Migraine
The Headache Detective: Digging for the True Cause Takes Time, Effort
Headaches severe enough to warrant a visit to the doctor affect millions of people every year. In such cases, the old adage “take two aspirin and call me in the morning” simply doesn’t qualify as a valid treatment option. On the other hand, assuming a debilitating headache is a migraine isn’t always an accurate or helpful strategy either.
What, then, is the best course of action?
According to Dr. Ben Taimoorazy of Beverly Hills Migraine and Pain Management Institute, accurate diagnosis and treatment of severe headaches takes a bit of detective work. “To correctly treat a headache, you must first find the origin of the pain,” he states.
Primary headaches, those caused by neurological disorders, include migraine, tension and cluster headaches and are often incorrectly diagnosed and treated. Unfortunately, if the cause of the pain isn’t truly due to a chemical or hormonal imbalance in the nervous system, treating it as if it is won’t make the headaches go away.
“If a patient comes to our office and has been on proper migraine medication without relief, chances are the condition may not even be a migraine,” says Dr. Taimoorazy. Some secondary headaches (those that involve a structural abnormality or disease) mimic the pain of a migraine or other primary headache, making accurate diagnosis difficult. “If the symptoms are similar, we need to look at what else can give rise to similar headache pain.”
“Before deciding on a treatment strategy, it’s important to rule out the almost 300 other potential causes of headaches,” explains Dr. Taimoorazy. Common secondary causes include hormonal imbalances, injuries to the brain or spine, eye injury or disease, and dental issues. Many of his patients with migraine diagnoses did not have migraine at all, which is why their pain was chronic—the true cause was not being treated.
The detective work begins with a complete medical history that should include as much information as possible regarding past illnesses, surgeries, injuries, and anything else that might affect the patient’s physical well-being—including social and vocational information. For example, it helps to know if a person spends most of their work day on the phone and cradles it using the shoulder-to-ear method. That information could be a huge clue about what might be causing headache pain.
Hormonal problems can cause severe headaches, as can whiplash injuries from years ago. Even the most seemingly insignificant event can be a clue to a current headache problem. “A patient may have had a whiplash injury long ago that has lead to arthritis in the cervical spine. This condition can cause headaches that have the same symptoms as migraine,” says Dr. Taimoorazy.
Next is a complete physical exam, which includes not only the head and neck, but also an oral exam for TMJ or other dental problems, examination of the 12 cranial nerves, and looking into the patient’s eyes. “A physical examination is not complete unless I’ve done a fundoscopy, which allows me to see what is going on inside the brain and how that might be affecting the body.” The optic disc should have sharp, clear edges; fuzzy edges indicate issues such as hypertension, diabetes, or excessive pressure buildup—in addition to eye problems associated with the optic nerve. If, proverbially speaking, the eyes are the window to the soul, “the back of the eyes is the window to the brain,” says Dr. Taimoorazy.
Finally, some additional tests may be necessary, including include blood work, examination of the head, neck, and spine utilizing CT scans and MRIs when necessary. When Dr. Taimoorazy puts the information from the exams and history together, he can focus more specifically on the cause of a person’s headache and recommend a course of treatment that will best alleviate the pain.
Solving headache mysteries may involve a lot of detective work, but when the end result allows a patient to live without the pain and frustration of chronic headaches, the effort is well worth the process.
