WHEN STRESS GOES TO OUR HEAD. HEADACHES CAUSES AND THERAPIES
Sometimes, after an intense workweek, we may feel our head pulsating lightly but constantly up to the point of causing prolonged distress. Other times, without apparent reasons, we may start to feel acute signals, like brief but frequent electric sparks coming from one side of our head. Both conditions can often lead to interrupt our work and prevent us from focusing on useful or relaxing activities.
The so-called “headache” is a generic term used to define several kinds of pain to the head. Among headaches, two of the most frequent are migraines and tension-type headaches1. Migraines can last from a few hours to a few days and can generate intense pain to the head, to the stomach and vomiting. Tension-type headache, as the name suggests, is related to muscular tension of various body parts, especially neck and shoulders. This latter kind of headache is the most common among adults and adolescents and is characterized by moderate pain that can last for many days and for many hours a day1,2.
More generally, headaches are caused by painful signals that originate in and interact with brain areas, blood vessels and adjacent nerves. Despite the huge number of studies conducted in the last decades, the cause of these painful signals is still unclear. Broadly speaking, two theories have been proposed: according to the vascular theory, the main cause of headaches is located in the circulatory system. Headaches may be associated to the dilation of blood vessels that could lead to the stimulation of the Trigeminal nerve (or V° cranial nerve), a mixed nerve (composed by both motor and sensory nerves) located around the skull3. The neurogenic theory, on the other hand, implies that some nervous alterations (inappropriate activations of specific neuron groups) may cause the inflammation of blood vessels and the consequent stimulation of cranial nerves because of the production of algogens (substances that can produce painful sensations). This hypothesis states that the cause of headaches is primarily neural instead of vascular4.
Despite the fact that the causes of these headaches are related to neurobiology and personal susceptibility, we have to consider how the environment, along with other psychological conditions, can constitute a “trigger” for the insurgence of headaches. The association between depressive symptoms and headaches, in fact, has now been ascertained5. More specifically, in a study conducted on 116 participants suffering from major depressive disorder (a depression which is persistent for many days and for the most part of the day), researchers demonstrated that these patients feel an increase in perceived pain during depressive attacks. More recently, more than 50.000 patients suffering from migraine and other kinds of headaches participated to a study aiming to demonstrate the association of these kinds of pain with other psychological disorders. The study showed that depression and anxiety are significantly associated with several kinds of headaches. Furthermore, this association resulted stronger for anxiety disorders6. Emotional and physical stress, in fact, represents one of the most important risk factors for migraines7 and tension-type headaches8.
Regarding headache treatment we can differentiate pharmacological therapies from psychological and educational therapies. Anti-inflammatories and triptans (vasoconstriction-inducing drugs that reduce the irritation caused by the dilation of blood vessels)8,9 are usually prescribed for migraines and tension-type headaches. The problem is that these drugs have several contraindications especially when used together with other drugs such as antidepressants. That’s why it is necessary to consider different therapies in the treatment of headaches. In a recent study conducted by a research team from Turin, more than 900 people participated in a training program to alleviate tension-type headaches (with concomitant cervical and shoulder pain) and to induce relaxation. The exercises, consisting in simple, repetitive movements that had to be executed 2-3 times a-day for 6 months, lead to a 40% reduction in headache frequency. These results were stable even at a 12-month follow-up11. Furthermore, it seems that the role of therapies aiming to psycho-physical relaxation can be fundamental in the treatment of headaches. A study conducted on 147 patients suffering from headache focused on the use of specific relaxation methods aiming to reduce negative sensations related to stressful events. The study showed a significant headache reduction after only 4 weeks of treatment12. In summary, careful control of our every day’s stressful factors definitely represents both a chance to treat and to prevent headaches (prevention is often forgotten or considered secondary to treatment). That’s why psychotherapy and hypnotherapy can constitute a valid help in the treatment of headaches.
Bibliography
[1] “The International Classification of Headache Disorders: 2nd edition.” Cephalalgia: an international journal of headache 24 Suppl 1 (2004): 9–160.
[2] Evans, R W. “Diagnostic testing for the evaluation of headaches.” Neurologic clinics 14, no. 1 (February 1996): 1–26.
[3] Shevel, Elliot. “The extracranial vascular theory of migraine--a great story confirmed by the facts.” Headache 51, no. 3 (March 2011): 409–417. doi:10.1111/j.1526-4610.2011.01844.x.
[4] Eggers, A.E. “New Neural Theory of Migraine.” Medical Hypotheses 56, no. 3 (March 2001): 360–363. doi:10.1054/mehy.2000.1214.
[5] Garvey, M J, C B Schaffer, and V B Tuason. “Relationship of headaches to depression.” The British journal of psychiatry: the journal of mental science 143 (December 1983): 544–547.
[6] Zwart, J.-A., G. Dyb, K. Hagen, K. J. Ødegård, A. A. Dahl, G. Bovim, and L. J. Stovner. “Depression and Anxiety Disorders Associated with Headache Frequency. The Nord-Trøndelag Health Study.” European Journal of Neurology 10, no. 2 (2003): 147–152. doi:10.1046/j.1468-1331.2003.00551.x.
[7] Robbins, Lawrence. “Precipitating Factors in Migraine: A Retrospective Review of 494 Patients.” Headache: The Journal of Head and Face Pain 34, no. 4 (1994): 214–216. doi:10.1111/j.1526-4610.1994.hed3404214.x.
[8] Holm, Jeffrey E., Kenneth A. Holroyd, Karl G. Hursey, and Donald B. Penzien. “The Role of Stress in Recurrent Tension Headache.” Headache: The Journal of Head and Face Pain 26, no. 4 (1986): 160–167. doi:10.1111/j.1526-4610.1986.hed2604160.x.
The so-called “headache” is a generic term used to define several kinds of pain to the head. Among headaches, two of the most frequent are migraines and tension-type headaches1. Migraines can last from a few hours to a few days and can generate intense pain to the head, to the stomach and vomiting. Tension-type headache, as the name suggests, is related to muscular tension of various body parts, especially neck and shoulders. This latter kind of headache is the most common among adults and adolescents and is characterized by moderate pain that can last for many days and for many hours a day1,2.
More generally, headaches are caused by painful signals that originate in and interact with brain areas, blood vessels and adjacent nerves. Despite the huge number of studies conducted in the last decades, the cause of these painful signals is still unclear. Broadly speaking, two theories have been proposed: according to the vascular theory, the main cause of headaches is located in the circulatory system. Headaches may be associated to the dilation of blood vessels that could lead to the stimulation of the Trigeminal nerve (or V° cranial nerve), a mixed nerve (composed by both motor and sensory nerves) located around the skull3. The neurogenic theory, on the other hand, implies that some nervous alterations (inappropriate activations of specific neuron groups) may cause the inflammation of blood vessels and the consequent stimulation of cranial nerves because of the production of algogens (substances that can produce painful sensations). This hypothesis states that the cause of headaches is primarily neural instead of vascular4.
Despite the fact that the causes of these headaches are related to neurobiology and personal susceptibility, we have to consider how the environment, along with other psychological conditions, can constitute a “trigger” for the insurgence of headaches. The association between depressive symptoms and headaches, in fact, has now been ascertained5. More specifically, in a study conducted on 116 participants suffering from major depressive disorder (a depression which is persistent for many days and for the most part of the day), researchers demonstrated that these patients feel an increase in perceived pain during depressive attacks. More recently, more than 50.000 patients suffering from migraine and other kinds of headaches participated to a study aiming to demonstrate the association of these kinds of pain with other psychological disorders. The study showed that depression and anxiety are significantly associated with several kinds of headaches. Furthermore, this association resulted stronger for anxiety disorders6. Emotional and physical stress, in fact, represents one of the most important risk factors for migraines7 and tension-type headaches8.
Regarding headache treatment we can differentiate pharmacological therapies from psychological and educational therapies. Anti-inflammatories and triptans (vasoconstriction-inducing drugs that reduce the irritation caused by the dilation of blood vessels)8,9 are usually prescribed for migraines and tension-type headaches. The problem is that these drugs have several contraindications especially when used together with other drugs such as antidepressants. That’s why it is necessary to consider different therapies in the treatment of headaches. In a recent study conducted by a research team from Turin, more than 900 people participated in a training program to alleviate tension-type headaches (with concomitant cervical and shoulder pain) and to induce relaxation. The exercises, consisting in simple, repetitive movements that had to be executed 2-3 times a-day for 6 months, lead to a 40% reduction in headache frequency. These results were stable even at a 12-month follow-up11. Furthermore, it seems that the role of therapies aiming to psycho-physical relaxation can be fundamental in the treatment of headaches. A study conducted on 147 patients suffering from headache focused on the use of specific relaxation methods aiming to reduce negative sensations related to stressful events. The study showed a significant headache reduction after only 4 weeks of treatment12. In summary, careful control of our every day’s stressful factors definitely represents both a chance to treat and to prevent headaches (prevention is often forgotten or considered secondary to treatment). That’s why psychotherapy and hypnotherapy can constitute a valid help in the treatment of headaches.
Bibliography
[1] “The International Classification of Headache Disorders: 2nd edition.” Cephalalgia: an international journal of headache 24 Suppl 1 (2004): 9–160.
[2] Evans, R W. “Diagnostic testing for the evaluation of headaches.” Neurologic clinics 14, no. 1 (February 1996): 1–26.
[3] Shevel, Elliot. “The extracranial vascular theory of migraine--a great story confirmed by the facts.” Headache 51, no. 3 (March 2011): 409–417. doi:10.1111/j.1526-4610.2011.01844.x.
[4] Eggers, A.E. “New Neural Theory of Migraine.” Medical Hypotheses 56, no. 3 (March 2001): 360–363. doi:10.1054/mehy.2000.1214.
[5] Garvey, M J, C B Schaffer, and V B Tuason. “Relationship of headaches to depression.” The British journal of psychiatry: the journal of mental science 143 (December 1983): 544–547.
[6] Zwart, J.-A., G. Dyb, K. Hagen, K. J. Ødegård, A. A. Dahl, G. Bovim, and L. J. Stovner. “Depression and Anxiety Disorders Associated with Headache Frequency. The Nord-Trøndelag Health Study.” European Journal of Neurology 10, no. 2 (2003): 147–152. doi:10.1046/j.1468-1331.2003.00551.x.
[7] Robbins, Lawrence. “Precipitating Factors in Migraine: A Retrospective Review of 494 Patients.” Headache: The Journal of Head and Face Pain 34, no. 4 (1994): 214–216. doi:10.1111/j.1526-4610.1994.hed3404214.x.
[8] Holm, Jeffrey E., Kenneth A. Holroyd, Karl G. Hursey, and Donald B. Penzien. “The Role of Stress in Recurrent Tension Headache.” Headache: The Journal of Head and Face Pain 26, no. 4 (1986): 160–167. doi:10.1111/j.1526-4610.1986.hed2604160.x.
