Headache

Headaches. Who hasn't had one? Nine out of ten adults experience headache at some point in their lives--and wish they could wave a magic wand to make it disappear.

Facts About Headaches

Some people get headaches only occasionally, but up to 50 million Americans get frequent headaches that can make them feel miserable on a regular basis. Each year, headache is responsible for 157 million lost workdays, 10 million doctor's visits, and $50 billion in health care costs. That's no small price to pay. Yet headaches are often not seen as a true medical disorder--either by patients or by doctors.

The vast majority of headaches aren't serious, although they can seriously impair your ability to function well. What's sad is that 70% of headache sufferers never seek medical help, either because they don't believe they have a legitimate illness or because they don't think effective treatments are available. And even when headache sufferers do complain to a doctor about their problem, they may give up before a treatment is found that can relieve their pain.

The fact is that headache therapy is very individualized: What works for one person may not work for another. And you may have to try a variety of medications and nondrug techniques before you find a cure.

Symtomps

Tension headaches, also known as muscle-contraction headaches, are characterized by dull, constant pain, often on both sides of the head. A tension headache is often likened to the sensation of a tight band or vise squeezing the head. The pain is usually mild to moderate, and not incapacitating, and may be accompanied by tightness in the neck and shoulders. These headaches can last between four hours and a week.

Tension headaches are classified into two categories:

1. Episodic headaches

2. Chronic (daily) headaches

Migraine headaches are signaled by intense throbbing pain, which is usually one-sided, near an eye, and of moderate to severe intensity. The headaches, which can be disabling, can last up to 72 hours. Nausea and vomiting, sensitivity to light and sound, dizziness, and blurred vision often come with a migraine.

About 40% of migraine sufferers also experience an aura--in other words, warning signs such as flashing lights or dots--to signal an attack is coming. Cluster headaches produce severe, sharp, stabbing pain, usually on one side of the head and centered around one eye. They are severely incapacitating. These headaches tend to occur in clusters of 1-4 a day for 4-8 weeks, last between 30 and 90 minutes each, and then disappear for months.

Flushing of the face, tearing of the affected eye, and a stuffy or runny nose on the same side where the pain is located may occur during an attack. Cluster headaches are most frequent in the spring and fall.

Types of Headaches

There are three main categories of headaches:

Tension headaches
Migraine headaches
Cluster headaches

Some people are prone to just one type of headache, while; others may get both migraines and tension headaches.

Other less-common types of headache are:

Post-traumatic headaches (those that occur after an injury or accident)
Sinus headaches
Temporomandibular joint (TMJ) headaches (those that are linked to a disorder of the jaw)
Exercise-induced headaches
Sexual activity-induced headaches
Allergy headaches

Causes and Risk Factors

What Causes Headaches?

Tension and Migraine Headaches: Doctors aren't entirely sure what causes headaches, but they now believe that tension and migraine headaches--even though they lie at opposite ends of the same spectrum--are related to one another. What's more, both headache types are likely inherited: It appears that tension and migraine headache sufferers have a genetically predisposed defect that involves the brain chemical serotonin. This chemical, which seems to be on the tip of every scientist's tongue these days, regulates your mood, how well you sleep, and the narrowing and widening of your blood vessels.

Here's what likely happens when you get a migraine and probably a tension headache, too:

An electrical wave sweeps over the brain.
The electrical activity causes a surge in the serotonin level, which causes blood vessels to constrict.
Serotonin seeps into the surrounding tissues, which lowers the level of serotonin in the brain.
The blood vessels expand and the nerves in the brain become irritated by the lack of serotonin.

What brings on the electrical activity and the rise and fall in serotonin? The answer is triggers.

Common triggers for tension and migraine headaches include:

Stress
Worry
Anxiety
Depression
Anger
Too much or too little sleep
Changes in weather and seasons
Missing a mealDrinking too much caffeine

Eating certain foods:

Chocolate
Aged cheeses
Citrus fruits
Pickled, fermented, or marinated foods
Cured meats (hot dogs, luncheon meats)
Aspartame (NutraSweet)
Monosodium glutamate (MSG)
Drinking alcohol (especially red wine)
Getting too much sun or overexposure to bright, glaring indoor lights

Female hormones:

Menstruation
Oral contraceptives
Estrogen replacement therapy
Pregnancy
A change in altitude or pressure
Strong odors (perfume, cigarette smoke, paint, etc.)
Motion (in a car or boat)

Cluster Headaches:

Doctors don't believe that cluster headaches, which are potentially the most painful headaches, are inherited. They may, however, be caused by a serotonin imbalance and/or by a defect in the body's biological clock.

Who is affected?

Tension and Migraine Headaches:
At some point in their lives, 90% of people will get a tension headache; migraines affect about 15% of the total population. Both headache types affect women three times as often as men.

Cluster Headaches:
Cluster headaches affect 1% of the population overall, and strike men four times more often than women.

Diagnosis

Clinical diagnosis

Doctors typically diagnose headaches by doing a physical examination and asking you about your symptoms, your health and lifestyle habits, and your family history.

In some cases, if doctors can't readily classify your headache type, or if they suspect an underlying cause for your headaches, they may order blood tests or imaging tests--an x-ray, a CAT scan, or an MRI to get a better look at your brain.

Frequently Asked Questions

I have to take a pain reliever almost every day because of headaches. I know it's bad for me to take so many pills, but what else can I do?

It sounds like you're suffering from "rebound headache," which is brought on by taking too many headache medications. What happens is that your body becomes tolerant to the medication and you need more and more medicine--daily doses--to avoid the pain. Up to three-quarters of people with headaches fall into the rebound trap. The only way out of it is to stop taking your medicine for a few days. Unfortunately, you may experience intense headaches during this time, along with nausea and vomiting. But if you stick it out, you'll improve in 3 to 5 days. From then on, don't take pain medications more than 3 days a week. If you experience frequent headaches, see a doctor for stronger or perhaps preventive therapy.

When do I need to see my doctor about my headaches?

If you're able to cure your headaches with OTC medications and nondrug remedies, then you don't need to see a doctor. But if headaches are frequent, very severe, become worse over time, or start suddenly, it's advisable to consult a health care practitioner.

Do I need to see a headache specialist for my headaches?

Not necessarily. Start with your primary care physician. If he or she can't find a treatment that relieves your pain or doesn't take your complaint seriously, then ask for a referral to a headache specialist (usually a neurologist).

Why do women get more headaches than men?