Headaches

Arterial Circulation of the Brain, including Carotid Arteries. (Click image for larger image)

There are four major types of headache: vascular, muscle contraction (tension), traction, and inflammatory. The most common type of vascular headache is a migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, nasuea, and, at times, disturbed vision. Women are more likely than men to have migraine headaches. Other kinds of vascular headaches include "cluster" headaches, which cause repeated episodes of intense pain, and headaches resulting from high blood pressure. Muscle contraction headaches appear to involve the tightening or tensing of facial and neck muscles, while traction and inflammatory headaches are usually symptoms of other disorders, ranging from stroke to sinus infection. Like other types of pain, headaches can serve as warning signals of more serious disorders. This is particularly true for headaches caused by rapidly stretching or rupturing weakened blood vessels (aneurysms), those caused by infection (infectious meningitis) as well as those resulting from diseases of the sinuses, spine, neck, ears, and teeth.

Drug therapy, biofeedback training, stress reduction, and elimination of certain foods from the diet are the most common methods of preventing and controlling migraine and other vascular headaches.

Ongoing research

Research related to headaches is remarkably broad and comprehensive. Ongoing studies involve many scientific disciplines and areas of exploration. Mayo Clinic researchers are studying the numerous kinds of headaches and have made milestone advances in headache research. Some of the ongoing research and their accomplishments are listed below.

Research efforts by David Dodick, M.D., at Mayo Clinic Arizona include the testing of novel compounds for the acute and preventive treatment of migraine and cluster headaches. Dr. Dodick is also involved in basic studies to determine the underlying central nervous system abnormalities involved in the development of chronic daily headache. In collaboration with colleagues in Neurosurgery and Anesthesia/Pain, his team is conducting clinical trials to evaluate the safety and efficacy of peripheral neurostimulation devices for chronic head pain/migraine.

Research advances

Mayo Clinic researchers have made significant progress and discoveries in diagnosis and treatment of headaches. This section contains some of their milestones in conquering this disease.

• Mayo Clinic researchers found that deep brain stimulation (DBS), an advanced surgical treatment only in existence for a decade, could be used to reduce cluster headache occurrences. David Black, M.D., a neurologist at Mayo Clinic Rochester, led the study that shows that while medications remain the mainstay of treatment for patients whose attacks do not respond to medications, DBS may be a well-tolerated option that significantly reduces pain and suffering. The Mayo Clinic team also included neurologist J.D. Bartleson, M.D., Susan M. Torgrimson, and neurosurgeon Dudley Davis, M.D.
• Mayo clinic researchers in Arizona found that patients suffering from chronic migraine headaches who have found no relief through the use of medication may find hope through occipital nerve stimulation (ONS). Their clinical studies show ONS as a safe, effective treatment for chronic headache. More than 32 million Americans, 70 percent of whom are women, suffer from migraines, and many sufferers progress to a chronic condition, experiencing headaches more than 15 days per month. It is estimated that approximately 40,000 people in the U.S. do not respond to existing treatments, and many may be candidates for alternative therapies. The Mayo Clinic study involved 16 patients, 13 of whom where females age 21 to 52. Of the 16 patients, nine underwent bilateral stimulator placement. Patients experienced an average decrease in pain of 54 percent. Six patients had no change or less than 50 percent reduction in pain, eight reported 50 to 95 percent pain relief, and two had complete relief.
• F. Michael Cutrer, M.D., and colleagues in the Headache section at Mayo Clinic Rochester have developed a large searchable database that allows the physicians to assess the outcomes of their treatment. Currently the database registry has over 1,000 members. Registry-based projects currently underway include an analysis of the relationship between changes in migraine and comorbid depression in patients at the Mayo Clinic. In another project, the Headache group is assessing the differences between headache self-report modalities (interval questionnaires versus daily diaries) in migraine patients.
• Utilizing the Headache registry at Mayo Clinic Rochester, Dr. Cutrer and colleagues are currently involved in building a Genomic Library in Migraine. Patients seen in the Headache section who wish to participate are enrolled, and a sample of their DNA is obtained. The detailed clinical information (phenotype) combined with the information from the DNA (genotype) will for the basis of studies look for the genes that underlie the common forms of migraine and which might predict response to treatment.
• In addition, Ivan Garza, M.D., in the Rochester headache group is studying the relationship between sleep patterns and the tendency to develop the severe, chronic form of migraine in a study entitled Chronotypes and the risk for chronic migraine.