"Oh, my aching head!" *

David A. Gershaw, Ph.D.

Each year, physicians receive about 80 million visits related to headaches. Americans spend over $400,000,000 on over-the counter drugs to get rid of headaches. Although some headaches are caused by serious diseases strokes or brain tumors most are not due to any underlying diseases. They are called primary headaches.

The most common and mildest of the three types of primary headaches are called tension headaches. These headaches are accompanied by muscle tightness around the scalp or back of the neck. They may be dull, steady pains over the whole head, or they can be localized in the forehead, temples or back of the neck. Tension headaches are equally common in both sexes, and most of us have had one. They seem to occur after stress or fatigue, like sleep deprivation or staying in a position that tenses the neck and head.

The second type migraine headaches involves pulsating pains that typically occur on one side of the head. Usually triggered by emotional factors, migraines can cause intense throbbing pain that can last for a few minutes to days. They can incapacitate the person. These headaches may start with some visual effects, like seeing bolts of light. At the extreme, these headaches can cause vomiting and great sensitivity to light and noise. Women are four times more likely to get migraine headaches, and they tend to run in families. The first attack often occurs before the age of 30.

The third type cluster headaches involves steady, piercing pains usually around the eye or temple. They typically occur in groups (clusters), with each lasting for hours. They might occur repeatedly each day for a week but be absent for months before starting a new group of headaches.

In contrast to migraines, cluster headaches are found 6-9 times more often in men than women. The first attack typically strikes between the age of 20 and 40. Although we really don't understand their cause, they seem to be triggered by heavy drinking or smoking.

All three types of headaches seem to be linked to abnormalities of blood flow in the brain. These abnormal changes in the blood vessels seem to be related to a chemical messenger serotonin.

The major drug treatment involves the old standby aspirin. Besides reducing ordinary headache pain, aspirin heals to prevent headaches. In a health study, they found that frequent sufferers of migraines reduced their risk by 20% by taking one aspirin every other day. The aspirin starts a chain of events that controls serotonin. By controlling the production of serotonin, it reduces the abnormal blood flow that causes migraines.

Tension headaches respond to over-the-counter medications like aspirin, ibuprofen (Advil) and acetaminophen (Tylenol). However, if you have to use them over a long period of time, you should consult a physician.

In addition, a new drug sumatriptan reduces abnormal blood flow in the brain by controlling the effect of serotonin in the brain. Not only does it reduce headaches, but it also has fewer side effects than other treatments. Sumatriptan needs to pass experimental tests before it can be available in the United States.

Drugs are not the only way to treat headaches. Some of us can avoid headaches by improving our posture. As an example, if you are working with a computer or reading for a long time, make sure that your neck is straight. You can also help by using stretching exercises for your back, neck and shoulders. Tension headaches can also be reduced with heat, cold or massage around the head and neck.

Some of us can reduce the possibility of headaches by avoiding certain foods caffeine drinks, alcoholic drinks and cured or processed meat. Caffeine, alcohol and the nitrites in cured meats all change the blood flow in your brain.

Although drugs can help reduce headaches in the short run,
learning to cope with your emotions and stress is better in long run.

Lastly, emotion and stress are related to many headaches. Psychologists can help people to deal with stressful situations. As an example, a 1988 study used a behavioral approach to help people cope better with stress, relax more effectively and gain better control over their physiological reactions to stress. This behavioral approach was compared to merely taking a drug when a migraine headache was beginning. Both approaches were effective for the first six months. But after three years, the behavioral approach was more effective. Those with behavioral training still did very well without drugs. Meanwhile, all the people taking the drug had to switch to another drug. Reasons for switching included undesirable side effects and loss of effectiveness of the original drug.

Studies like this indicate that headache sufferers should consider behavioral approaches, but these approaches are best under the guidance of trained professionals. They can help you cope better, relax more effectively and gain more control over your physiological functions. These methods can help you head off your next headache.

* Adapted from Stephen Worchel and Wayne Shebilske's Psychology: Principles and Applications, Prentice Hall Publishers, 1992, pages 44-45.

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