Heading off headaches

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What You Say Works Best

LOOKING FOR RELIEF FROM that stubborn headache that never seems to go away, no matter what you try? Well, you might just find the answer right here, courtesy of the 3,000 Prevention readers who responded to our Headache Remedy Survey, published in our August 1992 issue. They shared their secrets with us--what they think triggers their headaches, which treatments they've tried, what they believe works for them and what doesn't.

Some of the results were expected--like the fact that prescription drugs and over-the-counter medications were judged most effective overall. But there were some surprises, too. Perhaps the most interesting fact was that so many of our respondents tried nondrug treatments and reported some relief. Here are a few quick facts, gleaned from our survey:

Migraines were the most common type of headache reported (46 percent of respondents reported them).
Almost half of the respondents get headaches more than once a week.
85 percent of those responding said they've seen a health professional for help with their headaches.
51 percent said their headaches cause them to miss work or social activities several times a year.
Now, this isn't a scientific study--we can't say that the results prove that a given remedy is effective (only controlled studies can do that). And if you have frequent severe headaches, see your doctor--they may be symptoms of a more serious health problem. But the survey's an opportunity for you to learn from what others have tried. And it may provide a starting point for scientific research in areas where laboratory evidence is lacking. "There's a gold mine in this data," says Barker Bausell, Ph.D., director of the center for research methodology at the University of Maryland, Baltimore, and an expert in research methodology. "Asking people who suffer from a condition for their perspective on remedies can be extremely valuable."

We asked our readers about the five most commonly diagnosed headaches: migraines, tension headaches, tensionmigraine combinations, cluster and sinus headaches. For a description of each and information about triggers, see "Headache Types Defined," on page 116.

Here's the top headache-remedy countdown, from our exclusive reader poll. The treatments are ranked according to the percentage of respondents who said the remedy provided substantial pain relief or seemed to cause their headaches todisappear. We've added valuablecomments, explanations and ad-vice from a leading headache expert, Seymour Diamond, M.D., executive director of the National Headache Foundation and founder of the Diamond Headache Clinic, in Chicago, the world's largest and oldest private headache clinic.

MEDICATION
Prescription drugs ranked number one in effectiveness--61 percent of the respondents who tried them got results. They were the overwhelming favorite of survey participants who have migraines, tensionmigraine combinations and cluster headaches.

"Prescription drugs work in one of three ways--as pain relievers, as agents that abort the headache before it really takes hold or as headache preventives," Dr. Diamond says.

Prescription pain relievers go through the central nervous system to block the pathways that transport pain messages. The abortive drugs work best for cluster and migraine headaches because they shrink blood vessels in your head that dilate and cause the intense, pounding pain. They're often combined with caffeine, another vasoconstrictor. The main migraine-and cluster-headache-preventing drugs are beta-blockers and calcium-channel blockers, usually used to treat people with heart problems. Dr. Diamond did the original American study to help prove their effectiveness. "We think they stabilize blood vessels so they don't contract and expand so easily," he says.

Some of the best headache drugs are combinations of prescription medications and over-the-counter pain relievers, such as aspirin, acet-aminophen and ibuprofen, Dr. Diamond says. And a new drug, called Sumatriptan, holds promise for migraine- and cluster-headache sufferers, he adds. It brings the level of the chemical serotonin back to normal in the brain. Low levels of that chemical are thought to be the root cause of migraine and cluster headaches. The drug, which is used widely in other countries and is expected to be available here early next year, also has fewer side effects than other prescription drugs, Dr. Diamond says.

OTC pain relievers used alone ranked third with our survey respondents, 40 percent of whom said they worked. Dr. Diamond says the OTCs can be as effective as the more powerful prescription drugs. They work by numbing the nerve endings in the skin, tissues and blood vessels that lead to the brain. Some are also combined with caffeine, which has an added effect on blood vessels.

OTC decongestants, ranked ninth in effectiveness by our survey respondents, may provide temporary relief by reducing the swelling of the blood vessels, Dr. Diamond says. Antihistamines, ranked tenth, aren't often recommended as headache remedies. They may seem to ease your pain because they have a sedative effect. But antihistamines don't get to the root of your pain, Dr. Diamond says. So your headache's likely to reappear a short time after you take them.

A fundamental strategy for pain relief or aborting a headache is to nip it in the bud, Dr. Diamond says. If you take your medication--prescription or nonprescription--at the first hint of a headache, you may dull its effect.

One of the problems with both prescription and OTC medications is what's known as the rebound effect--frequent use can actually cause headaches. That happens because your blood vessels become immune to pain medications, so they don't respond as quickly. And you may have to take substantially more medication to get the same relief you previously received from a normal dose. Prescription drugs may have other side effects, like nausea, dizziness and stomach upset. Some can also be addictive.

Most of our survey respondents take medications one to four days a week. The average number of OTC pills taken each day was almost five. "Five pills a day is excessive and should be a clue that you're taking too much medication," Dr. Diamond says. The average number of prescription pills taken per day by our survey respondents was three. He recommends that you stick to your doctor's instructions for taking medications and strictly follow manufacturers' guidelines for using OTC products. If you're in doubt about how to use an OTC or prescription drug, ask your pharmacist or doctor for advice.

RELAXATION
Forty-five percent of those who tried it said sleep gave them the most relief from headaches, making it the number-two remedy in our survey. More than half of the people who found relief from a dose of shut-eye were tension-headache sufferers.

Why does sleep work for some? Eight hours of sleep is just about the length of the typical migraine, Dr. Diamond notes. "And sleep relaxes and reduces muscle tension, which relieves pressure on the blood vessels," he says. "There's very good scientific evidence for the beneficial effect of sleep."

But sleep can be a double-edged sword. Too much sleep is known to cause headaches--so you have your own built-in rebound effect. "A lot of people get weekend headaches, when they finally catch up on all the sleep they've missed during the workweek," Dr. Diamond says. Excess sleep causes serotonin levels to fluctuate too much, making blood vessels dilate and sparking headache pain.

General relaxation methods ranked seventh in our survey--24 percent of those who tried them said they found relief. Relaxation may include anything from taking a leisurely stroll to listening to your favorite mood music. Whatever eases your tension or reduces your stress may ease your headache, too, Dr. Diamond says. That includes handling your emotions better. "Emotional triggers, such as depression, anger or repressed hostility, are some of the most common causes of headache," he says. A 70-year-old Las Vegas, Nevada, reader, writes, "I suffered from severe migraines ever since I was very young, but as soon as I learned to express anger, they were less intense. It's important to recognize and accept inner anger as a cause of headache."

Indeed, stress was cited by nearly half of our survey respondents as a common headache trigger. Stress on the job and stress from relationships ranked second and fifth respectively on the list of headache triggers.

There hasn't been adequate research on the effects of relaxation on headache. But one study suggests that biofeedback combined with relaxation training reduced the frequency, duration or intensity of headaches in migraineurs by 65 percent, and by 52 percent with either technique used alone. Tension-headache sufferers averaged about 60 percent improvement, whether with biofeedback, relaxation or a combination. Biofeedback teaches you to mentally direct blood flow from the swollen blood vessels in your head to your hands. "I use a great deal of biofeedback in my practice," Dr. Diamond says. "It's not a cure-all, it's not preventive, but it's a good adjunct to other therapies."

HANDS-ON THERAPY
Chiropractic ranked fourth among the most effective headache remedies--33 percent of the people who tried it said it gave them substantial relief, or their headaches disappeared. It was especially popular with tension-headache sufferers. "Lots of headaches originate from stress or from tension in the neck that radiates up from there," says Scott Haldeman, M.D., Ph.D., D.C., associate clinical professor of neurology at the University of California at Irvine. "Chiropractic manipulation can sometimes relax those muscles or reduce neck pain, which may in turn ease the headache." It's time to get a referral to a medical specialist, however, if your headaches are getting worse and not responding to treatment with manipulation.

Massage, at number six on the top-treatment list, was a favorite with respondents. Twenty-five percent of those who tried it said they found relief. "I have found pressure applied to the trigger points in my neck, shoulder and back muscles most helpful," a reader from New York writes. That's probably because massage helps relax spasms of the scalp and neck that accompany many headaches. You may also lightly massage your temples. "There isn't a lot of scientific evidence, but I think hands-on techniques like massage may act as both physical and psychological reinforcement to pain relief," Dr. Diamond says.

FOOD TRIGGERS
Eliminating certain "trigger" foods ranked fifth among the survey respondents who tried it--31 percent said it helped keep headaches at bay. That strategy's well supported by science as a treatment for migraine. "I give all my migraine patients an elimination diet," Dr. Diamond says. "It's effective 35 to 40 percent of the time." But there's no research that links foods with sinus or tension headache. If giving up certain foods makes your headaches go away, chances are you've got a migraine.

Chocolate topped the list of headache-inducing foods named by our respondents. It contains tyramine, an amino acid that makes the body release certain hormones that in turn constrict blood vessels. Those blood vessels then dilate, and you experience that familiar throb. Aged cheeses and some alcoholic beverages, especially red wine and beer, also contain tyramine, which explains why they also ranked high on our respondents' list of food triggers. Hot dogs, bacon, lunch meats and cured meats were also cited as headache triggers. The nitrates in those products dilate blood vessels in your head.

And even though caffeine is found in many headache remedies because it constricts blood vessels, it also showed up on the list of triggers. That's because excessive amounts of caffeine can cause a rebound expansion of the blood vessels, triggering a headache. This is the same rebound effect that can result from frequent use of prescription drugs and OTCs. And you can get a rebound headache, too, if you try to quit cold turkey. Dr. Diamond suggests you taper your intake of caffeine-containing beverages, if you decide to quit.

Monosodium glutamate (or MSG), a seasoning found in many processed foods and often used in many Chinese restaurants, is another trigger commonly cited by our respondents. And for good reason--the glutamate in MSG may directly dilate the blood vessels that can cause a headache in people who are supersensitive. If you think you're sensitive to MSG, check food labels for ingredients that may contain MSG, such as "natural flavorings," hydrolyzed vegetable protein and sodium caseinate. When eating out, ask the chef to leave out the MSG and seasoning salt.

Such reactions don't mean you have a food allergy. You may just be supersensitive to certain foods, so it doesn't take much to trip your headache trigger.

ICE AND HEAT
Many of our survey respondents get results with ice--it ranked eighth of the top remedies, with the backing of 22 percent of the people who tried it.

Dr. Diamond says ice helps both tension and migraine headaches by constricting blood vessels, especially if you use it on yourself at the very first signs of a headache.

A reader from Winona, Minnesota, writes, "My sister told me to apply ice to the back of my neck for 30 minutes. It helped me shake a headache I just couldn't get rid of. I still try this before aspirin."

The back of the neck is a strategic place for an ice pack. Try a flexible ice pack that can mold to the shape of your neck, or a cold gel pack so you concentrate the cold at the base of your skull. Or, you can try placingthe pack on your forehead or temples--some people find that works better for them. In any case, you should find some relief within about 20 minutes. If you're sensitive to cold, wrap the ice pack in a small towel to buffer the effect.

Heat may have a soothing effect, Dr. Diamond says. Indeed, heat ranked eleventh among the top remedies named by our survey respondents. Placing a heating pad on tight muscles on your neck for 20 or 30 minutes might relax them and ease a tension headache.

One reader from New York turns her shower into a heat massage: "With the water hitting my head, I move my head slowly from right to left and back again under a hot stream of water."

For more information about how to care for headaches, write: National Headache Foundation, 5252 N. Western Ave., Chicago, IL 60625 (send a self-addressed business-size envelope with two first-class stamps. Indicate type of headache and if you want the list of physician members); or the American Council for Headache Education (ACHE), 875 Kings Highway, Suite 200, West Deptford, NJ 08096.

READER-TESTED TOP 10 HEADACHE REMEDIES

1. Prescription drugs
2. Sleep
3. OTC pain relievers (aspirin, ibuprofen, acetaminophen)
4. Chiropractic
5. Eliminating "trigger" foods
6. Massage
7. Relaxation
8. Ice
9. Decongestants
10. Antihistamines
WHAT READERS SAY MAKES THEIR HEADS HURT

1. Bright light
2. Job-related stress
3. Caffeine
4. Skipping meals
5. Stress from relationships
6. Changes in weather
7. Menstrual cycle
8. Cigarette smoke
9. Noise
10. Posture problems
PHOTOS (6): A woman going throught the stages of a headache to final relief (JAN COBB)

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By William LeGro

With Toby Hanlon

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