What a headache.

• Author: Wykes, Sara
• Position: MIND & BODY - Interview

ROBERT COWAN is the founding director of the Headache and Facial Pain Clinic at Stanford Health Care. Its doctors help patients prevent and manage their headaches, working in collaboration with colleagues at the recently opened Stanford Neuroscience Health Center. Cowan, who founded the headache clinic in 2011, is board certified in pain medicine, neurology, and the neurological subspecialty of headache medicine. He holds several nationally elected positions, including chair of the Section on Chronic Daily Headache for the American Headache Society. Cowan brings a special motivation to his work: he has managed his own migraines for decades.

Question: Are there different sorts of headaches?

Cowan: Headache is very common: every year, more than 90% of people in the U.S. experience some type of headache. Tension-type headache is the most common, and 70% of people have them at one time or another. The American Migraine Foundation estimates about 12% of people in the U.S.--about 37,000,000--suffer from migraines. Sinus problems only occasionally cause headache, no matter what TV ads for decongestants and allergy and cold remedies may say. Studies show that most sinus headaches are actually migraines. Headaches that do not respond to treatment of allergies are probably migraine or tension-type headaches, or they are related to overuse of pain medicines--medication overuse headache.

Question: What is the difference between migraines and other types of headaches?

Cowan: A migraine is much more than a headache. It occurs on average one to four times a month. Unlike a tension headache, it is often accompanied by nausea or vomiting. Its pain is intensified by physical activity and is so severe it interferes with daily activities. About 30% of migraineurs--people with migraine--have a warning that consists of neurologic signs, or auras, they experience before the migraine episode begins. The most commonly experienced aura is visual, during which patients see small, colored dots, flashing bright lights, or multicolored zigzag lines that may form a shimmering crescentlike shape. Sometimes there are blind spots in the visual field.

Aura symptoms last for 20 to 30 minutes. They are followed within five to 60 minutes by the headache. An aura shorter than five minutes may be something else, so we do not diagnose a patient with short auras as having migraine with aura. Aura symptoms that last more than one hour may be a sign of other neurological problems and...