CEPHALALGIA
IT IS a common experience: the throbbing, the agony hammering away at your temples, the dull ache behind your eyes. Most people have experienced a headache, and many millions suffer from one daily. The medical term for a pain in the head is cephalalgia, also called cephalgia or cephalodynia. It is no respecter of age heachaches plague the young and the old alike. However, some kinds of headaches get worse as you age. Migraine headaches are an exception that allows ageing to bring some good news: after age 60 research suggests that migraines become less frequent in incidence and less intense in severity.
However, Johannesburg headache specialist Dr Eliot Shevel says this may be true for most, but not all, migraine sufferers. Anyone over 50 who has a migraine for the first time should have see a specialist to rule out intracranial lesions or giant-cell arteritis (inflammation of the arteries of the scalp). Shevel, a maxillo-facial surgeon who founded and runs the Headache Clinic, says that the variety of causes of the pain that may drive many to the doctor or pharmacy means that older people may be just as likely to suffer from chronic headaches as their younger counterparts. He says most headaches in the elderly are of benign origin, including tension and cluster headaches. That doesnt mean headaches should not be checked out. In older people the likelihood of it being a sign of a serious disease condition is almost three times higher than in the younger population, Shevel says. Cape Town-based neurologist Dr Etienne van der Walt say that falling is another source of headaches common in older people. They can cause the pain of a subdural haematoma, a condition requiring surgical treatment when the veins crossing the space between the dura (the outermost brain sack) tear and the bleeding forms a swelling. This swelling stretches the dura, which leads to the resultant headache.
He says that other intracranial masses could also cause a headache, including secondary intracranial masses caused by lung or breast cancer and a dull, persistent posterior headache may well be a warning sign of cervical spondylosis, as chronic obstructive pulmonary disease sufferers usually suffer a dull diffuse throbbing headache early in the morning. Waking up with a headache could have a simple cause: a stuffy bedroom with bad ventilation. For this reason heating in a room during winter should be shut off when going to sleep, especially gas heaters. Another form of sleep-related headache is the hypnic headache in people over 65. It develops during sleep and wakes the patient once or twice during the night, which is why it is called the alarm-clock headache. Both Van der Walt and Shevel say sleeping disorders, including sleep apnea, can lead to chronic low-grade headaches. Shevel says that the most common headaches in people are known as rebound headaches that are connected to medication taken for headaches, whether prescribed or purchased over the counter. Such headaches are usually dull, diffuse and may be throbbing in nature.
The most important factor in this type of pain is that apart from the rebound headache, the cause of the underlying headache for which the treatment was taken in this first place needs to be treated first. Rebound headaches bring the added problem of withdrawal from the painkillers. Van der Walt says a prophylactic painkiller, taken initially with the painkillers the patient uses, can wean a patient off medication causing the rebound headaches. Secondary headaches as a side effect of prescription medication for disease conditions are also common in the elderly. The drugs involved include dopamine, antiarrythmics, sedatives, stimulants, hypotensives, vasodilators, anti-inflammatories, H2 blockers, bronchodilators, hormone replacement therapy and analgesics (painkillers). The starting point of treatment for headaches is the structures around the head and neck, says Shevel. Thats because headaches are not actually brain pain, as most people think, he says. The cause for some patients could be dental or muscular and others have several factors working together when a headache strikes.
He says that two factors most commonly found in most headaches are muscles and extracranial arteries the arteries in the scalp. Lifestyle factors, too, contribute to headaches: low blood sugar and high blood pressure are common in older people, both leading to headaches requiring intervention. Low blood sugar is easiest to correct by eating small meals throughout the day and not using sugar when feeling low but rather a low GI (glycemic index) snack or fruit. The GI is a measure of the speed with which a carboydrate food releases its sugar or glucose content into the bloodstream. Being overweight is also associated with headaches. Last year, study results by Dr Earl Ford, reported in the international headache journal Cephalalgia, released by the US Centres for Disease Control and Prevention in Atlanta, found a positive correlation between obesity and the prevalence of headaches. Shevel says this can be seen in South African patients too. Older people are also likely to have dentures or teeth implants, which could lead to TMJ (temporomandibular joint) problems causing headaches, says Shevel.
Although the term TMJ refers to the joint, most of these problems relate to the jaw muscles acting on the joint. This could be corrected without drug treatment by treating the muscles. He says the bottom line is that elderly people, after ruling out possible serious conditions, need to treat their headache problems just as much as younger people should do. The underlying causes need to be found, whether these are lifestyle related or structural, and if possible corrected. Van der Walt says treating chronic headaches requires persistence from patient and medical practitioner. There are answers one just needs to persevere to find them.
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