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Here's an interesting bit of headache trivia: In the past year, 50 per cent of neurologists have had at least one migraine, compared to 32 per cent of family physicians, and 12 per cent of the general public.

So, what's up with that? Are neurologists more prone to migraines because of their big brains? Are they just more neurotic than ordinary working stiffs? Are they drawn to neurology because their own brains are wonky?

None of the above, according to new research presented yesterday at the American Headache Society scientific meeting in Vancouver.

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Rather, neurologists are just more informed on how to recognize and respond to cries for help from the grey matter.

And the fact that they treat themselves so frequently for migraines suggests that far more members of the general public suffer from migraine headaches than previously believed.

"We believe migraine is much more common than we realize," said Jonathan Gladstone, a neurology resident at the University of Toronto who, for the record, suffers a few migraines a year himself.

He's even willing to admit that he misdiagnosed himself.

"For years, I believed I had ordinary 'tension-type' headaches, but once I began specializing in neurology, I was able to recognize that they were indeed migraines," Dr. Gladstone said.

So what is the difference between a migraine, a tension headache, and a sinus headache?

A migraine is essentially a really bad headache that lasts for more than four hours and is accompanied by certain telltale symptoms -- such as sensitivity to light, sound or colours. Migraine can also be a chronic, debilitating condition.

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A tension headache is characterized by a dull, annoying but generally bearable pain. And a sinus headache is, well, increasingly looking like a sign that your doctor is not quite informed enough.

"Sinus headaches are greatly overdiagnosed and overtreated," said Dr. Gladstone, who is also a fellow at the Mayo Clinic in Scottsdale, Ariz.

"The majority of people who think they have sinus headaches unknowingly have migraines." (The confusion stems from the fact that migraine pain is often felt in the sinus and neck.)

The distinction is important because migraines don't respond to traditional painkillers such as acetylsalicylic acid (Aspirin), ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). And sinus medication doesn't help either.

Rather, migraines are best treated with triptans, a prescription medication. They include sumatriptan (sold under the brand names Imitrex and Imigran) and eletriptan (Relpax). Many doctors hesitate at prescribing triptans because they can cause side effects such as chest pain. (But new research suggests that the drugs do not increase the risk of heart disease.)

Dr. Gladstone's research was based on a survey of 135 neurologists, including 75 in Toronto and 60 who work at three Mayo clinics.

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A second, unrelated study presented yesterday at the Headache Society, revealed that children and teenagers who get frequent headaches are being grossly overmedicated.

"I've been astounded by the large number of kids using over-the-counter medications five or six times a week -- and sometimes 15 to 20 times a week," said David Rothner, director emeritus of child neurology at The Children's Hospital in Cleveland.

According to the research, one in four children with frequent headaches uses medication to excess -- meaning they take three doses or more a week for 14 weeks or more.

"Even more frightening was that a lot of them were taking the drugs without telling their parents," Dr. Rothner said.

The researcher said he has treated children for serious medical conditions such as gastrointestinal bleeding and kidney failure that were caused by excessive use of popular drugs like ibuprofen. (Children should never take ASA or Aspirin because it has been linked to potentially deadly Reye's syndrome.)

He said too few people realize that over-the-counter headache remedies should be used sparingly because otherwise they lose their effectiveness.

"Overuse can lead to rebound, chronic daily headache," Dr. Rothner said.

In effect, taking too many drugs for tension headaches can lead to chronic migraines, a much more serious condition.

Migraine headaches are often referred to as an invisible epidemic. They are the leading cause of absenteeism in the workplace.

More than $500-million is lost yearly in Canada due to migraine headaches. The condition affects more than 3.3 million Canadians.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More


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