Headache

Headache pain is one of the leading reasons why people see doctors, accounting for some 10 million office visits a year. But that's probably just the tip of the headache iceberg.

According to the International Headache Society, there are 129 distinct types of headache. The three most common are tension headache, which is caused by stress; migraine, which results from the expansion and contraction of blood vessels in the head; and sinus headache, which stems from sinus infections or hay fever-type allergies. Many headaches are not strictly one type but rather a combination of two or more.

This chapter deals with tension headaches. You know what a tension headache feels like: a steady, aching pain that wraps around your entire head. It's this pattern of pain that earned tension headaches the nickname "hatband headaches:"

Like most other types of headaches, tension headaches have nothing to do with your brain. Rather, they originate in the muscles that run through your scalp and neck. Tension headaches are usually associated with stress, hence their name.

A tension headache can strike at any time,though it's most likely to occur toward the end of a long, hard day. The pain can last from as little as 1/2 hour to as long as several days.

Only the most severe or persistent tension headaches require a doctor's attention. For more run-of-the-mill pain, you can usually get relief through self-care, using any of several effective mainstream and alternative remedies. The next time you feel a tension headache creeping up on you, try one of the following measures to keep the pain at bay.

Best Choices

Visualization

Picture pain vanishing. As an alternative to over-the-counter medicines, visualization exercises provide prompt relief from headache pain. They are an especially valuable treatment option for moms-to-be, who are advised not to take medication during their pregnancies.

Of course, you needn't be a mom-to-be to practice visualization. When you feel a tension headache coming on, try this exercise recommended by Gerald N. Epstein, M.D., director of the Academy of Integrative Medicine and Mental Imagery in New York City. Begin by closing your eyes and taking three slow, deep breaths. Imagine that you're looking down at the top of your head. Lift off the top of your skull as if you were removing the top of the shell of a soft-boiled egg. Look inside. Imagine that your brain is a lake and that your nerve fibers are underwater plants gently waving in the current. Now imagine that the lake is being drained, and with it, all of your tension. Once drained, your brain fills with new, clear water, as fresh blood circulates all around your head, your neck, and the rest of your body. Imagine replacing the top of your skull. Take a final deep breath and open your eyes.

Biofeedback

Learn how to relax. Biofeedback typically relieves headache pain in 70 percent of people who try it, says Mark Schwartz, Ph.D., a staff psychologist at the Mayo Clinic in Jacksonville, Florida. Many studies back up his claim.

In one study, researchers at the Medical College of Georgia in Augusta asked 26 people with chronic tension headaches to record the frequency, intensity, and duration of their pain. Then the participants received training in either progressive muscle relaxation or biofeed­back, which focused on relaxing their neck muscles. After 3 months, the people who practiced progressive muscle relaxation showed only 34 percent improvement in their pain. By comparison, the people who learned biofeed­back reported 74 percent improvement.

Massage

Rub the right place. When headaches strike, many people rub their temples. Right approach, but maybe the wrong location. Studies by neurosurgeon Walker 1. Robinson, M.D., at the University of Maryland Medical Center in Baltimore have shown that tension headaches often originate in the muscles at the back of the neck. Dr. Robinson suggests massaging those muscles for relief.

Aromatherapy

Be partial to peppermint. Researchers at the neurology clinic of the University of Kiel in Germany instructed 32 people with headaches to treat their pain with self-massage of their heads and necks. Each person also used one of four aromatherapy preparations.

The two preparations that contained large amounts of peppermint oil proved most effective in relieving headache pain. You can buy peppermint oil in most health food stores and bath and beauty shops. Add a few drops of the oil to unscented skin or massage lotion and rub it in.

Another good remedy is Tiger Balm, the popular Asian pain reliever that has been a health-food-store fixture for decades. It contains no tiger parts, but it boasts a generous helping of menthol, a major component of peppermint oil.

To purchase Tiger Balm, check your local health food store. Make sure that you follow package directions when using the ointment because it is very strong.

Herbal Medicine

Let willow whip your pain. Willow bark contains salicin, the natural precursor of the active ingredient in aspirin. "Any mild pain problem that you might treat with aspirin you can also treat with willow bark tea," says James A. Duke, Ph.D. To make the tea, add 1 to 1 1/2 teaspoons of powdered white willow bark to 1 cup of boiled water, simmer for 10 minutes, then strain.

Two other herbs, wintergreen and meadowsweet, also contain salicin. To make a tea from either herb, add 1 to 1 1/2 teaspoons to 1 cup of boiling water. Simmer for 10 minutes, then strain.

Chinese Medicine

Revive your qi. Practitioners of Chinese medicine attribute pain to stagnation of qi, Blood, or Moisture, says Efrem Korngold, O.M.D., L.Ac. Many headaches involve some degree of stagnation of all three elements, he says.

The classic Chinese herbal formula for headache is called Chuan Xiong Cha Piao. It contains quite a few herbs, including ligusticum, angelica, asarum, and peppermint. "It breaks up stagnation;" Dr. Korngold explains. If you want to try this herbal formula, you need to consult an oriental medicine practitioner.

For relief, press on. When staff members from the National Institutes of Health reviewed research involving acupuncture as a headache treatment, they found that in eight of nine studies, acupuncture relieved headache pain significantly better than a placebo treatment. In light of such research, both the National Institutes of Health and the United Nations World Health Organization endorse acupuncture for headaches.

Of course, acupuncture must be administered by a trained professional. If you prefer a self-care approach, try acupressure instead. Apply steady, penetrating finger pressure to each of the following points for 3 minutes, says Michael Reed Gach, founder and director of the Acupressure Institute.

• Large Intestine 4, located on the back of your hand where the bones of your thumb and index finger meet
• Governing Vessel 24.5, located between your eyebrows where the bridge of your nose meets your forehead
• Governing Vessel 16, located in the center of the back of your head, in the hollow at the base of your skull
• Bladder 2, located on either side of your nose, where the bridge of your nose meets the ridge of your eyebrows.
• Stomach 3, located at the base of the cheekbone, directly below your pupil
• Liver 3, situated on top of your foot in the webbing between your big toe and second toe

For chronic headaches, however, Dr. Korngold recommends professional acupuncture treatments. Acupuncture generally provides greater pain relief than acupressure.

Home Remedies

Give pain the cold shoulder. Two­thirds of people with tension headaches experience at least some relief when they use cold treatments, says David Trachtenbarg, M.D., clinical assistant professor at the University of Illinois College of Medicine in Peoria. Here are two ways in which you can use cold treatments.

• Place a wet towel in your freezer until it's cold but not frozen. Drape it over your forehead or wrap it around your head or neck. Leave the towel in place for 10 to 15 minutes.
• Put a few ice cubes in a plastic bag, then wrap the bag in a clean cloth. Apply the ice pack across your fore­head for 20 minutes, then remove it for 10 minutes before reapplying. "Just don't apply ice directly to your skin, or you may give yourself frostbite;' says Anne Simons, M.D.

Wash down your aspirin with coffee. Studies dating back about 20 years show that 65 milligrams of caffeine-roughly the amount in a cup of instant coffee or 1/2 cup of brewed-boosts the effectiveness of aspirin and other over-the-counter pain relievers by about 40 percent. Scientists believe caffeine helps because moderate, occasional consumption constricts the blood vessels in your head. It's the sudden opening, or dilation, of these vessels that causes headaches.

Some over-the-counter pain relievers, including Excedrin, Midol, and Vanquish Caplets, already contain caffeine. Or you can simply wash down your pills with a cup or two of coffee.

Keep a headache diary. Many tension headaches have triggers: emotional upsets, sleep disturbances, artificial sweeteners, certain foods, or drugs or alcohol (especially red wine). So if you're prone to tension headaches, Dr. Simons suggests keeping a headache diary. "Every time you get a headache, write down the date and time as well as any psychological, physical, or environmental factors that might have contributed to it;' she says. "Also list all of the foods and beverages that you consumed within the previous 12 hours. You may see a pattern that you can change."

Over-The-Counter Drugs

Head for the drugstore. Most everyday tension headaches respond well to aspirin, acetaminophen, ibuprofen, or naproxen (Aleve), says Robert Smith, M.D., professor and director emeritus of the department of family medicine and founder of the Headache Center, both at the University of Cincinnati. Which of these pain relievers works best? Despite what the television commercials say, they all work about the same when taken in their recommended dosages. Which you choose depends on your individual preferences. Of the four drugs, aspirin is the most likely to cause stomach distress.

When taking a pain reliever, don't exceed the dosage indicated on the label. Over­dosing is rare, but it can happen. According to the American Association of Poison Control Centers, acetaminophen accounts for 66 percent of overdoses involving over-the­counter pain relievers, with ibuprofen causing 19 percent, and aspirin, 15 percent. Overdoses of all three drugs can cause nausea and vomiting. Aspirin overdose also produces ringing in the ears and, ironically, headache. At very high doses-to to 15 grams-these drugs may cause liver damage.

Other Good Choices

Nutrition

Cutting back on caffeine? Proceed with caution. If you're a java junkie, beware: Caffeine is addictive. If you drink coffee regularly and then stop suddenly, you're in for a rough ride in the form of a caffeine with­drawal headache that can last for several days. To avoid this type of headache, taper off regular coffee slowly, over several weeks.

Eat ice creanl wisely. While a cold pack can help relieve a headache, a cold food-especially ice cream-can actually cause one. Neurologist Joseph Hulihan, M.D., of Temple University School of Medicine in Philadelphia, calls ice cream "the most common cause of food-induced headaches:" At least 30 percent of people develop head pain within moments of scooping a spoonful of ice cream into their mouths, he says.

One veteran of ice cream headaches is Dr. Smith. Intrigued by the phenomenon, he tried applying crushed ice to different parts of his mouth. He discovered that the ice produced a headache only when it touched the back of his palate. His advice: Eat your ice cream slowly, in small bites or licks. Let it melt in your mouth. That way, it's less likely to touch the back of your palate and trigger a headache.

Supplements

Increase your magnesium intake. Magnesium deficiency has been linked to both tension headache and migraine, says Alan Gaby, M.D. He advises people who experience chronic or fairly frequent headaches to take 200 milligrams of magnesium three times a day.

Homeopathy

Discover a healing quartet. According to homeopath Dana Ullman, homeopaths typically rely on four medicines to treat tension headaches. They are Belladonna, Bryonia, Gelsemium, and Nux vomica. "But for chronic headaches, you might be better off with a constitutional remedy;' he says. A constitutional remedy treats the whole body rather than specific conditions. See a homeopath to find the treatment that is best for you.

Ayurvedic Medicine

Blame your bowels. Ayurveda attributes tension headaches to problems in the colon, primarily constipation, says David Frawley, O.M.D. When treating people with tension headaches, Ayurvedic physicians often prescribe laxative herbs-notably, aloe powder and rhubarb-along with other herbs, including ginger, calamus, bayberry, and winter­green. In addition, they suggest massaging the head, neck, and shoulders with sesame oil.

Medical Measures

Doctors treat especially severe or persistent tension headaches with an array of medications, including prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs), combinations of pain relievers and narcotics, and even antidepressants.

Often these pharmaceuticals help. But NSAIDs may cause abdominal distress and ulcers, while narcotics are associated with drowsiness and confusion. And antidepressants cause a variety of side effects, including dry mouth.

Because headaches are so common-and because they're often chronic and complicated-special clinics that focus exclusively on treating them have sprung up around the country. To find a headache clinic near you, contact either of the following organizations.

• American Association for the Study of Headache, 19 Mantua Road, Mount Royal, NJ 08061-1006
• National Headache Foundation, 428 West Saint James Place, Second Floor, Chicago, IL 60614-2750

Red Flags

A headache can be a symptom of an enormous number of conditions. So if you have a headache that doesn't respond to home treatment within 3 days, you should see your doctor to rule out an underlying medical problem, Dr. Simons advises.

In addition, see your doctor right away if you experience any of the following:

• An unusually severe headache
• A headache accompanied by a fever of 102°F or higher or a stiff neck
• Head pain that gets worse when you bend your chin to your chest
• A headache accompanied by slurred speech, blurred vision, or numbness or weakness in the arms or legs
• A headache following a head injury
• Headaches that recur with increasing frequency or get worse over time