From studies conducted in 1992 we learned that 14% of Canadians suffer migraine headaches and 50% of these (7%) describe the pain as giving them significant disability. 36% of Canadians suffer from chronic tension headaches and 14% have both migraine and tension types. Over 7 million workdays per year were lost because of headaches. In the U.S. 27% of females and 14% of males suffer from serious headaches.
Given these staggering numbers of people who cope with head pain one would think that our knowledge and understanding of headaches as well as our collective clinical treatment experience would be vast. Indeed, much is unknown concerning the cause and treatment of this common disorder. In a 1994 Consumer's Report survey the highest level of treatment dissatisfaction was from headache sufferers. 25% of headache patients are unhappy with the treatment they receive and 27% of all headache sufferers seek treatment other than medicine. The most frequent non-medical health professional consulted for headaches is a chiropractor.
Sometimes the decision as to whom one should consult for a headache is difficult for a patient; perhaps this series of brief articles will help in that decision. To reach a decision, several questions need to be asked.
"Are my headaches primary or secondary?" Primary headaches are also known as benign or simple headaches. These account for over 90% of all headaches. They are called primary as these are headaches that are not caused by some underlying disease process. Primary headaches are not life-threatening to the patient beyond the pain itself. The category of primary or benign includes tension, migraine and cluster headaches.
Secondary headaches are caused by disease processes, some of which pose dire threats to the patients and are of grave concern to the treating health professional. Although there are many possible diseases that can result in secondary headaches, the most serious ones are tumours, hemorrhages and meningitis.
"How can the doctor tell the difference between primary and secondary?" Most useful information about a headache diagnosis is attained by a detailed history and physical examination. Advanced imaging techniques such as CT scans and MRIs are touted to be highly useful in the art of diagnosis, but in reality studies have shown that given the cost, the exposure to radiation, and the relative high value of a good history and physical exam, CT and MRI are of very limited value. It has been estimated that statically it would take over 11,000 headache patients all having these procedures to find one positive scan. Despite this fact, in the Portland, Oregon area of the U.S. on study showed that 24% of tension headache patients and 32% of migraine sufferers had had either a CT scan or an MRI. I'm sure that this is representative of most other areas as well.
