When pondering the power of modern technological breakthroughs that shape my practice of medicine, I marvel at our ability to continue to unravel the mysteries of the human machine. However, medical technology, even when infinitely precise, cannot on its own perform the basic task of medicine, that is to alleviate human suffering. As time constraints continue to shorten patient/provider interactions, patients have become dissatisfied with the conventional system of medicine and have begun to seek answers elsewhere.

In The Headache Sourcebook, Paulino and Griffith open the doors of the halls of medicine to their patients. In the process, they clearly and simply reveal what is understood and what mysteries remain to be solved regarding headache pain. However, they do not limit their scope to merely conventional medicine. Treating the whole patient, they delve into mind and body interactions, nonpharmacological interventions, herbal and alternative therapies, and coping methods for chronic conditions.

Great healers are great teachers. They bring a body of knowledge to suffering patients, and offer relief by helping them to understand their disorder. I anticipate that headache sufferers will find Paulino and Griffith's comprehensive analysis invaluable in their trek to manage this poorly understood but extremely common ailment.

Anthony A. Donato, Jr., M.D.
Associate Professor, Department of Medicine
Uniformed Services University of the Health Sciences
Bethesda, Maryland

Between clients, all Emily can think of is rushing home, crawling into bed in her darkened bedroom, and promptly falling asleep. During the past four days, sleep has been her only respite from the grip of a severe, throbbing headache over her left temple that has been almost completely unresponsive to a variety of high-dose painkillers, including extra-strength acetaminophen, naproxen, and ibuprofen. The accompanying nausea is unaffected by a diet of crackers, dry toast, flavored gelatin, and other favorite home remedies. Emily's clients are none the wiser. As a seasoned mental health professional with a long history of unconquered chronic headaches, she has grown adept at concealing any physical expressions that would betray her suffering.

You'd think that Emily would be used to the monthly visitations of vicious headaches by now. After all, this popular psychotherapist has been plagued by menstrual migraines since the summer following her fifteenth birthday. Nineteen years have come and gone and Emily is still helpless when faced with these dreaded head pains that adversely affect her personal, social, and professional life. She misses about twenty days of work each year (over $4,500 in lost wages), was spurned by her high school sweetheart, and regularly turns down invitations to parties -- all because of repeated, disabling headaches. She has put off going to see a physician for an evaluation in hopes that she'd eventually "get used to it." Nearly two decades later, she hasn't. The passage of time has only served to further isolate her in a world of recurrent headache -- a world of despair, anger, anxiety, depression, and loneliness.

But Emily is not alone in her suffering. As a matter of fact, she has plenty of company. The best estimates indicate that between forty and fifty million Americans are affected by tension-type, migraine, cluster, or other forms of chronic or repeated headaches. By contrast, sixteen million Americans suffer from diabetes, thirty-seven million have arthritis, and forty-three million have high blood pressure -- leaving headache the hands-down winner in the contest for most chronic medical conditions afflicting Americans. At any one time, an estimated twenty million people in the United States are experiencing headaches. Worldwide, upward of 93 percent of all men and 99 percent of all women will experience one or more headache episodes during their lifetimes, making headache the most prevalent of all human diseases.

The National Headache Foundation (NHF) estimates that ten million health care visits are made in the United States each year because of head pain. Approximately 2.5 percent of all visits made to emergency rooms annually are for headache complaints. It is the seventh leading "presenting complaint" (primary reason a patient seeks medical care) in ambulatory medical care settings.

Unfortunately, surveys show that for every person who seeks medical care for headaches, about two more don't, due in part to the false assumption that nothing can be done to relieve recurrent headaches. If that's not troubling enough, experts tell us that, of those headache sufferers who seek treatment, nearly 50 percent receive ineffective treatment.

Recurrent headache -- the number one reason for lost productivity in the United States and the biggest reason for disability payments made to American workers -- also costs lots of money to evaluate and treat. According to the NHF, businesses lose a staggering fifty billion dollars annually to absenteeism and payment of medical benefits to headache sufferers. Migraine headaches alone affect twenty-five to thirty million adults and about one million children and cost a whopping eleven billion dollars per year to treat, and incur 157 million lost workdays. Moreover, one out of seven U.S. workers curtails his work activities because of distracting head pain each day. Canadian public health authorities estimate that twenty-seven of one hundred lost workdays are due to migraine headaches, at an annual cost of $500 million. In a 1993 survey of American children with migraines, 10 percent of respondents missed one day of school over a two-week period, and 1 percent missed four days because of headache.

Americans spend an additional four billion dollars annually on over-the-counter headache remedies such as aspirin, acetaminophen, naproxen, ibuprofen, and ketoprofen. Most sufferers have an incomplete understanding of their disease and lack an integrated approach to the management of their head pain. Many take narcotics and other prescription medications with little or no physician oversight. Sadly, in their desperate quest for pain relief, countless chronic headache sufferers become addicted to prescription painkillers -- in effect, trading one distressing problem for another.

These statistics tell the chilling story of a single but far-reaching medical condition with enormous health, social, and economic effects. Is headache "a modern day pestilence," a contemporary disease that came into its own during the twentieth century? As it turns out, it's not. Headache has been around about as long as mankind has. The first-century physician Arateus of Cappadocia in Asia Minor accurately described the migraine headaches that afflicted many of his patients. The modern name migraine is not at all modern; in fact, it's derived from the term hemikrania, meaning "half a head," used by the second-century Greek physician and writer Galen to describe the characteristic one-sided head pain of migraine sufferers (also known as migraineurs). Written accounts from ancient civilizations stretching from Egypt to Sumeria and India tell stories of headache sufferers devastated by their disease. Although our premodern ancestors suffered from the scourge of headaches, however, we don't have to do so.

Recent advances in headache research have uncovered tantalizing clues to the causes of migraine, cluster, and other enigmatic types of headaches. Many novel treatments -- acupuncture, progressive relaxation, elimination diets, aerobic exercise, and drug therapy, among others -- are now available to manage even the most recalcitrant headache. Cutting-edge therapies notwithstanding, the cornerstone of headache management remains self-care with physician guidance.

Headache self-care begins with a thorough education about your headache: what it is, what it isn't, what causes it, how to manage it, and how to conquer it. Reading this book will provide you with the requisite headache education; it contains a comprehensive delineation of migraine, tension-type, cluster, and other forms of chronic headaches that affect adults, adolescents, and children. We'd like to emphasize caution, however. No health care information book, no matter how well written, can take the place of a physician or other health care professional. Your health care provider is the person best qualified to diagnose and guide you in the management of your recurrent headache.

On the other hand, no clinician can be an effective practitioner without a well-informed patient. As Plutarch put it,

Each person ought neither to be unacquainted with the peculiarities of his own pulse (for there are many individual diversities), nor ignorant of any idiosyncrasy which his body has in regard to temperature and dryness, and what things in actual practice have proved to be beneficial or detrimental to it. For a man who has no perception regarding himself is but a blind and deaf tenant in his own body, who gets his knowledge of these matters from another, and must inquire of his physician whether his health is better in summer or winter, whether he can more easily tolerate liquid or solid foods, and whether his pulse is naturally fast or slow. For it is useful and easy for us to know things of this sort, since we have daily experience and association with them.

Good medicine is virtually useless if the patient has an incomplete understanding of her illness. This is especially true when it comes to chronic illnesses such as high blood pressure, diabetes, and recurrent headaches. Author and migraine sufferer Susan L. Burks, drawing on considerable personal experience, writes in her book Managing Your Migraine, "Just as it will benefit you as a headache sufferer to locate a doctor with a special attitude, you'll likewise find it to your advantage to acquire an in-depth knowledge of your own condition."

Our first objective in writing The Headache Sourcebook is to help you become a better-informed patient, which will ultimately allow your health care team to better help you manage your chronic headaches. Another of our main objectives is to help you overcome the communication barrier between health care provider and patient. Recent surveys of patients with chronic illnesses, such as ulcers, arthritis, and asthma, show a widening gap between what a health care team has time to tell patients and what patients need to know about their conditions. This growing "disconnection" stems from time constraints imposed by the new way Americans get their health care. The proliferation of health maintenance organizations (HMOs), preferred provider organizations (PPOs), and other forms of managed-care networks places greater emphasis on seeing larger numbers of patients in less provider hours. What suffers in this new paradigm of health care delivery is the time it takes to fully educate patients. Consequently, persons who want to fully understand the nature of their diseases will have to take the initiative to tap into alternative resources to obtain complete health information. Information dissemination -- via books like this one -- is the only feasible way to close the doctor/patient information gap that seriously threatens to separate patients from their doctors.

Many well-meaning headache books on the market today are filled with the latest headache information, but fail to address this "disconnection" between chronic headache sufferers and their health care teams. Having lots of information is great, but you are still powerless if you don't know how to use it. This headache primer is unique because it will help bridge the widening communication gap between you as patient and your health care provider. We hope that this book, based on the very latest headache information discussed in easy-to-understand terms, will give you a detailed account of the information your health care professional does not have the time to teach you. Additionally, we hope that The Headache Sourcebook will help you formulate the right questions to ask your doctor and other members of your health care team. In this way, you can get the most "bang for your buck" during your visit to your doctor, even if he practices in a managed-care setting. It is our hope that you, your family and friends, your employer, and your health care providers will read this book, use it, and recommend it as a comprehensive guide to eliminate -- or at least reduce -- the frequency and intensity of recurrent headache pain.

The Headache Sourcebook is organized into eighteen chapters, each detailing a specific aspect of recurrent headache pain. We recommend that you read the entire book, even if, for instance, you suffer only migraine headaches and spend most of your time digesting the information in . The and set the tone for the book and will help you fully understand the "big picture" regarding chronic headache before you learn about the details. We suggest that before delving into the heart of the book you browse through the glossary to familiarize yourself with the terminology used throughout the book and that you refer to it thereafter as needed.

discusses the biological basis of head pain and the major classifications of headaches and offers some historical perspective on chronic headache suffering. lists some common myths about headaches held by both the general public and some medical professionals and, by pointing out headache facts, aims to dispel these misconceptions. In , we examine the environmental, dietary, and psychological factors and the social habits and common drugs that can trigger recurrent head pain.

In , we talk about the most prevalent of all headaches, tension-type headache -- its causes, treatment, and prevention. We discuss migraine headache, the second most common type of chronic headache, in , and detail migraine facts, migraine causes, who gets it, and how doctors diagnose and treat it. will give you clear insight into cluster headache suffering, what causes it, and who gets it, and will delineate the state-of-the-art treatments for this enigmatic headache.

In , we provide a full review of the features of mixed headaches and the ways clinicians diagnose and treat them. In and , we discuss the unique features of headache pain among women and children, respectively. We'll show you why headache in women is different from that in men, and why head pain in children is different from that in adults. delineates the common medical conditions, such as sinus infections and high blood pressure, that can cause headache. will inform you about the signs and symptoms that can signal the presence of brain tumors, brain infections, and other life-threatening forms of headaches.

delineates the "Medical Evaluation of the Headache Patient." We'll talk about the most common laboratory tests and X-rays doctors order when evaluating a headache patient. gives you some time-honored tips on working with your health care team and getting the most out of each health care visit. After reading , "Which Practitioners Should Evaluate and Treat Your Headache?" you'll understand the roles of the various medical specialists and alternative medicine practitioners who evaluate patients with recurrent headache. lists the nondrug strategies (such as yoga and biofeedback) you can employ to manage your headache, while , "Headache Drugs," details the myriad drugs used to prevent and to abort chronic head pain.

, "How to Be a Savvy Consumer," will help you avoid becoming the victim of health care fraud. We'll also discuss ways to reduce the cost of your headache medications. Your friends and relatives play crucial roles in helping you rid yourself of your chronic headache, and in we teach them how to support you as you embark on your journey to freedom from headache. We also teach you how to get health care in today's managed-care market. The Epilogue summarizes all the information outlined in The Headache Sourcebook.

At the back of this book, you'll find helpful information such as a list of suggested readings, a comprehensive glossary of headache terms, and a complete list of resources for obtaining further information on chronic headache.

A note on the terminology used throughout this book: The terms clinician, provider, health care practitioner, and health care provider refer to health care professionals who practice medicine in the United States and Canada. These professionals include physicians, physician assistants, and nurse practitioners. Other health professionals who evaluate and treat individuals with headache pain include chiropractors, optometrists, dietitians, pharmacists, psychologists, acupuncturists, and occupational therapists. A physician is the final authority on matters related to chronic headache. Nonphysician providers, such as physician assistants, work in concert with a licensed physician when caring for patients with chronic headache. Therefore, a licensed physician ultimately makes the decisions about your health care.