All headaches are not equal
The three primary types of headaches are tension, cluster, and migraine. The most common-tension headaches-are typically experienced as a dull, non-throbbing pain in the back of the neck or in a "headband" distribution. Cluster headaches are painful one-sided headaches that tend to occur in clusters of several headaches in a short period of time, after which there may be no headaches for weeks or months. Migraines are very painful, even debilitating, headaches that usually begin on only one side of the head and may become worse with exposure to light or sound.
Treating tension headaches
Tension-type headache symptoms may include pain, throbbing, aching, dullness, heaviness, and tightness in the head, and may be associated with tender nodules in the neck called trigger-points, or with tenderness in the muscles around the head. People with this type of headache may also experience irritability, problems sleeping, fatigue, and discomfort worsened by movement or pressure. Conventional treatment includes the use of oral medications, such as salicylate analgesics (e.g., Bayer®, Dolobid®), non-steroidal anti-inflammatory drugs (e.g., Advil®, Motrin®, Aleve®, Naproxen®), and acetaminophen (e.g., Tylenol®).
Tension-type headaches often occur more frequently and may become more severe during or following times of mental or emotional stress. Several controlled studies have found tension headache sufferers to report higher levels of stress, depression, anxiety, suppressed anger, or significantly greater muscle tension than those who do not get headaches. Minimizing stress and getting enough sleep and regular exercise are often recommended as treatment though the effectiveness of these measures has not been investigated through research. Additionally, there is evidence that relaxation techniques such as spinal manipulation, massage, and biofeedback may help reduce tension and therefore help prevent tension headaches.
L-5 hydroxytryptophan (5-HTP) may be helpful for tension-type headaches. A recent double-blind study found 5-HTP reduced the need for pain relieving medications, although only small improvements in headache frequency and severity resulted. A preliminary report suggested that peppermint oil has relaxing and pain relieving effects, and may be useful as a topical remedy for tension-type headache.
Caring for cluster headaches
Cluster headaches involve pain in the eye or upper face, tearing, runny nose with nasal congestion, and facial sweating. Those that continue for more than one year without remission, or with remissions lasting less than 14 days, are considered chronic and are difficult to treat. Typical treatments consist of drugs that lead to narrowing of blood vessels, such as methysergide (Sansert®). Oxygen inhalation is another option, especially with nighttime onset of symptoms. Other therapies that do not affect blood flow are also used, including a corticosteroid trial, and indomethacin (Indocin®).
Some doctors report that food sensitivities may trigger cluster headaches in some people, though this has not been investigated with controlled research. Many people with cluster headaches are smokers or heavy consumers of alcohol, though no research has investigated the effects of avoiding alcohol on cluster headache recurrences.
Researchers have found low levels of the hormone melatonin in cluster headache sufferers. Melatonin supplementation (10 mg at bedtime) appears to be effective against both episodic and chronic cluster headache in some people; however, more research is needed to establish the long-term effects. Capsaicin, a constituent of cayenne pepper, can reduce the levels of substance P, a nerve chemical involved in pain transmission that may cause some of the symptoms of cluster headache. Only intranasal capsaicin has been tested and found effective for cluster headache; this treatment should be utilized only under the supervision of a qualified doctor.
Migraines may be preceded by warning symptoms (prodrome) that may include depression, irritability, restlessness, loss of appetite, and a characteristic "aura"-usually a visual disturbance such as flashing lights or a localized area of blindness that follows the appearance of brilliantly colored shimmering lights. Migraines often involve nausea, vomiting, or sensitivity to sound or light. The most common drugs prescribed for acute migraine symptoms are sumatriptan (Imitrex®), dihydroergotamine (DHE®), and ergotamine-caffeine (Cafergot®). Many different drugs have been prescribed for migraine prevention, most commonly propranolol (Inderal®), verapamil (Calan®, Isoptin®), and amitriptyline (Amitril®, Elavil®).
The connection between diet and migraine headache is well established. Migraines can be triggered by food sensitivities and may be relieved by identifying and avoiding the problem foods. For some sufferers, improvement in the frequency and/or severity of migraines can result from dietary changes designed to control the blood sugar, such as strict avoidance of refined carbohydrates, caffeine, and alcohol, and eating small, frequent meals (such as six times per day). Some people who suffer from migraines also react to salt, and others have been reported to improve after removing all cows' milk protein from their diet. In addition, some migraine sufferers have an impaired capacity to break down tyramine, a substance found in many foods that is known to trigger migraines in some people. Ingestion of the artificial sweetener, aspartame, has also been reported to trigger migraines in a small proportion of people.
Compared with healthy people, people with migraines have been found to have lower blood and brain levels of magnesium. Preliminary research has shown that supplementing with magnesium (between 200 and 600 mg per day) reduced the frequency of migraines. Intravenous magnesium has been reported to produce marked and sometimes complete symptom relief during acute migraines, usually within 15 minutes or less. Vitamin B2 (400 mg per day) has also been shown to decrease the severity and duration of migraines.
Authorities believe the cause of migraine headaches is related to abnormal serotonin function in blood vessels. The amino acid 5-HTP (which is converted by the body into serotonin) may affect this abnormality. In most, though not all, studies, supplementing with 5-HTP (from 200 to 600 mg per day) reduced the frequency, severity, and duration of migraines.
The most frequently used herb for the long-term prevention of migraines is feverfew. Studies suggest that taking standardized feverfew leaf extracts that supply a minimum of 250 mcg of parthenolide per day is most effective. Results may not be evident for at least four to six weeks. Although there has been recent debate about the relevance of parthenolide as an active constituent, it is best to use standardized extracts of feverfew until research proves otherwise.