A nasty headache puts happiness on hold, whether you're at work, cooking dinner, running errands, or on vacation (oh, please, no!). Most of us can't get our hands on that pain reliever soon enough. Pills work, thankfully… until the next headache happens. And it will happen.
The most common are called tension-type headaches; they're the kind that crop up unexpectedly and make you feel like your head is in a vise. Up to 80% of the population is struck by them at least occasionally, and women are unfairly targeted: They're twice as likely as men to have them—the result of hormonal upheavals. Scientists dubbed them tension headaches when they thought the culprit was stress-induced tight neck and shoulder muscles. Now they know that stress is just one trigger of many. What goes on in your brain is a complicated stew of chemicals, increased pain sensitivity, and possibly even your genes (this is why they're now known as "tension-type" headaches).
Migraines are the debilitating doozies that grab more headlines (and research attention). They're less prevalent, affecting 12% of the population, but if you suffer from them, you really suffer (symptoms include excruciating pain and nausea). People with migraines have an arsenal of in-the-moment painkillers to try, but better still, they've got effective preventive meds to help ward them off.
So what if there were also a way to avert tension-type headaches, which strike so many more of us? Turns out there is. These everyday troublemakers "respond well to simple lifestyle changes," says Jennifer Kriegler, M.D., at the Cleveland Clinic Neurological Center for Pain.
First, you have to figure out what's triggering them—the questions below will help you dig deep. The detective work may take a little more effort than downing an over-the-counter drug, but it can do something that pills can't: prevent the next headache, and many more after that, too.
8 Questions for Anyone Who Gets Headaches
Did you wake up with the pain?
The Trouble: You might be grinding your teeth or clenching your jaw in your sleep. This leads to an ache in the muscles around the TMJ (the temporomandibular joint), the hinge that connects your jaw to your skull—and that ache often travels to the temples. Chewing gum for hours can also bring on this trouble.
Try applying moist heat for 15 minutes several times a day (use a towel dipped in warm water or a microwavable heat pack); it encourages tight muscles to relax. If you're a regular grinder (your bed partner will know from the crrk-crrk noise and your dentist from your worn-down tooth enamel), it's hard to teach yourself to stop, so the best remedy is a mouth guard. One model that you place over your bottom teeth at night is as small as a piece of gum.
Did you skip your morning coffee?
The Trouble: Caffeine withdrawal. The blood vessels in your brain have become used to the constriction that caffeine produces. When you don't give them their daily fix, it's like the crowd at a doorbuster holiday sale: Blood rushes through the vessels at full throttle. To manage the overflow, they swell, which hurts.
Try drinking a full-strength cup of joe, stat!, advises Alan M. Rapoport, M.D., clinical professor of neurology at the David Geffen School of Medicine at UCLA. You should feel better in about an hour. In the future, keep your caffeine intake steady or gradually decrease it. If you need to fast before a medical procedure and know the withdrawal headache is going to hurt worse than whatever you're facing at the doctor's, ask if you can have a small cup of coffee beforehand, Rapoport suggests. (But no milk or sugar.)
Did you miss lunch?
The Trouble: Low blood sugar, which deprives your brain of the glucose it needs to function. Basically, it runs out of fuel, and a headache is its way of yelling at you to fix the situation.
Try eating something with protein, not the nearest cupcake—unless you want to repeat the whole cycle a few hours from now. Sugary refined carbs (like candy and cookies) send your blood sugar soaring, then plummeting, so your pain roars back. Going forward, eat at regular intervals and make sure each meal contains some lean meat, eggs, nuts, fish, or dairy, which keeps blood sugar more even. Also, pack your menu with magnesium. Too little of this mineral is known to affect migraines and may be a factor in common headaches, too. Women over age 31 need 320 mg a day (men need 420 mg). A cup of raw spinach (160 mg), an ounce of almonds (80 mg), plus a half cup of black beans (60 mg) gets you almost all the way there.
Is your head buried in your work?
The Trouble: Hunching over your computer, your notebook, your pastry board, or whatever else is demanding your attention. Mechanical issues, from slouching to sleeping awkwardly, can cause the muscle tightness in the neck and shoulders that creeps up to your head.
Try this stretch. Cross your arms over your chest, hands touching opposite shoulders. Bend to one side a few inches, then continue to rotate your upper body in a circle, until you return to your starting position. Reverse the circle. Now you're loosened up enough to focus on the root cause: your computer. Adjust your setup so the middle of your monitor is at eye level (put a few books under it if needed). If you wear progressive lenses, you may be doing a headache-inducing neck tilt to see the top of the screen. Instead, get a pair of glasses just for computer use. And make sure you have the right prescription: Squinting can make you strain your facial muscles in a way that leads to headaches.
Have you been taking lots of pain relievers?
The Trouble: Rebound pain, which docs refer to as "medication overuse headaches." Turning to an over-the-counter (OTC) pain remedy more than two days a week can backfire, bringing on and intensifying headaches. OTC drugs may alter certain pain pathways and receptors in your body so that they actually perceive more pain instead of ignoring it.
Try enlisting a neurologist or headache specialist to help you get off the painkillers. She may suggest other medicines that have pain-relieving properties but that don't carry the rebound risk, such as epilepsy or blood pressure drugs or low-dose antidepressants. In a 2010 review, tricyclic anti-depressants reduced the number of headaches people had and cut the intensity of the ones they did get in half.
Did you go to bed later than usual?
The Trouble: Too little sleep. Why it hurts: Any change in your routine might disrupt the biological clock in the hypothalamus deep in your brain, says Rapoport. It's a bit like jet lag and makes your whole body miserable, including your head.
Try going for a short walk, Rapoport advises. It will relax you and produce endorphins, the body's own opiate-like painkillers. You might be tempted to try to squeeze a nap into your day, but some people find that makes their head hurt more—again, due to the messed-up routine.
Are you under extra pressure right now?
The Trouble: Stress. In a recent study, even small jumps in stress—say, from a speeded-up deadline or a no-show repair person—raised the number of headaches per month by more than 6%. Not only can stress bring on headaches, but it can also bump their frequency up to chronic.
Try slowing your breathing. Stuff happens—and when it does, you need to regroup before you can tackle it, says psychologist Paul Duckro, Ph.D., professor emeritus at St. Louis University School of Medicine. One way: Sit quietly and drop your chin to your chest. Inhale, gently roll your head to one side, pause, and exhale as you return to center. Switch to the other side and keep alternating for a few minutes.
When breathing isn't enough, consider mind/body approaches like meditation, biofeedback, and cognitive behavioral therapy. They require more time and effort, but according to a review published in the journal Headache, people who've used them cut their number of episodes by 35% to 50%. That's as much improvement as researchers have found from medications, but with fewer side effects.
Have you been eating different foods lately?
The Trouble: "Headache foods." Many notorious migraine triggers may kick off tension-type headaches, too. It's a long list, but top troublemakers include chocolate; tyramine (an amino acid in red wine, aged cheese, smoked fish, figs, and some beans); and nitrate-containing meats, such as salami, cured meats, bacon, and hot dogs.
Try figuring out your food triggers. It's tricky, because the pain from eating the wrong thing could come on right after a meal—or not until 48 hours later. And a headache might not be from just one food, says David Buchholz, M.D., professor of neurology at the Johns Hopkins School of Medicine. Every choice you make in a day might create a little smoke, so to speak. Say you have some wine, and then you graze on figs and aged cheddar: Finally there may be enough trouble for the alarm to go off. Similarly, a bit of a trigger food and a large helping of stress can trip the switch.
To help pin down any links, some doctors recommend that you keep a diary to track your headaches and possible causes, including food. Headache diaries can be a chore but are often the only way to nail down any food/pain relationships. And a bit of note-taking is well worth it if it helps you do away with your headaches for good.
Science-Tested Natural Remedies
These easy moves have been proven by research to help—quickly—no matter what the headache trigger:
- Mini-Massage: Clasp your hands behind your head, placing thumbs at the spot where neck muscles attach to the skull. Relax and breathe deeply while you massage with your thumbs.
- Peppermint Oil: Rub a 10% solution of essential oil of peppermint (don't use the peppermint extract you cook with) on your forehead and temples. This works as well as acetaminophen, according to research from Germany. The Oz family swears by it.
- Hot or Cold Packs: There's no rule about which to use; it's whatever you prefer (the National Headache Foundation says that most tension-headache sufferers prefer warm ones). When using a warm pack, place it on the neck and back of the head or on TMJ aches; cold ones should go on the forehead and temples. For either, the regimen is 15 minutes on, 15 minutes off.
Most obvious Headache Reliever: Water.
Being even a little dehydrated can bring on the pain. In one study, 47% of participants found that swigging about six extra (8-oz) glasses of water a day relieved their headache pain.
- "Tension-type headaches" The everyday headache that feels like a band wrapping around your head. Pain can last from 30 minutes to (yikes!) 7 days.
- "Migraine headaches" Known for pulsating pain on one side of the head; often accompanied by nausea or vomiting and unusual sensitivity to light and/or noise.
- "Sinus headaches" The pain you get when the cavities around your nose and eyes are congested. If you have a sinus infection, you'll usually have pain, plus a fever and thick phlegm.
- "Chronic or episodic headaches" Describes how often you get a headache; chronic means you're hit 15 or more days per month (that is, "more days than not"). Fewer than 15 means they're episodic.
- "Cluster headaches" Also known as "suicide headaches" due to the excruciating pain, usually around one eye. They come on in cycles (clusters). More men than women are affected.
- "Medication overuse headaches" A.k.a. rebound headaches; occur due to frequent painkiller use.
Sometimes You Just Need A Pill (So Know How to Take These Safely)
The racks and racks of headache-relief products in stores can be dizzying. They fall into two categories: acetaminophen and NSAIDs (non-steroidal anti-inflammatory drugs), but "there's just no research to show that one is any better than another for any type of headache," says UCLA's Alan M. Rapoport, M.D. The caveats of each drug can help you determine your better choice.
- Acetaminophen: If you're a frequent pill popper, use this with caution (it's in more than 600 products, so read the labels!). Manufacturers reduced the maximum daily dose to 3,000 mg—that's just 6 extra-strength pills. The most dramatic risk with too much of this drug is acute liver failure, more likely if you also drink alcohol.
- NSAIDs: Ibuprofen, naproxen, and aspirin can cause stomach upset or bleeding (more likely if you have more than three alcoholic drinks a day), and serious allergic reactions. High doses or long-term use of ibuprofen (max: 1,200 mg/day) or naproxen (max: 1,500 mg/day) has been linked to heart attack and stroke risks.
Signs You Should See a Doctor
- If you have headaches more than 15 days a month, you need help on how to deal with them. Same thing if you're taking pain-relievers all day more than twice a week, as you may be setting yourself up for rebound pain.
- If you also have a fever or nasty-looking nasal discharge, you may have a sinus infection. Key sign: The pressure behind your nose and eyes feels even worse when you bend over.
- You develop intense pain ("the worst headache of my life") that comes on like a bolt and peaks within one minute.
- You are disoriented, lethargic, or have a high fever along with a headache.
- You have speech, vision, or movement problems (like loss of balance), especially if you've never experienced these symptoms before.
- You suspect you're having a stroke. Make sure the emergency room doctor understands the severity of your symptoms. A recent Johns Hopkins study found that nearly 13% of people who were admitted to the hospital with a stroke had actually had a separate one within the previous 30 days. But they'd been misdiagnosed, usually with migraines, and sent home from the ER. This was especially true with women and minorities.
This story originally appeared in the October/November 2014 issue of Dr. Oz The Good Life.