Headache

Headache

Some days, it seems like headaches are the price of modern life. We’re bombarded with too much noise, too much stress, too much traffic, too much everything, and the result is a pounding headache.

Doctors estimate that over 45 million Americans have histories of getting chronic, recurring headaches. They figure that temporary tension-type headaches affect 70 percent of the population. Headache patterns begin in youth and middle age, say experts. And those patterns are likely to continue as you mature.

But all sorts of things can cause a headache at any age. Chocolate, cheese, red wine, cured meats, flickering fluorescent lights, stress, tension, or changes in sleep habits can trigger migraines. Chronic disease and neurological disorders can bring on headaches, as can something as mundane as coughing. According to one study, the most common cause of head pain is ice cream.

Each year, the vast majority of Americans who visit physicians for headaches suffer from what is known as primary headaches, says Alan Rapoport, M.D., director and co-founder of the New En gland Center for Headache in Stamford, Connecticut, and assistant clinical professor of neurology at Yale University Medical School. For these individuals, the headache itself is the primary problem and not just a symptom of some other disease. Primary headaches are divided into three general categories, says Dr. Rapoport: tension-type headache, migraine headache, and cluster headache.

Nine out of 10 people who get headaches have the tension-type. Also known as muscle-contraction headaches, some are caused by a tensing of muscles in the scalp and neck. With these, you’ll feel a dull, achy pain, as if pressure were being applied to your head or neck. Tension-type headaches may be triggered by anxiety and stress, poor posture, muscle strain, or something out of kilter in your joints.

Migraines produce throbbing pain on one or both sides of the head. Other symptoms can include nausea, vomiting, light and noise sensitivity, fever, chills, flulike achiness, and sweating. Migraines may last from a few hours to days. You might get migraines several times a week or as infrequently as once every few years.

Cluster headaches are a relatively rare but very distinct type of headache that mainly affects men. The headaches come in series. They are sudden, excruciating one-sided headaches that can run from 45 minutes to two hours. Along with the headache comes nasal congestion. Typically, one eyelid droops, and the eye on the painful side gets irritated and watery. Dr. Rapoport says that cluster headaches occur chiefly in middle-age men. Fewer than one-tenth of 1 percent of the population gets this type of headache, and those in their senior years are even less likely to get them.

Then there are secondary headaches, which are probably most common to seniors. These are brought on by some other ailment like a sinus infection, temporomandibular joint disorder, shingles, glaucoma, brain hemorrhage, or meningitis, says Robert Kennedy, M.D., internist and director of geriatrics at Maimonides Medical Center in Brooklyn, New York. In older Americans, for example, dental and jaw problems caused by misaligned dentures often bring on headaches, says Dr. Kennedy. Cervical osteoarthritis can produce these headaches, too, by putting pressure on nerve roots in the neck and at the base of the skull. If you have chronic headaches, notes Dr. Kennedy, seek the advice of a headache specialist.

Although many tend to get fewer headaches as they age, says Dr. Kennedy, that fact won’t be much comfort to you when headaches do strike. But the following remedies can come to the rescue.

Try This First

Take a break. Many times, headaches go away when you break your routine, explains Richard W. Besdine, M.D., professor of medicine and director of the center on aging at the University of Connecticut Health Center in Farmington. “Do some stretching exercises, take a walk in the fresh air, play a game on the computer. Do something you enjoy to get your mind off the pain.”

Often, relaxation and gentle exercise are all that’s needed to relieve a mild tension-type headache, according to Dr. Rapoport.

Other Wise Ways

Keep a diary. The best way to beat a recurring headache is to keep a headache diary, says Robert Kunkel, M.D., migraine specialist at the Cleveland Clinic Foundation. In your diary, note when the headache begins, how long it lasts, and where it’s located, like the base of the skull or left temple.

A diary should also chart what you were doing when the headache began, where you were, whether you were around any potential allergens, what you recently had to eat or drink, and whether you were feeling tense or emotionally upset. And include comments on any patterns you’re noticing. For example, you might note that, “Headaches are more intense when I haven’t had eight hours of sleep.” This information will help you spot patterns that you may be able to alter, notes Dr. Kunkel. A diary can also help your doctor identify the best treatment, he says, while making you a better advocate for your own health.

Get physical. Regular exercise relieves headaches, says Dr. Kunkel, and reduces their frequency. Exercise causes the release of brain chemicals called endorphins, which are powerful natural painkillers, he says. Plus, people who exercise regularly tend to be in better health and have fewer headaches in general.

Try physical exercise like brisk walking, jogging, swimming, bicycle riding, rowing, or aerobic dancing for 20 to 30 minutes a day. It can be very relaxing, calming, and therapeutic for someone with a headache, according to Dr. Kunkel. If the exercise makes a headache more intense, stop what you’re doing and try something a little less jarring to your body. Check with your doctor before you begin an exercise program, says Dr. Kunkel.

Try the tried and true. You probably already knew this, but some over-the-counter pain medications, like Excedrin Migraine, Nuprin, and Orudis KT, provide very effective relief for most headaches, says Dr. Rapoport.

Mild headache pain can be treated with common painkillers like aspirin, acetaminophen, or ibuprofen tablets. “But take care not to use these too often,” advises Dr. Rapoport, “because analgesics can cause rebound headaches.” He suggests limiting use of these drugs to two or, at most, three days a week to avoid rebound headaches. Take no more per day than is recommended on the label.

Pinch yourself. Acupressure is a procedure based in a traditional Chinese medicine that may help relieve headaches by promoting the release of painkilling endorphins, says Dr. Kennedy.

Pinch the acupressure point on the same side that your head hurts. Using the thumb and index finger of one hand, lightly pinch the web of skin between the index finger and thumb of your other hand. Hold for three minutes, then release.

Cool it. An ice pack can relieve tension-type headaches, says Dr. Kennedy, by relieving muscle spasm and numbing the painful area.

To put the deep freeze on your headache, fill a plastic sandwich bag with ice cubes and wrap it in a damp towel, then hold it on the painful area for 10 minutes, suggests Dr. Kennedy. A bag of frozen vegetables or a specially made product called an ice pillow can be used in the same way, he says.

Give yourself a massage. Many tension-type headaches in older people are caused by arthritis in the neck, explains Dr. Kunkel. Gently massage your scalp and neck to help relieve the pain, he suggests. You can massage your scalp with your fingertips as if you were washing your hair.

Or softly knead the tight muscles of your neck and shoulders for as long as it feels comfortable. Or better yet, ask a loved one to massage your neck, head, and shoulders for 5 to 10 minutes, says Dr. Kunkel.

Roll out your neck. In addition to massaging tight muscles, Dr. Kunkel suggests doing neck rolls in the shower, where heat makes tight areas more pliable. Direct the spray to the back of your neck, let your chin hit your chest, and do big, slow rotations all the way around. Then switch directions, alternating after about five rotations per side, he says, and allowing the weight of your head to gently stretch stiff muscles. Stop if you feel any discomfort.

Boost In one Belgian study, people who took 400 milligrams daily of vitamin B₂, or riboflavin, reduced migraine intensity by 68 percent, he says. Other research found that patients improved when they started taking 50 milligrams of B₆.

B vitamins are generally safe because the body excretes any excess, Dr. Rapoport says. Nonetheless, check with your doctor before beginning vitamin therapy, he advises. Unstable gait and numb feet may occur, for example, in doses of B₆ at 50 milligrams to 2 grams daily over a prolonged time.

Magnify your magnesium intake. To prevent migraines, Dr. Rapoport recommends taking 250 to 400 milligrams of magnesium every day. Research suggests that magnesium deficiency is partially to blame for about 50 percent of migraines, he says. (People with heart or kidney problems should not take supplemental magnesium.) Supplemental magnesium may cause diarrhea in some people.

Keep regular hours. Migraines are commonly triggered by a change in sleep patterns, says Dr. Kunkel, who advises those prone to migraines to follow a routine as much as possible. It’s best to go to bed and get up at about the same time each day, he adds, since this helps to regulate the brain’s important biological clock.

While it’s important to get enough rest, average six to eight hours. Avoid oversleeping, warns Dr. Kunkel, since this can also trigger a migraine.

Eliminate food triggers. Hammering headaches, especially migraines, can be brought on by different foods, says Dr. Rapoport.

One of the most common triggers is tyramine. Chocolate, red wine, and aged cheese all contain this chemical. It causes blood vessels to constrict only to rebound and dilate painfully later. Nitrites, found in cured or processed meats like turkey, ham, hot dogs, and bologna, can cause problems for some people. So can monosodium glutamate (MSG), which is found in meat tenderizers, canned and dry soups, and some Chinese food.

Eating salty snack food has been linked to headache attacks by some studies. Use of the artificial sweetener aspartame has been associated with headaches in some studies, but not in others.

Suspect foods don’t cause problems for all people prone to migraine, says Dr. Rapoport. But if you might be susceptible, avoid many of these foods long enough to see if your headaches go away.

Turn down caffeine. If you consume caffeine every day then suddenly stop, you’re setting yourself up for a major headache, explains Dr. Besdine. As with some other drugs, the lack of caffeine can cause a headache if your body has come to depend on it. This is why it’s not a good idea to avoid caffeine altogether on the weekend if you’re accustomed to having one or more cups per day, he adds.

To minimize caffeine’s headache effect, Dr. Besdine recommends no more than two cups of caffeinated beverages a day. If you want to eliminate caffeine from your diet, it’s best to do so very gradually, he says.

Don’t skip meals. If you miss a meal, your blood sugar level drops, and that is one of the most common triggers mentioned by migraine patients, says Dr. Kunkel. Anyone prone to frequent headaches should avoid skipping meals, he says. Instead, have meals at regular intervals during the day, says Dr. Kunkel. And eat some protein, about three ounces at least three times each day.

Have a denture adjustment. If your bite isn’t symmetrical because your dentures are out of alignment, it can cause headache pain by straining your jaw and facial muscles, Dr. Kunkel says. “Many older people hate to spend money updating or fixing their dentures, but it’s really a small investment if it eliminates headaches and improves the quality of your life.”