The East Bay Headache Support Group is pleased to have Lynne Eilers, M.S., M.F.T., as its guest speaker in Sep-tember. Ms. Eilers will be talking to us about exercise, and when it might help a headache condition, or when it might not be beneficial, or perhaps even be dangerous.

Ms. Eilers is a family therapist who contracts with the John Muir Health Network to work with high-risk obesity clients. She has also had a private practice in Walnut Creek for 15 years, where she works with families, couples, and adolescents; and facilitates groups focusing on a variety of topics, including eating disorders, women’s issues, and couples issues.

Join us Tuesday, September 14th, from 7:30 to 9:00 pm in the Ball Auditorium at John Muir Medical Center. For more information, call (925) 938-5252.

Going up to altitude is very common in our fast-paced society. We do it, usually for a few hours at a time, when we fly on an airplane. A trip to the mountains to go skiing or camping exposes us to higher altitudes, sometimes for days or longer. What is the relationship between going to higher elevations and headache?

The first question about altitude and headache is: How high are you going? Extreme altitudes are those over 15,000 feet. These are levels that mountain climbers or certain pilots are likely to experience. These altitudes are associated with acute mountain sickness, a complex group of symptoms including pounding headache, dimming of vision, nausea, restlessness, difficulty sleeping, and anxiety. This can progress to a decreased level of consciousness and even coma. A rapid ascent to altitude increases the chances of developing acute mountain sickness.

At lower altitudes migraine and other types of headache frequently develop. Many individuals are sensitive to going to the mountains; as soon as they get above a certain altitude (3,000 or 4,000 feet, for example) they seem to be prone to developing a migraine. The same phenomenon may occur when they return back down the mountain.

Flying on a commercial airplane, which is pressurized to 10,000 feet, also seems to bring on a migraine. This problem has not been well-studied, though. It isn’t known if this occurs more often on longer or shorter flights.

Many people say they have headaches that are triggered by variations in barometric pressure, such as when there are changes in the weather. In fact, I have talked with a number of patients who swear they can tell when a storm is coming—they always get a migraine!!

Tension-type headache has been known by other names in the past, such as tension headache, muscle contraction headache, stress headache, even sinus headache. We know that there is more contraction in the scalp and neck muscles with migraine than with tension-type headache, and in fact muscle contraction may not be correlated with headache at all. Acute sinus infections can certainly cause head-aches, but chronic sinus inflammation is poorly correlated with headache. Occasional tension-type headache may be triggered by stress, but in its chronic form, TTHA may occur without any obvious relationship to psychological factors.

The chronic tension-type headaches may develop slowly over months to years or start rapidly over hours. Some people awaken one morning with a headache that may last for months or longer. If no underlying cause is identified, these headaches are known as new persistent daily headache or chronic daily headache of sudden onset. Many people with chronic headaches begin to use over-the-counter medications or prescription medications too frequently, actually perpetuating the headache rather than curing it. This is called drug-rebound headache (DRHA).

There are a number of similarities between tension-type headache and migraine. Indeed, it may be hard to differentiate one from the other. Just like migraine, tension-type headache may respond to serotonin-related treatments. As you may know, serotonin is a brain chemical that helps stabilize pain and mood. That is why antidepressants can be used to treat chronic pain and headache.

Your question about the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) does not have a simple answer. NSAIDs work well to alleviate tension-type headache or early migraine, especially when a loading dose (a higher initial dose) is given. Because of their efficacy and relative safety, NSAIDs are becoming available over-the-counter (OTC). These OTC forms are exactly the same as their prescription counterparts except that they are marketed in lower dose formulations. NSAIDs are less likely to cause drug-rebound headache even when taken more than 2-3 days per week. However, many doctors, myself included, believe we have seen cases of drug-rebound headache due to NSAIDs.

Although they are relatively safe when taken as prescribed, patients with chronic headache sometimes take NSAIDs in higher doses or more frequently than recommended by the manufacturer. They should always check with their doctor about doing this, since NSAIDs can cause problems with the digestive tract, kidneys, liver and hearing. These effects are rare when taken in recommended doses. Your doctor may choose to monitor kidney and liver function with blood tests if you require frequent or higher doses of the NSAIDs

The NSAIDs may also have some positive side effects. Certain doses affect platelet clotting to "thin the blood" the way aspirin does when it is given to prevent heart attack or stroke. They may also help with chronic arthritis and with menstrual cramping.

Longer-acting NSAIDs, such as naproxen sodium (Aleve), nabumetone (Relafen), indomethacin slow-release (Indocin SR), flurbiprofen (Ansaid), and ketoprofen (Orudis), which require less frequent dosing, may have fewer side effects during long-term use. These drugs may require 3 or more days to achieve their full benefit. Sensitive digestive tracts may tolerate ibu-profen and naproxen better than some of the other medications. The NSAIDs that come in suppository form, such as indomethacin suppository, may also be better tolerated.

Sherry Siegel, M.D., The Headache Treatment Center of Westchester, New York Medical College, Valhalla, NY.

I don’t remember a time in my life when I didn’t have headaches. Even as a small child, I clearly recall the feeling of a band tightening around my head right above my eyebrows, squeezing inward. I sought quiet, dark places, curled up in a corner or even under a bed, attempting to escape the pain.

I was lucky, though. My parents believed me when I complained of a headache and provided the usual treatment—a cold cloth or cool bath, a darkened room and an aspirin. Many people think that only adults have headaches—that children can’t get them. I’m glad my parents did not hold that opinion.

Conditions that seemed to precipitate my headaches included hot weather, fevers, and glares off windows or water. Glares were the worst. I remember nearly bursting into tears any time a sudden, bright flash of light streaked before me because it usually resulted in a headache. Sentenced to hours of pain, I grew angry at the perpetrator and vowed never to look at that window or that kind of car or truck again. At least in those days, the cool cloth and the aspirin usually worked. In later years, I would have headaches brought on by glares and reflections that lasted for days and days with no relief.

My migraines were formally diagnosed as chronic and hard to manage in late adolescence. The diagnosis caused little stir since I come from a "headache family" on both sides. What differed in my case, though, was that I sought specialized treatment once I was out on my own. Family members felt that the only thing to do for a headache was to take aspirin and wait it out. But I had a general practitioner point out to me that when people have problems with their eyes, they go to eye doctors. If you’ve got a problem with your head, go to a head doctor. His logic made perfect sense to me. But I was apprehensive about seeing a neurologist. I’m sure I harbored a common fear: What if my headaches were really symptoms of a brain tumor? And, both my father’s mother and brother died suddenly of cerebral hemorrhages. Would I be next?

So I had my first appointment with a neurologist in Los Angeles. He assured me, after several diagnostic procedures, that I had neither a brain tumor nor was I a likely candidate for a cerebral hemorrhage. Various medications, both abortive and preventive, were tried with mixed results over the next decade, none long-lasting.

I recall the Cafergot days, the Inderal, the Midrin, and calcium channel blockers, the antidepressants, and the Sansert of my earlier days, most taken while I was in graduate school. I remember calling my doctor in a panic, fearful that I would have to take my comprehensive examinations or defend my dissertation while in the midst of a full-blown migraine. I’m grateful it didn’t happen, but it could have. Many important events in my life were clouded by migraines, including job interviews. I had such a severe headache during one interview that I was certain the panel questioned the accuracy of my resume. Finally, several years later, DHE injections were proposed to me and I can still see myself sitting in my doctor’s office injecting water into an orange trying to muster the courage to inject myself with saline as practice. I mastered the technique and felt that, at least, here was a treatment that offered some relief.

Fast forward to the advent of the triptans after I had relocated to Northern California and had met Dr. Stein at a health fair. Depakote as a preventive worked well for several years and I impatiently awaited the availability of Imitrex. Hailed as the wonder drug for migraines, I was hoping it would be wonderful for me. It was. While I still have frequent headaches and take preventive medications, I know that Imitrex will spare me from day after day of headache pain that finds no solace. It’s been a blessing to me.

For the future? I hope that my head-aches will abandon me, and in the meantime, other preventive and abortive drugs are increasingly being developed. That’s the good news. It gives me hope that someday migraine pain will be a thing of the past. Also, researchers are working on identifying the gene or genes that cause migraine and I’m participating in a genetics study of migraine right now. We migraineurs are finally being taken seriously, and through our experiences we may be able to spare the next generation from that old, familiar pain that we know all too well.