Massachusetts Medical Society's Physician Focus

November 2011



  • The head is more sensitive than other parts of the body, one reason why headaches are normal, occasional occurrences for everybody.

  • Headaches run along a spectrum, from a common tension-type headache to the more severe and debilitating migraine headache.

  • Migraine headaches affect nearly 30 million Americans, with women three times more likely than men to be affected.

  • Environment and lifestyle choices, such as diet, can prompt or aggravate headaches. Caffeine, alcohol, and even chocolate can be irritants to those with a sensitive head.

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Nearly everyone experiences headaches at some point in their life, but headaches can vary widely. For some people, it can become a particular problem, one that can be extremely debilitating and impair function, at times for days.

When it comes to headaches, says Brian McGeeney, M.D., a specialist in headache and pain management, “Patients need to be educated that the head is incredibly sensitive, as opposed to thinking catastrophic thoughts like I must have a brain tumor. We all worry when we get a headache, but for the majority of patients, it is a disturbance of the pain system in the head.”

Dr. McGeeney, a staff neurologist at Boston Medical Center and an Assistant Professor of Neurology at Boston University School of Medicine, shared his knowledge of this common medical ailment as the guest on the November edition of Physician Focus with the Massachusetts Medical Society. Hosting this edition is John Fromson, M.D., Associate Director of Postgraduate Medical Education at Massachusetts General Hospital and Assistant Clinical Professor of Psychiatry at Harvard Medical School.

Headaches run along a spectrum in terms of severity, says Dr. McGeeney, from the common tension-type or muscular contraction headache, which may be quickly erased with over-the-counter medicines, to the most severe, or migraine headaches, which can be debilitating and impair function.

Knowledge of the specific root causes of headaches is still lacking, he says, but sometimes patients could be doing things to make headaches more likely. “Part of my role as a physician,” he says, “is to try to identify things that they may be doing to themselves unwittingly” to make headaches more likely. He cites diet as one example: Excessive caffeine, alcohol, or even chocolate for some individuals, can all be irritants for those with sensitive heads.

The most severe type of headache is the migraine, affecting nearly 30 million Americans, with women disproportionately afflicted: they are three times more likely to have migraines than men. Children as young as 5 or 6 years old can also experience migraines.

He describes migraine as an “episodic disorder with impairment” that may have associated symptoms, such as sensitivity to light and sound or nausea. A small number of migraine patients – about 5 to 10 percent - also experience an “aura,” or unusual visual abnormalities. A migraine may last anywhere from a half day to several days. An associated problem with migraines is the psychological factor of anticipation: Worrying about when the next migraine will occur can be “incredibly crippling,” says Dr. McGeeney.

Treatment of headaches may include lifestyle changes, including diet, and a range of medications, from simple aspirin for tension-type headaches to prescription drugs for the more severe migraines.

As to what may be done to prevent headaches, Dr. McGeeney responds with basic, solid advice: “Eating healthy, exercise, and good sleep are all protective factors for the burden of headaches,” he says.

Watch the accompanying video for the full discussion, including how patients of different ages are affected by headaches, when patients should see a physician about headaches, and how headache and pain specialists can help patients manage these conditions.

MMS/Richard Gulla

National Headache Foundation

American Headache Society

American Academy of Pain Medicine

National Library of Medicine

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Migranes PSA

Left to right, John Fromson, M.D., Brian McGeeney, M.D.
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