For Headaches, A Lifestyle Change May Be Better Than A Doctor Visit

May 11, 2015
Originally published on May 11, 2015 4:07 pm

Terri Bradford has suffered debilitating headaches all her life. Some days the pain is so bad, she says, "By 11 o'clock in the morning, I'm on the couch in a darkened room with my head packed in ice."

Over the years, Bradford, who is 50 years old and lives in Bedford, Mass., has searched desperately for pain relief. She's been to the doctor countless times for countless tests. "Everything I've had, I've had twice," she says. "I've had two spinal taps; I've had so many nerve blocks I've lost count."

Bradford is not alone. It's estimated that every year 12 million Americans go to the doctor seeking help for headaches. Nearly one quarter of the population suffers from recurrent severe tension headaches or migraines.

People who go to the doctor for headaches are increasingly likely to be sent for advanced testing and treatment, a study finds. That testing is expensive, it may not be necessary and it could even be harmful, says lead researcher Dr. John Mafi, of Beth Israel Deaconess Medical Center in Boston.

Mafi looked at the rates of advanced imaging like CT scans and MRIs in people with headaches, as well as referrals to other doctors, presumably specialists. He found that from 1999 to 2010, the number of diagnostic tests rose from 6.7 percent of all doctor visits to 13.9 percent. At the same time, referrals to other doctors increased from 6.9 percent to 13.2 percent. In other words, almost double what it was a decade ago.

Mafi says this isn't because more people are suffering headaches. The headache rate has remained virtually the same over the past decade. But what has changed is supply and demand. Today there are a lot more advanced diagnostic machines than there were a decade ago, and more patients are asking to be tested.

"Patients are more assertive than ever before," Mafi says. "They do research online, are more informed and sometimes go to the doctor demanding, 'I think I need an MRI.' "

And while an informed patient is a good thing, Mafi says sometimes the patient gets it wrong. "I think there's a subconscious perception that more is better, and that fancier, more expensive tests are better and that equals better care."

Mafi's study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies.

On top of that, exposure to radiation in tests like CT scans adds up over time and can increase the risk of certain cancers.

For Terri Bradford, the years of searching for effective treatment proved futile. "I've been to four neurologists. A lot of them have given up on me because I haven't gotten any better," she says.

Eventually Bradford ended up at Beth Israel Deaconess Medical Center, where neurologist Carolyn Bernstein directs the Comprehensive Headache Center. Bernstein says she sees lots of desperate patients like Bradford. "The majority of them have really been suffering a number of years and they're really miserable with the pain," Bernstein says. They say, " 'I hope you have a magic pill,' and of course there is no magic pill."

There is just no single reason why people get chronic headaches, although we do know that migraines have a genetic component and usually a trigger. "If you are a migraine sufferer and I expose you to the right trigger, you're going to have a migraine," Bernstein says.

But the triggers are different for different people. They can include poor diet, too much sugar or certain types of alcohol. Problems sleeping, stress, lack of exercise or a combination of any number of these things can cause chronic headaches.

At the headache center, patients receive a thorough medical history that includes headache patterns, disability and mood assessments. Then the center works with patients to try to identify what triggers their headaches and how they can avoid those triggers in the future.

Some people find relief through exercise. "I write an exercise prescription probably as often as I write a prescription for medication," Bernstein says. She acknowledges it's sometimes difficult to encourage a patient with cracking head pain to get up and exercise. But even a little can help, and according to Bernstein it doesn't have to be jogging for miles and miles. It can be yoga, tai chi or even just a little stretching.

A big lifestyle adjustment worked for Terri Bradford. She started exercising and changed her diet, giving up gluten, dairy and sugar. And she learned how to meditate to reduce stress. All these changes, she says, have made a huge difference. She has far fewer headaches and when she does have them, they're far less severe. "I'm finally healing," she says.


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STEVE INSKEEP, HOST:

Today in Your Health - treating your head. We begin with chronic, debilitating headaches. Twelve million Americans go to the doctor every year for headaches. Many are sent for further expensive testing, which may not bring any relief. NPR's Patti Neighmond has more.

PATTI NEIGHMOND, BYLINE: Terri Bradford knows about headache pain. She's had it all her life, often starting when she wakes up in the morning.

TERRI BRADFORD: And by, like, 11, I'm on the couch for the rest of the day with my head in ice.

NEIGHMOND: Bradford's 50 now, and for years, she's been seeing doctors, trying to figure out how to relieve the pain.

BRADFORD: I've had two spinal taps. I've had so many nerve blocks I've lost count - MRIs, MRAs, Botox.

NEIGHMOND: Bradford's hardly alone. New research shows over the past decade, more and more patients are getting more and more tests and treatments. Dr. John Mafi, with Beth Israel Deaconess Medical Center in Boston, compared what's going on with doctor visits and testing today to what was happening about a decade ago.

JOHN MAFI: Rates of advanced imaging, like CT and MRI studies, referrals to other physicians - presumably specialists - both of those doubled.

NEIGHMOND: Mafi says that's not because more people are suffering from headaches. The headache rate, he says, has remained virtually the same over the past decade. But what's changed is the supply and demand. Today, there's just simply a lot more advanced diagnostic machines than there were 10 years ago, and then there's the demand.

MAFI: Patients are more assertive than ever before, asking more questions. They're more informed. They're reading things online. They're seeing TV commercials about new prescriptions. So they're sometimes coming with a chief complaint of I think I need an MRI.

NEIGHMOND: A better informed patient is generally a good thing, says Mafi, but sometimes patients get it wrong.

MAFI: I think there's a subconscious perception that more is better. More fancy tests, more expensive tests are better and that equals better care.

NEIGHMOND: Now, Mafi's study did not include patients with tumors or other serious problems that can cause headaches. He only looked at otherwise healthy patients who suffered chronic headaches. And in these cases, repeated diagnostic testing can lead to further unnecessary procedures like biopsies. On top of that, exposure to radiation adds up over time and can increase the risk of certain cancers. For Terri Bradford, the years of searching for effective treatment proved futile.

BRADFORD: I've been to four neurologists. A lot of them have given up on me because I haven't gotten any better.

NEIGHMOND: Bradford ended up at Beth Israel Deaconess Medical Center in Boston, where neurologist Carolyn Bernstein directs the headache program.

CAROLYN BERNSTEIN: Patients will come in and say to me, I hope you have the magic pill. Of course, there's no such thing as the magic pill. By the time they come in, the majority of them have really been suffering for a number of years, and they're really miserable with the pain.

NEIGHMOND: And they've undergone many years of extensive, invasive tests. Bernstein says there's just no single reason why people get headaches, either tension headaches or the more severe and recurring migraine.

BERNSTEIN: With migraine, what we know is that it is genetic and that if you're a migraine sufferer and I expose you to the right trigger, you're going to have a migraine.

NEIGHMOND: And complicating things even more, the triggers are different for different people, and it may not be just one thing. It can be a combination of things - a poor diet, problems sleeping, stress or lack of exercise.

BERNSTEIN: I write an exercise prescription probably as often as I write a prescription for medication.

NEIGHMOND: Bernstein says it's difficult to encourage a patient with cracking head pain to get up and exercise. But just a little bit can help, she says, and it doesn't have to be jogging for miles. It can be yoga, tai chi or even just a little stretching. A big lifestyle adjustment worked for Terri Bradford. She started exercising and changed her diet.

BRADFORD: I gave up glutens, and I gave up sugar, which was huge for me, and I gave up dairy.

NEIGHMOND: And physical therapists taught Bradford how to meditate to reduce stress.

BRADFORD: Oh, my gosh, I feel so much better, and not to say that I don't have headaches anymore because I do.

NEIGHMOND: But they're far less debilitating. Bradford hopes the story of her journey to find headache relief might be helpful to other sufferers who may want to look at their diet and lifestyle before heading off to yet another doctor appointment. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright NPR.

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