Headaches are among the most common ailments, and maybe it’s because we’re so used to coping with them that we don’t bother investigating where they come from and how to treat them. The good news is that enormous progress has been made in keeping headache pain to a minimum, both with new medications and non-drug therapies. But in order to benefit from all this knowledge, you need to first understand the three main types of headaches and their own unique origins, characteristics, and solutions.

Tension Headaches

What they are: Unless you’re extraordinarily easy-going, you’ve probably experienced a tension headache and probably will again. “Tension headaches are usually the result of muscular contractions caused by factors like stress or lack of sleep,” says Seth Stoller, MD, a neurologist specializing in pain management at the Atlantic Neuroscience Institute at Overlook Hospital. This is why tension headaches tend to start in the neck and cause soreness around the temples and a tightening band-like sensation across the forehead.

Tension headaches can also be brought on by poor posture, eye strain, and working with your head and neck in an unnatural position for an extended period of time, as well as physical conditions like arthritis, jaw abnormalities, spinal compression, and stenosis. Although the pain from a tension headache can be constant and distracting, it’s generally just a dull ache and not the throbbing sensation associated with migraines. Although the majority of tension headaches occur episodically (meaning only occasionally), there are some unlucky folks
for whom these headaches happen much more frequently, sometimes every day.

What you can do: For most of us, tension headaches subside in a few hours with help from an over-the-counter pain reliever and a good night’s sleep. But for patients who suffer more chronically, medical intervention is sometimes necessary. Before resorting to medications with serious side effects, however, Stoller suggests first talking to your physician about the possibility of biofeedback treatments. “Biofeedback may be able to minimize the number of headaches a patient gets by helping to ease chronic tension around the scalp area,” he explains. Biofeedback works by monitoring the body’s involuntary responses, like breathing, heart rate, and muscle tension. Once you learn to recognize these responses, you can learn how to control them with physical relaxation methods and emotional coping skills. Other effective treatments for chronic tension headaches include such prescription anti-inflammatory drugs as Naproxen, muscle relaxants, anti-anxiety drugs (if the source of the stress is found to be clinical depression), and even physical therapy.

Migraines

What they are: Migraines are probably the most talked-about type of headache and rightly so, since they can be the most crippling, putting your life on hold for several hours or sometimes several days. Migraine headaches are generally experienced as severe, sharp, throbbing headaches that strike one side of the head (in fact the term “migraine” comes form the Greek word for “half the head”). Many migraine sufferers also report experiencing a variety of other symptoms, including nausea, vomiting, and sensitivity to light, sound, and smell. What’s more, unlike tension headaches, which tend to stay around the temples and forehead, migraine pain can radiate all around the head and neck. According to recent estimates, about 30 million people in the United States suffer from migraines—and the majority of them are women. “This is probably due to the fact that hormonal fluctuations, especially estrogen, are big migraine triggers,” says Stoller. But he is quick to add that there is also a laundry list of other migraine-inducing factors that vary from patient to patient, such as: too much sleep, hunger, road glare (or sharp light contrasts outside a car or bus window), alcohol, aged red wine, aged cheese, chocolate, changes in altitude or barometric pressure, weather changes, caffeine, and foods with nitrates or monosodium glutamate (MSG).

What you can do: The one upside to chronic migraines is that they tend to give some kind of warning signal before they attack. That’s why it’s vital to record all your activities and meals within 24 hours of each migraine and share this list with your doctor to see if a pattern can be established. “Identifying your particular migraine triggers and symptoms is key,” says Stoller, “because if you can see the headache coming you can take action to prevent it.” Some patients report that their headaches begin as a dull ache at the back of the neck that eventually develops into a constant, pulsating pain. Other sufferers experience a disconcerting phenomenon doctors refer to as “aura” (which involves your vision becoming temporarily obscured by wavy lines, dots, or flashing lights, or by blind spots or tunnel vision in one or both eyes) about 30 minutes before the pain hits. Migraine aura is often so intense that some believe it has actually inspired great works of art and literature, including Van Gogh’s famous “Starry Night” and certain scenes from Lewis Carroll’s Alice in Wonderland, where objects appear either very large or very small.

So what tools do doctors have in their arsenal to stop a migraine before it stops you? For patients who suffer frequent migraines, a regular course of treatment to limit the number of headaches is the best course of action. These solutions include vitamin therapy, prescription drugs, anti-depressants, and even Botox injections or other local nerve blocks. For those whose migraines crop up only occasionally, abortive medications are a great option for nipping incoming headaches in the bud. Doctors are particularly excited about a new drug therapy that combines the proven migraine-fighter Imitrex with the anti-inflammatory drug Naproxen. “Recent research has found that the muscle aches at the back of the neck that precipitate many migraines actually respond better to drugs that contain an anti-inflammatory component than to just migraine medication alone,” says Maria Alexianu, MD, an attending physician of neurology at Overlook Hospital. “When this new drug was tested on migraine sufferers, they got relief from their symptoms faster and more completely than with just conventional migraine medications.” Of course, the nausea and vomiting associated with migraines can sometimes make it difficult to keep down precious medication. “In this case we would simply prescribe an anti-nausea drug in addition to the migraine meds,” explains Alexianu.

If you’re looking for a more natural, drug-free migraine remedy, Alexianu points out that for some patients, relief can be found through vitamin therapy. “Research has shown that many migraine sufferers are vitamin-B12 deficient,” she explains, “and so replacing these nutrients can often minimize the problem.” Although you should talk to your doctor before beginning any vitamin regimen, Alexianu usually suggests taking an extra 200 milligrams of vitamin B12 daily.

Cluster Headaches

What they are: “Cluster headaches feel like a cluster of sharp jabs on one side of the head or around the eye,” says Stoller, “and tend to strike men between the ages of 20 and 50, without warning in the morning or late at night.” Cluster headaches also generally accompany other symptoms like nasal congestion, tearing, a bloodshot eye, and temporary facial drooping, and the pain can radiate from the eye to the forehead, temple, and cheek, all on the same side of the face. But what causes these excruciating episodes? “Cluster headaches are often brought on by smoking and alcohol,” says Stoller. So if you have a history of cluster headaches, try to curb your cigarette and drinking habits—it’s better for you in the long run, anyway.

To first-time sufferers, cluster headaches can be pretty scary, since they often look and feel a lot like a stroke (especially if the face begins to droop slightly), but the key here is that these symptoms are usually fleeting. In fact, cluster headaches are almost always short-lived, with episodes lasting just 30 to 45 minutes, although some patients report that they can experience as many as four separate cluster headaches in one day.

What you can do: “Sometimes you can get relief from a cluster headache simply by walking slowly around the room,” says Stoller. Other patients swear by abortive meds, like lidocaine and simple oxygen, which typically come in the form of nasal sprays and injections.

When to Get Help

In some cases, chronic headaches can be so frequent and severe that they interfere with your daily activities. If you’re experiencing any type of headache more than once or twice a week, don’t suffer in silence—see your primary care physician. He or she can recommend a course of treatment or refer you to a neurologist. And although most headaches are benign (even the most devastating ones), it’s important to remember that the symptoms of migraines and cluster headaches can mimic those of a stroke. So if a severe headache starts to feel different than what you’re used to or is accompanied by unexpected visual changes, loss of dexterity, numbness or weakness in any part of the body, or difficulty speaking, go to the emergency room or call 911.

Preparing to See Your Doctor

Treating chronic headaches isn’t like caring for a broken leg or managing other ongoing conditions, since they present so differently from patient to patient. That’s why you should arm your doctor with as much information as you can about your headaches—how they feel, as well as what you were doing when they hit. Although compiling all of this information can seem overwhelming, this checklist should help make it easier. If you answer the following questions and then bring the information with you to your first appointment, you and your physician will be one step closer to ending your headache pain.

• Note the date and time of every headache you can recall, and where you were and what you were doing when it hit.


• If you’re a woman: Do the headaches occur during your menstrual cycle?


• What type of pain do you feel? Is it a dull ache or a throbbing, piercing, or squeezing sensation?


• What other symptoms do you experience? Is there any nausea, vomiting, or dizziness? Do you have stiff neck muscles? Is your eyesight, hearing, or sense of touch affected?


• Where is the pain? Is it on one side of your head, or both sides? Is it in front or back, or over or behind one eye?


• How long do the headaches last?


• What do you usually do for your headaches?


• What is the weather like when your headaches occur?


• Did the headache start after you were exposed to any perfumes, chemicals, or smoke?


• What did you eat within 24 hours of your last headache? Did you skip a meal that day?


• What are your sleep patterns?


• Is there a history of headaches in your family?


• Do you have any other medical conditions or take any medications regularly?