Headaches are defined as pain in the head or upper neck. This is one of the most common locations of pain in the body and one of the most common reasons why people go to the doctor. Seven in 10 people have at least one headache per year, and 45 million Americans suffer from chronic headaches.
There are a number of underlying causes, most of which are benign. Primary headaches, which account for over 90% of headache pain, include migraine, tension, and cluster headaches, and are thought to have an underlying vascular (blood vessel) component.
Tension headaches are the most common type of primary headache and affect as many as 90% of adults. Tension headaches typically feel like a tightening on both sides of the head. They can last for minutes or days, and can happen frequently.
Tension headaches are often the result of stress or bad posture, which causes tightening of the muscles in the neck and the scalp. Tension headaches often worsen with noise and hot, stuffy environments. This type of headache occurs mostly in women over age 20.
Migraine headaches are the second most common type of primary headache. An estimated 25 million people in the United States (about 12% of the population) will experience migraine headaches each year. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.
Migraine headaches are intense and throbbing, often involve one side of the head, and can make you sensitive to light or noise. Migraines last from hours up to three days. Some sufferers have an “aura” (a group of visual symptoms) just before an attack. Migraines recur at intervals of varying length.
Some people have attacks several times a month while others have less than one a year. Most people find that migraine attacks occur less frequently and become less severe as they get older.
Medications can help prevent some migraines and make them less painful. Talk to your doctor about different migraine treatment options if you can’t find relief. The right medicines, combined with self-help remedies and lifestyle changes, may help.
Cluster headaches are less common than tension or migraine headaches, but still affect about 1 million people in the United States. Cluster headaches are non-throbbing and usually are felt on one side of the head behind an eye.
They generally occur between one and four times a day. Like migraines, cluster headaches are likely to be related to an increased blood flow as a result of the blood vessels in the brain widening. More common in men, they can happen over several days and usually last 30 to 45 minutes.
New severe headaches, especially those accompanied by a change in vision, mental status, loss of sensation or motor function, fever, stiff neck, fainting, or seizures, can be life threatening and should be immediately evaluated by a healthcare provider.
In addition, you should also see your healthcare provider if you have a history of headaches, but experience a change in the pattern or intensity.
Headaches, along with other systemic symptoms, like unexplained weight loss, known cancer, or immune disorders should be evaluated by a professional.
What Are The Conventional Treatments For Headaches
When lifestyle changes are not enough to manage headaches, there are medications that can be used to make less frequent and severe. Over-the-counter medications that are helpful include
- Aspirin and aspirin-caffeine combinations
- Non-steroidal anti-inflammatory drugs (i.e ibuprofen)
Tension headaches,migraine and other types of headaches should not be left untreated if occur for a longer period.
Exercise: a study showed that aerobic exercise done for 30 minutes, three times a week, decreased the intensity of headaches, and had mixed impacts on frequency of headaches.
Diet: up to 20% of migraine sufferers have identified food triggers, such as aged cheeses, wine, dark beers, cashews, onions, chocolate, processed meats, food additives, wheat, and dairy.
Migraine sufferers should consume a generally healthy diet food of whole foods, minimizing additives and avoiding identified triggers.
Excess caffeine use (6 cups of coffee or more) can result in chronic daily headaches, and caffeine withdrawal can trigger migraines. Episodic caffeine can help some migraine headaches acutely, probably by constricting the blood vessels involved.
Sleep: improving sleep can decrease the frequency of migraines, and is likely to benefit tension headaches as well.
There is a consistent body of research showing the effectiveness of behavioral treatments for tension-type headaches. Relaxation training, cognitive-behavioral therapy with or without relaxation training, specific types of biofeedback combined with relaxation training, and the same biofeedback alone have all been shown to be effective for reducing tension-type headache symptoms.
Physical therapy and movement training can help decrease muscle tension and improve range of head and neck movement. Studies have shown that physical therapy decreases frequency of tension headaches.
Massage therapy has been shown in some studies to be more effective than acupuncture for migraine pain, and equally effective for tension headaches.
Chiropractic manipulation for migraines have shown improvement in frequency, duration, disability, and medication use, compared with controls. Chiropractic may be additionally useful when combined with biofeedback practices.
Craniosacral therapy,which stems from osteopathic practice, is a very gentle manipulative approach, intending to restore balance and flow to the cerebro-spinal fluid, which circulates around the spinal cord and brain. A series of 4-6 treatments have been reported in practice to be very effective for both migraine and tension headache sufferers, and benefits may be long-lasting.
However, you should talk with your healthcare provider before adding supplementsto your health regimen and ask about the right dosage for you.
- Riboflavin or Vitamin B2 has significant preventive effects for migraines, taken in 200 mg twice daily with meals and may work as an additive ,with prescription beta-blocker medications.
- Magnesium has been found to have preventive effects for migraines, and may be helpful as an intravenous infusion in the office for patients suffering from an acute migraine.
- Feverfew can decrease the frequency and severity of migraines, although long term safety studies have not been done. The dose is up to 125 mg/d of dried leaf standardized to 0.2% parthenolide, the active ingredient.
- Butterbur has been shown in several good studies to decrease the frequency of migraine attacks by as much as 50% or more. It is used at doses of 50 mg 3 times a day for a month, then 50 mg twice a day thereafter, standardized to 15% petasins. Side effects reported are minimal.
- Co-enzyme Q10 taken in 100 mg three times daily, or a single dose of 150 mg per day, have both been shown to reduce migraine headache frequency after 3 months of use. It does not impact intensity or duration of a headache that does occur.
- Keep a diary of symptoms, looking for trends with weather, food, behaviors, hormone cycles, stresses and exercise patterns. This is especially helpful to identify the nature of the headaches (tension versus vascular versus combination)
- Make changes to avoid triggers whenever possible
- Establish daily routines of exercise, stress management and sleep
- Change your diet to optimize nutrition while minimizing any known food triggers
- If you try a therapeutic approach, such as massage, acupuncture, homeopathy, physical therapy, or others, allow 3-6 months for a fair assessment of the effectiveness of that approach for your individual situation
- If you plan to try drugs or supplements for prevention of migraines, consider natural products or supplements first, adding in prescription medications as needed
- In addition to working on prevention, it is a good idea to have a plan in place for the occurrence of an acute headache, whether migraine or tension. Experiment with self-care practices, therapeutic interventions (like acupuncture or manual therapies), and medications. You might want to minimize the use of prescriptive medications to keep them most effective when most needed.