Headaches are commonly classified under categories such as tension, sinus, migraine, menstrual and cluster among others. Many researchers and doctors are no longer drawing distinct lines between tension and migraine headaches. They may only be different degrees of the same disorder, tension headaches being less severe than migraines. Headaches have been difficult to study for several reasons and continue to be misunderstood and mistreated.
Although a headache may be associated with a serious medical condition, most headaches are not serious, even when debilitating. Headaches can be caused by a wide variety of factors, but the overwhelming majority are of the tension/migraine type. Headaches which may be more serious are those that:
- occur while pregnant
- occur after exposure to a potentially toxic substance
- occur after injury to the head
- occur while taking a new medication
- occur while experiencing other serious symptoms such as a fever, stiff neck, vomiting, vision changes, tingling sensations or speech difficulties
- are different from headaches you have had in the past or are very severe and come on very suddenly.
Differences between Tension and Migraine Headaches
For years, tension headaches were believed to be caused by muscle contraction due to stress. However, the muscle changes may occur in response to the pain and not be the cause of the headache. Similarly, in migraines, blood vessel changes can follow the onset of pain and not cause it.
Tension headaches usually have a steady, constant, dull pain that may start at the back of the head or in the forehead and then spreads over the entire head, giving the sensation of pressure or a vise grip applied to the skull. The tension headache is usually present on both sides of the head. These headaches can occur every day and are normally more severe in the evenings. Tension headaches are experienced when an individual is under stress.The more intense headaches, called migraines, are characterized by a throbbing or pounding sharp pain. The additional symptoms such as nausea, visual auras and dizziness occur simply because the headaches are more severe. Migraines are usually experienced after stressful periods have ended and the body is attempting to repair and detoxify.
Basilar Artery Migraine (BAM) is a variant on the theme of the migraine. It is a rare form of migraine, accounting for somewhere between 1 in 400 and 1 in 500 of all clinically diagnosed migraine cases. BAM belongs in the category of “episodic headaches of uncertain mechanism.” This grouping includes the migraine, cluster headache, and acute cerebral vascular insufficiency. Further information about this type of headache can be found at Karyn S. Huntting’s Web Site.
Signs, symptoms & indicators of Headaches, Migraine/Tension
History of headaches only or having headaches
Afternoon headaches
Menstrual headaches
Up to 25% of women have migraine during their reproductive years, with an average prevalence of 16% (11% without aura and 5% with aura). In 60-70% of cases in women, the headaches are related to the menstrual cycle. Attacks that occur exclusively with menses, called “true menstrual migraine“, affect about 14% of sufferers. Some researchers have suggested that migraines occurring on a regular basis between days -2 and +3 of the menstrual cycle be considered menstrual migraines; premenstrual migraines occurring between days -7 to -3.
Temple-based/rear-of-head/ocular/front-of-head headaches
Counter Indicators
Not having headaches
Risk factors for Headaches, Migraine/Tension
Environmental Illness / MCS
Central nervous system dysfunction is common, resulting in headaches, chronic fatigue, poor short term memory, hyperactivity, and increased appetite leading to food cravings and overeating.
Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
Vascular or migraine headaches occur in 10% of lupus patients.
Low Estrogen Levels
Women must first be exposed to elevated estrogen levels before low estrogen levels will trigger headache activity. Constant low levels of estrogen, as in menopause, are less likely to be associated with increased headache pattern.
Hypoglycemia
Although hypoglycemia may precipitate headache in some diabetic and nondiabetic patients, it is not a universal mechanism responsible for headache in those individuals or in normal fasting subjects.
Aspartame Intolerance
Double-blind studies have demonstrated that aspartame causes headaches. [Headache 1988:28(1) pp.10-14, Biological Psychiatry 1993:34(1) pp.13-17, Neurology 1994:44 pp.1787-93.]
Liver Detoxification / Support Requirement
A ‘sluggish liver’ often contributes to headaches.
History of migraine headaches
Headaches, Migraine/Tension suggests the following may be present
Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
Vascular or migraine headaches occur in 10% of lupus patients.
Mitral Valve Prolapse
Patients with classic migraine have a two-fold increase in incidence of mitral valve prolapse.
Headaches, Migraine/Tension can lead to
Increased Risk of Breast Cancer
Women who suffer from migraines may take at least some comfort in a recent, first-of-its-kind study that suggests a history of such headaches is associated with a significantly lower risk of breast cancer. Christopher I. Li, M.D., Ph.D., and colleagues at Fred Hutchinson Cancer Research Center report these findings in the November issue of Cancer Epidemiology, Biomarkers and Prevention.
“We found that, overall, women who had a history of migraines had a 30 percent lower risk of breast cancer compared to women who did not have a history of such headaches,” said Li, a breast-cancer epidemiologist and associate member of the Hutchinson Center’s Public Health Sciences Division.
In particular, migraine history appeared to reduce the risk of the most common subtypes of breast cancer: those that are estrogen-receptor and/or progesterone-receptor positive. Such tumors have estrogen and/or progesterone receptors, or docking sites, on the surface of their cells, which makes them more responsive to hormone-blocking drugs than tumors that lack such receptors.
The biological mechanism behind the association between migraines and breast cancer is not fully known, but Li and colleagues suspect that it has to do with fluctuations in levels of circulating hormones.
Recommendations for Headaches, Migraine/Tension
Tyramine-containing Foods Avoidance
Tyramine-containing foods are responsible for migraines in 15% of sufferers. If you have observed a sensitivity to such foods, you should try a tyramine-free diet for a short time. If headaches resolve, reintroduce foods high in tyramine. If headaches recur, you may be able to control your headaches by avoiding these foods; if not, you may be allergic to other foods.
Coffee (Coffea genus)
Researchers at the Diamond Headache Clinic in Chicago, Illinois have found that caffeine may make your headache feel better. Already an ingredient in some over-the-counter headache medications, caffeine may do more than speed the other
ingredients through your system to alleviate your headache faster. Caffeine, given by itself, was given to headache sufferers. The result was that 58% said it was completely successful; the same number reported ibuprofen alone was completely successful. Many said that they felt better, faster taking just the caffeine. When standard painkillers were
combined with caffeine, 70% of patients reported complete relief.
Caffeine does, of course, have a down side. It is a stimulant and some studies have actually found that high caffeine consumption is linked with suffering from more headaches, perpetuation of the headache cycle and a temporary rise in blood pressure.
Coffee Enema
A coffee enema will sometimes stop and often prevent headaches associated with toxicity.
Processed Foods Avoidance
Unhealthy practices such as drinking coffee and soft drinks, eating sweets and other nutritionless foods contribute to the problem. When migraine and tension headache patients are placed on low-protein, natural plant-based diets, with no refined sweets of any type, they often recover within a month, never needing medication or further treatments to control their condition. If improvement is not complete, other detoxification techniques should be employed. When diet change has not yet produced its full effect, the use of cold and pressure are usually the most effective and practical means to control the pain.
Therapeutic Fasting
It is believed by those specializing in detoxification that the major cause of both tension headaches and migraines is the retention of toxins or tissue irritants within the central nervous system. These chemical irritants may cause an oversensitivity of nerve tissues to other stimuli, resulting in headache. Drugs for relieving pain are rarely necessary if headache sufferers are allowed to fast and detoxify at the first sign of headache symptoms.
During periods when you are not ingesting harmful food substances or drugs, your body will often use that opportunity to detoxify, which may initiate another headache. This is the time when you must try to use non drug measures such as cold compresses, rest in a dark room, banding with Velcro, and biofeedback.
Headaches can also be caused and worsened by not eating. The reason is that not eating triggers withdrawal symptoms as the body begins to detoxify and get rid of retained toxins. Remember: For a short time you may feel bad so that for a long time you can feel good. Persistent severe headaches that do not respond within a few days of fasting should always be further evaluated by a physician.
Vegetarian/Vegan Diet
When migraine and tension headache patients are placed on low-protein, natural plant-based diets, with no refined sweets of any type, they often recover within a month.
MSG Avoidance
Those prone to migraines should avoid MSG and everyone should avoid it in large doses. There is no question that very high doses of MSG can overwhelm brain defenses and cause neural damage. It is interesting that it is young children with immature nervous systems who are most susceptible to MSG damage, and not the elderly.
Conventional Drugs / Information
The regular and frequent use of conventional drugs should be avoided when possible. While pain killers may provide relief, they don’t deal with the cause of the problem. Pain medications, though apparently effective, may even aggravate the problems they attempt to solve. The use of medication, even in quantities as low as ten aspirin tablets per week, can be the cause of a chronic daily headache syndrome. One medical study found that stopping all treatments and pain medication actually decreased headache frequency and intensity in the subjects by more than 50%. The best thing to do when tolerable and circumstances allow is to avoid taking medication and assist the body’s detoxification process.
Electrical Devices
A hand-held device which fires magnetic pulses into the brain could offer relief to millions of migraine suffers.
The transcranial magnetic stimulator has been recommended by National Institute for Health and Care Excellence (NICE) after clinical trials showed it was effective at reducing pain.
Of 164 patients treated with the device during trials, 39 per cent were found to be pain free after two hours. And 30 per cent were still without pain after 24 hours.
In a separate study, three-quarters of patients with migraine who were treated repeatedly with the device had a reduction in headache frequency.
Chemical Avoidance
Airborne chemicals and fragrances are increasingly cited as a trigger for migraine headaches. Until the 20th century, perfumes were made from natural ingredients derived directly from plants and animals, and as fragrances became cheaper and more widespread, they also became more synthetic. Studies have shown that inhaling fragrances can cause circulatory changes and electrical activity in the brain. These changes can trigger migraine headaches, the inability to concentrate, dizziness, and fatigue.
Melatonin
Three cases of idiopathic stabbing headache were reported in which melatonin (3 to 12mg at bedtime) was used successfully in their treatment. [Neurology 2003;61(6): pp.865-6]
Test for Food Allergies
Food allergy may be a factor in as many as 80% of migraine sufferers. In one study of 60 patients, the average number of foods causing symptoms was 10 per patient. All patients improved when offending foods were eliminated and 85% became headache free. All 15 patients who had high blood pressure at start of study saw blood pressure return to normal. The following were most often implicated as a cause of migraine: cow’s milk (30%); eggs (27%); chocolate (25%); oranges and wheat (24%); cheese and tomatoes (15%). Common food triggers of migraines were milk products, sweets, corn, beef, coffee and teas amongst others. While food allergies are an important factor in migraines, they play less of a role in tension type headaches.
Magnesium
Several researchers have provided substantial links between low magnesium levels and both migraine and tension headaches, based on both theory and clinical observations. A magnesium deficiency is known to set the stage for the events that can cause a migraine attack or a tension headache. Low brain and tissue magnesium concentrations have been found in patients prone to migraines, indicating a need for supplementation. One of magnesium’s key functions is to maintain the tone of the blood vessels.
Magnesium malate or other Krebs cycle chelates (citrate, fumarate, succinate, and alpha ketoglutarate) may be best. 600-1000mg of elemental magnesium per day in divided doses with meals may be required over a one to two month period.
Serum and urinary magnesium levels are only sometimes statistically lower in migraine sufferers than in controls. However, migraine sufferers retain more magnesium than controls when magnesium is given orally, indicating a more systemic deficiency [Headache 2002;42: pp.114-19]. Earlier studies have found reduced levels of magnesium in serum, saliva, red blood cells, mononuclear cells, lymphocytes, and cerebrospinal fluid in migraine patients.
Reading List
Headache Help by Lawrence Robbins, M.D. and Susan Lang. A Complete guide to understanding headaches and the medications that relieve them (Paperback).
Essential Fatty Acids
Omega 3 fatty acids can reduce the frequency and intensity of migraines. Two small double blind studies (using fish oil) demonstrated a high percentage of effectiveness. Supplementation should continue for longer than 3 weeks, which is the time it takes to change cell membrane composition with the new fatty acids.
However, another study using 6gm per day over 4 months for migraines showed no benefit over placebo. [Cephalalgia 2001;21(8): pp.818-822]
Acupuncture
Subjects (400) were randomly chosen to receive either usual care (typically medication), or acupuncture treatments for a
period of one year. Those receiving acupuncture were restricted to a maximum of 12 treatments every three months
and also had the option of using medication in instances where the acupuncture failed. During the study period, each
subject kept a diary, rating the severity of headaches with a six-point scale.
When the diaries were analyzed, researchers found that, compared with the usual care group, those in the acupuncture
group had an average of 22 fewer days with a headache, and some had well over 30. Acupuncture patients also used 15% less medication, made 25% fewer visits to the doctor and had 15% fewer sick days off from work.
Based on these uniformly positive outcomes, the authors of the study concluded that acupuncture leads to “clinically
relevant benefits for primary care patients with chronic headache.”[BMJ 1999;319: pp.973-976]
Researchers in Germany divided 270 patients with similar symptoms into three groups for a randomized, controlled trial. Over an eight-week period, one group was treated with full traditional acupuncture, one with minimal acupuncture, and one with neither method.
Headache rates dropped by almost half among those in the “traditional acupuncture” group. On average, they experienced 7 fewer days of headaches in the four weeks following the trial than they did in the four weeks preceding it. Those in the “minimal acupuncture group” fared almost as well, with an average drop of 6.6 days with headaches. The third group only saw an average drop of 1.5 days – just a tenth less than what they had experienced prior to the study.
The researchers concluded that acupuncture works as well or better for tension headaches than treatments already accepted. [British Medical Journal, July 29, 2005]
A new study of acupuncture (2012) — the most rigorous and detailed analysis of the treatment to date — found that it can ease migraines, arthritis and other forms of chronic pain.
The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients. [Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654]
Emotional Freedom Technique (EFT)
Newcomers who use this simple process by themselves achieve relief 50% to 80% of the time and, in many cases, the relief is complete and permanent. More sophisticated uses by an EFT expert may be required for some migraine sufferers.
Pressure
Many individuals with migraine can obtain effective relief by simply applying an elastic band around the head, securing it with Velcro, and inserting rubber discs (or any available substitute such as a bottle cap) for added local pressure over the areas of maximum pain. A study utilizing a 2-inch elastic band approximately 25 inches long with Velcro at each end showed impressive results with this non-drug approach for relief. Firm rubber discs the thickness of a finger and a little over an inch in diameter were employed. Patients were instructed to place these discs under the elastic headband over the area of maximum pain. Almost every patient in the study reported benefit. Twenty-three patients used the band for a total of 69 headaches. Forty of the headaches were relieved by more than 80% and 15 additional headaches improved by more than 50%.
Massage
In a study of tension headaches, individuals were treated with either a combination of spinal manipulation and massage, or massage and a placebo laser treatment. Both groups experienced an improvement in symptoms suggesting that massage alone provides benefits for the treatment of tension headaches.
Vitamin B1 (Thiamine)
Large doses of vitamin B1, along with the other B vitamins, have helped many suffering from headache pain.
Vitamin B6 (Pyridoxine)
One older study reported that L-tyrosine (200mg), vitamin B6 (2.5mg) and niacinamide (10mg) when given in combination for the treatment of hay fever, hives, allergic headaches and poison oak dermatitis produced significant symptomatic relief when 1-3 tablets were taken four times/day in milder cases and up to 6 tablets 4-6 times/day in more severe cases. In some cases characterized by more chronic disorders, such as chronic sinusitis, a worsening of symptoms often occurred during the first few days of treatment. This study found that treatment with each the nutrients individually, or with any two in combination, was ineffective. (Widmann RR, Keye JD Epinephrine precursors an control of allergy. Northwest Med 1952:51:588-590.)
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Proven definite or direct link |
| Strongly counter-indicative |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
Glossary
Migraine
Not just a headache, but a disorder affecting the whole body, characterized by clearly defined attacks lasting from about 4 to 72 hours, separated by headache-free periods; progresses through five distinct phases. Prodrome: experienced by about 50% of migraineurs and starting up to 24 hours before the headache - changes in mood, sensory perception, food craving, excessive yawning, or speech or memory problems. Aura: experienced by about 15% and starting within an hour before the headache - disruption of vision (flashing lights, shimmering zigzag lines, blind spot) or sensation (numbness or 'pins and needles' around the lips or hand), or difficulty speaking. Headache: usually pulsating and occurring on one side of the head, it may occur on both sides of the head and alternate from side to side. Muscles in the neck and scalp may be tender; there may be nausea and the desire not to eat, move, see or hear. Resolution: the headache disappears and the body returns to normal. Resolution may occur over several hours during sleep or rest; an intense emotional experience or vomiting may also end the headache. Postdrome: After the headache stops, the sufferer feels drained, fatigued and tired. Muscles ache, emotions are volatile and thinking is slow.
Tension Headache
This type accounts for nearly 90% of all headaches and is probably experiences by most people at some time during their lifetime; frequently associated with fatigue and stress and generally responding to simple measures such as rest or over-the-counter pain medicine; pain usually occurs on both sides of head and consists of a dull, steady ache.
Nausea
Symptoms resulting from an inclination to vomit.
Cluster Headache
A headache in which pain originates behind or around one eye and generally awakens the individual from sleep; pain may radiate into the temple, jaw, nose, teeth, or chin; the eyelid droops, the eye tears, the face flushes, and the nose congests; causes excruciating pain. Individual headaches last 15 minutes to 3 hours but tend to "cluster", occurring up to several times per day for periods of about 1 to 16 weeks and then not again for months or years.
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Nervous System
A system in the body that is comprised of the brain, spinal cord, nerves, ganglia and parts of the receptor organs that receive and interpret stimuli and transmit impulses to effector organs.
Chronic Fatigue Syndrome
CFS (Chronic Fatigue Syndrome) is a disorder of unknown cause that lasts for prolonged periods and causes extreme and debilitating exhaustion as well as a wide range of other symptoms such as fever, headache, muscle ache and joint pain, often resembling flu and other viral infections. Also known as Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS), Chronic Epstein-Barr Virus (CEBV), Myalgic Encephalomyelitis (ME), "Yuppy Flu" and other names, it is frequently misdiagnosed as hypochondria, psychosomatic illness, or depression, because routine medical tests do not detect any problems.
Estrogen
One of the female sex hormones produced by the ovaries.
Menopause
The cessation of menstruation (usually not official until 12 months have passed without periods), occurring at the average age of 52. As commonly used, the word denotes the time of a woman's life, usually between the ages of 45 and 54, when periods cease and any symptoms of low estrogen levels persist, including hot flashes, insomnia, anxiety, mood swings, loss of libido and vaginal dryness. When these early menopausal symptoms subside, a woman becomes postmenopausal.
Hypoglycemia
A condition characterized by an abnormally low blood glucose level. Severe hypoglycemia is rare and dangerous. It can be caused by medications such as insulin (diabetics are prone to hypoglycemia), severe physical exhaustion, and some illnesses.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Aspartame
A low-calorie sweetener used in a variety of foods and drinks and as a tabletop sweetener. It is about 200 times sweeter than sugar and is commonly known by names such as NutraSweet, Equal, Spoonful or Equal-Measure.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
pH
A measure of an environment's acidity or alkalinity. The more acidic the solution, the lower the pH. For example, a pH of 1 is very acidic; a pH of 7 is neutral; a pH of 14 is very alkaline.
Epidemiology
The study of the causes and distribution of disease in human populations.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.