Arthur L. Rudo, 32, K.C.C.H.
Westminster, Maryland

Few appreciate the true extent of suffering endured by millions of headache patients.

Headaches afflict thousands of Masons and millions of other Americans. It is easy to find articles in magazines and textbooks describing the classification of headaches--what characterizes “migraine” headaches versus “cluster” headaches and so on. However, no one ever tells the story of headaches the way they really are.

There are lots of people who can honestly say they have never had a headache; they just have no idea what one feels like. Unfortunately, these individuals are in the minority. Statistics show that most people do have headaches with a certain regularity and that, in fact, there are millions who have seriously painful migraines. “Headache” is among the top five complaints for which people see a physician. With that information in hand, let me tell you a surprising fact: I graduated from the Johns Hopkins University School of Medicine, and in my four years of education there was not one course, not one lecture, not one minute of instruction devoted to the evaluation and management of the patient suffering from headaches. The net result of this oversight/omission in training is that very few doctors know how to handle this multitude of headache-suffering patients.

People go to their family doctor, pediatrician, or gynecologist complaining of headaches only to make their doctor incredibly uncomfortable as to what to do. Usually a CAT scan or MRI of the head is ordered--the approach being that at least a brain tumor will not be missed. For lack of a better understanding as to the problem, the doctor usually tells the patient he has chronic “sinus headaches,” treats the patient with antibiotics and a decongestant, and sends him on his way. The truth of the matter is that chronic sinus headaches are quite rare, and the majority of patients so classified actually suffer from a form of migraine headache.

If the patient decides to pursue his unresolved problem, he may wind up in the office of a neurologist, and the result often is not much more beneficial. The neurologist will likely perform various (unproductive) tests like electroencephalograms and pronounce the patient free of any “serious” headache problems. Thus, the patient remains stricken with headaches without any sound treatment plan--comforted only by the pronouncement that these headaches are not going to kill him and that they do not represent a symptom of any other medical/neurological problem.

Society in general still does not appreciate the true extent of suffering endured by these millions of patients. The average parent to this day thinks that the child repeatedly complaining of headaches is simply trying to avoid schoolwork or the like. In fact, over 20 percent of migraine sufferers have their first attack before age 12, and serious headaches do occur frequently in the elementary-school-age population. In the general population, there remains a total misconception as to the overwhelming severity of this condition. If you ask the average citizen--let alone the average doctor--if anyone can suffer from a constant daily headache for years, the answer will be that that is impossible. How wrong this is! There are people in every walk of life who have constant headaches and just learn to live with them. Even more incredible, but true, is the fact there are people who suffer from debilitating migraine headaches on a daily basis for which no medication is effective. They cannot work, their family life is devastated, they cannot go out for a normal day’s activity. The resulting severe depression often becomes overwhelming. These are people (and they are not malingerers; to the contrary, they usually have type A, perfectionist personalities) whose very lives are destroyed in their prime years by incredibly severe headaches. Fortunately, such people represent only a small fraction of the average headache population, but the very fact that these patients exist is totally unknown and unappreciated by our society.

Underlying much of this predicament is the fact that treating the headache patient is a very difficult task. I know of almost no other commonly encountered benign entity in medical practice which is so disabling and, at the same time, for which there is no cure. We now understand that the mechanism of migraine headaches involves neuro- transmitters in the brain delivering unbalanced signals to the rest of the brain and surrounding blood vessels. But why this happens and how this malfunctioning thermostat in the brain is inherited, goes beyond our comprehension. The net result is a huge population of patients with a chronically recurring medical problem that is poorly understood, requiring multiple visits to achieve proper treatment, and necessitating a doctor willing and able to field countless phone calls from exasperated patients. Thus the specialty of Headache Doctor (for lack of a more medical term) has come into existence. There is a group of concerned and dedicated physicians who have taken special post-graduate courses to learn how to treat this very difficult population.

Many headache patients suffer in silence. Appropriate treatment with the proper medication, however, can remedy or relieve symptoms in the vast majority of cases. Fortunately, for the first time in history, we have access to qualified Headache Specialists.

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