Headache.(Women's Health Adviser)

Headache is the seventh leading reason for physician visits in the United States. Women suffer disproportionately from headache. Migraine, the most debilitating form, affects about four times more women than men--1820 million American women suffer from migraine, making it more common than diabetes, hypertension, or asthma.

Diagnosis. Headaches are either primary (migraine, tension, or cluster) or secondary (related to other disorders). While they can be painful and debilitating, primary headaches are not a medical emergency.

Some symptoms associated with secondary headache can signal a serious condition. The following situations warrant a high index of suspicion: new-onset headache in a patient over 40 years of age or in a patient with a systemic illness; headache that peaks in intensity in seconds to minutes: headache with fever, chills, or neurologic signs; the worst headache in a patient's life; and changes in the character or location of existing headache.

In many patients, migraine appears to be inherited. However, patients can also experience migraine without family history. The etiology is unclear.

In migraine, dilation of the dural blood vessels activates the trigeminal nerve endings, which release neuropeptides such as calcitonin gene-related peptide. Neurogenic inflammation can worsen the pain.

Three questions can help physicians diagnose migraine with great accuracy: Does headache interfere with your daily activities? Do you feel nauseated or vomit when you have a headache? Are you sensitive to light when you have a headache? If the patient answers affirmatively to at least two of these questions, migraine is most likely present.

With migraine, patients complain of throbbing pain, usually occurring on one side of the head. The pain is usually associated with light and/or sound sensitivity, nausea, and vomiting. About 20% will experience aura with the pain: changes ill vision, including seeing spots, lines, or waves, and tingling or numbness in the hands and feet.