What's Causing Your Headache
It's no secret that work stress can lead to splitting headaches. But surprisingly it can also cause what experts call let-down headaches. These kick in after you've finished a demanding project or even when you're finally vegging out during a much-needed vacation, says Lawrence Newman, MD, the director of the Headache Institute at St. Luke's-Roosevelt Hospital in New York City. Plunging levels of stress hormones, which can affect your sensitive brain chemistry, may be to blame.
Head off the hurt: Take a five-minute daily breather with this visualization exercise to short-circuit stress: Close your eyes and think of a happy place, say your favorite beach. Conjure up an image and then really concentrate on the feeling of being there -- the warmth of the sun on your face, the smell of salt water, and the sensation of sand on your feet. On particularly grueling days, treat yourself to a massage: A Spanish study found that a 40-minute rubdown wiped out tension-headache pain within 24 hours.
Skipping or delaying meals causes blood-sugar dips that can spark headaches, but did you know that eating certain foods can trigger them too? At least 30 percent of migraines are caused by diet, according to the National Headache Foundation (NHF). Among the biggest offenders are items containing tyramine, a naturally occurring substance in foods such as deli meats, sauerkraut, soy sauce, and aged cheeses. Some people experience headaches that are brought on by onions and citrus fruits. Other ingredients that can induce pain include caffeine, MSG, and aspartame, which is in some artificial sweeteners.
Head off the hurt: "Food triggers can be highly individual, so we often ask people to keep a headache diary for a few months to see if there are specific foods that can be hidden triggers," Dr. Newman says. Jot down everything you eat in a headache-diary app, such as My Migraine Triggers (free, iTunes), to get a sense of your own personal headache prompters so you can avoid them. If tyramine appears to be your trouble, try the NHF's Low Tyramine Diet for Migraine (headaches.org). Be sure to eat at least every three hours, aiming for about three small meals and three small snacks a day, Dr. Newman suggests. Keep in mind, dehydration can cause headaches, and the same goes for too much caffeine. So sip at least eight 8-ounce cups of water a day and limit your daily caffeine intake to less than 200 milligrams (a six-ounce cup of coffee contains around 100 milligrams, while a can of diet cola has about 30 to 50).
Your Social Life
When Friday night hits, you meet up with some friends, have a few drinks, stay out late, and then sleep in on Saturday. Ouch! "All of these factors combined are often why women wake up Saturday morning with a migraine," says Brian Grosberg, MD, the director of the Montefiore Headache Center in New York City. Alcohol is a migraine trigger in about a third of sufferers, and if you've been in a smoky bar, the fumes from cigarettes can make things even worse. But not crawling out of bed until 10 a.m is the real whammy. "We know that lack of sleep can trigger migraines, but getting thrown off your regular sleep schedule can do it too," Dr. Newman says. That's partly because changes in circadian rhythms affect your brain, and also because your snoozing delays your morning coffee, which in turn can worsen a headache (hello, caffeine withdrawal!).
Head off the hurt: You don't have to completely readjust your weekend routine; merely make a few tweaks. First, when you're out imbibing, limit yourself to no more than a cocktail or two and stick to light-colored ones like vodka or white wine, Dr. Newman says. (Red wine contains tannin, a chemical that's a known headache cause.) Second, get home a little earlier so you're not disrupting your sleep schedule too much; ideally you want to wake up the next morning not much more than an hour past your usual rise-and-shine time. If you're still sleepy come Saturday afternoon, you can always take a siesta.
Being overweight increases your risk of developing chronic headaches, and you're in double trouble if the extra pounds are around your middle. Women with belly bulge are about 30 percent more likely to get migraines than women who can't pinch an inch, according to a Drexel University College of Medicine study. "We're not exactly sure why, but it's known that the part of your brain that regulates your desire to eat and controls the function of fat cells is also activated during an acute migraine attack," explains study author Lee Peterlin, DO, director of headache research at the Johns Hopkins Headache Center. "Fat cells secrete high levels of proteins, such as adiponectin and leptin, that may contribute to inflammation in your body, which can affect a migraine."
Head off the hurt: Get your sweat on. Not only will exercise help slim you down, but it also has potent pain-relieving properties. A Swedish study found that 40 minutes of aerobic exercise three times a week is just as effective as drugs in preventing migraines. The more you can do, the better: People who exercise the equivalent of jogging 20 miles a week lost the most ab flab, according to research from Duke University.
In addition to giving you cramps and the crabbies, Aunt Flo can really mess with your head. Menstrual migraines hit 60 percent of female migraine sufferers. "Right before your period, estrogen levels drop, which causes brain changes that trigger a migraine," explains Alan Rapoport, MD, a clinical professor of neurology at the David Geffen School of Medicine at UCLA.
Head off the hurt: Your best defense is a good offense. Taking one daily OTC nonsteroidal anti-inflammatory painkiller, such as ibuprofen, starting a couple of days before your period may help reduce some of the inflammation and blood-vessel changes that lead to migraines, Dr. Rapoport says. If the OTC med isn't strong enough, your doctor can give you prescription NSAIDs, like the drug Cambia. Another option: Talk to your ob-gyn about using the birth control pill or patch continuously in order to skip your periods, which will prevent estrogen levels from falling. If you still can't get relief, your doctor can prescribe a migraine medication like frovatriptan or naratriptan, which stays in your system longer than other drugs, Dr. Grosberg says.
Your Sleep Habits
Headaches may be a clue that you have a jaw problem -- for example, one that causes you to grind your teeth while you sleep or clench your teeth during the day, according to Richard Ohrbach, PhD, an associate professor at the University at Buffalo School of Dental Medicine. It's common for people diagnosed with a tension headache (the most prevalent kind) to have TMJ, a constellation of conditions that cause pain around the jaw joint and muscles perhaps as a result of grinding. "It's a huge problem; a lot of patients I see have undiagnosed TMJ," says Suzan Khoromi, MD, a neurologist at George Washington University Medical Center. Another common culprit: snoring. Chronic daily-headache victims are more than twice as likely to be snorers, a recent National Institute on Aging study found.
Head off the hurt: Possible signs of TMJ are jaw pain, ear pain, and a clicking sound when you open your mouth or chew. Your dentist can tell whether you're grinding your teeth by examining them for erosion and can fit you for a mouth guard to prevent the problem from occurring while you sleep. Prescription nighttime muscle relaxants can also help; if your case is severe, though, you may need physical therapy and/or a steroid injection in your jaw joint. For snoring, see a sleep-medicine specialist, who can determine if you have sleep apnea, a disorder caused by abnormal pauses in breathing while you snooze. It's treated with either a custom mouthpiece or a breathing machine that you wear at night.
Is It a Headache or Migraine?
ID Your Ache
More than half of all migraine sufferers are undiagnosed or misdiagnosed with tension or sinus headaches, according to the National Headache Foundation. Here's how to tell what's what.
Tension (most common)
Feels like: A mild pressing or tightening pain in the forehead, temples, or back of the head that's not worsened by activity. About 88 percent of women get tension headaches.
Migraine (more common in women)
Feels like: Moderate to severe pain on one side of the forehead or in one temple that worsens with activity; the exact opposite of a tension headache. You may also experience nausea and/or vomiting and have increased sensitivity to light and sound. Less than a third of sufferers have "aura" -- flashes of light and blind spots. About 18 percent of women get migraines.
Feels like: Pain and pressure around the eyes, cheeks, and forehead, along with nasal stuffiness, yellow or green discharge, and even fever and chills. These symptoms are treated with antibiotics and decongestants. Most people who think they have a sinus headache actually have a sinus infection or a migraine.
Nearly 40 percent of people suffering from migraines could benefit from preventive therapy, but less than 14 percent use it, according to data from the American Academy of Neurology and the American Headache Society. Talk to your doctor about taking one or all of these herbal and vitamin supplements. Recent studies show the following to be effective.
Reduction in migraines
|Riboflavin (vitamin B2)||59 percent||400 milligrams a day|
|Butterbur (Look for the brand Petadolex, from which butterbur’s potentially liver toxic chemicals have been removed.)||48 percent||75 milligrams twice a day|
|Magnesium||42 percent||600 milligrams a day|
|Feverfew||24 percent||80 to 100 milligrams a day|
Originally published in FITNESS magazine, March 2013.