Headaches From A-Z

Rebound Headaches

Rebound headaches occur when you take too many pain relievers for too long and then take a break from them for a day or two. Some experts believe that rebound headaches occur because the body builds up a tolerance to the medication, thus requiring more and more medicine to achieve the same effect. Others believe that the continual use of artificial painkillers actually dampens the brain's ability to produce its own natural painkillers, thus triggering headaches.

One way to cure your problem is to discontinue the use of all analgesics until your body straightens itself out; in other words, go cold turkey. During your recovery time, you may experience more headaches, nausea and even stomach upset, which can be quite uncomfortable. If going cold turkey doesn't sound appealing, you can also gradually cut down on the use of medication, which may minimize some of the unpleasant side effects. Whatever you decide to do, I recommend that you talk to your doctor first to determine which approach is best for you. Although it is rare, morning headaches that clear up later in the day can be a sign of high blood pressure. If you have not had your blood pressure checked recently, by your physician, you should do so.

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Premenstrual Headaches

Headaches that come on during the week before your period may be caused hormonal shifts. Prior to menstruation, levels of estrogen drop and women often suffer from what doctors call vasomotor instability: Vessels constrict more easily than usual, including the vessels in the brain and the coronary arteries.

When estrogen levels are low, so are levels of a hormone called serotonin, which is produced by the brain. Although we don't know precisely how or why, low levels of serotonin are believed to promote headache pain, perhaps by somehow reducing the level of effectiveness of endorphins, the natural painkillers that are produced by the brain. In fact, we know that serotonin levels are consistently lower in people who have tension headaches or migraines--a particular type of throbbing, painful headache that occurs on one side of the head. Women in particular are prone to migraine headaches, especially around the time of their periods. In addition, women who are taking birth control pills or who are on hormone replacement therapy (HRT) are also more likely to develop headaches during the time of the month when they are taken off estrogen. (This is why some physician-experts in HRT recommend that estrogen never be interrupted and that women take it 365 days a year.)

What to Do

When you feel a headache coming on, the best thing to do is to try to sleep; sleeping slows down the metabolism of serotonin, thus relieving the headache. Over-the-counter nonsteroidal anti-inflammatory medications such as aspirin, naproxen sodium and ibuprofen may also help. These drugs block the production or action of hormones called prostaglandins, which promote muscle contraction and can aggravate menstrual cramps. If your headaches are extremely painful, your doctor can prescribe any number of medications that can prevent or lessen the severity of the headaches including sumatriptan, which enhances the action of serotonin, and ergotamine and beta-blockers, both of which dilate blood vessels.

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Migraines

Migraine headaches are very common, especially among women, who are three times more likely to get them than men. The typical migraine is frequently described by sufferers as a "throbbing" headache, usually causing pain on side of the head. The headaches are often accompanied by nausea and vomiting.

Types of Migraines

There are two types of migraines: classic and common. The main difference between a classic and a common migraine is that classic migraine sufferers experience what is known as an aura, which is a characteristic and consistent phenomenon that warns that a headache is on the way. Most aura are visual--that is, the sufferer sees flashes of bright light (called scotomata), often in a geometric pattern. The aura is usually but not always followed by a headache. In most cases, the aura disappears within an hour or two; however, for some people, the aura may last for days or even weeks.

Classic migraine symptoms can also mimic the symptoms of a stroke, including speech loss, weakness on one side of the body, or tingling or numbness in the face, arms, or hands. If you experience any of these symptoms, you should see a doctor to decide whether you are having a migraine or a more serious problem such as a stroke.

A common migraine, which, as its name implies, is the most typical kind, is characterized by a painful headache that is more severe and longer in duration than the average headache. In fact, it is not unusual for a migraine to last up to three days. People who get common migraines do not experience the pre-headache aura, but many do complain of feeling unusually tired, being unable to concentrate, and mood changes. In order to be classified as a common migraine, the headache must also be accompanied by two of the following symptoms:

• Nausea
• Pain on only one side of the head
• Pain that is so severe that it prevents normal activity
• Pain that is brought about or worsened by normal physical activity

Once a migraine is over, the pain disappears, but many people complain of feeling exhausted and completely drained.

What to Do

As many as 15% of all women and 5% of men may experience migraine-type headaches. Migraines are not considered serious medical problems unless they are so debilitating that the headaches are preventing you from leading a normal life. If your headaches are infrequent, and you can manage them on your own with OTC painkillers, there is no reason to see a doctor unless they are of recent onset. Any new, persistent headache deserves evaluation, and your doctor should do a complete physical examination and take a careful history to be sure the headache is not due to a more serious problem. Another reason to get your doctor's help is for severe pain, particularly if you're experiencing it for the first time. Migraines are so common these days that most doctors have had some experience in treating them. If, however, your problem is particularly complicated, your doctor may refer you to a neurologist or to a special headache clinic staffed by physicians trained in state-of-the-art treatments. If your doctor tells you that there is little to be done for your headaches, it is a sign that she is not up on the latest treatments, and it is then advisable to consult with a specialist.

When you feel a migraine coming on, try lying down in a dark, quiet room. Avoid bright lights, television screens or computer screens, which could irritate your condition. Some migraine sufferers find that a cup of peppermint tea or a glass of ginger ale can relieve the nausea and sick feeling.

Medications for Migraines

There are several prescription medications that have been shown to be effective against migraines:

• NSAIDs: Start with simpler, over-the-counter medications like Advil or Aleve; your doctor can write a prescription for other types of nonsteroidal medications if these don't work.
• Sumatriptan: This drug enhances the action of serotonin, a compound reduced by the brain, which is believed to be involved in pain control.
• Vasoconstrictors: Both ergotamine and beta-blockers (which are normally used to control high blood pressure) relieve headache pain. These are taken orally. Ergotamine is used only to abort an attack, while beta-blockading medications are needed on a chronic, everyday basis.
• Butorphanol: A potent painkiller, this drug is available in a fast-acting nasal spray. Often, if you use these medications at the onset of the headache, or when you feel a headache is imminent, you may be able to ward it off entirely. In other cases, these drugs may only lessen the severity and reduce the duration of the headache.

Migraines and Pregnancy

About 75% of all women with migraines will experience a worsening of their symptoms during pregnancy. Since many medications taken by the mother can pass through the placenta to the fetus and may cause birth defects, doctors are typically very cautious about allowing pregnant women to use painkillers.

During the early stages of pregnancy, when the fetus is most likely to develop birth defects, pregnant women are advised not to use any medication stronger than acetaminophen, which is safe if taken in recommended doses.

As any migraine sufferer knows, acetaminophen may barely make a dent in the headache, but it is certainly worth a try. If you can bear it, simply lie down and use an ice pack. If you are so sick that you cannot eat and are at risk of becoming dehydrated, which could harm both you and the baby, you must alert your doctor. In this situation, your physician may prescribe intravenous fluids and medication that will not harm your baby.

Although we do not want any woman to suffer unbearable pain, we are extremely cautious about the drugs we prescribe during pregnancy for good reason. Drug trials never include pregnant women intentionally, and researchers do not have a good animal model of pregnancy that would allow them to test the effect of drugs on the developing fetus. Virtually all of our information about the impact of a drug on a fetus comes from observing what has happened to the babies of women who happened to have taken medication during pregnancy: That's how we learned that thalidomide leads to birth defects; tragically, it was after the fact!

Interesting Facts About Migraine Headaches in Men and Women

45-65% of chronic headache sufferers have a family history of headaches.

As soon as puberty happens, young women have migraines much more frequently than young men. (15-17% of women have migraines; 3-6% of men do.) Before then, the occurrence is about the same for girls and boys. Headaches occur less frequently as people age.

As estrogen levels increase, levels of serotonin, a brain chemical that affects mood and perhaps certain vascular functions, also rise. When estrogen levels are low, during the monthly period, and the off-week for birth control pills or hormone replacement therapy, serotonin levels decrease and headaches occur.

Serotonin plays a critically important role in the development of some types of headaches. Indeed, the serotonergic system in headache sufferers may be different from that of normal people.

There is an association between migraine and depression; this is another reason some experts have given to explain the prevalence of migraine in women—depression is also more common in women than in men. This is perhaps the reason migraine has been successfully treated with tricyclic antidepressants. These medications are known to work through their influence on serotonin and norepinephrine synthesis and metabolism.

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Headaches After Sex

Some men and women get terrible headaches after having an orgasm. Whatever the cause, the anticipation of a miserable headache after sex can make the experience more of an ordeal than a pleasure. Fortunately, two different types of medication--beta-blockers and calcium channel blockers--can help to prevent after-sex headaches. Since you will need a prescription for either one of these drugs, you should talk to your doctor about your problem.

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Weekend Headaches

After a busy and stressful work week, a weekend headache may knock you off your feet. No one knows precisely what causes this type of headache, but there are theories that it may happen from a cascade of events triggered by relaxation!

• When your are under stress, your body is pumping out high levels of certain types of hormones.
• Stress makes your muscles tense and constricts your blood vessels.

Put these two facts together, and when the stress has passed and your level of stress hormones drops, your muscles relax and the blood vessels in your head dilate. This may cause swelling of the blood vessel wall, which irritates nearby nerves and produces the headache pain. Your best defense against the weekend headache is to learn how to control stress during the week.

There are other factors, however, that could also be causing your weekend misery. For example, when one of my patients complained of weekend headaches, I urged him to keep a diary tracking his activities from Friday night through Sunday to see what, if anything, he was doing differently on weekends than during the week. From his diary, I learned that on Friday nights he always visited his mother, with whom he had a strained relationship. To make the visit more bearable, my patient--who was normally a teetotaler--would down two glasses of Scotch and soda during the course of the evening. The headache that he was experiencing the next day was actually a hangover. Once he stopped his Friday night drinking, the headaches disappeared.

Anyone who has weekend headaches should examine whether some change in activity could be triggering the headaches. Things to consider include:

• Sleep patterns. If you sleep later on weekend mornings than during the week and therefore are eating breakfast later, your headaches could be from low blood sugar. Try waking up earlier and having something to eat, and then going back to sleep. If you typically need several cups of coffee on a weekday morning to get going, and you are sleeping later than usual, your headaches may be due to caffeine withdrawal. Studies have shown that when denied caffeine, caffeine users can develop symptoms of withdrawal, including headache, nausea, cramps and the inability to concentrate.
• Medications. Do you smoke marijuana or take Valium or other sedatives to ease into the weekend? If you do, these drugs could produce a hangover headache.
• Food and drink. Do you eat different foods on the weekend than during the week? In susceptible people, some food preservatives and flavorings--such as monosodium glutamate, which is often used in Asian cuisine, and sulfates, which may be sprayed on produce in salad bars and are also an ingredient in wine—can cause headaches. Chemicals found in chicken liver, chocolate, herring and aged cheese, as well as too much caffeine, can also cause headaches in susceptible people. Ice cream or cold drinks can also trigger headaches.
• Stress. Some people find the office a stressful place, but others may find it more stressful to be at home, particularly if there is tension between you and other family members. Dealing with the stressful situation is the best way to eliminate the headaches.Chemicalss. If you tend your garden on the weekends, you may be using fertilizer or some other chemicals that could be causing your headaches. If you paint on the weekends or putter around the house, you may be exposing yourself to solvents like benzine or turpentine, spray adhesives, rubber cement and other chemicals that give off fumes that could be triggering your headaches.

It may require some thought and investigation on your part, but once you identify the cause of your headaches, you can take positive steps to control them.

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Adapted and expanded from: What Women Need To Know: From headaches to heart disease and everything in between; by Marianne Legato, M.D., and Carole Colman; Simon and Schuster, 1997. Used with permission of the publisher.