Aid for Aching Heads

Of all human ailments, none is more common or causes more consternation than the headache. An anonymous Sumerian poet wrote about his blinding pain 3,000 years before Christ. England's "Bloody Mary" Tudor went to her coronation with a splitter. Ulysses S. Grant suffered so severely that he took to his bed on the eve of Appomattox, only to have his pain vanish when he received word that Robert E. Lee was ready to discuss surrender. Thomas Jefferson, who suffered from severe periodic headaches, tried philosophically to ignore them.

Most people suffer from headaches at some time in their lives. Once doctors were in the habit of dismissing patients who came to them complaining of headaches as chronic crybabies, offering them little more than consolation and aspirin. Now physicians are taking headaches seriously. Headache units for both clinical work and research have been established at several major hospitals. Their work has led to better--but far from complete--understanding of man's ancient affliction.

Headaches, doctors realize, are symptoms rather than diseases. Toothaches, hangovers and simple hunger can cause headaches that can be cured by dental work, black coffee and food. Chronic pain is occasionally a sign of a very serious problem, like brain tumors, and can require surgery. Decongestants may help sinus headaches, while those caused by allergies can be prevented by identifying and avoiding the substance that brings on the allergic reaction, a task that most physicians concede is far easier in theory than in practice.

Tension headaches, the product of anxiety and fatigue, are a common malady. The usual cure is rest and nonprescription aspirin-based analgesics (for which Americans now spend more than half a billion dollars a year) or sometimes tranquilizers. Somewhat different are headaches associated with depression, which can be manifestations of patients' hostility toward themselves. They sometimes respond to antidepressant drugs and psychiatric treatment.

Other varieties are more mysterious.

Migraine, a severe throbbing attack usually confined to one side of the head, affects as many as one out of every ten Americans. No one is sure just what causes migraine, which can last for days and completely incapacitate the victim. Dr. Arnold Friedman, neurology professor at Columbia University College of Physicians and Surgeons and chief of the Headache Unit at New York's Montefiore Hospital, believes that migraine is the result of a hereditary chemical imbalance that produces biochemical changes in the individual when he is exposed to stress. One of these changes induces pain by causing scalp arteries to dilate. Another produces a sterile (noninfectious) inflammation of the artery wall.

Equally debilitating are cluster headaches, which strike their victims repeatedly for relatively short periods. A siege of intermittent pain can last several months. These headaches, which usually affect one side of the head in much the manner of migraines, are seven or eight times more likely to afflict men than women.

Dr. John Graham, head of the Headache Research Foundation at Boston's Faulkner Hospital, believes that personality may be at least partially responsible, since clusters generally hit proud, hard-driving individuals who work under substantial self-imposed stress. Graham has found that most cluster sufferers are similar in appearance, with prominent masculine features and reddened, grainy, deeply furrowed skin. Dilation of blood vessels is also apparently present in clusters. Therefore liquor or a dose of any drug that expands vessels, like nitroglycerin, can trigger or worsen an attack.

Physicians in ancient times attempted to treat chronic headaches with remedies that owed more to folklore than pharmacopoeia. Some believed in trepanning, or opening the skull, to let out the attacking demons. Others prescribed elixirs of cow's brain and goat dung. American Indians used beaver testes, a sounder idea than it seems. The preparation has since been deter mined to contain a salicylate similar to regular aspirin.

Modern medicine has more potent weapons. Ergotamine tartrate, an ergot, or rye fungus derivative, constricts painfully swollen blood vessels and helps many migraine-and cluster-headache patients. Tranquilizers can also provide short-term relief of the tension that can trigger a severe headache. Psychological treatment to uncover emotional causes has worked for many people. But for some patients, nothing works very well. Taking what small solace they can from the fact that they are in famous company, they must do what headache sufferers have done for many centuries --learn to endure their ailment.

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