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Decode Your Headaches: How to Head Off a Headache

Pinpointing the exact cause of your pain, whether it's stress, the weather, or even your hormones, can help you stop the throbbing before it starts.
Decode Your Headaches

Not every headache can be solved by simply popping an over-the-counter pain reliever. "Headaches have many triggers, which require various treatments," says Mark W. Green, M.D., director of headache medicine at Columbia University. "If you're looking for real relief and to prevent future episodes, it's essential to put your finger on the type of headache you suffer from." Here, the common pain triggers women face and an action plan to stop the throbbing.

Trigger: You Are Just About to Get Your Period

The pain you're probably dealing with: A menstrual migraine.

Two to three million women deal with this pain, brought on by hormonal fluctuations. The symptoms are no different from those of a typical migraine: intense pain usually on one side of the head, nausea, an aversion to noise and light, and sometimes visual auras (like flashing lights). An episode can last from a few hours to a few days.

While it's the drop in estrogen that occurs right before your period that sets off menstrual migraines, the pain can hit anywhere from two days before menstruation to three days afterward.

How to find relief: One or two days before your period's due to start, try an over-the-counter (OTC) pain reliever, like aspirin, or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen—even if you don't yet have a headache. "Take the medication three times a day," says Dr. Green. If you can't estimate when the pain will begin because your cycle is irregular, or the OTC meds don't seem to help, ask your doctor about a triptan drug, like sumatriptan. When taken as soon as you feel symptoms, triptans do double duty, shrinking swollen blood vessels in the head back to their normal size while also blocking nerve impulses that transmit the pain signals.

If you are currently taking an estrogen-progesterone birth control pill, consider skipping the placebo week. "Keeping hormone levels continuous throughout the entire month may help keep menstrual migraines away," says Dr. Green.

Trigger: You've Spent the Whole Day Staring at Your Computer

The pain you're probably dealing with: A tension headache.

When you're stressed out you tend to unconsciously tighten your shoulder, neck and face muscles. The result: Blood flow to this area slows, irritating the surrounding pain fibers and creating a dull squeezing pain at the base of the neck and on both sides of the head.

While stress is the most common cause of tension headaches, anything that forces the neck out of alignment can contribute: wearing a bra with supertight straps, cradling a phone receiver in the crook of your neck, carrying heavy shopping bags or even working out with hand weights.

How to find relief: Aspirin or ibuprofen will often do the trick to combat occasional tension headaches. But beware if you're reaching for a pain reliever more than twice a week, since OTC medications can lead to rebound headaches. A better bet is trying a drug-free therapy, such as yoga or regular aerobic exercise. In addition, several clinical studies have found that biofeedback and relaxation therapy can treat headaches as effectively as drugs.

If you suffer from tension pain more than 10 days per month, have trouble sleeping, worry a lot or have mood swings, ask your doc to screen you for a depression-anxiety disorder. "It's common for someone prone to tension headaches to also be at risk for panic attacks or depression," says Robert Kaniecki, M.D., director of the headache center at the University of Pittsburgh. The good news: Antidepressants, such as a tricyclic or valproid acid, can treat both head pain and mood disorders.

Trigger: You Were So Busy You Totally Forgot to Eat

The pain you're probably dealing with: A migraine headache.

A change in your normal routine is the biggest factor in bringing on a migraine. If you're prone to these headaches—21 million women are—consider this laundry list of triggers: missed sleep or exercise, alcohol, stress, certain foods (such as aged cheeses and sour cream), skipped meals, and even a change in the weather. New evidence also shows that being overweight ups your risk. "Obesity causes increased inflammation of the blood vessels, which may irritate the brain and cause migraine pain," says Paul Winner, D.O., director of the Palm Beach Headache Clinic in West Palm Beach, Florida, and president of the American Headache Society. In addition, women who are overweight tend to produce more estrogen, and fluctuations of the hormone can further increase risk.

So if you do not currently exercise, it is time to get moving. "A new study indicates that regular exercise can reduce the number of migraines," says Dr. Kaniecki.

How to find relief: Mild to moderate migraines can often be treated with OTC anti-inflammatory drugs such as ibuprofen and naproxen. But if you have more than four a month or just one moderate to severe headache a month that can't be controlled with an OTC, call your doctor or a headache specialist. (Find one at achenet.org.)

To help your physician nail down your particular triggers, keep a headache diary. Visit the American Headache Society's Web site for samples (achenet.org/tools/diaries). Then the next time you see your doctor, let her know when you get headaches, how long they last, how you treat them—and if it's with a drug, how much you take. Be sure to also keep track of your menstrual cycle.

Triptans are often prescribed for migraines, as well as the tricyclic antidepressants amitriptyline and nortriptyline, says Dr. Green. "We use doses much lower than the amounts given to treat depression." These drugs may help by calming down nerve centers that transmit pain. Beta-blockers like propranolol, anticonvulsant medications (such as topiramate and divalproex sodium), and calcium-channel blockers like verapamil produce a similar effect. Clinical studies show some reduction in migraines from supplements such as magnesium and riboflavin (vitamin B2). Botox may be helpful in preventing or relieving migraines by blocking nerve impulses for pain, especially if you experience 15 days of migraine discomfort a month. But Botox isn't cheap: One injection costs around $500 and two are often recommended for head pain.

Trigger: You Slept Later Than Usual

The pain you're probably dealing with: A caffeine withdrawal headache.

If you usually down two cups of coffee by 7 a.m., the dull nagging pain you experience upon waking on the weekend is your brain screaming, "I need a caffeine fix, now!" Expect the same feeling if you decide to eliminate caffeine cold turkey or if you forgo your usual afternoon jumbo-size latte.

Caffeine acts as a stimulant and creates changes that the brain becomes accustomed to over time. Just two cups a day may be enough for you to experience withdrawal headaches if you skip. Consider all the caffeine in your diet, not just coffee, hot tea, and soda. Cold teas, energy drinks, OTC pain reliever pills, and powders (like Goody's Powder and BC Pain Relief Powders) all count.

How to find relief: Take an OTC pain reliever along with your coffee, tea, or soda and the pain should subside. Guzzling three cups of coffee in a row hoping for a quick fix will give you a case of the jitters from caffeine overload.

To avoid these types of headaches in the future, gradually cut back on your caffeine intake. Try to eventually limit yourself to less than 100mg a day. That's the amount typically found in one 8-ounce cup of regular coffee or one 12-ounce can of cola.

Trigger: You Pop Pain Relievers Like They're Mints

The pain you're probably dealing with: A rebound headache.

Consistently taking any pain medicine more than two to three times a week can backfire. Instead of making you feel better, it may cause a chronic headache. In a vicious cycle, you wind up needing higher doses of medication to get rid of the same pain.

Why does this occur? Doctors suspect that the regular use of OTCs causes nerve centers at the base of the brain that typically block pain to malfunction. As a result, the pain in the head gets worse—and more frequent. If you find yourself treating a headache 8 to 10 times a month or more, you may be dealing with a rebound.

These types of headaches may be more common in those who take painkillers that contain caffeine.

How to find relief: Consider using a different medication to deal with the head pain while you wean yourself off the offending meds. So if you think an NSAID, like ibuprofen, is causing the problem, ask your doctor about trying acetaminophen instead. Or vice versa. Then gradually cut back on the amount you take over the course of about two weeks. If a prescription med is what's causing your rebound headache, work with your doctor on lowering the dosage.

Trigger: You Indulged at Dinner

The pain you're probably dealing with: A food- or drink-sensitivity headache.

Sour cream, aged cheeses, red wine, dried fruits, and malted beer all contain the amino acid tyramine, which can overstimulate the body's nervous system and trigger a headache. Food additives such as artificial sweeteners, aspartame, and MSG also may irritate the nervous system.

The resulting headaches may feel like simple tension pain for some people, but in others these foods will bring on full-blown migraines.

How to find relief: Avoiding the offending food seems simple enough. But you can have more than one trigger. Plus, the headache can occur up to 12 hours after eating the food that sets you off. That's why it's a good idea to keep a headache diary to help you look for trends and pinpoint which food might be to blame. Treat your throbbing as you would a tension or migraine headache, depending on the severity of your pain.

Trigger: You Are Blowing Your Nose Nonstop

The pain you're probably dealing with: A sinus headache.

Sinus infections, and even colds, can cause pressure around your eyes, cheeks and forehead when the membranes lining the sinuses become swollen. Sinus pain often gets worse when you bend forward or lie down, and may be accompanied by thick nasal discharge, a sore throat, fever and cough. These headaches are often confused for migraines because the symptoms are very similar. But sinus headaches are not usually accompanied by nausea or aggravated by bright light.

How to find relief: Pairing a decongestant with an OTC pain reliever should help ease pain due to sinusitis until you can get antibiotics to clear up the infection. These OTC meds also help with cold-related headaches. Treat yourself to a facial steam too: Hold a towel over your head and position your face over a bowl of just-boiled water. Breathing in the warm mist drains your sinuses and alleviates pressure. In addition, flushing your nose with a mixture of warm water and 1/4 teaspoon of kosher salt can help eliminate symptoms (some experts recommend using a neti pot). If your nasal drainage is clear, however, the head pain could be a result of allergies and an OTC antihistamine can help.

Copyright © 2008. Used with permission from the March 2008 issue of Family Circle magazine.

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