Oh My Aching Head! Troubleshooting Headaches…

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Almost everyone has had a headache from time to time. And for most people, an occasional headache doesn’t interfere with life too much. But if you’re experiencing headaches more days than not, and especially if your headaches are interfering with work or play, it’s time to stop suffering and start taking action – so you can live most of your days headache-free.

Chronic daily headaches, according to Susan Hutchinson, MD, Director of Orange County Migraine and Headache Center in Irvine, California, are defined by their frequency. “Three to five percent of adults experience chronic headaches,” said Dr. Hutchinson. “This means that they have a headache 15 or more days a month for 3 or more months in duration.”

While there are many types of headaches, she added, the two most common “primary headaches,” or headaches that are not caused by an underlying condition like an infection or a tumor, are tension headaches and migraine headaches. While both cause pain, they have different characteristics.

“A tension headache is universal,” said Dr. Hutchinson. “It causes mild to moderate pain that may feel like pressure or tightening around your head. But it doesn’t interfere with your ability to get to the gym.”

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Migraines, on the other hand, she said, “are less common but more debilitating – you can’t work out when you have a migraine.”

A migraine headache is usually one-sided rather than an all over headache like a tension headache, said Dana S. Simpler, MD, an internist in private practice in the Baltimore, Maryland area for 26 years. “It’s often over one or the other eye,” she explained. “Sometimes the pain is preceded by an ‘aura,’ or a visual disturbance, such as a light flashing in front of your eyes, or a dark spot that interferes with vision.”

Although not always true, she added, a migraine headache is often associated with nausea, light and sound sensitivity. While migraines affect both men and women, they are more prevalent among women than among men.

While both migraines and tension headaches can become chronic, chronic migraines are more common than chronic tension headaches, said Dr. Hutchinson. And because it’s sometimes hard to tell which kind of headache condition you’re experiencing (some people have a mixture of both types), it’s important to have a headache evaluation by a healthcare provider, she added. Although there are no specific tests to diagnose types of headaches, a history, physical exam and possibly testing to exclude underlying conditions, such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan, can help to pin down a diagnosis. Following the evaluation, your doctor can help you to come up with a treatment plan. This will likely include one of a number of prescription medications, such as injections of Onabotulinum Toxin A (Botox), currently the only FDA-approved treatment for chronic migraine.

In the meantime, you can help yourself – and your doctor – by keeping a headache calendar to track your headaches (find one on the National Headache Foundation’s website at Headaches.org). Recording the timing and characteristics of your headache as well as what you were doing when it occurred can help not only to identify the type of headache, but also possible triggers for your condition (see sidebar on headache triggers). And while most chronic headache management plans include over the counter or prescription medications, changing underlying lifestyle factors that may contribute to your headaches, such as inadequate sleep, hydration or nutrients, or excess caffeine, alcohol and stress – will go a long way in helping to alleviate the problem. You may need the help of a nutritionist, a therapist or other health professionals in order to make these changes, said Dr. Hutchinson. “Athletes – or anyone with chronic headaches – should review lifestyle factors and consider getting help in a multidisciplinary approach.”

Headache Triggers
Many chronic-type headaches have “triggers,” or underlying factors that contribute to the development of the headache. Some common triggers for tension and migraine headaches, according to Dana S. Simpler, MD, an internist in private practice in the Baltimore, Maryland area:

Tension Headache Triggers
Emotional tension – It doesn’t have to be something serious, like a divorce or a death in the family. Things such as a big project due at work or school, a poor night’s sleep or excitement or anxiety over an upcoming event, can all cause emotional tension.

Physical tension – Prolonged muscle tension such as sitting in a hunched position over a computer or even squinting in the sun or while reading a book can cause physical tension sufficient to trigger a headache.

Migraine Headache Triggers
Foods – While not true for all migraine sufferers, particular foods may trigger an attack. Common food culprits are ripened cheeses, chocolate, anything fermented, pickled or marinated, foods containing monosodium glutamate (MSG), processed meats like bologna, pepperoni, salami and hot dogs, caffeinated and alcoholic beverages, such as red wine.

Hormonal changes – Such as premenstrual or postpartum changes.

Certain medications – Like birth control pills and certain antidepressants.
In addition, overuse of pain medications (more than three times per week) such as acetaminophen or ibuprofen, can trigger chronic headaches.

Exertion Headaches
Do you experience sudden, severe headaches following strenuous activity such as weight lifting, running – or even sex? If so, you may have an “exertional headache.” According to the National Headache Foundation, most exertional headaches are harmless, but some are caused by disorders such as abnormalities in blood vessels within the brain. If you develop a severe headache directly following physical activity, you should check in with your doctor to rule out underlying problems. And if things check out fine, you can ask about medications you can use prior to exertional activities to blast headaches before they start.

Alternative Headache Treatments
While most headache sufferers use over-the-counter or prescription pain medications at least some of the time, there are some non-medication therapies that can help to safely alleviate headache pain. A few to try:

Hot and Cold Treatment
According to the National Headache Foundation, the pain of chronic headaches can be lessened with ice and heat. While those with migraine headaches tend to prefer cold packs applied to the forehead and temples, and tension headache sufferers find relief with warm packs applied to the posterior head and neck, preference for cold or heat is an individual choice.

A recent study, performed by musculoskeletal pain specialist Giresh Kanji, PhD, Chair of the Wellington Education and Self Treatment Research Group and also for the New Zealand Pain Foundation, found that sauna treatments of 20 minutes three times a week for eight weeks had the same effect as hot and cold packs. “Pain, including headache pain, is amplified by stress chemicals, such as adrenaline, noradrenaline and serotonin in the brain and spinal cord,” said Dr. Kanji.” Heat, such as in a sauna, can produce an overall reduction in the output of stress chemicals over six to eight weeks, which, in turn, can reduce pain,” he explained.

According to Dr. Kanji, although his sauna treatment study was done on tension type headaches, “it is likely that heat should help other forms of headache.”

Connective Tissue Therapy
Connective tissue, or more specifically fascia, surrounds every structure of your body, including bones, organs, muscles and nerves. It’s made up of collagen, elastin and other fibers that are bathed in cellular fluid, and works like a river to help transport oxygen, nutrients and waste from cell to cell, according to Sue Hitzmann, MS, CST, NMT, a somatic-movement educator and manual therapist,. But “stress can get trapped in the connective tissue,” she said, “causing migraine and chronic tension headaches.”

Connective tissue therapy may consist of deep tissue massage with a manual therapist, or a “hands off” series of exercises using a soft body roller and small balls called Myofascial Energetic Length Technique (MELT), developed by Hitzmann and featured on The Dr. Oz Show. “MELT is a very simple technique that you can learn to do to rehydrate connective tissue and release stress trapped and stuck within your body, like sediment in a river,” said Hitzmann. “It keeps your connective tissue stable and functioning.”

You can learn more about Hitzmann’s self treatment system through her book, The Melt Method, or find a group class or one-on-one instruction with a MELT instructor at MeltMethod.com.

Can Fish Oil Reduces Migraines? 
Recent studies, such as one carried out at the University of Cincinnati with 15 migraine sufferers, have shown that regular consumption of fish oils containing omega-3 fatty acids EPA and DHA may reduce the frequency and severity of migraine attacks. While most of the studies utilized large amounts of fish oil capsules (more than six 1,200 mg capsules daily), it doesn’t hurt to take the dose most often recommended by healthcare professionals (two 1,200 mg capsules each day) – plus one or two fatty fish meals (salmon, mackerel, trout, herring) each week.