Catálogo de publicaciones - libros

That so many theories to explain the origins of headache have been advanced and rejected over the centuries indicates both its long enduring impact on society’s health and wellbeing and man’s determination to understand the condition and so rid himself of its burden. Happily, we no longer bore holes into the skulls of headache sufferers so as to release the evil spirits, humors, or vapors accumulated within, and our therapies today are considerably more effective as well as less invasive. The path from “there to here” is a fascinating one; the personalities of the individuals who have shaped headache theory often have been as brilliantly compelling as their theories have been wrong-headed. In this chapter we will trace that path.

While most head pain results from a primary headache disorder such as migraine, at times headache may be a symptom of a more serious, underlying disease. In this chapter, we will explore these “secondary” headaches in some detail, identifying their most common causes and the characteristics of the symptomatology that should compel one to seek immediate or elective medical attention.

The primary headache disorders account for the vast majority of the episodic and chronic head pain that is so pervasive in our society. Unlike the secondary headaches described in the last chapter, these primary headaches do not point towards the presence of serious, underlying disease. Even so, the financial, physical and emotional cost imposed by these disorders is staggering, and it is no exaggeration to state that migraine in particular has been and remains a chronic public health care emergency. In this chapter, we will begin our effort to provide the reader with the education and tools he or she requires to cope more effectively with migraine, the intimate enemy.

For the past two years our increasing knowledge of migraine’s biogenesis has been paralleled by an explosion of new therapies unprecedented in their biologic selectivity and clinical effectiveness. While these medications provide us with a potent arsenal of weaponry for combating migraine, all possess at least some imperfections, and their inappropriate use may make a bad situation worse. In this chapter, we will discuss the issues of acute migraine treatment, prevention of migraine attacks and suppression of chronic migraine, emphasizing the use of medications.

That the mind influences disease prevention and healing is inarguable, and for those skeptics who continue to resist this association there exists abundant “hard science” in its support. If one’s emotional state can influence the ability of individual white blood cells to combat infection, it requires no great leap of faith to perceive that chronic headache and psychological health inextricably are wedded. In this chapter, we will discuss common migraine triggers, the utility of migraine diets, other lifestyle modifications as therapy for migraine, and the use of various other “alternative” therapies for migraine suppression. In addition, we will discuss disorders that are comorbid with migraine, disorders whose existence may influence the clinical expression of migraine and whose successful treatment may improve that expression.

Your initial visit with the doctor represents a crucial step towards securing effective control over your headaches. Even though your headaches may have driven you to the depths of desperation, despair, and neediness, never forget that the management process involves a transaction between two parties that will require your active participation. The physician is not your savior; ideally he or she will serve as a compassionate, informed consultant who will advise you how best to direct your own ongoing headache management. Get this process off on the right foot. In this chapter we will offer suggestions as to how to maximize the benefits obtained from your initial visit. Although headache is endemic in our society and headache sufferers fill the waiting rooms of our clinics and EDs, surprisingly few healthcare providers are proficient in the diagnosis and treatment of headache, and many have a distinct aversion to dealing with headache patients. Your initial visit to the doctor will be far more productive if you arrive for that visit adequately prepared.

As we have emphasized at multiple points thus far in this book, migraine is a disorder that can be controlled— but not cured—and its clinical course is highly variable. While many exceptions occur, migraine tends to subside as we age. Female migraineurs frequently experience worsening of their headache syndrome prior to and during early menopause but then enjoy lessening or even termination of migraine as more years pass. Even so, this course is far from inevitable; even if your sisters, your mother, and your mother’s mother all miraculously ceased having migraine following menopause, this does not ensure you will duplicate their experience. Migraine is by no means a justifiable indication for performing a hysterectomy/ bilateral oophorectomy (removal of uterus and ovaries).

Courses of effective prophylactic therapy should help improve the natural history of your migraine by smoothing out those rough spots wherein you otherwise would suffer frequent or chronic headache. Effective abortive therapy should enable you to minimize the time you spend disabled due to a migraine attack or the side effects of any medication taken.

It is our hope that for you, the individual reader and headache sufferer, the knowledge you gain from this book will lead you to a better understanding of your disorder and its appropriate treatment. Thus empowered and working in tandem with your physician, you may become your own best ally in managing your headaches.