Ouch! Furrowing their brows and popping more than $1 billion in over-the-counter pain relievers every year, chronic headache sufferers make up 20% of the population in the U.S. According to the American Society for the Study of Headache (609 845-0322), the country is in the throes of a cranial crisis that costs about $50 billion a year in absenteeism and health care, not to mention lost productivity.
What's causing all this brain pain and associated financial drain? "There are a lot of theories out there about what causes headaches, but no one really knows for sure," says Dr. Seymour Diamond, director of the Diamond Headache Clinic and executive director of the National Headache Foundation (800 843-2256). Basically, common headaches occur when blood vessels swell or muscles contract, aggravating nerves inside and around the skull. But exactly why those blood vessels and muscles get out of whack is open to debate.
STRESS. Experts generally agree that headaches are an inherited tendency, triggered by predictable factors. Stress is a prime provocateur, whether a person is plagued with the sharp pain on one side of the head associated with vascular (migraine) headaches, or the dull, generalized pain typical of a muscular (tension) headache. Everyday pressures are enough to dilate blood vessels, tense up muscles, or both, in a "fight or flight" response. "The body primes itself to react in stressful situations as if it was in immediate physical danger," says Dr. Robert Ford, director of the Ford Headache Clinic in Birmingham, Ala. When no fight or flight ensues after a child or a boss quits screaming, there is no release, and a headache results in those who are genetically predisposed. Experts hope to isolate the chromosome associated with headaches in the next two years. "You can be stressed out to the max and never get a headache, if it's not in your genes," Ford says.
Stress also affects the production of serotonin, a chemical that controls blood flow in the brain. Many researchers believe low levels of serotonin in the brain stem go hand-in-hand with headaches. "The brain stem is the seat of emotional activity, so you can see how anxiety and stress would have a significant effect on its chemical equilibrium," says Dr. Paul Duckro, psychologist and clinical director of the Chronic Headache Program at the St. Louis Behavioral Medicine Institute. But headaches are not a purely psychological malady, Duckro says, because "stress merely aggravates a condition the patient already has due to his or her genetic makeup."
Life's constant changes can also trigger headaches. Changing weather patterns, altitude, lighting, disruption of eating or sleeping schedules, and a variable workload (the phones are dead, or the phones are ringing off the wall) can all bring on a head-banger by upsetting the balance of serotonin in the brain.
Chemicals found in certain foods and drinks may also tip the cerebral apple cart. For example, amines--substances found in chocolate, dark liquors, and aged cheeses--can be, well, a pain in the head. So can monosodium glutamate and caffeine in excess of 200 mg, or the equivalent of about two cups of coffee per day. Nitrates and nitrites, preservatives that are commonly added to hot dogs, salami, and bologna, are equally noxious and can cause a headache within an hour after eating them.
KEEP ROUTINES. Knowing what provokes the cascade of events that leads to a headache is only half the battle. Taking steps to change your lifestyle is the other. Since stress is a prime culprit, learning how to relax is key. Specialists urge patients to engage in relaxation exercises daily. This doesn't mean having to sit for hours in the lotus position surrounded by candles. It can be as simple as periodically taking five minutes to stare out the window. "Do whatever works," says Dr. Seymour Solomon, director of the Headache Unit at Montefiore Medical Center in the Bronx. "It doesn't have to be horribly involved." Among the relaxation techniques Solomon recommends are biofeedback, in which sensors attached to the forehead emit sounds that taper off as muscles go slack, diaphragmatic or deep-breathing exercises, and visual imagery (imagine you are lying on a beach, feel the warm sand...).
Besides mellowing out, headache sufferers should try to minimize changes in their routine. For example, headaches often occur on weekends when people sleep in and skip breakfast. Diamond recommends keeping on the same schedule seven days a week. If there's no avoiding a late Saturday, he says, "get up at the same time the next morning anyway, eat breakfast, and then go back to bed if you have to." Try also to structure the workday so that potentially stressful events--a performance review, perhaps--occur in the morning. "If you get stressed out at the end of the day and then go home, that's a huge change in stimulation," says Dr. Egilius Spierings, director of headache research at Brigham & Women's Hospital in Boston. But a full day of work after a difficult meeting allows you time to gradually unwind.
On the diet side, headache specialists say it's best to avoid certain "trigger" foods and beverages. Not everybody has the same food sensitivities, of course, but experts suggest eliminating all objectionable foods at least for a while. Dr. Alan Rapoport, director of The New England Headache Center in Stamford, Conn., says that after a month without eating or drinking anything containing a trigger chemical, you should "reintroduce one category at a time, like chocolate, and see what happens." If no headaches occur after several days, it's safe to indulge.
Some foods may actually prevent or relieve headaches. These include leafy green vegetables rich in magnesium, a mineral shown in scientific studies to soothe some kinds of headaches. Robert Crayhon, a nutritionist in New Rochelle, N.Y., and host of Alternative Medicine for Total Health, shown on the American Independent Cable Network, says leafy greens such as kale and spinach are also full of chlorophyll, which "may eliminate chemical toxins that build up in the body and cause headaches." Crayhon recommends eating cold-water fish such as salmon and albacore tuna as well because their essential oils have a natural, long-term anti-inflammatory effect.
BOOMERANG. Once the head begins throbbing, researchers in England have found that the feverfew plant, sold in health stores and taken in tablet form or brewed as tea, can provide relief. More traditional, over-the-counter pain relievers might help too, but only if taken sparingly. Experts warn that using popular products such as Tylenol, Bayer aspirin, and Excedrin more than three times a week can in fact exacerbate headaches by inducing the body to produce less of its own natural painkillers. Indeed, when the supermarket analgesic wears off, the headache may seem twice as severe.
There are other remedial strategies. Some people place cold packs on the head to treat vascular headaches and heating pads on the neck and shoulders to deal with muscular headaches. Spierings at Brigham & Women's says many of his patients swear by "putting one of their hands in ice-cold water and keeping it there for as long as possible."
Most experts prefer to treat common headaches without drugs, but if an attack is incapacitating, a prescription may be necessary. There are medications that mimic serotonin in the brain, block nerve signals, open blood vessels and relax muscles. But these drugs should be viewed as the "big guns" that are rolled out only in extreme situations, according to Rapoport.
Almost no one should have to live with head pain. Although the understanding of headaches is far from complete, there is more than enough known to substantially improve the quality of most headache sufferers' lives. That's heady news, indeed.