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.