If you suspect a tough conversation at work, a scented candle, or even a few bites of chocolate have given you a splitting headache, you’re not losing your mind. The tension type (caused by stress) and migraines (both sweets and smells can set them off) are two of the most common medical conditions in the world -- only tooth decay is more prevalent. But in many ways, headaches are still a mystery. The brain’s complexity is partly to blame, as is the fact that, unlike high BMI or blood pressure, they’re tricky to measure, according to Lauren Natbony, M.D., an assistant professor of neurology and headache specialist at Mount Sinai Hospital in New York City. What we do know is that veering from normal habits (skimping on sleep, skipping a meal) can cause the body to overreact and trigger one, says Jessica Ailani, M.D., director of MedStar Georgetown University Hospital’s Headache Center, in Washington, D.C. Read on to learn how to put a name to your headache and recover faster.
What it Feels Like
Painful but not unbearable pressure that wraps around your skull. Also known as stress headaches, these may stick around for just a few minutes or for up to a week.
What's Going On
Overly tight muscles in the head and neck are the most likely culprits, says Natbony. You may be sitting in front of the computer for too long, or clenching up due to worry or strain. That physical tension can cause nerves in the area to send a flood of pain signals to the brain, prompting a headache.
What To Do
Try yoga, meditation, exercise, or other stressrelieving activities. When you do get a tension headache, OTC medication (containing naproxen or ibuprofen) should be your go-to. But if they’re frequent enough to interfere with your daily routine, tell your doctor. She may recommend a low dose of an antidepressant -- since the chemicals thought to be responsible for headaches also play a role in anxiety and depression -- or a nondrug therapy (see Beyond the Medicine Cabinet, below).
What It Feels Like
Relentless throbbing on one side for hours or days; it can be excruciating enough to keep you in bed. You may also experience nausea, blurry vision, and sensitivity to light, sound, or motion. (Brushing your hair can feel agonizing.) Sinus-like forehead and facial pressure are other symptoms. In fact, true sinus headaches are rare; one study found that almost 90 percent of people who thought they had one actually had a migraine.
What's Going On
Genetics largely determine your susceptibility to this breed. Experts think the responsible gene makes you extra-sensitive to everything from the weather to dehydration to hormonal ups and downs (i.e., during your period), and that these triggers set off a wave of neural activity. When that wave washes over the brain and excites the trigeminal nerve, which runs from the base of your skull to your temple and eye area, the nerve can become overexcited, provoking a release of pain-inducing chemicals along that pathway, says Lawrence Newman, M.D., director of the headache division at New York University’s Langone Medical Center.
What to Do
Maintaining a healthy lifestyle can help desensitize the brain so it’s better able to handle triggers. Shoot for seven to nine hours of sleep a night, eat frequent meals (to prevent your bloodsugar levels from getting too high or low), exercise at least three times a week, and stay hydrated. At the very first sign of a migraine, take your usual OTC pain reliever. If that doesn’t help, or if you have more than one migraine a week, your doctor might prescribe preventive medication. Historically, blood-pressure pills as well as antiseizure and antidepressant meds have been used. But a new injectable specifically designed to prevent migraines -- the first of its kind -- is now in clinical trials, and may reach the market as soon as next summer. Called calcitonin gene-related peptide, or CGRP, it’s either a shot you’d self administer or an intravenous treatment you’d receive in a doctor’s office.
What it Feels Like
A piercing, one-sided bout of pain, sometimes described not so delicately as feeling like having an ice pick stuck in your eye. A cluster headache can last from 20 minutes to a couple of hours, and may be accompanied by a drooping eyelid and an uncontrollably tearing, reddening eye. Unlike with a migraine, lying down tends to worsen the pain.
What's Going On
Thankfully, clusters are rare, especially in women. Their pain pathway is thought to be similar to that of a migraine, involving the trigeminal nerve, says Newman, but the biggest trigger seems to be a change in the seasons; most people experience them in months with the most and least sunlight.
What to Do
Because clusters pass more quickly than pills can take effect, there’s not much you can do to relieve one in the moment, unfortunately. (Pure oxygen therapy does help, but it isn’t exactly practical to keep a tank and mask in your home, and insurance rarely covers it.) Ask your doctor about preventive medications; these can be taken year-round or only during weeks when your headaches tend to strike, if their timing is predictable. Some small studies suggest that supplementing with melatonin, the same hormone that helps regulate your sleep-and-wake cycle, may help reduce the frequency, too.
Beyond the Medicine Cabinet
Try these treatments alone, or pair them with your usual Rx.
The needle pricks reliably ease tension, and recent research found that they can reduce migraine frequency, too. Natbony, who uses acupuncture on her own patients, recommends six to eight weeks of treatments before determining if they’re beneficial and, if so, continuing them.
This therapy, which involves learning how to relax and lessen tension throughout the body, has been shown to help ease headache symptoms. Go to aapb.org to find a practitioner near you.
Doctors inject Botox into points along the forehead, temples, back of the head, neck, and shoulders. It calms the system of nerves in the brain that become overexcited, helping to reset the cycle that causes chronic migraines, says Ailani.
Other Head Cases
Secondary headaches occur when a separate health issue turns on the nerves around the brain. Here, a few pain factors and fixes.
Nerve endings can relay discomfort from an inflamed chomper around your head; see your dentist to take care of a potential cavity or infection.
A Cold (or Cold Food)
Swollen sinuses can translate into head or facial pain. Saline rinses and steamy showers offer relief, as can OTC pain relievers and decongestants. Also, the nerves in the roof of the mouth are sensitive to frosty drinks and ice cream, and will send pain signals right to your noggin. The blood vessels there constrict and contract, and voilà: brain freeze. To ease it, press your tongue against your palate.
A Hangover (aka Dehydration)
Fluid loss contributes to some headaches; alcohol expedites it by blocking the release of vasopressin, a hormone that helps you retain H2O. Drink water (aim for two liters in a day), and take a nonacetaminophen pain reliever, if needed.
Too Many Meds
The very pills used to relieve migraines can foster so-called rebound headaches when taken too often. If you reach for them 10-plus days a month, tell your doctor. She may recommend a preventive Rx instead.