Headache Expert Claims "The Book on Headaches Is Wrong"

In my weekly articles for this page I've made a point of writing about various types of headaches. I'm rethinking the whole issue, though. I recently read an article by David Buchholz, M.D., Associate Professor of Neurology at The Johns Hopkins University School of Medicine, in which he claims nearly all of these headaches are actually a form of migraine.

I had always defined migraine as a one-sided, severe headache, often accompanied by other symptoms, which is why my grandmother called them her "sick headaches." Other types of headaches were caused, I thought, by tension, TMJ syndrome, sinus problems, or something else.

Dr. Buchholz believes that definition is wrong. He says migraine is a mechanism in every person's nervous system which is activated by exceeding a genetically-determined threshold of trigger factors. As with pain in general, some of us have higher thresholds than others. That mechanism sets off changes in blood vessels that result in the many forms of headache pain.

The pain may be severe or mild, episodic or chronic, short or long term, involving the whole head or just part of it, or maybe even down into the neck and upper back. This migraine mechanism also causes other symptoms familiar to migraineurs such as dizziness, numbness and tingling, and difficulty concentrating or saying certain words.

But what about muscle contraction headaches? Dr. Buchholz says that tests using electromyography to measure electrical activity in the muscles showed no increased muscle activity in the neck or scalp during what we call a tension headache. Therefore, it isn't muscle contraction causing the headache, but rather the migraine mechanism.

But what about sinus or TMJ headaches? Since migraine causes blood vessels in the head to become inflamed and swollen, it stands to reason that the vascular rich area of the mucous membranes of the nose and sinuses would feel congested and swollen.

Because people attribute chronic headaches to various causes, they take short term relief medication which sets them up for rebound headaches. (See 3/28/00 article.)

Some trigger factors just can't be avoided, such as your menstrual cycle, weather and other environmental factors, some medications, stress and others. However, we can avoid those triggers that, as Dr. Buchholz says, "you put in your mouth and swallow," i.e. food, drink, and some medication.

He advises patients to discontinue pain relievers, decongestants and all the other quick remedies, and avoid all possible dietary triggers. Weeks later, when the headaches are under control, they can try a few of these items one at a time to see what they can tolerate.

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