HEADACHES

NOT ALL HEADACHES ARE CREATED EQUAL. Some produce a dull ache that is a nuisance but doesn't ruin your day. Others come with pain levels that bust the charts and send you to bed. Causes also vary.

Tension headaches, by far the most common kind of recurrent headache, arise from tight muscles in the shoulder, neck and scalp. Often, these headaches come on during the course of the day and resolve after rest or a good sleep. Given sufficient stress, they can persist for several days.

Migraine headaches result from a narrowing of the arteries in and around the brain. When that happens, the insufficient blood flow sometimes produces what's called an aura (when the symptoms are only visual) or prodrome (when they include different types of sensory disturbances). This stage of the headache is marked by symptoms such as sensitivity t6 light, abdominal discomfort, sweating, moodiness, transient numbness or weakness on one side of the body, difficulty speaking and visual disturbances, such as moving black dots, zigzag lines and blurred vision. After this phase the brain arteries dilate, which causes pain - typically, a throbbing pain on one side of the head. The pain may become constant and involve the whole head. Usually the headache lasts two to three hours, but it can persist for a few days. Vomiting often breaks the headache. Sleepiness follows. Common triggers of migraines include stress, insufficient sleep, sleeping late, a less-than-optimal diet, menstrual periods, noise and bright lights.

Cluster headaches are severe, begin suddenly and produce one-sided pain that localizes in the area round or behind the eye. Whereas a migraine makes a person want to lie in a dark, quiet room, cluster headaches produce restlessness. This type of headache is much less common than a migraine. Though the pain is intense, it usually goes away within 30 to 45 minutes. The term 'cluster' refers to the occurrence of such headaches in episodes; for instance, one every afternoon for a month, followed by its disappearance for months or years before recurring. If you have cluster headaches, check with a doctor to rule out glaucoma.

Other less frequent causes of headache include head injury, sinus infections, other infections, temporomandibular joint disorder, hangover, depression, overuse of over-the-counter pain relievers, brain tumour, congenitally malformed blood vessels in the brain, bleeding into the brain and high blood pressure.

SOME LIKE IT HOT
You can often find some relief from headache by using hot or cold applications. It's easy to tell whether a hot or cold compress makes your own headache worse or better. If heat seems to work, try wrapping a damp, hot towel around your neck and shoulders. This promotes circulation and helps relax tight muscles. You can also fill a clean sock with a grain such as lentils, sweetcorn or rice, knot the top, and microwave it for a minute or less. Test to see that it's not too hot; if it is, wait a minute or two or wrap it in another towel to buffer the heat. If cold is more soothing, apply a commercial cold pack or a bag of frozen vegetables to forehead, neck or shoulders.

DRUG TREATMENT

Analgesics
Aspirin, paracetamol, ibuprofen, naproxen, ketoprofen. Function: ease headache pain. Aspirin side effects: heartburn, indigestion, stomach irritation, and mild nausea or vomiting. Ibuprofen, naproxen and ketoprofen side effects: continuous use may irritate stomach lining; long-term high­dose use may damage the liver and the kidneys. Paracetamol side effects: long-term use or higher dosages may damage the liver and the kidneys. Note: using analgesics regularly and then quitting them abruptly can produce long-term headache with worse pain.

Prescription Analgesics
Isometheptene mutate with paracetamol (Midrid), buclizine hydrochloride with paracetamol (Migraleve). Function: ease acute migraine attacks. Midrid side effects: drowsiness, dizziness, nausea; risk of dependency.

Caffeine
Combination analgesics (Anadin, Andrews Answer, Beechams Powders, others); with ergotamine (Cafergot, Migril). Function: constrict arteries to tame headache. Side effects: rapid heartbeat, hunger, anxiety, jitteriness; long-term, heavy use of caffeinated beverages can lead to headaches.

Triptans
Sumatriptan (Imigran), zolmitriptan (Zomig), naratriptan (Naramig). Function: mimic the action of serotonin, a mood-controlling brain chemical thought to be involved in migraines; sometimes also used for cluster headaches. Side effects: burning, tingling or redness at injection site; nausea and vomiting.

Beta Blockers
Propranolol (Inderal), metoprolol (Betaloc, Lopresor), atenolol (Tenormin), nadolol (Corgard). Function: prevent migraine or cluster headaches. Side effects: fatigue, nausea, depression, slow heart rate, low blood pressure, constricted airways, nightmlares.

Calcium-Channel Blockers
Nifedipine (Adalat, and many others), verapamil (Cordilox, Securon, others). Function: prevent migraine headaches. Side effects: rapid heartbeat, depression, weight gain, constipation. Also, because these drugs dilate blood vessels, some people experience migraine-like headaches - the very condition the drugs are intended to relieve.

Tricyclic Antidepressants
Amitriptyline (Lentizol, Tryptizol) and nortriptyline (Allegron). Function: prevent migraines and recurrent tension headaches. Side effects: headache, dry mouth, constipation or diarrhoea, nausea, -indigestion, weakness, fatigue, drowsiness, nervousness, anxiety, insomnia, tremor, excessive sweating.

Other Drugs
Ergotamine (Lingraine). Function: constricts blood vessels and mimics the action of serotonin to relieve migraines. Side effects: dizziness, nausea, diarrhoea, vomiting; continuous use may cause worse headaches upon abrupt withdrawal.

HERBAL REMEDIES

Feverfew (Chrysanthemum parthenium)
Since the 1980s three studies have shown feverfew's benefits for people with migraines. It seems to work for about two-thirds of the people who try it. Feverfew contains parthenolides, compounds that seem to inhibit the release of the mood-controlling brain chemical serotonin from blood cells called platelets. That's how researchers believe it prevents constriction of brain arteries. Many of today's feverfew products are standardised to a specific parthenolide content, but whether standardisation is necessary isn't clear. For best results it's probably best to use the whole plant - the fresher, the better.

One labouratory study found that fresh leaf extracts blocked blood-vessel constriction, which is desirable in preventing migraines, whereas dried leaf extracts elicited contractions. Although you can eat the fresh leaves (one to four per day), they taste very bitter and produce mouth sores in some people who eat them. Better to take feverfew as a tea or as capsules of the freeze-dried leaf. Typical dosage: up to three 300- to 400-milligram capsules per day; or up to 2 average-sized leaves per day; or 15 to 30 drops of tincture per day. Caution: do not use if you are pregnant.

Bay (Laurus nobilis)
This familiar culinary herb, like feverfew, contains parthenolides.
Dr James Duke, author of The Green Pharmacy, suggests using bay
in combination with feverfew to prevent migraine. A typical dose is not well established, so you may want to check with your herbal practitioner.

Cayenne (Capsicum annuum)
Laboratory studies have shown that the capsaicin in cayenne blocks a chemical involved in the nerve transmission of pain. Cayenne is also rich in salicylates, natural aspirin-like compounds. One study found that repeated topical applications of capsaicin just inside the nose prevented the occurrence of cluster headaches, but the patients involved reported burning in their noses. Consult a qualified medical or herbal practitioner if you want to try this treatment. You don't need a doctors supervision to eat cayenne in your chilli. At the first sign of any type of headache, you can eat pepper-spiked food (with plenty of water as a chaser) or swallow encapsulated cayenne. Another way to use cayenne is to massage a balm containing it into your temples. Just be sure to wash your hands well with soap afterwards. Typical dosage: up to three 400- to 500-milligram capsules per day; or 5 to 10 drops of tincture per day. For topical creams, follow the manufacturer's recommendations.

Ginger (Zingiber officinale)
With its long history of use in relieving and preventing headaches and its good safety record, you'd think more people would know about this use of ginger. Laboratory studies show that it acts as an anti­inflammatory and decreases the tendency of platelets to clump together. Both attributes would help ease headaches, including migraines. Ginger also contains a substance called 6-shogaol, which seems to acts like the capsaicin in cayenne to decrease pain. Plus, it helps ease nausea, including the queasiness that comes with migraines. Its warming effect makes it useful when a migraine causes a person to feel chilled. Ginger combines well with turmeric, which is also anti­inflammatory and pain-relieving. Typical dosage: up to eight 500- to 600-milligram capsules per day; or 10 to 20 drops of tincture in water three times per day; or 1/2 to 1 teaspoon of the ground root per day.

Peppermint (Mentha x piperita)
When used internally or externally, peppermint's menthol reduces pain. Like ginger, it also settles the stomach. A triple-whammy approach is to brew a cup of peppermint tea and sip it while sitting in a bath containing 10 drops of essential oil of peppermint. Next, keeping the oil away from your eyes, massage your temples, forehead and neck with about two drops of peppermint oil in a teaspoon of olive or almond oil. Typical dosage: 6 to 12 drops of oil in water up to three times per day; or 10 to 20 drops of tincture in water per day; or 1 cup of tea as often as needed (steep 1 to 2 teaspoons of dried leaves in 1/4 litre of hot water for 15 minutes). Caution: do not take peppermint if you have heartburn or oesophageal reflux. Do not exceed recommended dosage of essential oil.

Willow (Salix spp.)
The bark of this family of trees contains salicylates, chemical close relatives to the acetylsalicylic acid in aspirin. Typical dosage: up to six 400-milligram capsules per day; or up to 3 cups of tea per day (steep 1/4 to 1/2 teaspoon of powdered bark in 1/4 litre of hot water for 10 to 15 minutes).

Ginkgo (Ginkgo biloba)
This anti-inflammatory and antioxidant herb makes platelets less sticky and improves blood flow. All these properties would seem to reduce the risk of a migraine attack. Although studies have not looked at the effectiveness of ginkgo in preventing migraines, trying this non-toxic herb might be worth a try. Typical dosage: 3 capsules of at least 40 milligrams standardised extract per day; or follow manufacturer's or practitioner's recommendations. Caution: do not use with aspirin. In some people, ginkgo may intensify headaches.

Passion Flower (Passiflora incarnata)
A gentle relaxant, passion flower helps unwind tight muscles during a tension headache. Herbalists often use it in combination with other traditional headache herbs. Typical dosage: 20 to 40 drops of tincture up to four times per day, or 2 tablespoons of tea three times per day (steep teaspoon of dried herb in 1/4 litre of hot water for 10 to 15 minutes).

Valerian (Valerian officinalis)
More strongly sedating than passion flower, valerian is a herb to save for when you absolutely want to go to sleep despite a headache. Typical dosage: 300 to 400 milligrams of capsules standardised to
0.5 per cent essential oil per day; or 20 to 30 drops of tincture per day. Caution: avoid if you are pregnant.

EATING TO STOP HEADACHES
Several studies have shown that many people who experience migraines have food allergies or a more subtle version of an allergy: food intolerance. Reducing or removing the amounts of these foods in the diet often reduces or
eliminates the headaches. As a bonus, the patients who give up these foods
often get rid of other allergy-linked problems, such as asthma and eczema. So which are the big allergy offenders? Topping the list are cows' milk, wheat, chocolate, eggs, citrus fruits, strawberries, cheese, tomatoes, rye, and the food additives tartrazine and benzoic acid.
Other foods and additives may cause headaches in sensitive people, not because they act as allergies, but because they contain substances that influence the diameter of blood vessels. Culprits may include chocolate, red wine, aged cheeses, caffeinated beverages, processed meats, the food additive monosodium glutamate (MSG) and aspartame (NutraSweet). The best way to figure out if these foods and additives might be at the root of your own headaches is to take a look at how often you consume them and to try eliminating them one at a time. Standard allergy tests may pick up some, but not all, food allergies.

OTHER WAYS TO CHASE AWAY HEADACHES
Acupressure and acupuncture can help relieve both tension and migraine headaches. In acupressure, the same points are stimulated with fingertips instead of with needles. In a study of more than 500 people with recurrent headaches, self-stimulation of acupressure points worked well enough to replace prescription headache drugs.
Two other strategies to try: relaxation training and biofeedback. Your doctor may be able to direct you to classes in both techniques.