Headache is a very common condition in the community - it's rare to come across someone who hasn't experienced headache at one time or another. Chronic headache, while less common, is certainly not uncommon. Current estimates state it affects at least 10 per cent of the population.
Dr Richard Sullivan is a Melbourne-based pain medicine specialist who regularly sees patients for headache conditions said such patients often see him "when they suffer headaches for more days then they don't."
"In its more debilitating form chronic migraine, patients experience migraines for 15 days or more per month, and can put people in the situation where they have substantial difficulties functioning day to day. There are people who for example, can't work [because of chronic migraines]," said Dr Sullivan.
Dr Sullivan said migraines affect more women than men, with a contributing factor being genetics, including familial heritability (people with parents who have migraine are also more likely to suffer themselves). Environmental factors can act as triggers and aggravators - certain foods, bright lights, loud noises, strong smells - and some people experience hormonal or menstrual migraines.
"Other forms of chronic headache include persistent daily headache or chronic tension headache which are less debilitating but still have a substantial impact on individuals in terms of quality of life, lost days of work, increased medication use," he said.
Migraines and technology
"The issue of whether technology itself is responsible for increasing headache prevalence, in my opinion, remains a debatable point. At this stage we don't have any strong evidence that changes in IT directly increase chronic headaches. But from the anecdotal perspective from those working in clinical practice, we do seem to see more and more people coming in complaining of headache and its impact on their health and wellbeing is a growing concern," said Dr Sullivan.
"There is a continuum from mild, moderate to the more severe headaches like migraine. Chronic headache can be caused by other medical problems.
"Cervicogenic headache for example is caused by problems in the neck, and the aspects of a modern lifestyle where we are generally more sedentary, our recreational activities are focused around passive forms of entertainment and we have largely desk-based jobs with a greater reliance on the use of technology, we have seen an increase in people with neck and shoulder problems - and that might be an associated cause of the observed increase in chronic headaches."
Dr Sullivan said living lifestyles with reduced activity can make us more susceptible to muscle weakening and posture-related issues.
This combined with extended use of technology devices that can hold us in ergonomically disadvantageous positions, and the performance of repetitive movements in a limited work space, can lead to the development of chronic pain conditions.
"When you have conditions that in the community have a stigma attached to them, and migraine is certainly one of those, then people tend to be quite stoic in their approach to pain, by hiding it and simply coping as best as they can," said Dr Sullivan.
"If your daily headache is occurring more frequently, with greater intensity and it is starting to adversely affect your ability to be yourself then it's worthwhile getting an expert opinion.
"It's important to highlight that there are people with chronic headache conditions who do exceptionally well on medication, but it needs to be prescribed appropriately and should be considered only once all of the relevant life-style factors have been corrected," he said.
Dr Sullivan's initial tips for optimising your lifestyle:
- ensure your workstation is set up ergonomically
- take regular breaks from your work - change tasks, stretch, go for a walk
- ensure adequate sleep, nutrition and exercise (ideally between 100-200 mins per week)
"These relatively simple things make the biggest difference in terms of the impact of pain in people's lives," said Dr Sullivan.
"There are psychological comorbidities that occur in people with chronic pain conditions, principally depression, anxiety and sleep disturbance. Individuals can get into a vicious cycle where each of these conditions can feed into each other - so access to a clinical psychologist is part of a quality treatment plan for those with chronic pain.
"One of the mistakes that people with chronic neck pain in particular make is thinking this can all be solved with the so-called "passive treatments" like soft tissue massage or ultrasound - these approaches can be good for short-term pain relief, but they don't lead to long term improvement in either pain or function. Beneficial exercises could include hydrotherapy, gym work or exercises done at home," he said.
There are more advanced treatment options for those who have tried and failed with the standard approaches. Botox injections, calcitonin gene-related peptide receptor antagonists, and interventional procedures such as neuromodulation (implantable devices for chronic pain) and even neurosurgery are options that have all emerged in recent years as the work on chronic headache continues.
Medical treatment of severe chronic headache should include an opinion from a neurologist or pain specialist with an interest in this area. GPs are well positioned to screen for rare but life-threatening conditions (such as infection, cancer or aneurysm), to recommend starting standard lifestyle approaches and to provide reassurance that the problem is common and treatable. Referral to a specialist will come at the recommendation of the GP.
"Now that we have a better understanding of the causes of chronic headache, and the treatment options have been refined and improved, a lot of sufferers have come forward wanting treatment for a problem that's been affecting them for a long time. So we've seen a potential increase in the presentation of chronic headaches that relate simply to the fact that we're talking more about it, and taking things more seriously," said Dr Sullivan.
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