Headaches are one of the most common human ailments. For most people a headache is merely an infrequent annoyance, a passing discomfort that results from lack of sleep, sitting in a smoky room, or having an argument with someone. With aspirin, rest and maybe a gentle massage, the pain goes away.
But for millions of others the pain does not go away; they suffer from chronic headaches. Americans spend upward of $400 million a year on headache remedies, leading researchers to estimate that as many as 45 million Americans suffer from chronic and/or severe headaches that seriously interfere with their lives.
Headaches are not completely understood by medical science and researchers have advanced numerous theories to explain them. Tension, personality traits, heredity and diet are a few of the factors that may play a role in chronic headaches. There appear to be various types of headaches, but any hard and fast classification is open to debate, in part because the types often overlapboth in their symptoms and in their response to medication. Moreover, triggering factors and modes of relief vary from person to person.
Symptoms of Headaches
- Tension headache: dull, steady pain that may be felt in the forehead, temples, or back of the neck, or throughout the head. A person may also experience stiffening or cramping of neck and upper body muscles.
- Migraine headache: recurrent headaches characterized by throbbing, pulsating pain; often accompanied by visual disturbances such as seeing dark spots, white spots or flashing lights; nausea; vomiting; lightheadedness; runny nose; lack of sensation in a part of the body; and unusual smell or taste. Abdominal pain or stomachache, weakness of the muscles, poor coordination or stumbling are other possible migraine symptoms. Episodes can last 30 minutes to several hours and can occur one to four times a month.
- Cluster headache: steady, piercing pain located around or behind one eye or in one temple; usually strikes at night or in the early morning. A person may feel worried or uneasy; poorly tolerate light and sound; have swelling or sagging of the eyelid, tensing of the eye pupil or teary eyes; and experience runny nose; facial and forehead sweating; vomiting and nausea.
Some physical activities, including sexual intercourse and strenuous sports, have led to exertion headaches. Football players and joggers are the athletes most frequently struck by them. These attacks are probably vascular, caused by abrupt dilation or constriction of blood vessels, but researchers have not been able to pinpoint the exact cause of the pain. The headaches often hit just after exercise and are so painful that some sufferers have been rushed to hospital emergency rooms. This is a prudent precaution in sports such as football, where a head injury is possible. But in nearly all cases exertion headaches are neither harmful nor symptomatic of other ailments. With rest, the pain goes away.
What Causes Headaches?
The great majority of primary headaches (that is, those not caused by underlying disease) fall into three categories, according to the International Headache Society: tension (which includes depression headaches), migraine and cluster. (Headaches can also be brought on by sudden exertion, as explained in the box below.)
- Tension headaches. These are also called muscle-contraction or stress headaches. Almost everyone occasionally gets a headache of this type. The pain is mild compared to migraine or cluster headaches. A feeling of tightness around the scalp is typical; muscles in the back of the upper neck may feel knotted and tender to the touch. It’s not known whether it’s the sustained muscle tension itself or the subsequent restricted blood flow that causes the pain. Tension headaches are associated with stress, such as working at the computer, prolonged reading or toting an ill-fitting or heavy backpack. Often the pain comes after the stress has ended. It may also follow fatigue or too much or too little sleep. Assuming a posture that tenses your neck and head muscles for long periods, such as holding your chin down while reading, can trigger these headaches; so can gum chewing, grinding your teeth, or tensing head and neck muscles during sexual intercourse. Men and women are about equally likely to suffer tension headaches. Some people who have daily headaches have been found to be suffering from depression as well. Usually these are muscle-contraction headaches. Persistent headaches accompanied by lethargy, insomnia, or suicidal thoughts are signs of clinical depression. Researchers do not understand the connection between depression and headaches, though some have suggested that the depression and the headaches may have a common biochemical cause. In some cases it may be the persistent headaches that cause the depression. And in some cases treating the depression makes the headaches go away.
- Migraines. The word migraine, derived from the Greek, means half a skull—an apt description of the pain, which often occurs in only one side of the head. However, the pattern of migraines is variable and pain that starts on one side of the head can spread to involve the entire head. Migraines appear to involve the abnormal expansion and contraction of blood vessels in and around the brain. In some people migraines start with an “aura”—neurological symptoms that typically include zigzag patterns of shooting lights, blind spots and/or a temporary loss of peripheral vision. The pain of a migraine episode can be incapacitating and can last anywhere from a few minutes to several days; if it lasts longer than that, it’s probably not a migraine. Migraine sufferers may also experience nausea, vomiting and sensitivity to both light and noise. About 80 percent of migraine sufferers have a family history of the ailment; women are nearly four times more likely to be afflicted. The typical sufferer is young (under 35 years of age) and had her first attack during her teens or 20s. With age, attacks usually become less severe and less frequent. Hormonal changes can play a role: thus, susceptible women may have more attacks if they take oral contraceptives or it’s around the time of menstruation; they may have fewer attacks during pregnancy and after menopause. Attacks can also be triggered by certain substances in foods, by emotional factors and environmental changes (like glaring light, strong odors and changes in weather).
- Cluster headaches. These strike in a group, or cluster, for up to a few hours and recur daily for days, weeks, or even months on end. Months of freedom may pass between attacks. Some researchers consider cluster headaches a variant of migraines, largely because the excruciating pain is centered on one side of the head, as in a migraine. But unlike the throbbing of a migraine, this pain is steady and piercing, it is centered in one area—usually behind one eye or in one temple—and it typically strikes at night or in the early morning. Cluster headaches are about six to nine times more likely to strike men than women; the first attack usually comes in a person’s 20s or 30s. They are sometimes misdiagnosed as a sinus disorder (because stuffy nose or sinus congestion is a common symptom) or even an abscessed tooth. There’s no clear cause, though heavy smoking and drinking are possible contributing or triggering factors.
- Other causes of headaches. Many people assume that high blood pressure (hypertension) can trigger headaches. In fact, it’s rare that high blood pressure actually causes a headache. If you suffer from frequent headaches, by all means get your blood pressure checked, especially if you are over 40. But in most cases, the two problems have to be treated independently.
Similarly, many people think first of a brain tumor as an important cause, but that is very rare. Of all the people who seek treatment for headaches, less than 0.5 percent have been found to have a brain tumor.
Eyestrain can cause a headache, but it will go away as soon as you rest your eyes. Poor lighting or poor posture may also lead to a headache, as can a hangover.
What If You Do Nothing?
Most headaches that aren’t caused by some underlying disorder will clear up on their own—although tension headaches can last for days at a time. Because the pain, especially from migraines and cluster headaches, can be severe, most people will want to take steps to relieve symptoms.
Feeding a Headache
Some researchers suspect that food plays a role in some headaches, especially migraines. But proving a definite link between diet and headaches has been difficult and no single food seems to affect all sensitive individuals. Most of the suspect foods and beverages contain substances that may constrict or dilate blood vessels in the brain. One major culprit is tyramine, a chemical that occurs naturally in many foods. Nitrites, used in cold cuts and frankfurters, can also dilate blood vessels. A variety of foods may provoke headaches in sensitive people. The following foods have been most commonly implicated:
- Aged cheeses.
- Alcoholic drinks (especially red wine).
- Nuts and peanut butter.
- Sour cream.
- Cured or processed meats.
- Caffeine-rich drinks.
- Freshly baked yeast products.
- MSG (monosodium glutamate).
- Hydrolyzed vegetable protein.
- Aspartame (artificial sweetener).
Home Remedies for Headaches
Many headache sufferers, particularly migraine sufferers, find that it’s essential to nip the pain in the bud—that is, to take medicine at the first sign of an attack. Unfortunately, the long-term frequent use of certain medications may actually result in drug-related “rebound” headaches. Many of the prescription drugs have unpleasant and sometimes dangerous side effects, so it’s always best to rely on nondrug treatments when possible.
If you have recurrent headaches, try to discover what triggers them. Keeping a diary may help—it can show you that a certain activity, circumstance, food, or medication is associated with the attacks. Treatments like the following may allow you to get by without prescription medications.
- For occasional headaches, start with over-the-counter pain relief. The most common headache remedies are over-the-counter medications—nonprescription NSAIDs (aspirin, ibuprofen, or naproxen) or acetaminophen. If one type doesn’t provide sufficient relief, try another the next time you have a headache. Remember that a drug is not harmless just because it is sold over the counter. No one should take a pain reliever for long periods without consulting a doctor.
- For migraines, an OTC combination may help. A combination of acetaminophen, aspirin and caffeine can relieve even severe migraine pain in some people, according to several panels of headache experts. You can find all three ingredients combined in Excedrin and other nonprescription headache formulations.
- Try to relax. Learning how to relax and cope with stress sometimes helps relieve headaches and other kinds of pain—in part by reducing muscle tension, in part by shifting attention away from the pain.
One common technique is progressive muscle relaxation. It calls for tensing and then relaxing specific muscle groups, working from the feet to the head, while focusing on deep, regular breathing. Another technique, called the relaxation response, is a form of meditation in which you repeat a word or phrase until your mind is free of distracting thoughts and your body relaxed.
One study published in the journal Headache found that migraine sufferers who were taught relaxation training had 30 to 40 percent fewer attacks over the course of three years. The 24 subjects in the study were also better able to cope with the attacks they did have and required less medication.
- Ice can help. Reusable gel packs—kept in the freezer and then wrapped around the neck during a headache—may provide relief in lieu of medication or as an adjunct to it. A study published in Postgraduate Medicine found that of 90 headache sufferers, 70 percent experienced some relief from such gel packs. Running cold water over your head may have a similar effect.
- Try heat for tension. You may find that heat, rather than cold, helps relieve some tension headaches. You can try a hot shower or bath, or moist heat applied to the back of the neck (use a wet towel wrapped around a waterproof heating pad—be sure to check heating pad directions).
- Massage. Many people find that massaging muscles in the neck, forehead and temples promotes relaxation and offers some relief, especially for tension headaches.
- Apply headbands. A study published in Headache found that a headband (with two small rubber disks to apply pressure over areas of maximum pain) provided at least partial relief in 60 out of 69 migraine headaches. The band provides more consistent pressure on the temples, scalp and forehead than finger pressure.
- Exercise. For some people regular exercise helps relieve tension and thus may prevent some headaches. Neck, back and shoulder stretches may also be beneficial.
- Improve your posture. When working at a computer terminal, for instance, adjust your seat and table so that you don’t have to bend your neck for long periods.
- Consider biofeedback. This high-tech relaxation method calls for hooking a subject up to a device that feeds back readings on a physiological variable—muscle tension, for instance, or skin temperature. The feedback supposedly enables the subject to gain some control over the variable. Biofeedback seems to help some headache sufferers.
- Get to the source. You may discover that your headaches disappear only when you resolve some underlying stressful problem in your life.
An Herb for Migraines
For centuries feverfew, a member of the flower family that includes daisies, was relied on to treat headaches. The herb was somewhat forgotten, however, until the late 1970s, when migraine sufferers started talking about feverfew’s potential to ward off these often debilitating headaches.
Since then, studies of feverfew as a migraine preventive have had confusing results. But the herb has been recognized by Canada’s Health Protection Branch as a nonprescription drug for preventing migraines. If you suffer from migraines, you might want to try feverfew. In the United States, however, commercially available preparations usually have very little plant material in them. (In Canada, you can purchase standardized doses of the dried leaves). Also, feverfew may interact adversely with aspirin.
Regular exercise and relaxation can help prevent headaches. If you are prone to migraines, avoid oversleeping, since this may lead to headaches. Also, keep a daily record to help identify possible activities as well as foods and beverages that appear to trigger headaches. Avoid eyestrain and poor posture, both of which can trigger tension headaches.
Beyond Home Remedies: When To Call Your Doctor
Most people who suffer from migraines or cluster headaches need to consult a doctor about treatment. In addition, in a small number of cases severe headaches may indicate a more serious disorder, such as very high blood pressure, stroke, bleeding in the brain, or even a brain tumor.
The following signs should send you to your doctor right away.
- A sudden onset of severe headaches, especially if they’re your first ones.
- A headache with a fever and neck stiffness.
- A headache accompanied by confusion or loss of speech—especially after a blow to the head, even one that occurred several weeks earlier.
- A headache accompanied by inflamed, clogged sinuses. Occasionally, a severe headache results from infection and the buildup of pus in the sinus passages.
- Any increase in the intensity or frequency of headaches.
- A severe headache during or immediately after physical exertion or straining. Some activities, including sexual intercourse and strenuous sports, may lead to exertion headaches, which are usually harmless. But to rule out internal head injury, it’s prudent to see your doctor.
What Your Doctor Will Do
In addition to taking a careful patient history and doing a physical examination, your doctor may order tests to rule out sinusitis, glaucoma, or other conditions that can produce headache symptoms.
If over-the-counter pain relievers haven’t proved sufficient, you and your doctor will work to find the right prescription drug for you. A wide variety of such drugs is available—from narcotic pain relievers and antidepressants to beta-blockers, muscle relaxants and drugs that relieve migraines by modifying specific neurotransmitters. Newer medications for treating migraines include “triptans” such as sumatriptan (Imitrex), zolmitriptan (Zomig) and rizatriptan (Maxalt).
Most of these medications are meant to get rid of the headache, but for people whose headaches are very severe or frequent, there are also drugs designed to prevent attacks.
Some migraine drugs are available as nasal sprays and/or self-administered injections, which are usually faster acting than oral tablets.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media