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What is it

Headaches are one of the most common human ailments. For most people a headache is merely an infrequent annoyance, a passing discomfort that results from lack of sleep, sitting in a smoky room, or having an argument with someone. With aspirin, rest, and maybe a gentle massage, the pain goes away. That’s the way it is.

But for millions of others the pain does not go away; they suffer from chronic headaches. Americans spend upward of $400 million a year on headache remedies, leading researchers to estimate that as many as 45 million Americans suffer from chronic and/or severe headaches that seriously interfere with their haves.

Headaches are not completely understood by medical science, and researchers have advanced numerous theories to explain them. Tension, personality traits, heredity, and diet are a few of the factors that may play a role in chronic headaches. There appear to be various types of headaches, but any hard and fast classification is open to debate, in part because the types often overlap both in their symptoms and in their response to medication. Moreover, triggering factors and modes of relief vary from person to person.


  • Dull, steady pain that may be felt in the forehead, temples, or back of the neck, or throughout the head (tension headache).
  • Recurrent headaches characterized by throbbing, pulsating pain; often accompanied by visual disturbances, nausea, vomiting, light-headedness, and a runny nose. Episodes can last 4 to 72 hours and occur one to four times a month (migraine headache).
  • Steady, piercing pain located around or behind one eye or in one temple; usually strikes at night or in the early morning (cluster headache).

What causes it

The great majority of primary headaches (that is, those not caused by underlying disease) fall into three categories, according to the International Headache Society: tension (which includes depression headaches), migraine, and cluster. (Headaches can also be brought on by sudden exertion.

Tension headaches

These are also called muscle-contraction or stress headaches. Almost everyone occasionally gets a headache of this type. The pain is mild compared to migraine or cluster headaches. A feeling of tightness around the scalp is typical; muscles in the back of the upper neck may feel knotted and tender to the touch. It’s not known whether it’s the sustained muscle tension itself or the subsequent restricted blood flow that causes the pain.

Tension headaches are associated with stress (often the pain actually comes after the stress has ended), fatigue, or too much or too little sleep. Assuming a posture that tenses your neck and head muscles for long periods, such as holding your chin down while reading, can trigger these headaches; so can gum chewing, grinding your teeth, or tensing head and neck muscles during sexual intercourse. Men and women are about equally likely to suffer tension headaches.

Depression headaches

Some people who have daily headaches have been found to be suffering from depression as well. Usually they are muscle-contraction headaches. Persistent headaches accompanied by lethargy, insomnia, or suicidal thoughts are signs of clinical depression. Researchers do not understand the connection between depression and headaches, though some have suggested that the depression and the headaches may have a common biochemical cause. In some cases it may be the persistent headaches that cause the depression. And in some cases treating the depression makes the headaches go away.


The word migraine, derived from the Greek, means half a skull an apt description of the pain, which usually occurs in only one side of the head. Migraines appear to involve the abnormal expansion and contraction of blood vessels in and around the brain. In some people migraines start with distorted vision, called an aura generally characterized by zigzag patterns of shooting lights, blind spots, and/or a temporary loss of peripheral vision. The pain can be incapacitating and can last anywhere from a few minutes to several days; if it lasts longer than that, it’s probably not a migraine. Migraine sufferers may also experience nausea, vomiting, and sensitivity to both light and noise.

About 80 percent of migraine sufferers have a family history of the aliment; women are nearly four times more likely to be afflicted. The typical sufferer is young (under 35 years of age) and had her first attack during her teens or 20s. With age, attacks usually become less severe and less frequent. Hormonal changes can play a role: thus, susceptible women may have more attacks if they take oral contraceptives or it’s around the time of menstruation; they may have fewer attacks during pregnancy and after menopause. Attacks can also be triggered by certain substances in foods, by emotional factors, and environmental changes (like glaring light, strong odors, and changes in weather).

Cluster headaches

These strike in a group, or cluster, for up to a few hours, and recur daily for days, weeks, or even months on end. Months of freedom may pass between attacks. Some researchers consider cluster headaches a variant of migraines, largely because the excruciating pain is centered on one side of the head, as in a migraine. But unlike the throbbing of a migraine, this pain is steady and piercing, it is centered in one area usually behind one eye or in one temple and it typically strikes at night or in the early morning.

Cluster headaches are about six to nine times more likely to strike men than women; the first attack usually comes in a person’s 20s or 30s. They are sometimes misdiagnosed as a sinus disorder (because stuffy nose or sinus congestion is a common symptom) or even an abscessed tooth. There’s no clear cause, though heavy smoking and drinking are possible contributing or triggering factors.

Other causes of headaches

Some people with high blood pressure complain of headaches. If you suffer from frequent headaches, get your blood pressure checked, especially if you are over 40. Many people think first of a brain tumor as an important cause, but that is very- rare. Of all the people who seek treatment for headaches, less than one-half of 1 percent have been found to have a brain tumor. Eyestrain can cause a headache, but it will go away as soon as you rest your eyes. Poor lighting or poor posture may also lead to a headache, as can a hangover.

What if you do nothing

Most headaches that aren’t caused by some underlying disorder will clear up on their own although tension headaches can last for days at a time. Because the pain, especially from migraines and cluster headaches, can be severe, most people will want to take steps to alleviate the symptoms.

Home remedies

Many headache sufferers, and particularly migraine sufferers, find that it’s essential to nip the pain in the bud that is, to take medicine at the first sign of an attack Un-fortunately, the long-term frequent use of certain medications may actually result in drug-related headaches. Most of the prescription drugs have unpleasant and sometimes dangerous side effects, so it’s always best to rely on nondrug treatments when possible.

If you have recurrent headaches, try to discover what triggers them. Keeping a diary may help it can show you that a certain activity, circumstance, food, or medication is associated with the attacks. Treatments like the following may allow you to get by without prescription medications.

For occasional headaches, start with over-the-counter pain relief

The most common headache remedies are over-the-counter medications nonprescription NSAIDs (aspirin, ibuprofen, or naproxen) or acetaminophen. It’s impossible to predict which will work best for you. Remember that a drug is not harmless just because it is sold over-the-counter. No one should take a pain reliever for long periods with- out consulting a doctor.

Try to relax

Learning how to relax and cope with stress sometimes helps relieve headaches and other kinds of pain in part by reducing muscle tension, in part by shifting attention away from the pain.

One common technique is progressive muscle relaxation. It calls for tensing and then relaxing specific muscle groups, working from the feet to the head, while focusing on deep, regular breathing. Another technique, called the relaxation response, is a form of meditation and requires you to repeat a word or phrase until the mind is free of distracting thoughts and the body relaxed.

One study published in the journal Headache found that migraine sufferers who were taught relaxation training had 30 to 40 percent fewer attacks over the course of three years. The 24 subjects in the study were also better able to cope with the attacks they did have and required less medication.

Ice can help

Reusable gel packs kept in the freezer and then wrapped around the neck during a headache may provide relief in lieu of medication or as an adjunct to it. A study published in Postgraduate Medicine found that of 90 headache sufferers, 70 percent experienced some relief from such gel packs. Running cold water over your head may have a similar effect.

Try heat for tension

You may find that heat, rather than cold, helps relieve your headaches. A hot shower or bath, or moist heat applied to the back of the neck (use a wet towel wrapped around a waterproof heating pad), may relieve some tension headaches.


Many people find that massaging muscles in the neck, forehead, and temples promotes relaxation and offers some relief, especially for tension headaches.

Apply headbands

A study published in Headache found that a headband (with two small rubber disks to apply pressure over areas of maximum pain) provided at least partial relief in 60 out of 69 migraine headaches. The band provides more consistent pressure on the temples, scalp, and forehead than finger pressure.


For some people regular exercise helps relieve tension and thus may prevent some headaches. Neck, back, and shoulder stretches may also be beneficial.

Improve your posture

When working at a computer terminal, for instance, adjust your seat and table so that you don’t have to bend your neck for long periods.

Consider biofeedback

This high-tech relaxation method calls for hooking a subject up to a device that feeds back readings on a physiological variable muscle tension, for instance, or skin temperature. The feedback supposedly enables the subject to gain some control over the variable. Biofeedback seems to help some headache sufferers.

Get to the source

You may discover that your headaches disappear only when you resolve some underlying stressful problem in your life for instance, a troubled marriage or a major upcoming exam.


Regular exercise and relaxation can help prevent headaches. If you are prone to migraines, avoid oversleeping, since this may lead to migraines. Also, keep a daily record to help identify possible activities as well as foods and beverages that appear to trigger headaches. Avoid eyestrain and poor posture, both of which can trigger tension headaches.

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