There’s one health problem almost everyone has experienced at some time or another — having a headache. If you’re lucky, you don’t have a headache often and, when you do, a few aspirin or other over-the-counter pain relievers take care of it. But for millions of people, headaches can be chronic and even life disrupting.
In fact, headaches send about 12 million Americans to see their doctors every year and cost the U.S. economy about $31 billion annually in lost productivity and medical costs. But much of the personal and economic toll of headaches could be prevented or reduced if doctors and their patients relied less on unnecessary tests and more on paying attention to healthy lifestyle changes, according to a study from Beth Israel Deaconess Medical Center.
The National Institute of Neurological Disorders and Stroke (NINDS) points out there are four main types of headaches: vascular (migraines and cluster headaches), tension, traction, and inflammatory. Tension headaches, also called muscle contraction headaches, involve the tightening of facial and neck muscles. Migraines are vascular headaches and typically produce pain on one or both sides of the head, often accompanied by nausea and visual disturbances. Cluster headaches are uncommon vascular headaches marked by searing pain around an eye. Traction and inflammatory headaches are usually symptoms of other disorders, ranging from sinus infections to stroke.
While headaches can sometimes signal very serious problems, even brain tumors, most chronic headaches are the tension and migraine variety. And both of these types of extremely common headaches can often be prevented or relieved by healthy lifestyle changes.
However, instead of first looking at ways a healthier lifestyle could potentially help treat headaches, many doctors too often opt for high tech testing. They frequently send patients complaining of headaches for computerized tomography (CT) and magnetic resonance imaging (MRI) scans that peer inside the brain and for consultations with specialists, according to the Beth Israel study.
The research, which analyzed an estimated 144 million patient visits for headaches, revealed a persistent overuse of advanced imaging, as well as prescriptions of opioids and barbiturates. The study also found doctors are counseling patients about healthy lifestyles far less than they were a decade ago.
“I was particularly alarmed about the overall trend of more imaging tests, medications, and referrals alongside less counseling," said John N. Mafi, MD, who headed the study. "These findings seem to reflect a larger trend in the U.S. healthcare system beyond just headache: over-hurried doctors seem to be spending less time connecting with their patients and more time ordering tests and treatments.”
Patients with chronic or frequent headaches sometimes pressure their doctors to order the imaging tests, too, and some doctors go along with the requests — even though the tests aren’t indicated. What’s more, CT scans increase exposure to radiation, potentially raising the risk of other health problems later.
The bottom line, the researchers concluded, is that doctors should concentrate less on tests for common headaches and put more effort into counseling patients on making lifestyle changes, such as figuring out dietary triggers and reducing stress, to beat headaches.
The NINDS recommends getting adequate exercise, eating meals at regular times, maintaining a consistent sleep schedule, and drinking plenty of water as non-drug strategies that can reduce or prevent headaches in many people. In addition, obesity increases the risk of developing chronic daily headaches, so keeping weight under control can help, too.
A study from the University Duisburg-Essen in Germany found controlling stress is one of the most important ways to reduce the occurrence of common headaches.
"The results add weight to the concept that stress can be a factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, exacerbates headache episodes, and that the headache experience itself can serve as a stressor," said Sara H. Schramm, MD, who headed the research.
The NINDS advises biofeedback, relaxation training, meditation, and cognitive-behavioral therapy as ways for headache sufferers to reduce stress.
August 12, 2015
Janet O’Dell, RN