Headache

Headache

Taking Control of the Pain

It's been an especially busy week, so you've been skipping meals and missing sleep. Not only that, you're a few days away from your period and you're feeling run-down.

Don't be surprised if you get a headache, since these are just a few of the contributing factors that may bring on those nagging or disruptive pains that just about everybody gets at one time or another.

While your brother or your husband may complain about their headaches, researchers have found that women get headaches more frequently than men and experience more severe pain.

Egilius L. H. Spierings, M.D., Ph.D., director of headache research at Brigham and Women's Hospital in Boston, says 80 percent of his patients are women, generally between the ages of 20 and 50.

"Headaches are not a 'female problem,' " he says, "but headaches in women are generally more intense." That's because the female hormone estrogen is "among the most potent chemicals to cause headaches," says Dr. Spierings. Estrogen regulates the makeup of the endometrium, the mucous lining of the uterus, Dr. Spierings explains. The estrogen builds up during the first half of your menstrual cycle, falls during ovulation, rises further and falls once more when your period begins. "It's not known exactly how estrogens cause headaches, but they do have an effect on the blood vessels," Dr. Spierings says.

The most common type of headache is the tension, or muscle-contraction, headache, described as feeling as if a rubber band were being tightened around your head. In addition to this pressure, you may also feel painful knots in your neck or scalp. Eighty-eight percent of women and 69 percent of men studied at San Jose Medical Center in California said they had experienced at least one such headache within the previous year.

About 18 percent of women and 6 percent of men also suffer from migraine, one type of neurovascular headache in which vessels become inflamed and expand. In women prone to migraine, serotonin, one of the chemicals that normally regulates pain messages by carrying nerve impulses from your head and face back to your brain, may misdirect those impulses to blood vessels in the brain's protective covering and scalp. This causes them to swell, then send a pain message back to the brain.

Migraine is a throbbing or pulsating headache, usually felt on one side of the head. It may be accompanied by nausea and sensitivity to light or noise. Migraines often occur for the first time when a teenager begins to have menstrual periods or when a woman starts using birth control pills.

A cluster headache, sometimes mistaken for a migraine, is a particularly excruciating form of pain. At its worst, the cluster headache feels like a red-hot poker in the eye, and it can last up to three hours. Cluster headaches are much more prevalent in men--particularly heavy smokers and drinkers--than in women.

Another kind of headache, an organic headache, is triggered by a tumor or an abnormality in a blood vessel in the brain. This type of headache is rare, occurring in fewer than 5 percent of men and women.

The Origins of Headache

Why do women get headaches?

Let's start with the fact that we're female. "It is always important to see if headaches are related to your cycle," says Dr. Spierings. Migraine attacks, for example, occur around the time of menstruation in 60 percent of women who have them.

Migraines are associated with falling estrogen levels, but any changes in your estrogen levels--such as increases after menstruation--may bring on migraines. If you are using estrogen replacement therapy, you may also begin to suffer from migraines. Postmenopausal women using such therapy should take as low a dosage as possible on a daily basis, recommends Dr. Spierings.

Oral contraceptives can also lead to migraines for some women, again because they act by changing the level of estrogen in your system. "Headache is the most common side effect of the Pill," Dr. Spierings says. "Often headaches appear during the week when you are off the Pill." If that's the case for you, Dr. Spierings says you should discuss other birth control options with your gynecologist.

Another primary headache trigger is stress, and women may be hit harder than men. "For most headache sufferers, the incidence of headaches increases with significant stresses like divorce and loss of a job, as well as milder stresses like dinner guests and sick children," says Joan Miller, Ph.D., a clinical psychologist in Marietta, Georgia, and author of Headaches: The Answer Book.

Generally speaking, says Dr. Miller, women internalize their stress, as well as fear and anger. When you hold in any intense emotion, eventually your body will alert your system to the buildup of pressure.

"A headache is part of your feedback system telling you something needs to be changed," Dr. Miller says. "A headache sufferer needs to adjust both externally and internally in a way that's less difficult on her system."

When you're feeling stressed, you may sleep less, and this too can bring on a headache. Fatigue makes it difficult for the muscles to relax, so they stay tight and may go into a painful muscle contraction, says Dr. Spierings.

Another factor is diet. Caffeine is a well-known trigger. The drug--found not only in coffee and tea but also in cola, chocolate and pain relievers--works to constrict blood vessels, contributing to the onset of a tension headache.

If you are susceptible to migraines, the chemical tyramine, found in red wine, aged cheeses and yeasty products such as freshly baked bread and beer, may bring them on. Tyramine is another blood vessel constrictor.

What's Ailing Me?

The list of possible headache triggers, it turns out, is indeed a lengthy one. "You can usually identify at least ten," Dr. Spierings says. "Some you can't do anything about--like changes in the barometric pressure or your menstrual cycle. Look for the ones that you can do something about, like getting enough sleep and eating right." For example, he suggests, if you've missed some sleep, try to nap later. And eat at regular intervals so that you are not caught hungry, which in turn will lead to fatigue and possibly a headache.

When headaches begin to interfere with your life, no matter what their frequency, you should contact your physician or internist. A headache clinic may be the answer if your headaches don't respond to over-the-counter analgesics or are chronic or long-standing, according to William G. Speed III, M.D., director of Speed Headache Associates and associate professor of medicine at Johns Hopkins University School of Medicine in Baltimore.

How to Take Control

Once you know what's bringing on your headaches, you can set about preventing them. Perhaps most crucial is maintaining moderation in your daily life, says Patricia Solbach, Ph.D., a headache specialist and director of the Menninger Center for Clinical Research in Topeka, Kansas. "If your period is about to begin and you've worked a 60-hour week and you've had some glasses of red wine with the girls on Friday night . . . well, that probably wasn't the best thing to do," Dr. Solbach advises. Here are some other strategies for taking control.

Maintain a headache diary. Dr. Miller says that learning about your personal headache triggers is a key to preventing them. Keep a journal for two or three months, recording events prior to attacks. Keep a record of your food and alcohol intake and your menstrual cycle. Also note the type and location of each headache, how long it lasts and whatever action you take to relieve it--such as medication or relaxation. Then note the results of these actions. Look for patterns so you can check whether a certain food brings on a headache and whether you get one when you're feeling tired or stressed.

Vent your anger. Journal writing, talking over problems with a friend, changing your expectations and shifting into problem-solving mode are all proactive ways of handling stress and thus warding off headaches, suggests Dr. Miller.

Stay regular. Three meals a day, enough sleep and regular exercise to beat stress will go a long way toward keeping headaches at bay, Dr. Solbach says. Any disruption in your normal patterns, from a missed meal to sleeping late on the weekends, may wreak havoc with your head.

Regular meals and adequate sleep are especially important during the week before and during your period. Women are more easily fatigued at these times in their cycle, says Dr. Spierings.

Go mobile. Many of us live sedentary lives--on the job and at home. Dr. Miller suggests that when you're sitting at a computer keyboard or hunched over a sewing machine, you occasionally shift position, rotate your head, massage your shoulders or stand up for a while to avoid bunching up muscles. And Dr. Solbach emphasizes the importance of getting regular exercise to relieve stress and improve sleep. In addition, the endorphins released during a physical workout may help you to better withstand pain when it occurs.

Cut the coffee habit. Cutting your caffeine consumption gradually, by a half-cup at a time, will help the withdrawal process go more smoothly, says Dr. Miller. You can replace coffee, tea or cola with a variety of decaffeinated drinks. Avoid all sources of caffeine, including chocolates, colas, teas and pain relievers that contain it.

Be aware of other triggers. The artificial sweetener aspartame (NutraSweet); monosodium glutamate, often found in Asian dishes, soups and meat tenderizers; and sodium nitrate, which is added to hot dogs, bacon, salami and ham, all contain chemicals that act upon the nervous system and can cause headaches, says Dr. Spierings. If your journal reveals regular patterns of headaches after consuming these things, cut them out.

See your doctor. If you are having menstruation-associated headaches, consider asking for a prescription for an anti-inflammatory prophylactic medication, such as Syntex, to use during the week before your period, says Dr. Solbach, especially if headaches occur like clockwork--10 migraines out of 12 cycles, for example.

Make the Pain Go Away

If, despite your best efforts, you do develop a headache, you can act to reduce your suffering. Here's how.

Go over the counter. In most cases, over-the-counter pain relievers, such as aspirin, ibuprofen, acetaminophen or nonprescription-strength naproxen (Aleve), are all you need if you are experiencing a tension headache, says Dr. Speed. But be careful not to get into a cycle of overusing them. After a while they'll no longer ease the pain, so you'll increase your dosage and become dependent on them. "You should not take pain medications on the average more often than once or twice a week," says Dr. Spierings. "If you are taking them more often, you should do something good for your body, like using a heating pad or trying some relaxation exercises to relieve the headaches."

Studies and physician experience have shown a decrease in headache intensity and frequency following withdrawal from pain relievers, so Dr. Spierings recommends an abrupt withdrawal from such medications for those caught in the cycle. "Don't get scared by the withdrawal headache you may get," he says. "It is better to just tough it out for one or two days--you will be relieved from the perpetual headache."

Get a prescription. Ergots and ergotamines (Ergostat) have traditionally been used as therapy for migraine attacks, but these prescription drugs may exacerbate nausea and vomiting. Sumatriptan (Imitrex) has not shown any side effects and is extremely fast-working, says Dr. Solbach. Ask your doctor about it.

Most anti-migraine medications work by altering serotonin levels to block pain messages. Some also constrict swollen blood vessels.

Turn on the heat. To reduce muscle fatigue and turn back a headache, Dr. Spierings suggests you use a heating pad on your neck and shoulders every night for 15 minutes or so.

Relax and visualize. Because so many headaches are caused by fatigue, practicing progressive relaxation exercises can help, says Dr. Spierings. Tense and release your muscles in groups, first the feet, then the calves and so on up the body. But avoid contracting the muscles in your head, face or neck, which could make the headache worse.

Biofeedback maneuvers such as visualization may also help you relax your muscles--and make the pain disappear. The next time you feel a tension headache coming on, imagine the tight band loosening and continuing to slacken until the pain is gone. Or lie back and picture yourself in a peaceful place such as a deserted beach or an untouched forest. More than anything else, these moves give you back a sense of control. And ridding yourself of the frustrating sense of helplessness that so many women feel when they suffer recurrent headaches is an important aid to achieving a clear head, says Dr. Miller.