Headache problems

A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are extremely rare. Most people with headaches can feel much better by making lifestyle changes, learning ways to relax, and occasionally by taking medications.

Common Causes

Tension headaches are due to tight, contracted muscles in your shoulders, neck, scalp, and jaw. They are often related to stress, depression, or anxiety. Overworking, not getting enough sleep, missing meals, and using alcohol or street drugs can make you more susceptible to them. Headaches can be triggered by chocolate, cheese, and monosodium glutamate (MSG). People who drink caffeine can have headaches when they don't get their usual daily amount.

Other common causes include:

Holding your head in one position for a long time, like at a computer, microscope, or typewriter
Poor sleep position
Overexerting yourself
Clenching or grinding your teeth

Tension headaches tend to be on both sides of your head. They often start at the back of your head and spread forward. The pain may feel dull or squeezing, like a tight band or vice. Your shoulders, neck, or jaw may feel tight and sore.

Migraine headaches are severe, recurrent headaches generally accompanied by other symptoms like visual disturbances or nausea. They tend to begin on one side of your head, although the pain may spread to both sides. You may have an "aura" (warning symptoms that start before your headache) and feel throbbing, pounding, or pulsating pain.

Other types of headaches:

Cluster headaches are sharp, extremely painful headaches that tend to occur several times per day for months and then go away for a similar period. They are far less common.
Sinus headaches cause pain in the front of your head and face. They are due to inflammation in the sinus passages that lie behind the cheeks, nose, and eyes. The pain tends to be worse when you bend forward and when you first wake up in the morning. Postnasal drip, sore throat, and nasal discharge usually occur with these headaches.

Headaches may occur if you have a cold, the flu, fever, or premenstrual syndrome.

If you are over age 50 and are experiencing headaches for the first time, a condition called temporal arteritis may prove to be the cause. Symptoms of this condition include impaired vision and pain aggravated by chewing. There is a risk of becoming blind with this condition. Therefore, it must be treated by your doctor right away.

Rare causes of headache include:

Brain aneurysm -- a weakening of the wall of a blood vessel that can rupture and bleed into the brain
Brain tumor
Stroke or TIA
Brain infection like meningitis or encephalitis

Home Care

Keep a headache diary to help identify the source or trigger of your symptoms. Then modify your environment or habits to avoid future headaches. When a headache occurs, write down the date and time the headache began, what you ate for the past 24 hours, how long you slept the night before, what you were doing and thinking about just before the headache started, any stress in your life, how long the headache lasts, and what you did to make it stop. After a period of time, you may begin to see a pattern.

A headache may be relieved by resting with your eyes closed and head supported. Relaxation techniques can help. A massage or heat applied to the back of the upper neck can be effective in relieving tension headaches.

Try acetaminophen, aspirin, or ibuprofen for tension headaches. DO NOT give aspirin to children because of the risk of Reye's syndrome.

Migraine headaches may respond to aspirin, naproxen, or combination migraine medications.

If over-the-counter remedies do not control your pain, talk to your doctor about possible prescription medications.

Prescription medications used for migraine headaches include ergotamine, dihydroergotamine, ergotamine with caffeine (Cafergot), isometheptene (Midrin), and triptans like sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), andzolmitriptan (Zomig). Sometimes medications to relieve nausea and vomiting are helpful for other migraine symptoms.

If you get headaches often, your doctor may prescribe medication to prevent headaches before they occur. Examples of these include:

Antidepressants, like nortriptyline (Pamelor), amitryptyline (Elavil), fluoxetine (Prozac, Sarafem), sertraline (Zoloft), or paroxetine (Paxil), for tension or migraine headache
Beta-blockers, like propranolol (Inderal) for frequent migraine headaches
Calcium channel blockers, like verapamil for frequent migraine headaches

If you are using pain medications more than 2 days a week, you may be suffering from rebound headaches. Rebound headaches are caused by a cycle of using pain medications for short-term relief, followed by the headache pain returning for increasingly longer periods of time despite taking more pain medications.

All types of pain pills (including over-the-counter drugs), muscle relaxants, some decongestants, and caffeine can cause this pattern. If you think this may be a problem for you, talk to your health care provider.

Call your health care provider if

Take the following symptoms seriously. If you cannot see your health care provider immediately, go to the emergency room or call 911:

Your headache comes on suddenly and is explosive or violent.
You would describe your headache as "your worst ever", even if you are prone to headaches.
Your headache is associated with slurred speech, change in vision, problems moving your arms or legs, loss of balance, confusion, or memory loss.
Your headache gets progressively worse over a 24-hour period.
Your headache is accompanied by fever, stiff neck, nausea, and vomiting.
Your headache occurs with a head injury.
Your headache is severe and localized to one eye with redness in that eye.
You are over age 50 and your headaches just began, especially with impaired vision and pain while chewing.

Prevention

The following healthy habits can lessen stress and reduce your chance of getting headaches:

Getting adequate sleep
Eating a healthy diet
Exercising regularly
Stretching your neck and upper body, especially if your work involves typing or using a computer
Learning proper posture
Quitting smoking
Learning to relax using meditation, deep breathing, yoga, or other techniques