Having a headache from time to time is a normal, though annoying, part of life. More than 45 million Americans, however, suffer chronic, recurring headaches, resulting in medical expenses, lost work time and days spent in pain. While some headaches signal a medical condition such as infection, allergies, hypertension, eyestrain, aneurysm or tumor, 90 percent are not related to an underlying illness.
Understanding why headaches occur is the first step to controlling them. Here’s a look at three headache types:
• Tension headaches. Most headaches are related to muscle tension in the neck, back or forehead caused by poor sleep, bad posture, stress or depression. Some experts, though, believe these headaches arise from changing levels of serotonin (a brain chemical that regulates pain messages and influences mood) and endorphins (the body’s natural painkillers).
The steady, dull ache of a tension headache can be mild to moderate. Headaches are considered chronic when they occur more than 15 days a month for several months.
• Migraine headaches. The head-banging pain of a migraine is usually severe, one-sided and throbbing and accompanied by nausea; vomiting; and sensitivity to sound, light or movement.
More than 28 million people get migraines, and because 70 percent of sufferers are women, hormone fluctuations are often fingered in attacks. Many women report migraines in the days preceding their periods. Experts believe a migraine occurs within the brain itself, and once the attack begins, pain and other symptoms arise from inflammation caused by an interaction between the blood vessels covering the brain and one of the cranial nerves. Serotonin is thought to play a part in this inflammatory process.
About one in five migraine sufferers experience aura, a collection of symptoms that may include vision disturbances; numbness or tingling in an arm or a leg; and an odd sense of smell or taste. These symptoms precede a headache, so starting treatment at the first sign of aura may head off the pain.
• Cluster headaches. As if one isn’t enough to cope with, some people suffer serial headaches that come in groups, or clusters, lasting weeks. Cluster headaches tend to be rare, affecting only 1 percent of the population, mostly men. The intense stabbing pain centers around one temple or eye, which may become inflamed and watery. Some people experience nasal congestion. Most sufferers get one to four headaches a day during a cluster period.
Cluster series may occur seasonally, in the spring or fall, so the headaches are mistakenly associated with allergies.
Stopping the pain
Americans spend more than $4 billion each year on over-the-counter headache pain relievers. Unfortunately, many of these drugs prove ineffective and can cause gastrointestinal side effects. To guard against stomach upset, your physician may prescribe amitriptyline or another tricyclic antidepressant. While you may not be depressed, these drugs have pain-relief actions.
A class of drugs called triptans, which mimic the action of serotonin and cause blood vessels to constrict, is often helpful in treating migraines. Other headache drugs include ergots, which also constrict blood vessels, and medications to combat nausea. Taking lithium or corticosteroids, which reduces inflammation, or inhaling oxygen may relieve cluster headaches.
Take note: If your headaches suddenly seem different or pain becomes more acute, or if they change pattern or interfere with your ability to perform daily activities, see your doctor.
Making lifestyle changes such as quitting smoking, exercising regularly, managing stress and getting adequate sleep will help combat headaches. Cut down on caffeine intake gradually—pour more decaf instead of regular in your cup each day.
Many headaches may be thwarted if you identify and, when possible, try to avoid “triggers.” Physical factors may include certain foods such as chocolate, alcohol or nuts or those foods that contain monosodium glutamate or nitrates like hot dogs and bacon. Other physical triggers include eating something cold like ice cream and going several hours between meals, which causes a drop in blood sugar. Hormonal changes, emotions and environmental factors like smoky rooms and drastic changes in barometric pressure can also trigger headaches.
To determine your trigger, keep a diary for a few months and track when you have your headaches and what you were doing and eating that day. How did you sleep the night before? Describe the severity, location and duration of your symptoms. For people who suffer frequent migraines, preventive therapy may include drugs commonly prescribed to treat heart disease such as beta- blockers or calcium channel blockers. Other preventatives include tricyclic antidepressants, antihistamines and antiseizure drugs. Interestingly, some people receiving injections of Botox to reduce forehead wrinkles found their headaches improved.
Several nonpharmaceutical measures may prove helpful for preventing chronic headaches. Ask your doctor whether taking supplements of magnesium, riboflavin (vitamin B2) or feverfew is right for your migraines. In addition, chiropractic and massage therapies may relieve tension-type headaches. Acupuncture, which stimulates the endorphin release, may combat the pain and nausea of migraine. Therapies that help you master relaxation techniques—visualization or biofeedback—can help reduce headaches or stop an attack.