HEADACHE: THE MOST USEFUL PAIN IN THE WORLD

Greatness always has its penalties. Other ills besides death love a shining mark. Pain is one of them, and headache its best exemplar. If there be one thing about our bodies of which we are peculiarly and inordinately proud it is that expanded brain-bulb which we call the head. Yet it aches oftener than all the rest of us put together. Headache is the commonest of all pains, which fact gives the slight consolation that everybody can sympathize with you when you have it. One touch of headache makes the whole world kin, and the man or woman who has never had it would be looked upon as a creature abnormal and “a thing apart.” It has even become incorporated into our social fabric as one of the sacred institutions of the game of polite society. How could we possibly protect ourselves against our instructors in youth and our would-be friends in later life if there were no such words as “a severe headache”?

What is a headache, and why does it ache the head? This is a wide and hotly disputed problem. But one fact, which is obvious at the first intelligent glance, becomes clearer and more important with deeper study, and that is that it is not the fault of the head. When the head aches, it is, nine times out of ten, simply doing a combination of scapegoat and fire-alarm duty for the rest of the body. Just as the brain is the servant of the body, rather than its master, so the devoted head meekly offers itself as a sort of vicarious atonement for the sins of the entire body. It is the eloquent spokesman of such “mute, inglorious Miltons” as the stomach, the liver, the muscles, and the heart. The humblest and least distinguished of all the organs of the body can order the lordly head to ache for it, and the head has no alternative but to obey.

To discuss the cause of headaches is like discussing the cause of the human species. It is one of the commonest facts of every-day observation, and can be demonstrated almost at will, that any one of a hundred different causes,-a stuffy room, a broken night’s sleep, a troublesome letter, a few extra hours of work, eating something that disagrees, a cold, a glare of light in the eyes,-any and all of these may bring on a headache. The problem of avoiding headaches is the problem of the whole conduct of life.

Two or three broad generalizations, however, can be made from the confused and enormous mass of data at our disposal, which are of both philosophic interest and practical value. One of these is that, while headache is felt in the head, and particularly in those regions that lie over the brain, the brain has comparatively little to do with the pain. Headache is neither a mark of intellectuality, nor, with rare exceptions, a sign of cerebral disturbance. Indeed, it is far more a matter of the digestion, the muscles, and the ductless glands, than it is of the brain, or even of the nervous system. It is, therefore, idle to endeavor either to treat or try to prevent it by measures directed to the head, the brain, or even the nervous system as such.

Secondly, it is coming to be more and more clearly recognized that, while its causes are legion, a very large percentage of these practically and eventually operate by producing a toxic, or poisoned, condition of the blood, which, circulating through certain delicate and sensitive nerve-strands in the head and face, give rise to the sensation of pain.

Thirdly, the tissues which give out this pain-cry under the torture of the toxins in the blood are, in a large majority of cases, neither the brain, nor the nerves of the eye, nor other special senses, but the nerves of common sensation which supply the face, the scalp, and the structures of the head generally, most of them derived from one great pair of nerve-trunks, the so-called Trigeminus, or fifth pair of cranial nerves. Strange as it may seem, the brain substance is comparatively insensitive to pain, and the acutest pain of an operation upon it, such as for the removal of a tumor, is over when the skin and scalp have been cut through. These poisons, of course, go all over the body, wherever the circulation goes, but they produce their promptest and loudest pain outcry, so to speak, in the region where the nerves are most exquisitely sensitive. When your head aches, nine times out of ten your whole body is suffering, but other regions of it are not able to express themselves so promptly and so clearly.

These newer and clearer views of the nature of headache dispose at once of some of the most time-honored controversies in regard to its nature. In my student-days one of the most hotly debated problems in medicine was as to whether headaches were due to lack of blood (anæmia) or excess of blood (hyperaemia) in the brain. Few things could have been more natural for both the sufferer in, and the observer of, a case of throbbing, bursting headache, where every pulse-beat is registered as a thrill of agony, than to draw the conclusion that the pain was due to a huge engorgement and swelling of the brain with blood, resulting in agonizing pressure against its rigid, bony skull-walls.

One of the most naïve and vivid illustrations of this conception of headache is the remedy adopted for generations past, in this all too familiar and distressing condition, by the Irish peasantry. It consists of a band or strip of tough cloth, or better, of twisted or plaited straw, which is tied around the head and then tightened vigorously by means of a stick inserted tourniquet fashion. This is believed to prevent the head, which is aching “fit to split,” from actually bursting open, and is considered a cure of wondrous merit through many a countryside. Ludicrous as is the reason which is gravely assigned for its use, it does, in some cases, greatly relieve the pain, a fact which we were entirely at a loss to account for until our later knowledge showed us that the pain, instead of being inside the skull, was outside of it in the sensitive nerves supplying the scalp. By steady pressure of this sort upon the trunks of these nerves, pressing them against the bone, they can be gradually numbed into a condition of anæsthesia, when naturally the pain would diminish.

In politer circles a similar misapprehension has also given rise to a favorite form of treatment. That is the application of cold in the form of the classic wet cloth sprinkled with eau de Cologne. The mere mention of headache calls up in the minds of most of us memories of a darkened room, a pale face on the pillow with a ghastly bandage over the eyes, and a pervading smell of eau de Cologne. It was a perfectly natural conclusion that, because the head throbbed and felt hot and bursting, there must be some inflammation, or at least congestion, present, and that the application of cold would relieve this. The results seemed to justify this belief, for in many cases the sense of coolness to the aching head gives great relief; but this is apt to be only temporary, and in really severe cases makes the situation worse by adding another depressing influence-cold-to the toxin-burdens that are weighing upon the tortured nerves. The chief virtue in these cold cloths and handkerchiefs soaked in cologne was that you were compelled to lie down and keep perfectly still in order to keep them on, while at the same time they mechanically blindfolded you. Few better devices for automatically insuring that absolute rest, which is the best and only rational cure for a headache, have ever been invented.

We were not long in discovering that headaches, both of the mildest and the severest types, might be accompanied either by a rush of blood to the head, with flushing of the skin, reddening of the eyes, and a bursting sense of oppression in the head, or, on the other hand, by an absolute draining of the whole floating surplus of the blood into the so-called “abdominal pool,” the huge network of vessels supplying the digestive organs, which, when distended, will contain nearly two-thirds of the entire blood of the body, leaving the face blanched, the eyes white and staring, and the brain so nearly emptied of blood as to cause loss of consciousness or swooning. Other headaches, again, will be accompanied by a fresh, natural color and a perfectly normal and healthy distribution of the blood-supply. In short, the amount of blood in the head, whether plus or minus, has practically nothing to do with the pain, but depends solely upon the effect of the poisons producing it upon the heart and great blood-vessels.

A good illustration of the full-blooded type of headache is that which so very frequently, indeed almost invariably, occurs in the early stage of a fever or other acute infection, such as typhoid, pneumonia, or blood-poisoning, Here the face is red, the eyes are bloodshot and abnormally bright, the pulse is rapid and full, the headache so severe as to become the first disabling symptom in the disease,-all because this is the effect of the poison (toxin) of the disease upon the heart, the temperature, and the surface blood-vessels. Fortunately for the sufferer, this head-pain, like most others in the course of severe infections, is only preliminary, for as soon as the tissues of the body have become thoroughly saturated with the toxins, the nerves become dulled and semi-narcotized, so that they no longer respond with the pain-cry. As the patient settles down into the depression and dullness of the regular course of the fever, the headache usually subsides into little more than a sense of heaviness, or oppression and vague discomfort.

Moral: It is a sign of health to be able to feel a headache, an indication that your body is still fighting vigorously against the enemy, whether traitor within or foe without.

On the other hand, many of our most agonizing, and particularly our most persistent and obstinate headaches, occur in individuals who are markedly anæmic, with a low, weak pulse, poor circulation, blanched lips, and dull, lackluster eyes. The one and only thing in common between these two classes of “head-achers” is that their blood and tissues are loaded with poisons. Whether produced by invading germs or by starvation and malnutrition of the body-tissues makes no difference to the headache nerves. Their business, like good watchdogs, is to bark every time they smell danger of any sort, whether it be bears or book-agents. One of the most valuable services rendered us by our priceless heads is aching.

This view of the nature of headache explains at once why it is so extraordinarily frequent and so extraordinarily varied in causation. It is not too much to say that any influence that injuriously affects the body may cause a headache. It would, of course, be idle even to attempt to enumerate the different causes and kinds of this pain, as it would involve a review of the entire environment of the human species, internal and external. It makes not the slightest difference how the poison gets into the blood, or where it starts. A piece of tainted meat or a salad made from spoiled tomatoes will produce a headache just as promptly and effectively as an over-exposure to the July sun or an attack of influenza. It is even practically impossible to pick out from such a wealth of origins two or three, or even a score of, conditions which are the most frequent, most important, or the most interesting causes. The most exasperating thing about dealing with a headache is that we never know, until its history has been most carefully examined, whether we have to do with a mere temporary expression of discomfort and unbalance, due to overfatigue, errors in diet, a stuffy room, lack of exercise, or what-not, which can be promptly relieved by removing the cause; or whether we have to deal with the first symptoms of a dangerous fever, the beginning of a nervous breakdown, or an early warning of some grave trouble in kidneys, liver, or heart.

The one thing, however, that stands out clearly is that headache always means something; that it should be promptly and thoroughly investigated with a view to finding and removing the cause,-never as something which is to be cured as quickly as possible, as the police cure social discontent, by clubbing it over the head, with some narcotic or other symptom-smotherer. Nor should it be regarded as a malady so trifling that it is best treated with contempt, and still less as a mere “thorn in the flesh,” whose ignoring is to be counted a virtue, or whose patient endurance without sign a mark of saintship. Martyrdom is magnificent when it is necessary, but many forms of it are sheer stupidity. Don’t either gulp down some capsule, or “grin and bear it.” Look for the cause. The more trivial it is, the easier it will be to discover and remove before serious harm has been done. The less easy you find it to put your finger upon it, the more likely it is to be serious or chronic, and the more necessary it is to remove it.

Once, however, we have clearly recognized that no headache should be treated too lightly or indifferently, it may be frankly admitted that practically the vast majority of headaches in which we are keenly interested-that is, the kind that we individually or the members of our family habitually indulge in-do form a moderately uniform class among the hundreds of varieties, and are in the main due to some six or seven great groups of causes. We have learned by repeated and unpleasant experience that they are very apt to “come on” in about a certain way, after a certain set of circumstances; that they last about so long, that they are made worse by such and such things, that they are helped by other things, and that they generally get better after a good night’s sleep.

One of the commonest causes of this group of recurrent and self-limited headaches is fatigue, whether bodily, mental, or emotional. This was long an apparent stumbling-block in the way of a poison theory of headache, but now it is one of its best illustrations. Physiologists years ago discovered that what produced not merely the sensation but also the fact of fatigue, or tiredness, was the accumulation in the muscles or nerves of the waste-products of their own activities. Simply washing these out with a salt solution would start the utterly fatigued muscle contracting again, without any fresh nourishment or even period for rest. It has become an axiom with physiologists that fatigue is simply a form of self-poisoning, or, as they sonorously phrase it, autointoxication. One of the reasons why we are so easily fatigued when we are already ill, or, as we say, “out of sorts,” is that our tissues are already so saturated with waste-products or other poisons that the slightest addition of the fatigue poisons is enough to overwhelm them. This also explains why our pet variety of headache, which we may have clearly recognized to be due to overwork or overstrain of some sort, whether with eye, brain, or muscles, is so much more easily brought on by such comparatively small amounts of over-exertion whenever we are already below par and out of sorts. People who are “born tired,” who are neurasthenic and easily fatigued and “ached,” are probably in a chronic state of self-poisoning due to some defect in their body-chemistry. Further, the somewhat greater frequency and acuteness of headache in brain workers-although the difference between them and muscle workers in this regard has been exaggerated-is probably due in part to the greater sensitiveness of their nerves; but more so to the curious fact, discovered in careful experiments upon the nervous system, that the fatigue products of the nerve-cells are the deadliest and most powerful poisons produced in the body. Hence some brain workers can work only a few half-hours a day, or even minutes at a time; for instance, Darwin, Spencer, and Descartes.

A very frequent cause of these habitual headaches, really a subdivision of the great fatigue group, is eye-strain. This is due to an abnormal or imperfect shape of the eye, which is usually present from birth. Hence, the only possible way of correcting it is by the addition to the imperfect eye of carefully fitted lenses or spectacles which will neutralize this mechanical defect. To put it very roughly, if the eye is too flat to bring the light-rays to a focus upon the retina, which is far the commonest condition (the well-known “long sight,” or hyperopia), we put a plus or bulging glass before the eye and thus correct its shape. But if the eye is too round and bulging, producing the familiar “short sight,” or myopia, we put a minus or concave lens before the eye, and thus bring it back to the normal. By a curious paradox, however, it often happens that the headache due to eye-strain is caused not by the grosser defects, such as interfere with vision so seriously as absolutely to demand the wearing of glasses to see decently, but from slighter and more irregular degrees and kinds of misshapenness in the eye, most of which fall under the well-known heading of astigmatism. These interfere only slightly with vision, but keep the eye perpetually on the strain, on a twist, as it were, rasping the entire nervous system into a state of chronic irritation. Our motto now, in all cases of chronic headache, is, first examine the patient’s habits of life, next his eyes.

Many forms of headache are really stomach-ache in disguise, due to digestive disturbances, the absorption of poisons from the food-tube, whether from tainted, spoiled, or decayed foods, as in the now familiar ptomaine poisoning, or from imperfect processes of digestion. The immediate effect, however, of diet in the causation of headache is not so great as we once believed. We have no adequate basis for believing that any particular kinds or amounts of food are especially likely to produce either headache or what we might call the headache habit, except in so far as they upset the digestion. In a certain number of susceptible individuals, however, it will be found that some particular kind of food, often perfectly wholesome and harmless in itself, will bring on an attack of headache whenever it is indulged in. Very frequently the disturbances of digestion which are put down as the cause of a headache are only symptoms of some general constitutional lack of balance, as eye-strain or neurasthenia, which is the cause of both these discomforts. Far fewer headaches can be cured by dieting than we at one time believed, and underfeeding is a more frequent cause than overeating.

By an odd bouleversement the one type of headache which we have almost unanimously in the past attributed to digestive disturbances, the famous, or, rather, infamous, “sick headache,” is now known to have little or nothing to do with the stomach in its origin. In fact, incredible as it may seem at first sight, it is the headache that causes the sickness, not the sickness the headache. Stop the pain of a sick headache in the early stage, and the sickness will never develop at all. The vomiting of sick headache is an interesting illustration of vomiting due to disturbances of the brain and nervous system, technically known as central vomiting. Another illustration is the vomiting of seasickness, due solely to dizziness from the gross contradiction between the testimony of our eyes and of the balancing canals in the inner ear. The stomach or its contents has no more to do with seasickness than the water in a pump has with the plunger. Injuries to the head will bring on severe and uncontrollable vomiting, and the severer type of fevers is very frequently ushered in by this curious sign. As to what it means, we are as yet utterly in the dark, for in none of these conditions does the process do the slightest good, but simply adds to the discomfort of the situation. It would appear to be a curious echo of ancestral times, when the animal was pretty much all stomach, and hence emptying that organ would probably relieve two-thirds of his discomforts. Whatever the explanation, the fact remains that whenever our nervous system gets about so panic-stricken, it promptly begins throwing its cargo overboard, in the blind hope that this may somehow relieve the situation. The bile that we bring up at the end of these interesting acrobatic performances and which makes us feel so much better,-because we have now got the cause of the trouble out of our system,-is simply due to the prolonged vomiting, which has reversed the normal current and caused the perfectly healthy bile from our unoffending liver to pass upward into the stomach, instead of downward into the bowels.

In another great group of headaches natural poisons or waste-products are not burned up or got rid of through the body-sewers and pores as rapidly as they should be; for instance, the familiar headache from sitting too long in a stuffy room. Your well-known and well-earned discomfort is, of course, due in part to the irritating and often poisonous gases, dust, and bacteria, which are present in the air of an unventilated room; but it is also due to the steady piling up of the waste products of your own tissues. These poisons are normally oxidized in the muscles, burned up and exhaled through the lungs, and sweated out through the skin,-all three of which relief agencies are, of course, practically paralyzed, or working at lowest possible level, while you are sitting at your desk.

The well-known headache of sluggish bowels is an obvious case in point; and one of the early signs of beginning failure of the kidneys, as in Bright’s disease, is a headache of a peculiar type due to accumulation in the system of the poisons which it is their duty to get rid of.

There are few things the head resents more keenly than loss of sleep. The pillow is the best headache medicine. If this loss of sleep be due to the encroachments of work or of amusements, then the mechanism of its production is obvious. The fatigue poisons produced during the day and normally completely neutralized and burned up during sleep are not entirely disposed of and remain in the tissues to torture the nerves. The headache of insomnia, or habitual sleeplessness, on the other hand, is not, strictly speaking, caused by loss of sleep. Paradoxical as it may sound, the fatigue poisons, which in moderate amounts will produce drowsiness and promote sleep, in excessive amounts will cause wakefulness and inability to sleep. Insomnia and headache are usually symptoms of this overfatigued, or poisoned, condition, and should both be regarded and treated as symptoms by the removal of their causes, not by the use of coal-tar products and hypnotics.

Another common cause of headache is nasal obstruction, such as may be due to adenoids or deformities of the septum, or chronic catarrhal conditions. These probably act by their interference with breathing and consequent imperfect ventilation of the blood, as well as by obstruction and inflammation of the great air-spaces in the bones of the skull, closely underlying the brain, which open and drain into the nose.

It may be remarked in passing that “sick headache,” or migraine, though long and painfully familiar to us, is still a puzzle as to its cause. But the view which seems to come nearest to explaining its many eccentricities is that it is usually due to a congenital defect, not so much of the nervous system as of the entire body, by which the poisons normally produced in its processes fail to be neutralized and got rid of, and gradually accumulate until they saturate the system to such a degree as to produce a furious explosion of pain. This defect may quite possibly be in one of the ductless glands or in some of the internal secretions, rather than in the nervous system.

Obviously, after what has been said of the world-wide causation of headache, to attempt to discuss its treatment would be as absurd as to undertake to advise what should be done for the relief of hunger, for “that tired feeling,” or for a pain in the knee. The treatment for a headache due to an inflammation or tumor of the brain would, of course, be wide as the poles from that which would relieve an ordinary fatigue or indigestion pain. Besides, it is utterly irrational and often harmful to attempt to treat any headache as such. That is the open road to the morphine habit and drug addictions of all sorts. Remedies-and there are plenty of them-which simply relieve the pain without doing anything to remove its cause, merely make the latter state of that individual worse than the first. Headache is always and everywhere nature’s vivid warning that something is going wrong, like the shrieking of a wagon-axle or the clatter of a broken cog in machinery.

There is, however, fortunately one remedy which alone will cure ninety-nine per cent of all headaches, and that is rest. The first thing an intelligent machinist does when squeaking or rattling begins is to stop the machinery. This has the double advantage of preventing the damage from going any further and of enabling him to get at the cause. Headache, like pain anywhere, is nature’s imperative order to Halt, at least long enough to find out what you are doing to yourself that you shouldn’t. It makes little difference what you take for your headache, so long as you follow it up by lying down for an hour or two, or, better still, by going to bed for the remainder of the day and sleeping through until the next morning. If more headaches were treated in this way there would not only be fewer headaches, but two-thirds of the risks of nervous breakdown, collapse, insomnia, and chronic degenerative changes in the liver, kidneys, and blood-vessels would be avoided.

This, of course, is a counsel of perfection, and incapable of general application for the sternest of reasons; but it does indicate the rational attitude toward headache and its treatment, and one which is coming to be more and more adopted. No motorist would dream of pushing ahead with a shrieking axle or a scorching hot box, unless his journey were one of most momentous importance or a matter of life and death. Pain is nature’s automatic speed regulator. It is often necessary to disregard it, to get the work of the world done and to discharge our sacred obligations to others; but this disregarding should not be exalted to too high a pinnacle of virtue, and least of all worshiped as inherently and everywhere a mark of piety and one of the insignia of saintship.

A business firm or a factory, for instance, which would send home for the day each of its employees who reported a genuine case of bad headache, would, in the long run, save money by avoiding accidents, mistakes, muddles, and confusions, often involving a whole department, due to the kind of work that is done by a man or woman who is physically unfit to attempt it. And the higher the type of work that has to be done, the more the elements of insight, grasp, and sound judgment enter into it, the graver and costlier are the mistakes that are likely to be made under such circumstances.

Of course, it will probably be objected at this point: “What is the use of wasting a day, or even half a day, when by taking two or three capsules of So-and-So’s Headache Cure I can get rid of the pain and go right on with my work?” It is perfectly true that there are a number of remedies which will relieve the average headache; but there are two important things to be borne in mind. The first is that all of these are simply weaker or stronger nerve-deadeners; most of them actual narcotics. All that they do is to stop the pain and thus cheat you into the impression that you are better. You are just as tired and as unfit for work as you were before. Your nervous system is just as saturated with poisons, and the chances are ten to one that the quality of the work that you do will be just as bad as if you had taken no medicine. Further, like alcohol, when used as a “pick-me-up” under somewhat similar conditions, the remedy which you have taken, while producing a false sense of comfort and even exhilaration by deadening your pain and discomfort, in that very process itself takes off the finer edge of your judgment, the best keenness of your insight, and the highest balance of your control. In short, your nervous system has to struggle with all the poisons that were present before, with another one added to them!

After you have taken nature’s wise advice, and obeyed her orders, and put yourself at rest, then there are a number of mild sedatives, with which every physician is familiar, one of which, according to the special circumstances of your case, it may be perfectly legitimate to take in moderate doses, with the approval of a physician, as a means of relieving the pain and helping to get that sleep which will complete the cure.

One other measure of relief, which, like rest, is also indicated by instinct, is worth mentioning, and that is gentle friction of the head. One of the most instinctive tendencies of most of us when suffering from a severe headache is to put the hands to the head, either for the purpose of frantically clutching at it, rubbing as if our lives depended upon it, or pressing hard over the aching region. The mere picture of a man with his head in his hands instantly suggests the idea of headache. Part of this is, of course, little more than a blind impulse to do something to or with the offending member. We would sometimes like to throw it away if we could, or at others to bang it against the wall. But part of it is due to the discovery, ages ago, that pressure and friction would give a certain amount of relief.

For some curious reason the nerves most frequently involved are those which are most readily accessible for this kind of treatment, namely, the long nerve-threads which run from the inner third of the eyebrow up the forehead and over the crown of the head (the so-called supraorbital or frontal branches). A corresponding pair run up the back of the neck, about half-way between the back of the ear and the spinal column, supplying the back of the head and the crown (these form the cervical plexus); and a smaller pair run up just in front of the ear into the temple, and from there on upward to join the other two pairs at the top of the head.

Broadly speaking, the position of the pain depends upon which pair of these nerves is lifting up its voice most vigorously in protest. If it be the front pair (supraorbitals) then we get the well-known frontal or forehead headache; if the back pair (known as the occipitals) then we have the deadly, constricting, band-around-the-head pain which clutches us across the back of the neck and base of the brain. If the lateral pair are chiefly affected then we get the classic throbbing temples. Practically all of these aches, however, are of the “fire-alarm” character; and while certain of these nerve-gongs show some tendency to respond more readily to calls coming in from certain regions of the body, as, for instance, the forehead nerves to eye-strain, the back-of-the-head nerves (occipital) to grave toxic states of the system, the tips of any of the nerves in the crown of the head to pelvic disturbances and anæmic conditions, the lateral branches in the temples to diseases of the teeth and throat, yet there is little fixed uniformity in these relations. Eye-strain, for instance, may cause either frontal or occipital headache; and, as every one knows from experience, the pain may be felt in all parts of the head at once.

Gentle and intelligent massage over the course of these nerves of the scalp, according to the location of the pain, will often do much to relieve the severity of the suffering.

Treat headache as a danger signal, by rest and the removal of its cause, and it will prevent at least ten times as much suffering and disability as it causes.