Headaches and Your Phobia

by Richard C. Raynard, Ph.D.
Licensed Clinical Psychologist

Headaches can be a concern for phobic who are obsessed with bodily changes. Headaches can be brought on by a number of triggers such as stress, alcohol, food additives, medication, among others. There are also several different types of headaches.

Since the physical symptoms of headache can mimic some phobic symptoms, such as nausea, blurring of vision, excessive tear secretion, and exhaustion, we want to take a closer look at the types of headache you get. Knowing the type of headache you usually get helps you learn that you don't have to react to all headache-like symptoms with panic or worry. It can be extremely reassuring to know it is only an average headache requiring well-known remedies.

Sometimes headaches can be caused by a drug or other substance. Confirming a drug as a cause of headache is very difficult because of the fact that headaches come from various sources, including the underlying illness that is being treated by medication. For example, fever does produce widening of the blood vessels and can cause headache. But, because you may be treating the fever with medication, it is difficult to say whether the fever itself or the medication is responsible.

This considered, it is known that drugs that suddenly increase blood pressure can induce headaches. When epinephrine or similar drugs are given, there may be a sudden increase in blood pressure. The amphetamine-like drugs which replace norepinephrine at the nerve endings can cause similar effects. Monoamine Osidase Inhibitors (MAO Inhibitors) when used to treat depression, or persistent headache, can interact with drugs used on the sympathetic nervous system, foods containing tyramine, or alcoholic beverages, and induce a very severe hypertensive crisis, headache, or even stroke in less fortunate individuals. Some people will suffer a severe headache when these drugs are withdrawn abruptly. You may also experience headache due to rapid withdrawal of beta blockers, and rapid rebound hypertension is the cause of the headache.

The excessive consumption of coffee, tea or cola, or the excessive intake of caffeine-containing drugs such as Excedrin or Anacin may result in a throbbing headache caused by widening of the blood vessels. Persons taking an excessive amount of caffeine will need to be slowly tapered off these drugs. Abrupt ending will cause severe headaches.

"Hangover" headache has also been found to be a result of widening of the blood vessels. The pain has often been relieved by caffeine. Using fructose, 30g, in the form of honey, can increase the rate of alcohol metabolism.

Some drugs work directly on the blood vessels in the head and induce the widening which leads to headaches. The most common of these drugs are the nitrates and nitrites, such as those used for cardiac purposes - nitroglycerin, amyl nitrate, etc. Headaches occurring after eating hotdogs and cured meats such as ham and bacon are due to the addition of nitrites to the foods as a preservative. Antibiotics, primarily nalidixic acid, tetracycline, and ampicillin, have also been found to cause headaches. It is also believed that excessive amounts of vitamin A may be a factor. Knowing what common foods can trigger headaches can be helpful if you have a problem with regular or severe headaches.

As you can see, there are a lot of points to consider as a cause of headaches. Once you examine the types of headaches you are having and pinpoint some of the causes, you will be in a better position to make an informed choice about what kind of help or doctor you need. Here is a diagnostic guide to the types of headache:

Migraine
Frequency: Usually no more than 1/wk, 1-2 times per month
Duration: 3 hrs to 3 days (typically 12-18 hours)
Onset: Gradual
Pain Area: Unilateral; may switch sides or become bilateral
Characteristic Pain: Throbbing, moderate to severe
Associated Symptoms: Systemic - usually nausea or vomiting (visual aura in classic, no aura in common)
Signs: Usually none
Triggers: Stress, menstruation, alcohol, food additives
Sex Distribution: 3:1 female

Cluster
Frequency: 1-3 per day
Duration: 30-90 minutes
Onset: Sudden; reaches peak intensity in 1-3 minutes
Pain Area: Unilateral, usually retro-orbital
Characteristic Pain: Steady, severe
Associated Symptoms: Usually none
Signs: Tearing, complete or partial Horner's syndrome
Triggers: Reliably triggered by alcohol
Sex Distribution: 10:1 male

Muscle Contraction
Frequency: 1/wk - virtually continuous
Duration: Usually 8-12 hours
Onset: Gradual
Pain Area: "hatband"
Characteristic Pain: Steady, dull
Associated Symptoms: None
Signs: None
Triggers: Stress
Sex Distribution: Equal

Mass Lesion
Frequency: Varied
Duration: Varied
Onset: Varied, though onset of complaint may have been recent
Pain Area: Unilateral
Characteristic Pain: Varied
Associated Symptoms: Varied
Signs: May be focual neurologic
Triggers: None known
Sex Distribution: Equal

Psychogenic
Frequency: Omnipresent
Duration: Omnipresent
Onset:
Pain Area: Varied, but may be bilateral
Characteristic Pain: Described as severe by patient but without corresponding behavior
Associated Symptoms: Usually none
Signs: None
Triggers: None
Sex Distribution: Equal

Physicians analyze specific criteria in order to differentiate between the types of headache in order to determine appropriate treatment methods. Here is some of the criteria which will be examined:

1) Are headaches of recent onset, or do they represent a change in your typical type of headache?
2) Is there a history of trauma?
3) Do headaches occur in well-defined attacks and are they unilateral?
4) Are headaches related to coitus or other exertion?
5) Is chewing difficult and does it aggravate headache pain?
6) Are you over 40 years of age?
7) Are headaches becoming progressively worse, or are they accompanied by neurologic abnormalities?
8) Do you have excruciating retro-orbital headaches that occur several times a day for about an hour?
9) Are the headaches characterized by nausea and/or vomiting?
10) Are the headaches non-throbbing and generally respond to non-prescription analgesics?
11) Is there pain in your temporal arteries and do one or both tend to roll rather than compress?
12) Are attacks preceded by a scotomatous aura?
13) Do you have sleep problems, constipation, backaches?

If you experience sudden, severe, or atypical headaches, it is recommended that you consult a qualified physician to help determine the type of headaches you are experiencing and get appropriate treatment. If your headaches are "typical" for you, I hope you are able to put your worries to rest and not associate them with your panic or phobia.
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