Pulling Ahead of Headaches

First, you burned breakfast. Then, you were late for work. And on your way home, the car had a flat tire, making you miss your daughter's softball game.

Now you've got this throbbing headache that has gone from a minor annoyance to a major jackhammer pounding away in your skull.

And this jackhammer crew keeps busy: An estimated 45 million Americans suffer from chronic headaches, according to the National Institute of Neurological Disorders (NINDS) and Stroke and the American College of Physicians. In fact, for half that number, that pounding pain will be severe and possibly disabling.

For most of us, though, relief is as close as the medicine cabinet. The vast majority of all headaches are harmless episodes that can be treated with over-the-counter (OTC) painkillers—alone or together with rest, ice packs, or relaxation techniques.

Just what is a headache?

Medicine does not understand the exact process by which most common headaches are caused. These are two factors that are thought to play a role in some headaches, however:

  • An inflammation, spasm, or stretching in the scalp, in the membranes that cover the brain, and in the muscles of the face and jaw

  • A temporary distortion of the blood vessels that supply the brain; they tighten, then relax and expand. The enlarged blood vessels press against nerves, causing pain. A shortage of serotonin, a chemical in the brain, can cause the vessels to constrict.

In general, headaches fall into three classes: tension, migraine, and cluster.

Tension headaches

The most common type of headache is the tension type. Some people describe them as a band of pressure or tightness around the head, at the back of the neck, or at the base of the skull. Some can last weeks, months—even years.

A lot of stress factors, anxiety, and depression all contribute to headaches. The first step in controlling chronic headache pain is pinpointing the nature of its causes and symptoms.

Migraine headaches

Unlike tension headaches, you can blame migraines on those temporary changes in the diameter of blood vessels serving the brain and scalp. Migraines are three times more common in women than in men.

While some people call any severe headache a migraine, the real thing is usually much more intense—throbbing pain accompanied by nausea and even vomiting. Migraines can also bring visual changes and heightened sensitivity to light, sounds, and smells.

Migraines affect somewhere between 25 million and 29.5 million Americans, who often inherit the affliction. Research has also shown ties to diet, stress, changes in sleep-awake cycles, menstruation and hormonal changes in women, and environmental changes.

Cluster headaches

Cluster headaches bedevil about a million Americans, mostly men and mostly at night. Like migraines, cluster headaches follow changes in the brain's blood flow. Unlike migraines, they last less than an hour and occur in predictable "clusters," three- to eight-week periods in which they can strike several times a day.

Cluster headaches produce extremely severe pain, incapacitating victims even more than migraines. But cluster headaches can enter long periods of remission.

The causes

Doctors aren't sure what causes migraines or cluster headaches, but they've identified foods and food additives that can trigger a headache.

Have you heard of "Chinese restaurant syndrome"? It's the headache some of us get after a favorite Chinese meal. It comes from the food additive monosodium glutamate (MSG), also found in some frozen foods, lunch meats, canned and dry soups, and many other processed foods.

Then there's a class of chemicals called nitrites, used to preserve bacon, sausage, canned ham, smoked fish, and other meats. Nitrites can affect the body much the same way as low levels of serotonin-blood vessels in the brain dilate, sometimes producing a headache.

And certain foods that contain tyramine, such as hard cheeses, peas, navy and lima beans, fresh bread, yogurt, alcoholic beverages, and chocolate, might trigger headaches—especially in people who get migraines.

Red flags

Although not all headaches require medical attention, some should receive prompt medical care. If you or someone you're with has the following "red flag" symptoms, it's time to go to the doctor for a thorough exam: 

  • Headaches three or more times per week

  • Sudden or very severe head pain, especially if you were previously pain free

  • A headache you'd call the worst you've ever had

  • A headache after a head or neck injury

  • A headache accompanied by fever, nausea, shortness of breath, or vomiting, or unexpected symptoms of eyes, ears, nose, or throat, or a stiff neck

A trip to the doctor can help eliminate discomfort. However, if you have the sudden onset of a headache that is almost incapacitating in its severity--and you've never had headaches close to something like this before or it's the first time you've really ever had severe headaches--you should go to the nearest Emergency Room, especially if you have other neurological symptoms, such as those mentioned above.

Treating your headache

OTC medications, such as aspirin, acetaminophen, and ibuprofen, are the first line of defense for treating the common headache. Some other methods:

  • Place an ice pack on the forehead, eyes, temples, or nape of the neck.

  • Take a warm bath or shower to help relieve tension.

  • Rest in a quiet, darkened room.

  • Use simple relaxation techniques—breathing deeply, relaxing your muscles and using visual images.

  • Try progressive relaxation. Tense your toes slowly as you breathe in, then relax your toes as you let go of the tension and exhale. Work your way up the body, tensing and relaxing other muscles.

  • Exercise for 30 minutes at least three to four times a week. Any aerobic exercise slows your heart rate and releases painkilling chemicals in the brain.

  • Avoid foods associated with the onset of your headaches.

  • Limit caffeine intake.

  • Limit nicotine intake.

  • Get plenty of sleep.

  • Don't skip meals.

  • Have your eyes checked.

The NINDS recommends preventive treatment if you experience three or more headaches every month. Ditto if your headaches are increasingly unresponsive to OTC medications.

Finally, see a doctor if you experience "neurological manifestations," such as flashing lights, blurred vision, slurred speech, and numbness, weakness, or less feeling in a limb, or if the headaches seem to be triggered by exertion, such as exercise, sneezing, or bowel movements.