Headaches are considered by some to be one of the most frequent complaints, and have been identified as the fifth most common reason for outpatient medical care.1 A study conducted in 1977-1978 indicated that headaches were the 11th most frequent reason for a visit to the doctor.2 It is estimated that one person in three suffers from severe headaches at some point in life.
Most persons afflicted with mild recurrent or isolated headaches do not consult physicians, therefore, the true incidence is unknown. One recent survey demonstrated that in some populations, 70-90 percent of subjects questioned admitted to having at least one headache in the previous year, with a similar incidence reported in children. Another study conducted in Scandinavia indicated that 75 percent of children reported having had significant head pain by 15 years of age.
World-wide, more than 13,000 tons of aspirin are consumed per year, with a major portion utilized for the relief of headache.3
The chiropractic physician must have an understanding of the following areas in order to effectively manage the headache patient:
- Structures in the head which are potential sources of pain
- Where the pain from the pain-sensitive structures is felt
- The sensory tracts which carry the pain information
- Individual mechanisms which may be responsible for the patient's pain
- The structures which may be involved when a patient complains of pain in a given location
In addition to an understanding of the above mentioned areas, the chiropractic physician must also take an adequate history. A complete and detailed history is absolutely necessary in order to establish a diagnosis for patients with headaches, as most patients with headaches will have normal neurological and physical examinations.
1 Complicating the history process is the understanding that many persons afflicted with headaches, especially those with a chronic headache history, will suffer from more than one type of headache.
2 Due to the complexities presented with headache patients, the following summary of essential historical considerations is presented:
2 - How many types of headaches occur?
- When and how did the headaches begin?
- If the headaches are episodic, what is the frequency and periodicity?
- How long does it take for the headache to reach maximum intensity?
- How long does the headache last?
- When does the headache occur?
- What are the factors which precipitate the headache?
- Where does the headache pain start and how does it evolve?
- Is the pain in a deep location or is it near the surface of the skin?
- What is the quality/severity of the pain?
- Are there symptoms that signal the onset of the headache?
- Are there symptoms that accompany the headache?
- What measures increase/decrease the pain?
- Is there a family history of headache?
- Is the patient taking any medications at the present time?
- Who has the patient seen in the past for this condition and why is care being sought now?
- What other health problems does the patient have at the present time?
In subsequent columns, the realm of headache will be explored in more detail. The questions and considerations outlined above will serve as a starting point for the ongoing discussion.
References
- Diamond S, Solomon GD, Freitag FG: Differential diagnosis of headache pain; Tollison CD: Handbook of Chronic Pain Management, Williams and Wilkins, Baltimore, 1989.
- Swanson JW: Cranial and facial pain; Bradley WG, et al: Neurology in Clinical Practice, Vol. l, Butterworth-Heinemann, Boston, 1991.
- Campbell JK, Caselli RJ: Headache and other craniofacial pain; Bradley WG, et al: Neurology in Clinical Practice, Vol. II, Butterworth-Heinemann, Boston, 1991.
- Graham JR, Bana DS: Headache; Aronoff, GM: Evaluation and Treatment of Chronic Pain, Williams and Wilkins, Baltimore, 1992.
Brad McKechnie, DC, DACAN
Pasadena, Texas
