Headaches

With over 50 million cases per year in the United States alone, headaches top the list of the most common afflictions in humans. More than 70% of headache sufferers never consult a doctor because they assume that little can be done to help them.

While it’s true that not every headache can be cured, there are proven ways of controlling them. This website has been prepared so that you might better understand headaches--their nature, which symptoms to take seriously, the various types of headaches, and their possible causes and treatment.

As with any other medical condition, a consultation with a health professional is recommended before beginning a headache control program.

The Nature of Headaches
Symptoms to Take Seriously
Headache Triggers
Headache Diary
Types of Headaches
Headache Treatment
Final Comments

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The Nature of Headaches

Headaches are caused by two different categories of biological happenings: either by muscle contractions, or by vascular irregularities (the alternating constriction and expansion of arteries). Certain conditions such as brain tumors, arterial inflammation, and irritation of the facial nerves also cause headaches, but these are extremely rare.

Headaches Caused by Muscular Contraction

The attributes causing the pain are two mechanisms relating to muscle contraction: nerve compression within the muscle caused by poor posture, spinal misalignment, or physical and emotional stress; and nerve irritation caused by a buildup of metabolic wastes resulting from decreased blood and lymph circulation due to poor diet, constipation, or other digestive problems, and in women, pelvic irritation.

Headaches Caused by Vascular Irregularities

These types of headaches include migraines, cluster headaches, and caffeine withdrawal headaches, that account for less than 10% of all cases. With vascular headaches, the alternating constriction and expansion of the arteries of the head exerts pressure on arterial nerves and causes sharp pain.


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Symptoms to Take Seriously

Although it’s rare, headaches can be caused by serious disorders such as brain tumors or meningitis. That’s why you should never ignore chronic headaches and hope they’ll go away on their own. If any of the following symptoms occur, consult your family physician or neurologist as soon as possible.

  • Persistent headaches that progressively worsen over days or weeks.
  • Headaches that start suddenly (especially important if you’ve never had them before and you’re over 50 years of age).
  • Headaches that come on suddenly after coughing, straining, or exertion.
  • Changes in vision (or other senses), double vision, increased weakness, or loss of sensation.
  • Confusion or changes in memory, personality, or behavior.
  • General weakness, numbness, or slurred speech.
  • A stiff neck with a fever or a rash, or a seizure.
  • An unexplained fever or breathing problems (i.e. shortness of breath), which accompany the headache.
  • A sudden or dramatic change in the severity of your headaches.
  • Headache after a head injury or accident, or after a sore throat or respiratory infection.
  • A constant headache with no relief.
  • Persistent or severe vomiting.
  • Experiencing three or more headaches a week.
  • Use of a pain reliever every day or almost daily to relieve your headache symptoms.
  • If you get a very sudden and excruciating headache unlike any you’ve ever had, consult a doctor immediately.

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Headache Triggers

While a biological condition may make you more susceptible to headaches, certain factors called “triggers” are what actually set them off. Therefore, an important step toward solving your headache problem is to analyze what was happening right before your head began to hurt. What were you doing? Were you sunbathing? Did you skip a meal? Were you having an argument? A trigger can be almost any change inside or outside the body that can provoke a headache--something we see, feel, smell, hear, or eat. Each headache sufferer has different sensitivities, so not all triggers provoke a headache in all sufferers. Headaches may be produced by one particular trigger, sometimes by a combination of them. Because something is a trigger, however, doesn’t mean it will always result in a headache; frequently, it may not. Only by looking for possible patterns will you be able to identify your personal triggers and avoid them in the future. The most common headache triggers, in order of their frequency, are:

  • Stress.
  • Sudden weather changes.
  • Hormonal changes caused by PMS, menstruation, birth control pills, pregnancy, or menopause.
  • Missing a meal.
  • Exposure to bright light (particularly fluorescent light or sunlight).
  • Too little sleep.
  • Reaction to certain foods eaten within the last 24 hours.
  • Exposure to cigarette smoke, perfumes, or other strong odors.
  • Experiencing a letdown after stress.
  • Too much sleep.
  • Exercise or exertion.
  • The changing of the seasons (Spring and Fall are the worst).
  • Medication, such as high blood pressure drugs with reserpine or hydralazine.
  • Eyestrain.
  • Travel on planes, trains, cars, or buses, especially in compartments with poor air circulation.

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Headache Diary

Proper treatment of headaches involves careful diagnosis to locate the disturbance actually causing headache pain. It is very important to keep track of your headaches so your doctor can properly diagnosis your headache pain, type, and causes. One of the most important tools in headache prevention is the headache diary. It is used in determining the underlying causes and patterns related to your headache. Use the diary to record on the days you get headaches:

  • Date.
  • Warning Signs.
  • Time Pain Began.
  • Time Pain Ended.
  • Type of Pain.
  • Intensity of Pain (Low) 1 2 3 4 5 6 7 8 9 (High).
  • Location of Pain.
  • Treatment/Medication Taken.
  • Effect of Treatment.
  • Hours of Sleep.
  • What I Ate Today.
  • Unusual Events Occurring.
  • Additional Comments.

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Types of Headaches

In order to help alleviate your pain, you first need to recognize what type of headache you are having. Approximately 90% of all headaches are classified as tension-type (sometimes referred to as muscle contraction headaches). Another 8% are migraine or other types of headaches. Only about 2% of headaches are potentially more serious--that is, secondary to an underlying illness or other medical condition.

Tension Headaches

Symptoms

A dull, steady, non-throbbing pain, usually on both sides of the head is common. The pain can be mild to severe. Sometimes it feels as if your head is in the grip of a vise or that you are wearing a tight band across your forehead and temples. Pain may also extend into the neck and shoulder area.

Duration

Occasional tension headaches can last from 1 - 2 hours, to all day, or longer. They often occur in the late afternoon or evening as a result of accumulated stress during the day. Chronic tension headaches may occur every day, or almost every day, for months or years. They may last from several hours to all day.

Causes

Emotional stress is the leading trigger of tension headaches, particularly among chronic sufferers. But tension headaches may also be triggered by physical causes such as arthritis, poor posture, or staying in one position for long periods of time.

Lack of sleep is also a common contributor to tension headaches. This is just one aspect of the physical and emotional toll that working more and sleeping less takes on most of us. Another more surprising effect, is difficulty sleeping. People who don’t get enough sleep often find it harder to handle the stresses of everyday life. This, in turn, generates even more stress, which frequently interferes with getting to sleep or sleeping through the night. The result is a lose-lose situation.

Treatment

Tension headaches may be effectively treated with over-the-counter (OTC) pain relievers as well as non-medicinal therapies. An extensive listing of such therapies is listed under the “headache treatment” section. If chronic tension headaches occur everyday or almost everyday, it is important that you consult a physician immediately.

Sinus Headaches

These headaches are termed “sinusitis.” They are an inflammation of the lining of the sinus cavities. There are two types of sinusitis:

  • Acute sinusitis develops after an upper respiratory tract infection, with symptoms usually clearing after 2 weeks of treatment.
  • Chronic sinusitis results from an infection in the sinuses involving the mucosal lining and the bones. Symptoms may not always resolve from drug treatment and sometimes a surgical opening into the sinus area to allow adequate sinus drainage is required.

Symptoms

The symptoms of both types of sinusitis vary with the particular sinus or sinuses involved. In general, the basic symptom is a constant or recurrent deep, dull headache, which is usually around the nose, forehead, eyes, or ears. Facial pain, sinus tenderness and pressure, stuffy nose, yellowish discharge from the nose, persistent cough, loss of smell, and pain in the upper jaw, cheeks and even the teeth may also occur. There may be swelling of the eyelids and excessive tearing if the sinuses over the eyes are involved. Another symptom of sinusitis is drainage of mucus behind the nose and down the back of the throat--also called “postnasal drip.” The pain from sinusitis often worsens when you bend over. In most older children and in about half of adults, fever is present.

Causes

Anyone can have sinusitis. In fact, sinusitis is one of the five most common health complaints in the United States. However, certain groups of people may be more likely to develop sinusitis.

  • People who are frequently exposed to infection (for example, school teachers and health workers) are especially susceptible.
  • People with allergies are also prone to sinusitis because an allergy attack, like a cold, causes congestion that blocks the sinus openings.
  • Others who may be more likely to develop sinusitis include people who smoke (because tobacco smoke and nicotine irritate the nasal passage and impair the body’s natural resistance) and people with a crooked nose or deviated septum (because such conditions impair good breathing and proper drainage).

Treatment

Once a diagnosis of sinusitis is made, your doctor will probably prescribe a course of treatment to clear up the source of infection and relieve your symptoms.

Treatment of sinusitis involves:

  • Controlling the source of sinus infection.
  • Re-establishing proper drainage of the nasal passages.
  • Relieving sinus pain.

Antibiotics may be prescribed to eliminate the infection that is causing sinusitis. As the infection subsides, so should the pain. However, antibiotics may take several days to work, so your physician may also recommend an over-the-counter decongestant and analgesic to help relieve sinus pain and re-establish proper drainage.

Among the most widely used non-prescription drug for relief of nasal congestion and sinus pain is pseudoephedrine hydrochloride, a substance that shrinks the swollen mucous membranes and thus restores proper nasal drainage. Ibuprofen, also available without prescription, has been demonstrated to be effective in relieving headache pain and in reducing fever.

Antihistamines are also widely available, but should be avoided in treating sinusitis. Although, they reduce swelling and let you breathe a little easier, they also dry up the nose and thicken the mucus--exactly the opposite of what you want to do. Some antihistamines may also make you drowsy adding to the discomfort of sinusitis.

Most cases of sinusitis are not serious and respond promptly to treatment. However, untreated sinusitis can progress to more serious complications such as acute bronchitis, asthma, ear infection, and even pneumonia.

Other Remedies

To help lessen the discomfort that accompanies sinusitis, it may help to apply warm, wet compresses or a hot water bottle to the painful area. Inhaling steam from a vaporizer or bowl of steaming water and using a humidifier may also make you more comfortable.

Rebound Headaches

Symptoms

The pain is a mild or moderately dull pain around the front and back of the head; and, it may be continuously present.

Duration

These headaches may occur 3 or 4 hours after a medication wears off. They may occur daily or almost daily and last from 6 hours to a full day.

Causes

Rebound headaches are a result of overuse of over-the-counter medications and sedatives, resulting in a tolerance/dependence cycle. Research by Dr. Simon Ellis, of the North Staffordshire Infirmary in England, indicated that when people take pain medication too often, they develop tolerance. When the drug wears off, the headache recurs.

Migraine Headaches

Symptoms

Migraines involve a throbbing or pulsating pain, often worse on one side of the head. Often people get a warning signal before a migraine attack. Fewer than one out of five sufferers experience an “aura,” a disruption of brain functioning that occurs 20 to 30 minutes before the attack. This is characterized by visual disturbances like flashing lights, zigzag lines, and blurred or lost vision. Other common symptoms include numbness or a tingling feeling around the lips or hands, hallucinations, and loss of speech.

Other migraine sufferers get what is known as a “prodrome.” This is a warning that occurs several hours or even a day before the attack. The symptoms may include yawning, fatigue, mood changes (irritability, euphoria, depression, etc.), food cravings, and sensitivity to light, sound, touch, or odors.

International Headache Society (IHS) criteria: Today there are very specific symptoms than can be used as guidelines for diagnosing migraine headaches. These are known as the IHS (International Headache Society) criteria. First, your physician may rule out organic factors by examination and testing. After that, it’s like a Chinese menu.

To be classified as migraine, your headache should include at least two symptoms from Column A and at least one symptom from column B.

Column AColumn B
  • Headache that is one-sided.
  • Headache that is throbbing.
  • Pain intensity that is moderate to severe, and restricts or inhibits functioning.
  • Headache that is worsened by activity.
  • Presence of nausea or vomiting.
  • Sensitivity to light or sound.

Duration

Migraines vary widely in duration from a few hours to 3 days. On average, migraine sufferers experience about one attack a month. Auras typically last about a half hour and then subside before the pain begins. What’s more, incidences of migraines appear to be on the rise. The National Center for Health Statistics reports that during the past decade, migraines have increased by as much as 77% in women under age 45 and by 64% in men of comparable age. Migraines are believed to be a hereditary condition. About 70% of sufferers have other family members with the condition. Migraines affect women more often than men . . . approximately 75% of sufferers are women.

Causes

Although migraines have been recognized for thousands of years, no one knows for certain what causes them. Today, however, medical science has a theory that may explain why an attack occurs.

In a susceptible person, migraines often can be triggered by any of a whole range of stimulating factors. It may be something you eat, smell, hear, or even see. Or it may be related to activity, emotions, medications, or hormones. For some people, one particular trigger may cause a migraine. In others, it may be a combination of factors.

According to Dr. Douglas DeGood of the University Pain Management Center in Charlottesville, Virginia, these triggers affect centers deep in the brain, causing the blood vessels of the head to expand, and the area around them becomes inflamed, irritating nerve endings. This irritation may account for the throbbing pain in the temple or behind the eye which occurs during migraines.

Migraine Triggers

Migraines are not like other kinds of headaches--they have very specific physical causes, and a unique group of “triggers.” Triggers do not actually cause migraines. If a person does not have a physical predisposition for migraines to begin with, a trigger will probably have no effect. But for people who do have a physical predisposition, a trigger is the catalyst that may set the attack in motion.

There are many conflicting theories of how triggers produce a migraine. Some suggest triggers produce migraines by causing blood vessels to dilate (swell). Others suggest just the opposite. For instance, one theory is that emotional triggers (anger, frustration, depression, etc.) release adrenaline, the “fight or flight” chemical, and this causes blood vessels to narrow. Once the emotion has passed, the vessels open again and a headache results.

Triggers for migraines vary from individual to individual. Below is a list of common migraine triggers:

Dietary Triggers

Clinical research from The National Headache Foundation suggests that a large percentage of all migraines are directly linked to food allergies or to reactions caused by food additives, particularly certain preservatives and colorings, caffeine, and chocolate.

Many sufferers are allergic to more that one food, and surprisingly the offending allergies are often among the sufferer’s favorite foods. The most common offenders are cow’s milk, eggs, wheat, cheese, and rye, along with benzoic acid (a preservative), and tartrazine (a popular food dye). Other allergens may be hidden in complex foods. For example, two common allergens, corn and brewers yeast, hide in many recipes and even in some vitamin pills.

A well-kept headache diary plays an important role in discovering if dietary allergies may be playing a part in your pain. Our list includes a variety of dietary migraine triggers:

Caffeinated foods and drinks: Coffee, tea, chocolate, colas/soft drinks.

Alcohol: Especially red wine, vermouth, champagne, beer.

Dairy products: Aged cheese, sour cream, whole milk, buttermilk, yogurt, ice cream.

ALLOWED: Low-fat or skim milk, no more than ½ cup of yogurt per day, soft cheeses (except Camembert, mozzarella, and Brie) processed cheeses, butter, margarine, vegetable oils.

Breads: Sourdough, fresh yeast, some types of cereals.

Vegetables: Some types of beans (broad, Italian, lima, lentil, fava, soy), sauerkraut, onions, peas, pickles, olives.

ALLOWED: String beans, onions--when used only for flavoring, asparagus, beets, carrots, spinach, tomatoes, squash, corn, zucchini, broccoli, lettuce, potatoes.

Snacks: Nuts, peanuts, peanut butter, pickles, sesame seeds.

Meats: Organ meats, salted meats, dried meats, cured meats, smoked fish, meats with nitrites (such as hot dogs, sausages, packaged lunch meats).

ALLOWED: Fresh and nonprocessed meats, eggs--when limited to no more than three per week, fresh or frozen fish, canned tuna or salmon.

Fruits: Most citrus fruits, bananas, avocados, figs, raisins, papaya, passion fruit, red plums, raspberries, plantains, pineapples.

Monosodium Glutamate (MSG)--a flavor enhancer often used in restaurants, found in seasoned salt, instant foods, canned soup, frozen dinners, pizza, potato chips.

Soups: Soups containing MSG, soups made from bouillon cubes.

Desserts: Chocolate, licorice, molasses, cakes/cookies made with yeast.

Seasonings and Flavorings: Soy sauce, some spices, garlic powder, onion powder, salt, meat tenderizers, some marinades.

Hunger: Missing meals, dieting.

Environmental Triggers

Changes in your environment, many of them subtle, can trigger migraines.

  • Sight: Bright lights, glare.
  • Sound: Loud noises.
  • Smell: Strong odors.
  • Weather: Changes in temperature, humidity, wind, barometric pressure.
  • Atmospheric pressure: Changes in altitude, air travel.

Emotional Triggers

Emotions, especially stressful ones, are common triggers. Stress can be caused by life changes (marriage, birth, death, divorce), catastrophes (fire, flood, bombings), or even everyday events. Changes in emotions, whether positive or negative, can act as triggers.

  • Stress.
  • Anger.
  • Depression.
  • Anxiety.
  • Fatigue.
  • Anticipation.
  • Excitement.

Activity Triggers

Activity can trigger a migraine for some people and relieve a migraine for others.

  • Motion from riding: Trains, planes, automobiles, bikes.
  • Irregular exercise.
  • Lack of exercise.
  • Changes in sleep patterns.
  • Eyestrain.
  • A fall or head injury.

Medication/Vitamin Triggers

Medications for non-migraine conditions and over-the-counter (OTC) pain relievers and analgesics, like aspirin, can trigger or worsen migraines. Many medications also contain caffeine or additives, triggers for some people.

Some vitamin supplements: Recent studies have shown a link between migraines and low levels of the mineral magnesium. Research by Dr. Burton Altura, of the State University of New York Health Science Center at Brooklyn, New York, found that 42% of people who suffered with intermittent migraines had low magnesium levels. And in tests using imaging techniques to measure metabolic shifts in the brain during migraine attacks, it was discovered that in some patients magnesium levels drop right before or during an attack.

B vitamins: While the link has not been clinically proven as with magnesium, there is some evidence to suggest that people who suffer with migraines may have a lifelong deficiency of some B vitamins.

Prescription medications: Some high blood pressure medications, nitroglycerin, OTC pain relievers, and analgesics.

Hormonal Triggers

Hormone fluctuations can trigger migraines, though in some women, they may alleviate migraines. Hormone levels can be affected by the following:

  • Birth control pills.
  • Estrogen supplements.
  • Menstrual cycle.
  • Pregnancy.
  • Peri-menopause.

Blood-clotting Triggers

Another common cause of headaches is blood clotting, also known as platelet aggregation. Clotting creates constriction of the arteries, which results in inadequate blood supply to the brain. This is then followed by a rebound dilation of the blood vessels, leading to headaches. Studies have shown that the platelet of migraine sufferers release abnormal amounts of serotonin (a chemical in the brain), which enhances the arteries’ constriction.

Smoking Triggers

Smoking can also trigger headaches. According to studies, nicotine constricts the blood vessels while inhaled carbon monoxide overly expands them, thus creating a condition which often triggers migraines and cluster headaches. Smoking also cuts down the effectiveness of pain relievers, and may disrupt the nutritional balance of the body.

Dental Triggers

Dental problems can also contribute to headaches. Many dentists treat patients who have headache problems they have been unable to cure by other means. Semi-annual dental check-ups are valuable in helping to avoid migraines triggered by dental problems.

Treatment

The foundation for effective treatment of any medical disorder is an accurate diagnosis by a physician. In the case of migraines, this is almost entirely based on a thorough medical history of the patient. The key to developing this history is effective communication between physicians and patients, including a detailed headache diary, and recognition of certain triggers of the migraines.

Medicinal Therapies: Migraine sufferers experience such headaches that it is quite understandable why they might turn to quick pill-popping remedies. Although over-the-counter medications might meet the need for quick pain relief, the result is often an “analgesic rebound headache” triggered by the high amounts of caffeine in store-bought remedies.

Other Types of Headaches

CLUSTER: These are relatively uncommon. Though the cause of these headaches is unknown, researchers do suspect an interaction of the blood vessels and the nervous system.

The primary symptom of a cluster headache is excruciating, sharp-as-a-knife pain around one eye. The attacks occur daily in clusters of weeks or months, then disappear completely for months or years. Ninety percent of sufferers are males, and most are between the ages of 20 to 30.

HANGOVER: Caused when nerve endings on the blood vessels become sensitive after being exposed to chemicals in the bloodstream, such as the breakdown of alcoholic beverages. These headaches often greet the drinker the morning after the drinking has occurred. Sufferers may experience a pounding headache as well as sensitivity to light and noise.

According to research at Harvard Medical School, brandy, cheap brands of rum, and red wine have been found to produce the worst hangover headaches, whereas gin and vodka are less likely to produce this type of headache.

MIXED: The mixed headache is a fairly new classification. Patients suffering from mixed headaches experience various combinations of tension-type headaches and migraine headaches. Often a person who has suffered for years from one type of headache will begin to experience the other as well. This phenomenon has led many researchers to believe that these two forms of headaches may share a common mechanism in the brain.

NIGHTTIME: These headaches, occurring at or just before bedtime, are often accompanied by sleeplessness. Stress from your daily activities may be the source of your pain--check your headache diary. There are a variety of over-the-counter PM pain relievers which help to alleviate both the headache and the sleeplessness.

According to the Excedrin Headache Resource Center’s educational outreach program, the ingredients in combination PM products are not addictive when taken as directed on the label. People who use them awaken alert and well-rested the following morning.

ORGASM: Brief, intense headaches during or immediately following orgasm are rather common, but usually are not a cause for worry. Researchers at Harvard Women’s Health Watch aren’t certain what causes such headaches, but they suspect changes in blood vessels and muscles that occur naturally during sexual activity are a factor. If this problem is common for you, taking ibuprofen or another nonsteroidal anti-inflammatory drug prior to sexual activity may help ward off the pain.

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Headache Treatment

Just as there are many different types of headaches, there are many different types of treatment. What works for one person, may not be as effective for another. Overall, the best form of treatment is certainly prevention of the headache in the first place. Be aware of your own personal headache triggers and attempt to avoid them. Having said that, we realize that avoidance of triggers is not always possible and may not always be the answer. The following list of treatment alternatives, whether used separately or together, should be of assistance to you when a headache does strike.

Non-medicinal Therapies

A 1993 study published by the New England Journal of Medicine found that a third of Americans surveyed had used at least one form of “alternative therapy” in the past year. And the National Institute of Health has established an Office of Alternative Medicine to fund research on over 25 different alternative practices. Gauging the effectiveness of these therapies will not be easy. Few careful, scientific studies have been conducted. The following guide is based on what is known today, and will perhaps give you some effective alternatives to medicinal therapies.

Cold therapy: The Doctor’s Book of Home Remedies by Rodale Press, Inc. suggests an ice pack as one of the most effective non-drug treatments. The earlier you use an ice pack to treat your headache, the better. Besides applying it to the painful area, try placing it on the back of the neck, forehead, and temples.

Warm therapy: Using heat to foster relaxation increases blood flow and relaxes your muscles. Take a warm shower, letting the water beat down on your head, neck, shoulders, and back. Hot tubs and heating pads can have a similar result. Be cautious not to burn yourself--warm is better than boiling hot.

Experiment with both cold and warm treatments to see which works best for you.

Time out: Remove yourself from a stressful situation by taking a walk or by taking a few minutes to concentrate on something relaxing. Concentrate on the relaxing quietness. A five-minute time out "vacation" is a quick and easy stress reducer.

Transcendental meditation: TM is a technique that purports to facilitate the body’s natural healing ability. Patients sit comfortably with their eyes closed for 15 to 20 minutes twice a day, concentrating on a "mantra," a word or sound. Their minds become progressively more tranquil until they reach a point of "transcendental consciousness," and gross physical experiences (such as pain) are transcended (overshadowed).

Creative imagery: This process uses the mind to visualize images that relieve pain. For example, patients may close their eyes and imagine themselves on a tropical beach, a cool sea breeze blowing away their headache. Or the image may be more literal. Instead of the beach, the patient may imagine his or her headache being caused by dilated blood vessels in the brain. The patient then imagines these blood vessels constricting, thus relieving the cause of the headache.

Guided visual imagery: Proven especially effective in controlling the pain accompanying migraine headaches, it is most useful if you use guided visual imagery in the beginning stages of your headache. Even in the midst of the most painful attacks, patients have been able to take their mental focus away from the pain through this technique. To use guided imagery, close your eyes and compare your pain to a physical event. For example, you may see your migraine as a raging forest fire. View this scene in your mind and feel the pain it brings. Next, bring the scenario to a happy ending. Picture this forest fire being drowned by torrential rain. Tell yourself that as the fire goes out in your scene, so does your pain.

The number of imaginary scenes like this example that can be used to mentally "drown" your pain is limitless. Try making up several and then plan to use them when you have a headache. After a while, you will get an idea of which ones work best for you.

Progressive relaxation: This is a technique that attempts to relax the body until it reaches a state of detachment and well-being. With progressive relaxation, each part of the body is alternately tensed for about 20 seconds, then relaxed. When all the parts of the body have gone through this process, the patient lies in this detached state for periods of five minutes of more.

Deep breathing: Take deep, slow breaths, concentrating on breathing from your diaphragm. Hold your breath for several seconds, then slowly exhale, completely emptying your lungs. Repeat several times. As you inhale, your chest and stomach areas should expand; and, as you exhale, these areas should contract (shrink). Many times the pain of a headache can be intensified by improper breathing, most specifically hyperventilation. When we are in danger, in a panic, or very anxious (as we might be when we sense a headache is coming), we tend to take short, shallow breaths that reduce the amount of oxygen we take into our body. When you feel a headache coming on, it’s very possible that you are exacerbating the pain by changing your breathing pattern. Deep breathing exercises can help you normalize your breathing, which will reduce the intensity of your pain.

Stretching and exercising: Gentle neck and shoulder exercises may be used to relax and stretch strained, shortened muscles. This can reduce tension and decrease the risk of headaches triggered by muscle irritation. For some people, strengthening exercises are also recommended. The following basic exercises, recommended by headache experts, are effective for both tension and migraine headache sufferers.

For best results, be sure to breathe deeply and stretch slowly and gently. DO NOT PUSH! If you have any neck, shoulder, or back injuries, consult your physician before trying any of these exercises.

  • Neck rotation--Keeping your head level, slowly turn it until you are looking straight out over one shoulder. Hold this position for 1-2 seconds, then gently move your head to look down at this shoulder. Return your head to center, then repeat the procedure with your other shoulder. Repeat the entire process 5 times for each shoulder. For greater stretch, remain in each position for 10-20 seconds.
  • Shoulder retraction--With your fingertips touching behind the tops of your ears and your elbows raised, attempt to squeeze your should blades together. Make sure not to push or pull on your neck. Hold the position for 5 seconds and then release.
  • Upper back stretch--With your arms extended in front of your body, clasp your hands together. Gently pull your should blades apart, then drop your chin to your chest. Hold this position for 10-30 seconds.
  • Neck retraction--Squeeze your should blades together. Then gently move your head straight back, making sure to keep it level. Hold this position for 5-10 seconds, then relax. Repeat 10 times.
  • Chinning--Starting with your head level and looking straight ahead, inhale and tuck in your chin. Then exhale and stick out your chin. Repeat 3-5 times. This exercise helps your head stay in the proper position on your neck.
  • Shoulder shrug--Relax your arms at your sides, then lift your shoulders to your ears. Squeezing your shoulder blades together, rotate your shoulders to the back and then down. Repeat 10 times. Note: Never rotate your shoulders forward.

Aerobic exercise: While an excellent countermeasure against the effect of stress, it’s important that the exercise you select is something you enjoy and that fits your schedule, as well as your level of skill. If stress is a problem for you, you may want to avoid highly competitive sports. Many people find that non-competitive forms of exercise such as swimming, cycling, walking, or calisthenics are better choices. And when you do have a headache, if it’s not too severe, go for a walk. Aerobic exercise not only helps you relax, but also increases your levels of endorphins, a naturally occurring brain chemical that diminishes pain. Always check with your physician before beginning any exercise program.

Massage: A good neck and shoulder massage can relieve the muscle tension caused by stress. It can improve circulation inhibited by constricting blood vessels. Both of these changes can ease the pain of a mild headache. A professional massage therapist administering Swedish massage can often provide pain relief as well as aid in the prevention of pain.

Chiropractic: There is evidence that chiropractic treatment is effective in the management and alleviation of headache pain. A reason for this effectiveness seems to be that stiffness and pain in the cervical (the neck area) spine is a frequent and major factor of headaches.

Proper nutrition: Missing a meal and other improper eating habits can bring on a headache. If you haven’t had time to eat properly, get a healthy snack, such as a piece of fruit, or even a glass of water.

Acupressure: Many headache sufferers are doing this without even realizing it. The technique for acupressure remains the same regardless of the pressure point you use. Apply gentle, steady rotating pressure to the point with your index finger or thumb. Maintain pressure for 7 to 15 seconds, then release. Repeat every few minutes as needed.

Acupuncture: Recognized as a successful technique for pain relief, acupuncture uses hair-thin needles to stimulate specific points of the body through which an energy known as qi (pronounced chee) flows. Qi is believed to be the body’s life force or vitality. The goal of acupuncture is to restore a smooth flow of qi throughout the body. A more conventional explanation of its effectiveness it that acupuncture stimulates nerves in the skin and muscle that signal the release of chemical known as endorphins, the body’s natural pain relievers.

Though several studies have shown favorable results in using acupuncture for the treatment of headaches, larger and better controlled studies are needed before acupuncture’s effectiveness is scientifically proven.

Botanical/Herbal medicine: Many herbal medicines claim to dull the symptoms of headaches. Being used extensively in England, and despite the fact that many headache experts in the United States regard its use as experimental, the herb feverfew has received the attention of the National Headache Foundation. Recent findings of the Foundation report that continually taking feverfew extracts decreases the occurrence of migraine headaches in certain individuals.

Other homeopathic practices have often been found to relieve the pain of headaches. There are several popular remedies, but each is unique to the specific characteristics of the individual’s pain. Therefore, it is difficult to offer generalized therapies. However, those most commonly used in the treatment of headache pain are belladonna, bryonia, and nux vomica.

Belladonna is commonly used to treat the violent, throbbing pain of migraines that are aggravated by light, noise, touch, strong or unusual smell, or motion, and are characteristically worse in the afternoon. Belladonna is the most commonly prescribed homeopathic medicine for headaches associated with high fever, and is unique in that it suits headaches relieved by sitting or made worse by going down a slope or stairway.

Bryonia is best used to treat the steady ache of migraines that are severely aggravated by motion. Sufferers who cannot even make slight motions with the head or eyes without increasing the pain’s intensity are likely candidates for this homeopathic remedy. Bryonia is commonly suggested for the treatment of headaches that are worse in the morning and are accompanied by nausea and vomiting.

Nux vomica is commonly suggested for the treatment of migraines caused by overeating, alcohol, coffee, other drugs, or fatigue. It also frequently helps those sufferers who feel especially irritable.

It is best to consult a qualified homeopathic professional about taking any of these botanical remedies.

Psychotherapy: Because headaches can be caused or aggravated by stress, a variety of psychological therapies can be helpful in reducing the frequency and intensity of these headaches. All require the help of a professional therapist.

  • Cognitive therapy--The way you think about your pain influences your experience of it. Cognitive therapy can teach you to think about your headache pain in ways that can raise your pain threshold, thereby diminishing the debilitating aspect of your condition. Cognitive therapy can also help you change the way you think in general.
  • Behavioral therapy--This is an appropriate approach for headache sufferers who have developed pain behaviors in response to their disorder. Common pain behaviors include chronic complaining and worrying, incessant talking about the headache experience, developing dependent or helpless attitudes, withdrawing from social activities, and anticipating headaches at every turn of the day. A therapist can offer concrete steps that can help you overcome these habits and give you a more positive and active role to play in you own pain management.
  • Other kinds of psychotherapy including couples, family, supportive, exploratory, psychoanalysis, and Gestalt have also helped headache sufferers find the root of their pain and deal with its presence in their lives.

Sexual activity: Making love may be a tonic for head pain. Research has shown that many people get full or partial headache relief from having sex. Sexual activity releases endorphins, the body’s natural pain killer.

Good posture: Posture plays a key role in many tension headaches. Avoid leaning or tilting your head to one side (a problem for frequent phone users). Be aware of your posture as you sit at your computer/desk, drive your car, stand in line at the grocery store, or carry a bag/purse. Many of the positions we put ourselves in tighten neck and back muscles--leading to tension headaches.

Biofeedback: One of the few natural therapies endorsed by the National Headache Foundation, and commonly used in headache centers, biofeedback can reduce both the frequency and severity of headaches. A machine is used to provide feedback to sufferers about muscle tension (which is associated with pain) and blood flow to the hands. Using this information, patients learn to reduce muscle tension in their bodies and to increase the blood flow to their hands. When blood is directed to the hands, it reduces the rush of blood that has strained the vessels in and around the head area. As these blood vessels become less swollen, the head pain subsides. Studies have shown that up to 92% of the people who learn biofeedback techniques can reduce the intensity of their pain. In fact, biofeedback is often used to wean patients from their dependence on drugs to natural and holistic forms of therapy.

A skilled biofeedback professional is needed to help you learn the skills involved. But once you’ve learned how to control your response to your tension and headaches, this relaxation technique is easy to do at home.

Autogenic training: This relaxation technique is actually a combination of guided imagery, meditation, and biofeedback. The ultimate goal is to regulate the body’s blood flow and bring it back to a normalized rate. Because headaches are often triggered by irregular blood flow, improved circulation will lessen the pain. Practicing autogenic training on a routine schedule can serve to reduce the frequency of headache attacks.

Try this example of an autogenic exercise for your headache:

Lie down in a comfortable position. Close your eyes and attempt to shut out all other thoughts, especially those of your headache. (Since autogenics relies on getting a message to your unconscious mind, it is extremely important to concentrate on clearing the lines of communication to your unconscious mind.) Next recite the following six lines over and over in a slightly audible tone:

1. My arms and legs are heavy.
2. My arms and legs are warm.
3. My heartbeat is calm and regular.
4. My breathing is calm and regular.
5. My abdomen is warm.
6. My forehead is cool.

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Final Comments

We realize that no website can provide all the answers for everybody, but we hope we’ve been able to help you answer some of your questions about headaches.


The Counseling Center at Sam Houston State University has staff available to assist you with the diagnosis and treatment of your headache. We can help you establish your headache diary, recommend various treatments, and make any needed referrals to other health care providers. In its effort to assist students and staff, the Counseling Center also offers biofeedback therapy.


Should you have more questions regarding headaches or wish to make an appointment with a staff member, call 936/294-1720.


Finally, DO NOT GIVE UP. Hopefully, you will work towards an alliance with your health care provider and together arrive at a treatment plan that works for you. There are many myths about headaches, but the most destructive of all is, "You just have to learn to live with it." Don’t accept it. We have come a long way in our understanding of this disorder, and research continues today. Do not give up and good luck!

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