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How To Manage Your Headaches

Got a headache? You’ve got plenty of company.

More than 45 million people in the United States have chronic headaches, says the National Headache Foundation, and 28 million of those suffer from migraines.

Headaches are most common among 40-somethings and tend to decrease in frequency as people age. In a 2004 study, 18 percent of people ages 18 to 44 had experienced a severe headache in the previous three months, compared with only 6 percent of people over 75. No matter what the age group, more women are affected.

The economic impact of all those sore heads is huge. People who have migraines miss more than 157 million workdays each year, says the American Academy of Neurology.

And even those who don’t call in sick accomplish less on the job. A 2002 survey found that 13 percent of the U.S. workforce lost productive time at work because of pain during a specific two-week period. Headaches, the most common malady, caused a mean loss of three and a half work hours a week.

This report will help you understand the common causes of headaches and effective ways to lose the pain.

Types Of Headaches
All headaches are not created equal. Here’s how to tell them apart:

• The most common form is the tension-type headache (TTH), affecting 75 percent to 90 percent of people who have chronic or frequent headaches. It’s characterized by feelings of pressure or dull pain, like a band squeezing your head. TTH is usually felt on both sides of the head and can last from a half hour to a week.
  
• The pain of a migraine headache may be severe and often throbs or pulses. It’s usually felt on one side of the head. A migraine may be accompanied by other symptoms such as nausea, vomiting, and sensitivity to lights, sounds and odors. It can last from several hours to three days.
  
  Some people experience an aura, or sensory warning, 15 to 30 minutes before a migraine starts. Signs include flashes of light, blind spots in vision, or pins-and-needles sensations in an arm or leg.
  
  Up to 17 percent of women and 6 percent of men have had a migraine. Fully 70 percent of migraine sufferers are women, says Stephen Silberstein, M.D., of the Headache Center in Philadelphia.
  
• Sinus headaches are the result of inflamed sinus passages or sinus infection. They cause pain behind the brows and/or cheekbones.
  
• Cluster headaches are somewhat rare, affecting only about one in 1,000 people. Many more men than women have them. Pain may be sharp and severe and is typically felt on one side, around or behind the eye. Cluster headaches may be accompanied by symptoms such as runny or stuffy nose and redness or tearing of the eye. They’re usually experienced several times a day for months at a time.

Headache Triggers
The two primary kinds of headaches – tension-type (TTH) and migraine – have different triggers. And despite the fact that they’ve been around as long as mankind, scientists still don’t have a complete understanding of their causes.

The consensus used to be that TTH was simply the result of stress-induced tension in the muscles of the head, neck and shoulders. But it may be that TTH is “a response by the body to emotional strains and pressures rather than to excessive muscular tightness and resultant constriction of the scalp arteries,” writes Manish Singh, M.D., of the Medical College of Pennsylvania.

Migraines, on the other hand, are known as vascular headaches because they’re related to abnormal function of the blood vessels of the brain. Interestingly enough, people with high blood pressure have fewer migraines, probably because their blood vessels are stiffer.

Triggers for tension-type headaches include:

• Sleep deprivation
• A long, stressful workday
• Poor posture or body position (such as holding the phone between your shoulder and your ear)
• Poor sleep position
• Hunger
• Eyestrain (for example, from staring at a computer for hours on end)
• Anxiety and/or depression
• Arthritis or other degenerative disease of the neck or spine
• TMJ (temporomandibular joint) disorder, often characterized by clenching the jaw

Migraine triggers include:

• A drop in estrogen level, as happens just before and during the first two days of a woman’s monthly cycle
• The use of oral contraceptives or hormone-replacement therapy
• A long list of foods that include amino acids such as tyramine, which can affect blood vessels, (for example, beer, red wine, chocolate, cheddar and other ripened cheeses, soy sauce, monosodium glutamate, lima beans, sour cream, figs and raisins, sausage and other processed meats, chicken livers, and fermented or pickled foods, to name a few)
• Skipping meals
• Stress
• Intense physical activity
• Bright lights or sunshine
• Changes in weather
• Sleep deprivation or oversleeping

For some people, vigorous exercise such as running, rowing and weight lifting can trigger a headache, especially in hot weather or at high altitude. Most of the time such headaches are harmless, but occasionally they point to a serious underlying cause such as a tumor or blood vessel abnormalities.

See your doctor if you have an exercise-induced headache. Get help immediately if you also experience vomiting, double vision or rigidity of the neck.

Headache Medication And Other Therapies
Over-the-counter (OTC) meds are often effective against garden-variety tension-type headaches. On the shelves you’ll find single-ingredient drugs such as acetaminophen, aspirin, ibuprofen and naproxen as well as combination medications (e.g., those containing acetaminophen, aspirin and caffeine).

If tension headaches are chronic, though, see a doctor to rule out more serious problems and discuss whether prescription medicines are necessary. Your physician may prescribe an antidepressant or other drugs.

Migraine sufferers may get sufficient relief from the OTC drugs listed above. If not, your doctor may prescribe drugs such as ergot alkaloids, triptans, antidepressants or opiates. Or she may recommend a combination of drugs, for instance, sumatriptan and a nonsteroidal anti-inflammatory such as naproxen.

Whether you’re using prescription or OTC drugs, you run the risk of rebound headaches by overusing pain relievers. If you take something for a headache more than two or three times a week, talk to your health care provider.

Treating headaches caused by sinusitis depends on whether the underlying problem is a sinus infection, allergies or both. Therapies may include antibiotics to treat the infection, and nasal sprays and prescription or OTC decongestants. If your sinus cavities have structural problems that tend to cause sinusitis, you may need surgery.

Some patients find that complementary and alternative therapies provide relief for all headache types. Options range from deep-breathing exercises, yoga, and guided meditation with visual imagery to acupuncture, biofeedback and hypnosis.

Low-tech commonsense approaches can also help:

• Resting in a dark, quiet room
• Applying an ice pack or moist heat
• Taking a brief nap
• Stretching
• Doing progressive-relaxation exercises

When To See A Doctor
There’s no need to make a medical appointment for occasional headaches. But when they become chronic and interfere with your life and work, it’s time.

Schedule a visit if your headaches are increasing in intensity. See a physician right away if you’re over 50 and having headaches for the first time. They could be the result of a condition called temporal arteritis, which can cause blindness.

The National Institute of Neurological Disorders and Stroke advises seeking immediate help if you experience any of the following danger signals:

• A headache that strikes suddenly, with especially severe pain
• A headache that follows a head injury
• A headache that’s accompanied by fever, confusion, rash, stiff neck, double vision, seizure, numbness, difficulty in speaking, or pain in the eye or ear

Build Health To Reduce Headache Pain
Experts agree that simple health-enhancing behaviors have the potential to reduce the frequency of headaches.

Start by getting plenty of sleep, preferably going to bed and getting up at about the same time every day. And don’t skip meals, as hunger can be a potent trigger.

Coffee is fine, but don’t go overboard. People who drink more than four to seven cups a day may be more prone to headaches and irritability, the Mayo Clinic says. And if your doctor has recommended you cut back on caffeine, do it gradually. Going cold turkey can cause intense withdrawal headaches.

Keep a journal to get a fix on the causes of your discomfort. Record when you have pain, when it begins and ends, what you’ve eaten that day, how well you’ve been sleeping, whether you’ve been under stress, and whether medications are helping. Note suspected triggers such as foods, hormonal changes and weather. If you see a doctor for relief, the journal will help her make better treatment decisions.

If you have employees, encourage them to get up from the computer at least once an hour to stretch and refocus their eyes. Walking breaks are another good way to reduce stress and muscular tension.

For employees who have frequent headaches, provide a quiet spot where they can turn off the lights and take a short break.

For More Information
To learn more, visit these Web sites.

Medline Plus headache page
www.nlm.nih.gov/medlineplus/headache.html

National Headache Foundation’s consumer information sheets
www.headaches.org/education/Headache_Topic_Sheets

Mayo Clinic headache center
www.mayoclinic.com/health/headaches/HE99999