8 Reasons Why You Still Get Headaches
A tiny twinge tells Kelli Smith that The Headache is coming. "I feel pressure behind my left eye. Then my pulse starts pounding in my left temple. It feels like a bruise if I touch it," she says. "I get nauseous. The pain becomes so sharp I have to lie down in a dark room."
Raw onion, red wine, cigarette smoke, motion sickness, an off-kilter sleep schedule, hormone swings, and even weather changes can set off the skull-busting pain that has tormented Smith since she was 17. Surprisingly, so can her migraine drugs. "Last year, my pain medicines -- the ones that are supposed to stop a migraine -- seemed to be causing rebound headaches," she says. "They were coming almost every day."
Smith found a licensed acupuncturist near her home in Omaha. Weekly sessions, along with avoidance of migraine triggers, have reduced her headaches significantly. "I vacationed in Hawaii recently and didn't have to worry. I even went snorkeling," she says.
Head pain like Smith's is not unusual. More than 30 million Americans live with migraines (some of whom suffer chronically, defined as a headache 15 or more times a month); 45 million people cope with chronic headaches of some kind (tension headaches are also considered chronic if you have one 15 days a month). But the relief Smith found is unusual. One reason: Many headache sufferers try to cope on their own. In one survey of 20,000 Americans, researchers from Albert Einstein College of Medicine found that half of those who got migraines had never received a diagnosis -- a key step toward reducing and preventing the pain.
The American Academy of Neurology is now updating its migraine-treatment advice, while the International Headache Society has called for new research on fixes for all headaches. But you don't have to wait for the results to ease your pain. We've spoken with leading specialists and reviewed the latest studies to find treatments that work. And that starts with identifying your particular mistakes:
1. You think it's tension
Believe migraines are always a big deal and everything else is a tension headache? That's old-school -- and could stand in the way of relief. By definition, you have migraines:
If your headaches fit two or more of these descriptions: moderate to severely painful, throbbing, on one side of your head, or worse when you move or bend over;
• If you also feel nauseous and/or vomit, or are sensitive to light, sound, or odors;
• If you've had at least five attacks that last from four hours to three days if untreated.
• It's a tension headache if the pain's on both sides of your head; there's no nausea or sensitivity to light, sound, or odor; and it doesn't get worse with regular activities like walking.
Real pain relief: Despite these seemingly neat divisions, experts now believe that the two headache types may have their roots in the same mechanism inside your brain -- that shifting brain chemicals play a role in tension headaches, just as they do in migraines. If you write off your pain as "just a tension headache -- not worth seeing the doctor for," you could be suffering more than you need to. Address it, and you might even become headache-free: "Strategies to control the mechanism behind migraine can effectively prevent whatever type of headache you tend to experience," says David Buchholz, M.D., associate professor of neurology at Johns Hopkins University School of Medicine.
Related: 6 Pill-Free Ways to Outsmart Allergies
2. You blame your sinuses
Head pain plus congestion, a runny nose, and facial pressure feels like sinus trouble. But don't swallow that decongestant just yet. In one multicenter study of 2,991 adults who thought they had sinus headaches, researchers discovered a whopping 88% really had migraines.
The confusion is understandable. When the trigeminal nerve -- the brain's superhighway for migraine pain signals -- is activated during a migraine, it can cause sinus symptoms like congestion, too, Dr. Buchholz explains. And weather changes that bring on sinus pain -- shifts in temperature, humidity, and barometric pressure -- also trigger migraines. "But sinus remedies containing decongestants just make things worse," warns Dr. Buchholz. "When the decongestant wears off, blood vessels in your head expand again, and your headache gets worse."
Real pain relief: If you have head pain and facial pressure -- but no fever or greenish or yellow discharge -- you may be having a migraine, not a sinus attack. Talk to your doctor. Lifestyle changes could prevent future headaches or, if that's not enough, you may need medication.
3. You pop pain pills
Taken too often, pain meds, even over-the-counter varieties, can be setting you up for nonstop headaches. In one German study of 7,417 women and men, half of those with chronic migraines had medication-overuse headaches. Other experts estimate that two out of three people who get frequent headaches (tension or migraine) are stuck in this pain-pills-pain cycle.
What happens in your body depends on the type of drug you're taking. Opioids, such as codeine, mute pain-sensing receptors on brain cells, but as a dose wears off, the receptors become exquisitely sensitive to the tiniest pain signals. Migraine-alleviating triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig), work by helping the brain use more serotonin, a feel-good brain chemical that blocks pain signals in the trigeminal nerve. But -- experts theorize -- as each triptan dose wanes, serotonin levels plummet, leaving you extra-vulnerable to another headache.
You may be getting overuse headaches if you're taking over-the-counter remedies (especially those that contain a mix of aspirin, acetaminophen, and caffeine) or sinus headache formulas with a decongestant 15 days a month or more. Some experts think even plain aspirin or acetaminophen taken this often can spur headaches, possibly by sensitizing brain cells to pain signals. Popping prescription pain relievers at least 10 days per month may also set you up for medication-overuse pain. "Over time, these drugs lower the threshold: You wake up with headaches more often, have more headaches throughout the day, and your medications stop working," says Dr. Buchholz.
Real pain relief: Stop taking your pain drugs, with your doctor's help. Easy? No. But consider this: Studies show quitting pain pills significantly reduces migraine intensity and frequency. "None of the other strategies that prevent migraines will work until you do this," says Dr. Buchholz. Once you're free of rebound headaches, you can work out the best preventive and treatment strategies for you.
4. You're a caffeine fiend
There's a reason washing your pain reliever down with a cup of joe or a cola seems to vanquish pain: Caffeine shrinks swollen blood vessels that make migraines and even tension headaches throb. That's why it's a featured ingredient in migraine remedies. But as the caffeine wears off, your headache rebounds, maybe because blood vessels re-swell -- irritating already sensitive nerve endings.
Real pain relief:
If you are drinking coffee, limit the amount. "Stick to a cup or two and have it at the same time each day," advises Carolyn Bernstein, M.D., clinical director of the Harvard Medical Faculty Physicians Comprehensive Headache Center at Beth Israel Deaconess in Boston. "You don't need a caffeine-withdrawal headache on top of a migraine!"
Related: Surprising Facts About Caffeine
5. You ignore triggers
When researchers at the Headache Center of Atlanta surveyed 1,207 women and men, 76% reported they had triggers. What set off their migraines?
• 80% said stress,
• 65% of the women blamed hormone fluctuations,
• 50% named sleep disturbance,
• 44% had trouble with perfumes and other strong odors,
• 38% were bothered by bright lights,
• 32% by sleeping late,
• 30% mentioned heat,
• 27% were troubled by certain foods,
• and for an unlucky 5%, sex led to a headache.
If your brain is extremely sensitive, your triggers can be obvious, says Dr. Bernstein. "You may get a migraine every time you eat a pomegranate. But if you're less sensitive, something may bother you only when you're already vulnerable."
Real pain relief:
Keep a headache diary. "Chart when you got a headache as well as weather changes, what you ate the previous day, whether you had alcohol (and what type), your stress level, if you exercised, and, for women, where you are in your menstrual cycle," Dr. Bernstein suggests. Include medications you're taking for other health issues; some antidepressants, bronchodilator drugs for asthma, contraceptives, and diet pills can trigger migraines, too.
Your next step? Eliminate avoidable triggers, and be vigilant when you're exposed to those you can't control -- such as hormonal changes at menstruation, sudden weather shifts, or high-tension days. "If you've got a big deadline at work and you know stress triggers your headaches, this is the time to be sure you're getting enough sleep, not overdoing caffeine, and eating well," says neurologist Christina Peterson, M.D., of the Oregon Headache Clinic.
Your diary may point to certain foods and additives that are triggers for you. But since they're such a frequent cause of migraines, some headache specialists recommend that all patients cut out common offenders, including caffeine, monosodium glutamate, chocolate, nitrite-processed meat and fish (like cold cuts or lox), cheese (especially aged types like Cheddar and blue), nuts, and alcohol (particularly red wine, champagne, and dark-colored drinks like rum). Being alert to triggers can help you avoid milder headaches, too. Ones to watch include dehydration, skipping meals, skimping on sleep, and downing too much caffeine or chocolate.
6. You're too stressed out to exercise
Anxiety plus a lack of activity is a double whammy for your poor aching brain. "Exercise reduces stress, helps you sleep, and boosts endorphins -- brain chemicals that are natural painkillers," says Dr. Bernstein.
Related: 4 Natural Fixes for That Pounding Headache
Real pain relief: Aim for 30 to 45 minutes of brisk physical activity three to four days a week, Dr. Buchholz suggests. In Swedish research, 26 migraineurs who rode exercise bikes three times a week for 12 weeks reported that their headaches became less frequent and less intense. If exercise tends to bring on pain, try taking ibuprofen or naproxen 30 to 60 minutes beforehand, Dr. Buchholz suggests. Also, skip activities that make your head bob up and down, such as running on a treadmill. (Switch to an elliptical trainer or exercise bike.) Drink water before, during, and after your workout, warm up gradually, and exercise in a cool environment.
7. Your sleep schedule is wacky
In a 2006 survey conducted by the National Headache Foundation, 79% of headache sufferers admitted they got hit when they overslept. But 66% said too little sleep was also a trigger. And naps can be counterproductive; although they may dull the pain of a tension headache, they lead to insomnia, which can set off a new headache the next day.
Real pain relief: "Go to bed and wake up at the same time every day, even on vacation," Dr. Bernstein suggests. "And get enough sleep -- seven to eight hours each night." In one University of North Carolina at Chapel Hill study of 43 women with daily or near-daily migraines, those who improved their sleep habits -- including adopting a strict eight-hours-a-night sleep schedule -- got migraines 29% less often and found pain intensity dropped 40%.
8. You skip pain-prevention drugs
These pharmaceuticals -- which include anti-seizure meds, tricyclic antidepressants, and certain high-blood-pressure drugs -- could cut your risk for future migraines up to 50%, and may also benefit some other headache sufferers. But chances are, your doctor hasn't recommended them. In one 2007 study of 162,576 Americans, researchers found 39% of migraine patients were candidates for pain preventers, but just 12% were using them.
Real pain relief: If lifestyle changes haven't helped, ask your doctor about preventive meds. It takes patience to find the right one, but if you've tried several and still haven't gotten relief, see a headache specialist or neurologist, advises Dr. Peterson.
-Sari Harrar
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