In this article: Headaches: common causes and treatments

Fighting headaches is a pain

Americans spend $1 billion a year on over-the-counter headache remedies. It's time to learn more about the source of your suffering.

or those of us lucky enough not to have them, it is hard to appreciate the full impact of recurring headaches on 45 million Americans. In my practice, I see few things more disruptive to lifestyles than headaches. Fortunately, we've come a long way in understanding what aggravates headaches and how to treat them effectively. Most headaches still can't be "cured." But they can be managed.

Because the causes are so varied, and may require ongoing medical attention, I recommend that anyone who has recurrent headaches or just started getting headaches establish a relationship with a physician who has experience treating this pain. Do not assume all headaches are the same, because they are not!

One of my middle-aged patients had been suffering from headaches for years and had been treating them on his own with over-the-counter remedies. When he came in for a checkup, we discussed his symptoms, and one or two tests later we were treating him for a disorder called obstructive sleep apnea. His headaches ended, his quality of life rose and we addressed a potentially serious medical problem.

When my own daughter began having headaches, a workup revealed the cause to be a deep-seated sinus infection. For these two people, oxygen and antibiotics, not pain medications, were the treatments of choice. It is important to understand your type of headache (see chart below) so you can adjust your lifestyle and minimize the frequency and severity of problems. In general, sufferers should:
Eliminate foods associated with headaches (some common culprits are chocolate, cheese, yeast and tomatoes).
Limit alcohol. I recommend no more than one drink a day.
Restrict or eliminate caffeine.
Minimize stress with counseling and biofeedback if necessary.
Do regular aerobic exercise.
Get 7-8 hours of sleep a night. Be sure to get the latest information from a physician with experience treating headaches and from sources such as the National Headache Foundation, at 1-888-643-5552 or www.headaches.org. Many of us have a lifelong battle with headaches. Don't give up. Make your fight a team effort.

Go to top

Muscle tension headache	Migraine headaches	Cluster headache
What it is A "dull," pressing ache, usually on both sides of the head. Intensity varies with time. Often comes with tight, stiff neck and shoulders.	What it is A "throbbing" ache, usually on one side of the head. Warnings often occur just before a migraine (seeing "spots", light flashes). Intensity is aggravated by movement. Comes with nausea, lightheadedness, intolerance to bright light or loud noise. Sleep usually dispels headache, but fatigue, poor concentration and sore muscles linger. Occurs more often in young women; associated with menstrual cycle.	What it is Sudden "piercing" pain, usually on one side of the head. Peaks in 15 minutes, lasts less than a few hours. Comes with tears, red eyes, nasal congestion, runny nose, nausea, sweating, restlessness or agitation. Attacks occur for several days at the same time each day (hence the name "cluster"). Typically occurs in men over 30.
Possible causes Sleep disorders, such as sleep apnea Excess caffeine Arthritis or disc problems in neck Tooth grinding or dental disease Depression Chronic sinusitis The wrong eyeglass prescription High blood pressure	Possible causes Genetics (seems to run in families) Alcohol and certain foods Hunger, emotional stress, fatigue or certain medications (estrogen replacement, birth control pills) can aggravate a migraine headache	Possible causes Alcohol, even in small amounts, can bring on an attack during a "cluster" phase High altitudes
Treatment options Relax in quiet, dark room with cold washcloth over eyes Massage muscles of neck, back and temples Take your preference of over-the-counter analgesics (aspirin, non-steroidal anti-inflammatories, acetaminophen)	Treatment options Apply cold compress to the ache in quiet, dark room Rest with pillows supporting head and neck; try to sleep Withdraw from stress Take over-the-counter analgesics or a combination of prescriptions	Treatment options Oxygen therapy as directed by a physician Medications as directed by a physician (common prescriptions include triptans, ergotamines) Tobacco use can make headaches resistant to therapy
To top future attacks Reduce stress with lifestyle changes and biofeedback Do aerobic exercise Exercise to increase flexibility and strength of neck muscles Reduce or eliminate caffeine and alcohol Take medication as directed by physician	To top future attacks Keep a diary to identify migraine triggers; avoid those things Work with a physician to use medication effectively (common prescriptions include beta-blockers, calcium channel blockers, tricyclic antidepressants, ergotamines)	To top future attacks Keep a diary to identify triggers; avoid those things Work with a physician to use medication effectively (common prescriptions include ergotamines, prednisone, lithium carbonate)

Tedd Mitchell, M.D., is director of the Cooper Clinic's Wellness Program in Dallas.