer the patient for medical care.

Ordinarily, the pain comes on during waking hours, be-cause that is when the “trigger” conditions described occur. If you are troubled with this ailment, you will learn to recognize what brings on the attacks, and avoid such situations.

How Long Does It Last?

The sieges of trigeminal neuralgia may become more frequent as the years go by, and may be so severe that surgery is required to correct the problem. Sometimes, however, the illness disappears as mysteriously as it came on.

Causes

There are at least four possible physical causes of trigeminal neuralgia:

(a)          Hardening of the arteries which supply blood to the trigeminal nerve.

(b)          Pressure against the trigeminal nerve inside the skull, perhaps due to an enlarged or misplaced blood

vessel.

(c)           A simple growth or tumor, called a neuroma, on the nerve inside the skull. (This is extremely rare.)

(d)          Pinching of the nerve where it passes through the skull because of a narrowing of the opening.

Diagnosis

Although the nature of trigeminal neuralgia is very dis-tinctive, your doctor may wish to make tests to confirm what you have told him about your attacks. This is done by trying to reproduce the attacks.

Treatment

Obviously, with attacks that come so quickly and last for so short a time, ordinary “pain killers” will be of no help. But there are various types of treatment which can give relief from the pain of trigeminal neuralgia:

(a)          Inhalation of special vapours such as amyl nitrite or trichlorethylene. These liquids are packaged in small glass containers or ampules wrapped in gauze, and so made that they can be easily crushed in the fingers. This allows the liquid to saturate the gauze and makes the vapours available for sniffing.

Either of these vapours will usually stop an attack in a few seconds. In some cases it has been found effective for the patient to make a practice of in-haling these vapours three times per day during a siege of trigeminal neuralgia, thus eliminating attacks almost entirely, or greatly reducing them.

Patients with irregular heart action should use these medications with caution, and only under a doctor's care.

(b)          Injection of alcohol directly into trigeminal nerve at the point where it passes through the skull. This blocks the nerve action for a period of months and stops the pain. When inhalation, as described above, does not give adequate relief, this procedure would normally be the next step in the treatment of this disease.

The alcohol injections can be repeated if pain returns after a period of months. Only if the injections cease to produce relief would step (c)— surgery—be indicated.

(c) Surgery. Where other treatment is unsuccessful, two types of surgery may be employed. In cases where the trigeminal nerve is pinched as it passes through the skull, the opening in the bone can be enlarged thus relieving the pinching.

The second procedure, which is used only as a last resort, is to sever that branch of the trigeminal nerve which serves the area where the pain occurs. In this case, the pain is stopped, and the sense of touch of the area is permanently destroyed.

Where pain has been severe, patients can learn to live with-’ out this sense of touch without too much annoyance. Most patients feel that the relief from pain far outweighs the disadvantages. Both surgical procedures are relatively simple.

In recent years, experimental work with a drug called Stilbamadine has been carried out in an effort to find a new treatment for this very painful form of headache. Stilbamadine produces numbness in the area served by the trigeminal nerve. This treatment is not yet sufficiently developed to be in general use.

CHAPTER 15

INFECTION, FEVER, AND HEADACHE

Any infectious illness which causes fever can also produce a headache. The increase in body temperature causes an increase in the blood flow through the brain. As the arteries increase in size, a traction or pull is created and the result is pain.

Any ailment—from the common cold or a simple boil to relatively serious illnesses such as pneumonia—can bring on a fever, and headache. Relief of headache due to in¬fection and fever is best obtained by simple medicines such as aspirin—which is particularly helpful in such cases, be¬cause it not only reduces the pain, but also brings down body temperature.

Some diseases—such as polio, encephalitis, and meningitis —are infections of the nervous system. In such illnesses, Nature seems to protect the affected areas by producing muscle rigidity at the back of the neck.

This rigidity is created by a continuous tightness of the neck muscles and causes a muscle tension headache. The real problem, of course, is to cure the basic disease, although some relief of the headache might be provided by the use of medicine to control the pain.

Headaches caused by infections are all classed as acute (that is, temporary), and will disappear when the infection is cured.

CHAPTER 16

ALCOHOL AND HEADACHE

There's an old saying among sailors that when you are seasick, you are first afraid that you will die, and then afraid that you won't. Hangover produces much the same effect.

Strangely enough, one reason for hangover headaches is thought to be a loss of fluids from the body (brought on by alcohol intake).

There are several ways in which alcohol may cause or help cause headache, and it is important that we distinguish among them.

(A)          Headaches that occur almost immediately.  These occur in people who are subject to headaches such as migraine and histamine types. Here, the alcohol dilates the blood vessels in the head excessively, and acts as a trigger to the migraine or histamine process which causes the head pain. Allergy to some types of alcoholic beverages also can produce an immediate headache.

It is an easily observed fact that excessive use of alcohol for a prolonged period of time permanently enlarges certain blood vessels in the head— particularly those of the skin of the nose and face. But in most people, the dilation of blood vessels due to drinking is not sufficient in itself to bring on headache.

(B)          Hangover headache—that is, “morning after” headache—is characteristically deep-seated, throbbing, and aggravated by movement, light, noise, or almost any other disturbance. It is often an “all-over and all-through” headache, which may eventually be-come a dull pain lasting for many hours.

Its cause is thought to be dehydration of the body generally (that is, loss of body fluids) and more specifically, reduction of the amount of fluid sur¬rounding the brain and spinal column.

The dehydration comes about in two ways: first, alcohol is a diuretic and makes the body eliminate more than a normal amount of water; and, second, alcohol raises the body temperature, which produces sweating.

This loss of fluid from the body, when great enough, draws water from the fluid surrounding the brain and spinal column, and this, in turn, produces a traction on blood vessels in the brain. The result is intense, throbbing pain. An additional fluid loss may occur if nausea and vomiting result from ex¬cessive drinking.

(C)          Emotional tension—either before or after drinking. Many people are under emotional strain either before they begin to drink or as a result of drinking. It may be that this, rather than the alcohol alone, will bring on a tension headache along with pain which is caused by the alcohol's direct physical effects on the body.

(D)          Associated activities—such as excessive smoking and loss of sleep—may also be contributing factors to headaches brought on by excessive use of alcohol.

Treatment

There are a few people, who might be classed as “heavy drinkers,” who build up something of a tolerance for alcohol and can drink excessively without painful hangovers. But most people find that drinking too much takes its toll the next morning. Obviously, the best “treatment” for hang-over is moderation.

In the case of migraine sufferers, the effects of alcohol may be so severe in triggering a migraine attack that drinking should be avoided completely.

People subject to histamine headaches will find that extreme caution in the use of alcohol is necessary during their headache “seasons.”

Hangovers for the average person, however, can often be avoided by drinking two or three glasses of water before retiring—the purpose being to replace some of the water drawn from the system by alcohol in the blood stream.

If this does not eliminate the hangover, it will still help to reduce its intensity. Hot baths and aspirin may help overcome the pain and shorten the discomfort.

Most people who use alcohol have learned that to drink on an empty stomach is a very bad idea—not only because of possible digestive upset, but also because the after-effects can be much more severe. Recent research into the effects of various types of alcohol in producing “hangover” may lead to much better ways to treat or prevent this type of headache.

Contrary to popular belief, the use of more alcohol to relieve a hangover is not a good idea . . . and is not recommended.

CHAPTER 17

FUN IN THE SUN CAN BE OVERDONE

Headache due to sunstroke is very much like headache from too much alcohol. Both are caused by loss of water from the body, and the pain results from traction on the blood vessels inside the brain when the fluids around the brain and in the spinal column become depleted. The pain is “deep seated” and usually throbbing—and may be severe. It may last for a full day.

Sunstroke has other important effects, too, and may be a very serious matter—but headache is one of the first symptoms.

Prevention, of course, is important. If you plan to spend much time in the sun—especially before you have developed a protective tan—wear a hat and keep yourself otherwise adequately covered.

If you do develop headache after overexposure to the sun, lie down, drink as much water as you can, comfortably —but it should be warm water taken slowly—and, if the pain has not stopped in two or three hours, consult your doctor.

Sunstroke headache may be accompanied by several other symptoms including fever, low blood pressure, flushed skin, and even unconsciousness.

CHAPTER 18

HEADACHES FROM BRAIN INJURY AND DISEASE

The world was shocked, in 1945, at the sudden death, from stroke, of Franklin D. Roosevelt. His last words, as reported by the newspapers, were “I have a terrific headache.” And then he was overcome and never regained consciousness. The cause of the headache—brain hemorrhage (stroke).

In February, 1956, the New York Daily News reported: “Fearing Future, Mother Kills Girl, 9, and Self and then went on to say: “Mrs. H―was convinced that severe headaches that had plagued her in recent months were caused by a malignant growth (tumor) in the brain . . .”

Unfortunately, stories of this type have greatly over-magnified in many people's minds the frequency of illnesses involving the brain, and have caused much unnecessary concern on the part of headache sufferers that unexplained headaches might have such serious causes.

It is our purpose in this chapter to make clear the types of headaches resulting from brain injuries (both illnesses and “mechanical” damage) so you can eliminate as quickly as possible the worry which often accompanies unexplained headaches.

If Mrs. H―, as mentioned above, had known that headaches which come and go are seldom a sign of brain tumor, she might have sought the help she needed to over-come her problem.

In earlier chapters various types of headaches have been discussed in which the pain takes place within the skull such as fever and hangover headaches—but the cause of the headache was some outside condition.

There are also a few types of headaches which are caused by some disturbance of the brain tissue:

(a)          aneurysm—a “bulge” in an artery wall

(b)          “stroke”—that is, a hemorrhage or blood clot withinthe brain

(c)           brain abscess—local infection of brain tissue

(d )         brain tumor—abnormal growth of brain tissue (e) skull injuries which damage the brain.

As you can see from the preceding list, brain injury headaches are not a common problem. Let us explore each of them briefly.

Aneurysm

When an artery wall becomes weakened—often due to a defect that has existed since birth—it may “bulge” in much the same way that an inner tube bulges when too much air is put into it.

An aneurysm might exist for years without causing any trouble—and then, due to a further weakening of the artery wall, or to an increase in blood pressure, it may become large enough to become trouble-some.

Aneurysms occur very seldom in any part of the body, and even less so in the brain. But when they do occur in the brain, they may produce headache due to either pressure or tension on the nerves in or near the artery wall.

Headache caused by aneurysms are generally severe, throbbing, and continuous. Diagnosis when this condition is suspected, is by the use of dyes injected into the blood stream, plus observation by X-ray of accumulations of the dye in the aneurysm, if it exists.

The only treatment for aneurysm is surgical, if the blood vessel affected can be reached. Brain surgery today has been developed to such a high degree that it is to be respected rather than feared.

Stroke

“Stroke” is a general or popular term used to describe what happens when one of the arteries supplying the brain becomes clogged, or breaks. The effects of this interference with blood flow may be several, principally: headache—sudden and severe partial paralysis—usually on one side of the body loss of sight or speech.

Stroke, by its very nature, develops rapidly, and the headache occurs at the same time as other symptoms. Consequently, headache may be a very important symptom to the doctor in diagnosing stroke.

However, the headache that accompanies “stroke” is not a “headache problem” as are most of the other types discussed in this book. If the stroke is a minor one, the headache will ordinarily stop in a day or two.

Two of the major causes of strokes—other than the original defects that may exist in the arteries—are high blood pressure and hardening of the arteries, both of which may be accompanied by prolonged headaches.

Brain Abscess

An abscess is a form of infection in which bacteria have lodged at some point in the body and multiplied very rapidly—so much so that the bacteria destroy body tissue faster than the blood stream can carry the damaged tissue away.

The result is a collection of damaged tissue (called “pus”) that creates a lump, and produces pressure on the surrounding tissue. One minor form of abscess is the boil.

Occasionally, when infection is present, some live bacteria may be carried by the blood stream to another part of the body, and a secondary infection is established. Secondary infection might also result from a direct spread from nearby infected tissue.

Brain abscess can develop as a result of invasion of the brain tissue by bacteria through:

(a)          direct injury to the brain,

(b)          spread of infection from the ear sinuses or nose or

(c)           transfer of bacteria by the blood stream from a primary infection elsewhere in the body.

The use of antibiotics to control infection has made brain abscess a very infrequent occurrence. It is most likely to occur when a serious primary infection has been badly neglected.

Brain abscess causes high fever, severe headache (most intense at the site of the abscess), and usually interference with some body function, depending on what part of the brain is affected—for example, impaired vision, hearing, or speech, or partial paralysis.

Generally, the headache and fever will be the first symptoms to be noticed. There is a danger in neglecting any body infection because blood poisoning—which could lead to brain abscess—may develop.

Treatment is generally by surgery, and the chances of recovery are good. But again it must be emphasized that prevention is important, and any acute infection—especially in the ear sinuses or nose—should have prompt attention by your doctor.

Brain Tumor

If you have had frequent or continual headaches, you may have worries—as many people do—that you have a brain tumor. If these headaches have been bothering you for a year or more—and you have had no other symptoms along with them—you can be almost certain that you do not have a brain tumor.

Why? Because brain tumors, as they grow, create pressure on the brain and interfere with its operation. This will show up in symptoms very much like those caused by brain abscess—impaired sight, hearing, or speech . . . partial paralysis . . . fits. But brain tumor does not or¬dinarily cause fever.

A tumor is a swelling caused by an abnormal collection of tissue. It may be malignant (cancerous) or benign (non-cancerous). Cancerous tumors spread to other parts of the body; benign tumors do not.

Either type, when it occurs in the brain, requires surgery. Benign tumors are relatively slow growing—and might take years to become harmful. Cancerous tumors develop so rapidly that their growth can be measured in weeks.

Headache alone, as indicated above, is not a definite symptom of brain tumor, and, in fact, may not appear at all, or may appear only as a late symptom of the disease.

If you are worried about having brain tumor, by all means see your doctor at once. The chances are very great that he can relieve your mind on this score, and help you find the true cause of your pain.

Epilepsy

Although today epilepsy can be controlled effectively, the disease was, for centuries, so little understood and given so black a name that the very word still frightens many people. Epilepsy was once thought to be a disease to be ashamed of.

Without going into great detail, we might think of the cause of epilepsy as simply a fault in the electrical circuits in the brain. Some people develop epilepsy after head in-juries; others seem to develop it without apparent cause. The precise cause is not known—but methods of control are.

Epilepsy takes one of two forms—called “petit mal” or “grand mal.”

Petit mal, the milder form, shows itself by causing fre-quent “blank” spells, during which the individual may stare into space for a few seconds, and then resume his conversation or activity without realizing that he was temporarily “out.” These spells may occur many times in one day—with long periods (even months) between attacks.

Grand mal produces “fits” or convulsions, followed by brief spells of unconsciousness which may last as long as two or three minutes. After these, may follow a period when the individual appears to be awake, but is not fully aware of what is going on about him. Attacks of grand mal might occur daily at times—and then not again for months.

Presence or absence of either form of epilepsy can be fairly well established by recording brain waves (with an instrument called an electro-encephalograph). This is a simple procedure in which electrical impulses generated by the brain are picked up by applying electrodes to the outside of the head—a completely safe and painless test.

People who have epilepsy are frequently troubled with headaches—but the headaches are not confined to periods when attacks are occurring.

The treatment of epilepsy consists of small daily doses of any of a variety of special medicines developed for this purpose. They act to control the disturbances which bring on attacks, and prevent the attacks from occurring. With the help of these medicines, epileptics can live nearly normal lives.

CHAPTER 19

HEADACHE FOLLOWING INJURY TO SKULL AND UPPER SPINE

There are four causes of headache which may occur as a result of injuries in or about the head or upper spine:

(a)          Superficial   (surface)   injury  to  the  head,  which may slightly damage a nerve or blood vessel and produce a pain or headache at the point of the injury. These headaches, while they may be temporarily painful, do not last long, and are relieved by aspirin or other pain killers.

(b)          Severe blows which result in internal damage to the brain or to blood vessels or nerves within the skull. The headache may not develop immediately—in fact, one of the dangers of such injuries is that, aside from a momentary unconsciousness at the time of the injury, there are often no indications of any damage.

Your doctor, when he examines you after such an injury, will want to know about this momentary unconsciousness, and if it did occur, will put you to bed for at least a day, to protect you from serious and even fatal consequences of such a

blow. Damage to a blood vessel can produce a slow hemorrhage which ultimately can cause death. Headache, in such cases, is a most important symptom, and should be reported to your doctor immediately.

(c) ”Whip-lash” injuries, in which the head is thrown suddenly forward or backward. These occur often in automobile accidents when a car stops suddenly or is hit from behind, causing its passengers' heads to be snapped back and forth. When severe, these accidents may cause damage to the vertebrae, the ligaments attached to the vertebrae,or the discs between the vertebrae.

The headache is usually at the back of the head and neck, and the pain may extend down to one or both shoulders. The pain is aggravated when the head is moved; this causes the patient to tighten the neck muscles in order to prevent the pain, and may add to his misery by bringing on a muscle tension headache which may extend up into the forehead, or all over the head.

When such an injury occurs, immediate examination by your doctor is indicated—partly to determine what the extent and nature of the injury may be, and partly to avoid improper treatment. Usually, X-ray examination is required before any treatment is undertaken.

This is another case where headache is a very important symptom and one which should be heeded promptly, because the possibility of permanent damage is very real.

Both severe skull injuries and whip-lash injuries respond well to proper and prompt treatment—but both may have serious consequences if they are neglected.

(d)  Emotional upset as a result of head injury. It is not unusual for some people to be very disturbed about head injuries, even though no serious physical damage has taken place. Somehow, injuries to the head can be frightening. And, unfortunately, it is actually true that people injured in accidents where law suits are pending can and do “hold onto” these emotional headaches for weeks or months.

Often, this is an unconscious reaction —perhaps caused by the stress of the litigation. Occasionally, it may be more deliberate.

In any case, as the emotional upset subsides, the headaches should clear up. The treatment, of course, must be directed toward clearing up the emotional problem, although sedatives or pain killers (such as aspirin) may be required to relieve the pain.

It may be an unpopular observation, but it is nevertheless occasionally true that a substantial cash settlement in accident cases seems to be a very effective treatment.

CHAPTER 20

ARTHRITIS, RHEUMATISM, AND HEADACHE

Arthritis is one of the oldest diseases known to man—and has been described in the writings of Hippocrates and others. But even if there were no written records or descriptions of this painful condition, examination of the bones found in ancient tombs, such as the pyramids of Egypt, would tell us that it was not uncommon thousands of years ago.

Arthritis and rheumatism in their various forms—mild and severe—affect millions of people throughout the world —and are no respecter of age. A two-year-old child may suffer severely from rheumatoid arthritis, for example.

Arthritis means, in simple language, “inflammation of the joints.” Rheumatism, which means “mobile or moving pain,” is mainly in the muscles or other tissues surrounding or near joints. Although the diseases are separate and distinct, they often afflict their victims at the same time.

These two diseases are sufficiently complex and varied in their forms that whole books have been written about them. In this book, we are concerned only with those forms of both which produce headache as a symptom.

These are: osteo-arthritis in the neck-spine area, and myositis and fibrositis (both forms of rheumatism) in the muscles at the back of the neck.

Arthritis

Arthritic headaches occur mainly in connection with osteo-arthritis which is a disease affecting older people. The headaches are infrequent, at first, often occurring after the patient has gone to bed, and may become more severe during the night.

There is usually some stiffness in the neck along with the pain. As the arthritis becomes worse, the headaches become more frequent and long-lasting, and eventually may become continuous.

The pain will follow the path of the occipital nerves (the nerves which run from the back of the neck to the top of the scalp) and may be felt anywhere from the nape of the neck to the forehead, on both sides. It will be dull and steady, but may become severe.

Moving the head forward increases the pain, and sometimes tipping the head back relieves it. Drafts, dampness, and extreme cold may bring on such headaches or make them worse.

Headache is unlikely to be the only symptom of arthritis, and it will seldom be the first. But this does not make it any less annoying. Arthritic pains are usually felt first in the small joints of the hands or feet, or in the knees or elbows.

What Causes the Pain?

Osteo-arthritis is a disease in which calcium deposits build up on the ends of the bones, within the joint area. Because the bone surfaces are no longer smooth, every time they rub together—which is whenever the joint is moved—the “lining” of the joints (that is, the membrane which covers the ends of the bones) is subjected to a sort of grinding action.

The greater the deposit and the roughness, the greater the discomfort. The joints are enclosed and bathed in a constant supply of natural lubricating oils, but as osteo-arthritis comes on, the lubrication becomes less effec¬tive. (This is a whole subject in itself, and we will not go into the details here.)

Help For Your Headaches

When osteo-arthritis affects the neck-spine joints, head-ache is one of the results. And, as explained earlier, because the same nerves (right and left) service the neck-spine region and the scalp, a general “all over” headache is the usual result.

As this condition progresses, there is a tendency for the neck muscles to tighten to keep the vertebrae apart and prevent the irritation of the membranes between the bone ends.

The continuous work which these muscles do, in this fashion, causes an excess of waste products to develop in the muscles, and additional pain is created by the irritation from these waste products. Thus, a muscle tension type of headache is usually found in osteo-arthritis cases.

It can be seen, therefore, that the continuous, nagging headaches which bother many arthritics are complex in nature.

Diagnosing Arthritic Headaches

There is little likelihood of confusing arthritic headaches with other types—with the possible exception of frequent tension headaches in older people. Even then, your doctor, as he studies your medical history and the other symptoms of arthritis which are usually present, will have little diffi-culty in identifying arthritic headaches if you have them.

The sure test is X-ray of the neck-spine region, which will reveal abnormal bone conditions that are associated with osteo-arthritis.

Treatment

Much greater hope exists for the arthritic patient today than ever before. Great strides have been made in recent years to help arthritics—and some people seem virtually  “cured” of the disease, or, more accurately, are relieved of practically all discomfort and disability. These results have been achieved with new drugs, and there is good reason to believe that the disease will eventually be conquered by medical research.

So, if you have been suffering with arthritis for years without doing anything about it, it is certainly worth the effort to seek medical advice. In many areas there are arthritis clinics.

Among treatments your doctor may advise are:

Modified diet. Proper diet has been found to bring great relief in certain types of arthritis.

Exercise, heat treatments, and massage, including hot baths. There are famous health resorts all over the world to which arthritic people have gone for relief.

Medicines. Several new types of drugs have been found very effective, and new developments in this field are coming along rapidly.

Neck traction. (Stretching of the neck by carefully applied pressure, using a specially designed collar and a weight-and-pulley system). If this type of treatment is recom¬mended, your doctor will suggest equipment which you can use at home for this purpose. The cost is under $20.

Aspirin has been time-tested in the relief of the pain of arthritis, as well as of simple headache, and is still widely used for the relief of both arthritis and arthritic headache.

Climate and Weather

Just about everyone knows or has heard of people who claim they can predict the weather because of “an ache in my big toe” or some similar sign. The reason that this is true is that something in their joints responds to changes in the atmosphere—perhaps in air pressure or electrical conditions—and they react by feeling pain or discomfort.

We may laugh at these “weather predictors,” but it is certainly true that certain climatic and weather conditions aggravate arthritic pains, and in general, arthritics feel better in a warm, dry climate than in cold, damp areas. There is no guarantee that your arthritis will be helped by moving to Arizona or the French Riviera, but it may be a pleasant experiment.

Rheumatism

Rheumatism, like arthritis, is one of man's oldest diseases, and yet we still know relatively little about it. The term “rheumatism” covers several different conditions, of which the two major forms are myositis and fibrositis.

Myositis means inflammation of the muscle. Fibrositis means inflammation of the fibers (within either muscles or ligaments). Rheumatism does not affect the same areas of the body all the time—and may “flit” about the body from day to day.

When rheumatism occurs, the muscles and ligaments affected tend to stiffen and become painful. And when rheumatism appears in the neck area, this pain is likely to be in the form of headache. Sometimes it will resemble a simple tension headache; sometimes an arthritic headache.

Such headaches will come and go, often with changes in the weather. They will be more common at night or upon waking in the morning. The pain is a nagging ache, generally steady and dull, and may be either mild or severe.

Rheumatism generally occurs after childhood (although it may affect children). It is more common in people over 40.

Although rheumatism and arthritis are very similar in terms of the discomfort produced in and around joints, rheumatics do not have the joint changes found in arthritic patients.

If you have rheumatism, your doctor will find muscle stiffness and tenderness, occasionally limitation of move-ment, and sometimes mild fever. He may use X-ray to be sure you do not have arthritis.

Treatment of Rheumatic Headache

All of the treatments used in arthritic headache cases might also be applied to rheumatic headache problems.

CHAPTER 21

HIGH BLOOD PRESSURE AND HARDENING OF THE ARTERIES

Before undertaking to explain the relationship between high blood pressure and headache, it is necessary that we understand just what high blood pressure means, and how blood pressure changes occur.

Blood pressure is created by the pumping action of the heart, which forces blood through the circulatory system (arteries and veins). Just as we can measure the water pressure in a pipe, so can we also measure the blood pressure in arteries.

But unlike the pressure in your home water supply, which remains fairly constant, the pressure of blood in your arteries changes during each heart beat. The pressure is highest at the moment of the beat, at which point the artery walls “give” a little to absorb the shock, and to store up energy momentarily.

As the heart beat is completed, the elastic walls of the arteries begin to contract, forcing the blood to continue its path through the body. Because Nature very wisely installed “check valves” in the arteries, which prevent the blood from flowing back toward the heart, the contraction of the artery walls pushes the blood onward, away from the heart.

The blood pressure at the moment of the heart beat is called the systolic pressure—and is the higher of the two pressures. The pressure drops off: to its low point just before the next heart beat. This pressure is called the diastolic blood pressure.

High Blood Pressure and Hardening of the Arteries      

In the course of a normal lifetime, both the diastolic (low point) and systolic (high point) blood pressure gradually increase.

During the course of a day, however, your blood pressure may vary widely, as your activities change. When you are asleep, your blood pressure tends to be at its lowest point.

Intensive physical activity, as you might expect, tends to raise blood pressure because the heart is working harder to supply the needs of the body. But, blood pressure can also be increased greatly by anxiety, tension, and other emotional upset.

What Causes Changes in Blood Pressure?

If you have ever watered your lawn with a garden hose and, in the absence of a nozzle, put your thumb over the end of the hose to make the water squirt farther, you can appreciate how narrowing down a blood vessel produces a higher pressure within.

(The smaller you make the opening in the end of the hose, the higher the pressure within the hose and the harder it is to hold your thumb in place.)

Of course, opening the valve that feeds the hose will also increase the pressure, just as increasing the heart action increases blood pressure.

But other factors affect blood pressure—the quantity of blood in the system (if it is below normal, the pressure drops) and the thickness of the blood (an anemic person has “thinner” blood).

Finally, if the blood vessel walls are hardened—that is, if they lose part or all of their elasticity (as they do in hardening of the arteries)—Nature compensates for this change by increasing the blood pressure (both diastolic and systolic).

What is “Normal” Blood Pressure?

Within any group of normal individuals of a given age, there will be a range of “normal” blood pressures which medical researchers established, by observation, many years ago. But the fact that an individual's blood pressure departs slightly from these averages is ordinarily no cause for alarm.

Because blood pressure is, in many people, greatly influenced by worry or other emotions, it is sometimes diffi-cult for a doctor to obtain an accurate measurement. For example, if you are worried about your health and visit your doctor, your worry may cause your blood pressure to go up.

If he finds it unusually high and suspects that your emotional state is the cause, he will try to “calm your troubled nerves” before taking another measurement.

High Blood Pressure Usually Discovered by Your Doctor

Most people who develop high blood pressure as a continuing condition do not know it until their doctors discover it in the course of an examination. Why? Because high blood pressure has no distinctive symptoms that belong to it and no other disease.

For example, the following may be symptoms of high blood pressure, but also of other diseases: general feeling of weakness, dizziness, headache, “fullness in the head,” ringing noises in the ears, numbness in hands or feet.

It is possible to have high blood pressure without any of these symptoms and it is also possible to have many of these symptoms without high blood pressure

High Blood Pressure and Hardening of the Arteries       

How Does High Blood Pressure Cause Headache?

Most researchers now agree that high blood pressure is not a direct cause of headache, but the two often occur at the same time.

The most frequent cause of headaches that accompany high blood pressure has been found to be nervous tension. And it is not uncommon for a person to develop headaches after he learns of his high blood pressure and begins to worry about it.

In clinical work, where there is an opportunity to observe many high blood pressure patients, it often happens that a patient will say ”I know my blood pressure is high today because I have a splitting headache.” Yet, upon examination, his blood pressure will be found normal.

Who Gets High Blood Pressure?

Both men and women are subject to high blood pressure— usually after age 25, although it does occur in younger people. There are no indications that it is confined to people of any particular occupation or intelligence level.

But there does seem to be some relationship between salt intake and high blood pressure. Dr. Lewis K. Dahl of Brookhaven National Laboratory reports that in a study of the relationship between diet and high blood pressure he “had found no society in which salt consumption is low and the incidence of high blood pressure is high; and . . . no society in which salt consumption is high and the incidence of hypertension is low.”

Some authorities on this disease believe that a tendency toward high blood pressure may be inherited.

The factor most commonly found in hypertensive people is emotional tension.

Two other diseases which are often present when high blood pressure is found are arteriosclerosis (hardening of the arteries) and certain kidney diseases. Both of these will be detected in routine physical examinations by your doctor.

Treatment of High Blood Pressure

Until 1951, our principal attack on high blood pressure was one or more of the following:

a)            Counseling on anxiety problems

b)            Restriction of salt in the diet

c)            Reduction of weight where overweight was a problem

d)            Use of sedatives to relieve tension.

In rare cases, where the blood pressure was so high that immediate results were required, surgery was used. The procedure was to sever a nerve in the chest—the nerve being involved in the control of contraction of arteries. This was a last-ditch procedure that is little used today.

Inl951, new medicines came into the picture. Practically all of them work by acting on certain nerve centers in the brain to slow down the release of one of the body chemicals which causes blood vessels to contract. In this way, the blood vessels are kept “open” and the pressure prevented from rising unduly.

High blood pressure today need not be feared as it was only a few years ago, because the new drugs which are available have been found so effective.

It is entirely possible that another five years will see the development of completely new approaches to the problems of controlling blood pressure. The problem is being studied very extensively today, and interesting new results are beginning to emerge from the laboratories.

Although headache appears in a minor roll in the hyper¬tensive theater, it does point a finger to the basic ailment in a number of cases, and it is cheering to see the progress which has been made in curbing this disease.

CHAPTER 22

CHILDREN'S HEADACHES

There are no headaches which are peculiar to children alone, although there are a number of types (as discussed in various chapters of this book) that do not affect children. Those which do occur would include head¬aches caused by:

diseases causing high fever, especially

upper respiratory infections

(colds, sinus conditions), and

ear infections (particularly when mastoid is involved) eyestrain

tension

migraine

epilepsy

head injuries

ice cream headaches.

Except for those headaches caused by head injuries and infections, any of the types listed above may occur fre-quently. When they do, they often become a cause for worry on the part of the parents. In fact, it may even be that worry on the part of the parents will bring about a state of tension in children and produce headaches.

It has been said that children are largely what their parents make them, and this often applies to headache problems.

Headaches in children should never be ignored. They are a sign of either a physical illness or an emotional disturbance. Those related to purely physical causes are often valuable in helping you detect illness in its early stages, and hence in giving your doctor a chance to treat the illness before it becomes serious.

But when a child develops regular headaches that cannot be traced to physical causes, the problem may be more complex.

In a remarkably large proportion of children who com-plain of headaches, there is a history of the child's hearing one or both parents (or others around the house) com¬plaining of headaches frequently. Children usually identify themselves with one or both parents, and tend to imitate them—even unconsciously.

Often—particularly in younger children—the term “headache” simply means “pain.” One youngster of four, brought in with headache complaints, when asked where it hurt most, said “In my arm.”

If the pain is not real, they will have difficulty describing where it is and how it hurts, and will be vague in answering questions. But if the pain is real, and the origin is emotional, your doctor will usually be able to sense a condition of tension or strain that is producing a tension headache in the child.

Can Children Get Migraine Headache?

Yes—this is not unusual, especially if there is a history of migraine in the family. A migraine attack in a child will be similar to that in an adult, and the accuracy of the diagnosis can be confirmed by the response of the headache to ergotamine preparations.

Treatment of migraine in children is similar to that oí migraine in adults.

Ice Cream Headaches

Ice cream headaches rarely need a specialist to determine their cause. But actually, they may indicate either faulty teeth or some other dental problem, or simply a natural tendency to react excessively to cold.

Even sound teeth can transmit cold quickly enough to the trigeminal nerve to cause a sudden sharp pain in the face or lower forehead. An additional cause may be irritation of the stomach nerves by cold.

Because the nerves in the stomach have connections with the trigeminal nerve (which serves the outside of the head), impulses caused by cold substances in the stomach can produce “referred” pain to the head.

Ice cream headaches last for only a few seconds, and are of no great significance other than occasionally indicating a dental problem.

Tension Headaches in Children

It has been the observation of many doctors that the most common cause of headaches in children is their parents. Tension in daily living, too much pressure on children to get better grades, or to perform distasteful or difficult tasks, jealousy of other members of the family, fighting or constant bickering in the home, fear of punishment or mistreatment, lack of love and attention, and many other everyday conditions bring about emotional upset, anxiety, or fear in children.

Bad situations at school or with playmates, unusual fears created by superstitions, frightening books, stories, TV or radio shows, and a host of other causes may be involved in children's tensions.

The appearance of these anxiety-produced headaches is perhaps a fortunate symptom for those wise enough to heed it, for it indicates that all is not well in the child's world, and that steps MUST be taken to find and eliminate the causes.

CHAPTER 23

HEADACHES DUE TO VAPORS, FUMES, AND POISONOUS SUBSTANCES

The importance of this chapter will be principally to those people who live or work under conditions where they are frequently exposed to some substance that is “poisonous” or irritating to the body mechanism—and where continued exposure might have serious or even fatal consequences.

Examples:

Headaches from carbon monoxide, caused by breathing fumes from gasoline engines, or improperly adjusted coal, oil, or gas heaters or stoves. Headache or dizziness is one of the first symptoms—and if the condition is not corrected quickly, death may result in a matter of minutes.

Headaches from arsenic poisoning, which come on slowly —occur mostly in agricultural workers who use arsenic sprays and in some workers in glass factories. Arsenic accumulates in the body slowly, and ordinarily is retained by the body.

When the arsenic level becomes high enough, headache and other symptoms begin to appear. Workers in arsenic-using industries should have regular medical examinations; and most industrial concerns which use arsenic or other potentially harmful materials provide routine medical check-ups for their employees.

Headaches from mercury poisoning, which come on much like those from arsenic poisoning. Workers in factories making certain types of electronic and electrical equipment, thermometers, barometers, etc., are particularly subject to this malady. Great care should be taken by people who handle mercury frequently to prevent mercury poisoning.

Headaches from carbon tetrachloride (an ingredient of both commercial and home cleaning fluids and some fire extinguishers). Minor exposure to such fumes can produce headache—which should serve as a warning, because the inhaling of large quantities of fumes from this liquid can have very serious and even fatal results.

Headaches from high altitudes. In La Paz, Bolivia— altitude 12,500 feet—an illness called soroche which brings on violent nausea and splitting headaches is serious enough to prevent many people from living and working in the area. The cause—too little oxygen because of the thin air.

If you travel through high mountains, you may have the same trouble—which can be corrected, temporarily, by inhaling oxygen, if available. Some people can develop a tolerance for thinner air, over a period of time.

Headaches due to poorly ventilated rooms. The famed “smoke-filled” room of political conventions . . . the thick air of smoking cars on trains ... the oxygen-starved air of poorly ventilated areas in home, factory, office, school, or automobile, may have a high con¬centration of carbon dioxide.

Laboratory experiments have shown that when carbon-dioxide concentration in the blood reaches 6 per cent, headaches result. Carbon dioxide is a normal product of our bodily processes, and is given off by all living things when they breathe. But when oxygen concentration in the air is too low, carbon dioxide in the blood rises. Correct ventilation is the proper prevention.

Headaches during automobile travel. These headaches may result from a combination of circumstances. Leaky mufflers and exhaust systems are the most dangerous, for they can release into the car fatal quantities of carbon monoxide.

The first symptom of carbon monoxide poisoning may be headache . . . accompanied by dizziness and sleepiness. Since this gas is colorless, odorless, and tasteless, it gives no other warnings.

If you keep the driving compartment tightly closed —as during the winter—carbon dioxide, from normal breathing, may reach a level that will produce head-aches. In addition to these “chemical” causes of head¬aches, you may add motion sickness, fatigue, and nervous tension.

The preceding list is, of course, not complete—you may find other materials to which you have a sensitivity that will cause headaches. These you can isolate by observation, and by eliminating other possible causes of headaches.

CHAPTER 24

THE HEADACHES THAT INVENTED A NEW MACHINE

Many years ago, engineers in the short-wave in-ternational broadcasting stations of General Electric in Schenectady, N. Y., developed a strange tendency to head-aches which usually came on during the afternoon.

The problem was bothersome to them, and their curiosity leads them to discover that their headaches were also accom-panied by fever. There were no other symptoms of illness.

By investigation, they found that the high-frequency waves of the powerful transmitters were acting on their bodies to raise their temperatures—and after a few hours exposure, the temperature reached a point where headaches resulted.

Technical changes in the equipment eliminated the un-desirable effects—but the engineers did not stop there. Realizing that there are occasions when doctors wish to produce fever in the body to help relieve pain or clear up local injuries such as sprains, they developed what we now call “diathermy” or artificial fever machines, which make use of controlled high frequency radio waves to produce fever.

So out of scientific work in the field of international broadcasting came one of the very useful tools of modern medicine—which today is available throughout the world.