The science of headaches | Understanding and managing pain better

There is a need to promote headache science in order to understand and manage pain better, says Founder of World Headache Society, Dr Pravin Thomas

March 01, 2021 10:14 am | Updated March 03, 2021 10:43 am IST

A searing pain around the eye and on one side of the head wakes up Niranjan on most nights. It lasts between 15 minutes to an hour and on some days returns after short periods of respite.

It took Niranjan seven years, multiple doctor visits, a battery of tests and hours of internet research to figure out that he has a condition called cluster headache.

Dr Pravin Thomas

Dr Pravin Thomas

Considered to be one of the worst headaches (affecting one out of 1,000 individuals), it is also called suicide headache. “Some people end their lives because they cannot bear it anymore,” says Dr Pravin Thomas, founder and chairman of the World Headache Society (WHS) and Consultant Neurologist and Chief of Headache Medicine, Basildon and Thurrock University Hospitals, NHS Foundation Trust, UK.

The cluster is apparently one among 300 different types of headaches, based on the classification by the International Headache Society (a London-based organisation that helps people suffering from headaches). The WHS, that promotes headache science through a network of medical practitioners across the globe, has launched a first-of-its-kind certification course in headache medicine in collaboration with the All India Institute of Medical Sciences (AIIMS), New Delhi.

(Dr Pravin, who specialises in pain management, is an Honorary Clinical Teaching Fellow at the Queen Square Institute of Neurology, UCL, UK and a visiting professor at the SVYASA University).

Excerpts from an interview with Pravin Thomas:

Why do we need a certification course in headache medicine?

The World Health Organization and the Global Burden of Diseases mention from time to time, that migraine is not only the most common neurological illness but also the most misdiagnosed and mismanaged condition. The disability of chronic migraine is compared to that of paralysis and schizophrenia. Data from around the world shows headache neurology is a minuscule part of MBBS and Post Graduate syllabus.

The course is meant for MBBS and BDS doctors and soon in the future will also be open to AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy) doctors, specialist nurses, physiotherapists, and clinical pharmacologists.

What are the dangers of self-medication or the excess use of over-the counter-drugs to treat headaches?

It depends on the type of headache. In case of migraine, overuse of painkillers can lead to perpetuation of headaches and chronic migraine. For other types of headache, the danger of over-the-counter medications can lead to missing the diagnosis and may even cost the life of the individual, along with other medication side effects and costs.

What are the most common types of headaches?

The most common type, of course, is migraine. Then there are those which mimic migraine, but are more life-threatening. It is important to diagnose, classify and treat head aches properly.

Headaches are broadly classified as primary — those with normal brain scans and other tests, and secondary — with an abnormality that can account for the headache. A common cause of primary headache is the cluster headache while viral infections, including COVID-19 can cause secondary headaches. This apart, neck and face pain could also be reasons.

Can altering lifestyle/food choices help in preventing/managing headaches?

To some extent, yes, if we are able to control our regular eating and sleeping habits. Certain compounds like monosodium glutamate found as additives in food, or consumption of alcohol can trigger migraines. Some individuals have specific food triggers but more often than not, it is the deviation from the routine that causes headaches. Then there are the uncontrollable factors as well, such as the weather or the work environment. Sometimes slight modifications and adjustments help to contain the trigger.

Does Yoga help in managing headaches?

The traditional way of doing yoga does help to some extent. There is no evidence yet if modern day variants such as power or gym yoga are beneficial. A study done at the AIIMS using a series of yogasanas and breathing practices (Pranayams) found it beneficial when done along with the conventional treatment. There are several wellness practices which have gone into oblivion in many of the countries represented in the World Headache Society. Our aim is to also revive the forgotten wellness practices in other countries and couple them under headache treatment, if found effective.

Are headaches common among children? What should parents do to help them cope?

Headaches are common in children but their symptoms for migraines can be unique and different. They may not actually get a headache but have abdominal pain, vertigo, loss of consciousness and vomiting and are usually made to undergo tests for the alimentary tract. When the tests come negative, unfortunately, they are blamed for malingering their illness out of laziness to go to school. Or it is treated as a psychological problem. It is important to be sensitised about headache syndromes in children so that they do not suffer loss of education and are not subjected to unnecessary tests.

Are women more prone to headaches than men?

Yes, migraine is more common in women. Some headaches are more common in men. Genetics and hormones play a role in some migraines, which account for some of the gender differences.

Pain is subjective. Is there a scale to measure pain? How do doctors quantify pain?

Pain always remains subjective. It is the patient’s experience. It is difficult to quantify experiences like hunger, desire and pain. Assessments are possible but they can never be accurate. A pain perceived as a needle prick may be given a 2/10 severity score by one individual and the same needle prick may be felt as 9/10 by another individual. Tolerance to pain is dependent on genetics and also the environment of the individual and how the individual was moulded.

What are the long-term goals of WHS? With special reference to India?

India and several other countries we represent, are in a stage of transition. We have reached great heights in some fields yet there is a lot to desire for. For instance there are 17,000 neurologists in the USA for a population of 330 million, while there are only 1,200 neurologists in India for a population of 1.3 billion. Therefore there is a huge unmet need for training our clinical workforce in headache neurology so that they can safely and competently practice headache and facial pain management. We aim to educate clinicians and empower patients in all the countries we represent.

Could you tell us a bit more about the headache certification course?

This headache and facial pain certification course is perhaps the first of its kind in the world. It is open to both MBBS and BDS doctors, for a fee of ₹2,000. The fee is expected to cover some of the administrative expenses over 1 year, such as learning management system, webinars, office staff salaries and conduct of written and viva exams. The surplus amount would be donated to charity.

Those in distress or having suicidal tendencies could seek help and counselling by calling 044 24640050

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