Headaches — one of the most common medical condition—affects 70 percent of adults at least occasionally and provoke 50 million Americans a year to seek medical relief.


Most headaches are transient and due to tension or temporary condition such as a cold or the flu, but some reflect a serious underlying problem. A recurrent headache warrants medical attention to diagnose the type and determine the best treatment. When you see your doctor, bring a detailed written description of your headaches, their severity, ranging from mild to incapacitating; their frequency; their duration; the exact area affected by the pain; and any related symptoms, such as nausea.

Migraine Headaches

About 23 million Americans suffer from a migraine, a one-sided, severe, throbbing or pulsating headache often accompanied by sensitivity to light and sound, as well as by nausea and vomiting. Migraines are also called vascular headaches, because they usually involve changes in the arteries of the head, resulting in pulsating pain. The headaches may last from a few hours to several days or even longer.

About 10 percent of migraine sufferers experience a warning aura before the headache starts; this early symptom involves a visual disturbance, such as partial or temporary loss of sight or flashes of light and color. An aura may also cause tingling on one side of the face or body or a disturbance in the sense of smell. Even those who don’t experience an aura may have warning signs in the few hours leading up to a migraine, such as feelings of cold, craving for specific food, mood changes, a sudden burst of energy, or frequent yawning.

Migraines affect women about three times as often as men, and they most commonly start between the ages of 18 and 44. Doctors think that they begin when triggers—dietary, hormonal, environmental, emotional, and other factors—cause blood vessels in the brain to constrict and then relax. These distorted blood vessels prompt nerve endings to send out pain signals.

The triggers that can set off a migraine vary widely from one person to another, but some are common than other. A number of the following triggers can be avoided entirely; others can at least be minimized.

Environmental triggers include glare, bright light, loud noise, strong odors, cigarette smoke, and changes in temperature, weather, or altitude.

Hormonal triggers are experienced by women and are usually related to the menstrual cycle; they can also be caused by the use of estrogen supplements or high-estrogen oral contraceptives.

Activity triggers includes irregular or no exercise, inadequate or excessive sleep, eyestrain, and motion sickness.

Emotional triggers tend to be the negative ones, such as anger, resentment, depression, fatigue, anxiety, and stress.

Dietary triggers may be the easiest to control. Keep a food diary, note what foods seems to prompt symptoms and then eliminate them. It’s also important t eat regular meals, because excessive hunger can trigger a headache.

The caffeine in coffee, tea, colas, and other beverages—as well as in many over-the-counter analgesic drugs—can play a dual role in migraines. Regular and excessive ingestion can contribute to the frequency of the headaches. On the other hand, once you are completely off caffeine, you may be able to use it to abort an impending attack, because it constricts dilated blood vessels. At the first sign of an aura or a pain, drink a cup of strong coffee or cola, take two aspirin, and lie down and relax in a dark quiet room. The episode may pass within an hour or so.

In addition to using relaxation techniques to control stress, many doctors recommend taking a course in biofeedback to learn how to raise the temperature of your hands, thereby diverting some of the blood flow from the hand to another part of the body. This technique can be used to abort a headache at the start of an attack.

Two different drugs can also abort a migraine if taken early enough. Sumatriptan (Imitrex) is a new medication that can be taken by self-injection, which typically gives relief within an hour, or as a pill, which usually takes up to two hours to work. Ergotamine drugs are older medications that are available as a pill placed under the tongue, a suppository, and a nasal spray.

Cluster Headaches

The most incapacitating of all vascular headaches, this type last from 15 minutes to 3 hours and typically occurs in clusters, coming and going repeatedly over several days or weeks and then disappearing for months or even years. Often starting during sleep, they cause excruciating, stabbing pain on one side of the head, usually behind or around one eye. Some people liken the pain to a hot poker stabbing the eye. Cluster headaches are far more common in men than women, especially among those who are heavy smokers and frequent alcohol users. Eliminating these habits may banish the headaches. In addition, keeping a diary of food and lifestyle factors may reveal that some of the factors known to trigger migraines can prompt clusters as well.

Tension and Other Headaches

Tension headaches are the most common type and are caused by muscle contractions or an imbalance of natural chemicals in the brain. The pain causes a band like pressure around the head and may be accompanied by a sense of tightness in the head and neck and shoulder muscles. They often begin in the afternoon or evening and produce a steady pain. Prevention is the best approach; relaxation techniques, such as biofeedback, massage, meditation, and visualization, work for many people. Another recommendation is to eliminate foods and drugs that contain caffeine, which can increase tension and anxiety, thus contributing to headaches.

Headaches also may be due to sinusitis, an inflammation of the lining of the sinus cavities. This causes a deep, dull ache around the eyes and sometimes in the forehead and ears. A good diagnostic clue is that the pain tends to worsen when you bend over.

So-called rebound headaches can result from overuse of over-the-counter analgesics, prescription pain medications and sedatives, and caffeine (which is common ingredient in such drugs), resulting in a vicious cycle of growing tolerance and increasing dependence. These tend to be mild to moderate headaches. Although you may have to go through a painful, headachy period for a week or more to withdraw from dependence on these drugs, you will feel better in the long run.

Dental problems too can cause very severe one-sided headaches, which may feel like migraine or clusters, especially if a tooth is abscessed.

The many factors that can cause headaches include squinting for hours in bright sun, eyestrain, hunger, excessive alcohol consumption, and too little or too much sleep.

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