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There are many different kinds of headaches. However, there are five major


They are migraine headaches, cluster headaches, tension headaches, chronic

daily headaches, and rebound headaches.

Because these are the kinds of headaches that affect the vast majority of

sufferers, I cover only these types in this book. I believe the information you

will find in this book will help you better understand what kind of headaches

you have, why you suffer from these headaches, and what you can do to

cope with them and improve the quality of your life.

What You will Learn from this Book

This book focuses on the four most common types of chronic headaches:

Migraine headaches

Cluster headaches

Tension headaches and

Chronic daily headaches.

If you suffer from chronic headaches but don't know which kind, you will

learn the symptoms of these four headache types to help you begin an

accurate diagnosis.

You will learn about headache triggers, including:

Eating and sleeping patterns

Environmental factors



Physical exertion

Diet and foods

An important part of headache treatment and relief is to get the right


© 2009, Douglas Hanna All Rights Reserved

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In Chapter 5, you will learn:

The importance of a headache diary

What to do to get ready for your initial visit to a doctor

What your physical examination will be like

Other diagnostic tools your doctor may use

If your problem is migraine headaches, you might want to go directly to

Chapter 6, which will teach you:

9 How to choose an effective treatment

9 Understanding the prescription drugs that are most commonly used in

migraine treatment

9 Which techniques are used most often to treat specific types of


9 The use of triptans in treating migraines

9 Ergotamine tartrate and migraine treatment

9 What DHE is and how it is used to treat migraines

9 Isometheptene Mucate and migraines

9 Which nonsteroidal anti-inflammatory (NSAIDs) are used to treat


9 Phenethiazines and migraines

9 The use of Intranasal Lidocaine in migraine treatment

9 Narcotic analgesics and migraines

9 Antinauseants and migraines

9 The use of cold packs in migraine treatment

Information on treating and living with cluster headaches can be found in

Chapter 7 where you will learn:

9 How to prevent cluster headaches

9 How to stop a cluster headache that has already started

© 2009, Douglas Hanna All Rights Reserved

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You will find chronic daily headaches treated in Chapter 8, which has a lengthy section on preventative medications.

If you are suffering from tension headaches, Chapter 9 will teach you:

9 What episodic tension-type headaches are

9 How to recognize chronic tension headaches

9 Preventing tension-type headaches

9 Treatments for tension-type headaches

In Chapter 10, you will learn about the many different kinds of alternate

treatments and self-help techniques available to combat chronic headaches.

There is also a comprehensive chart of alternate headache treatments and self-help techniques, highlighting which ones can be used effectively to treat

specific types of headaches.

Chapter 11 will teach you about using natural supplements in the treatment of chronic headaches. Here, you will learn:

9 What natural supplements are

9 Who Takes Natural Supplements

9 Herbs and supplements used in the treatment of headaches

9 A new supplement that may be useful in treating all types of chronic


Finally, Chapter 12 is all about online resources for headache sufferers. This includes:

9 Forums

9 Groups and Newsgroups

9 Websites

© 2009, Douglas Hanna All Rights Reserved

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1. Facts about Headaches

If you suffer from headaches, you are not alone. It was recently reported

that during the past year nearly 90% of men and 90% of women reported

having experienced at least one headache.

Here's another interesting statistic. Did you know that more than 28 million

Americans suffer from migraine headaches? And that another 1.5 million

Americans suffer from trauma headaches?

On the other hand, only about one half percent of our population suffer from

cluster headaches, and that they are predominantly men -- as 80% of those

who suffer from cluster headaches are male.

It is also interesting to note that the onset of cluster headaches typically

occurs in the late 20s, but that there is no absolute age restriction. Statistics

also show that approximately 80% of cluster headaches are episodic -- the

remaining 20% are considered chronic.

For that matter, nearly everyone will have at least one tension headache in

his or her lifetime. And approximately 3% of our population suffers from

chronic tension-type headaches.

If you suffer from migraine headaches, you are actually in good company.

Many famous people have suffered from migraines, including Julius Caesar,

Joan of Arc, Karl Marx, George Bernard Shaw, Saint Paul, Thomas Jefferson,

Edgar Allan Poe, Pyotr Tchaikovsky, Robert E. Lee, Ulysses S. Grant, Pablo

Picasso, Lewis Carroll, Sigmund Freud and Vincent Van Gogh.

Headache Myths

Headaches may be one of the most misunderstood medical conditions in

America. There are at least five serious myths about headaches.

For example, one is that all headaches the same, which is clearly not the


Another is that increased levels of stress cause chronic headaches. The

correlation between stress and headache is certainly true for some people

but not for others.

© 2009, Douglas Hanna All Rights Reserved

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This is where the confusion arises.

Stress may very well trigger a headache in someone who is susceptible to

migraines but, if a person is not susceptible to headaches, it is unlikely that

one will be triggered by rising levels of stress.

Another prevalent myth about headaches is that headaches are all in your

head. You cannot just imagine or cause a headache to occur.

Headaches are a medical condition caused by physiological events that can

be diagnosed and treated just like appendicitis or arthritis.

They require medical care and self-care measures to manage them, just like

other chronic conditions.

Did you know that headaches are more prevalent during early adulthood and

often become less common after middle age?

For example, migraine headaches are most common in people aged 25 to 55,

which unfortunately, is a time when most of us are in our peak work years.

Migraine headaches are experienced more by women than men.

The reason for this may be that migraine headaches can be influenced by

changes in hormonal levels, such as those that occur during a woman's

menstrual cycle or during pregnancy.

But then, men also get migraines and not all women do.

And, most women who suffer from migraines experience them throughout

the month, even when their hormones are not fluctuating.

Here is another fact that is sad but true. Regardless of all those

advertisements you see on television or the articles you may read in some

publications, there is no “miracle” drug that can stop headaches in

minutes and not all headaches can be wiped away by taking any pill.

While various medications can play a vital part in treating headaches, the

most effective drug therapies often require a combination of drugs.

It is also sad but true that relatives, friends and co-workers often may not

understand the impact that headaches have on a person's performance.

© 2009, Douglas Hanna All Rights Reserved

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For that matter, people suffering from chronic headaches often believe that

they themselves are to blame. This misperception can actually work to

prevent people from seeking help for their headaches.

Another common misconception is when some people think that you are

suffering from headaches because there is something wrong with you


This is also untrue. Chronic headaches are not the sign of psychological or

mental problems. They're a biological disorder. While it is true that some

people who have mental health problems do get headaches, the headaches

are not necessarily because of these problems. It is also true that while

people who are suffering the pain of a throbbing headache may be calm

angry, irritable or moody, this does not mean they have a mental disorder.

Headaches are an established medical condition.

You cannot just imagine or cause a headache to occur. Headaches are not

just a complaint from someone who is acting hysterically or who is a


Headaches are a medical condition caused by physiological events.

They require medical care and self-care measures to manage them, just like

any other chronic condition.

Are you a guy? Then you should pay attention to this -- men are especially

reluctant to see a doctor about chronic headaches because they don't wish to

appear unable to handle the problem on their own. But, seeing a doctor is

exactly what they should do.

Another misconception is that people complain about headaches who

cannot handle pain. There is no scientific evidence that suggests that

people with severe migraine headaches, for example, are more sensitive to

pain than people who do not have migraines.

In fact, many people are able to carry on with everyday activities despite

their migraine headaches, which shows they are resilient.

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Finally, some people think that sinus headaches are chronic headaches.

The fact is that sinus headaches occur only when you have sinusitis or

infected sinuses – in other words only once in a while and only for a short


If you have chronic headaches and believed it was because of your sinuses,

you need to stop thinking this and find out what kind of headaches you really


As you'll read in this book, there are medications you can take to stop or end

a headache, and there are drugs and methodologies you can use to lessen

the effect of your headaches.

But, anyone who tries to tell you that there is one medication, alternative

treatment or supplement that can permanently "cure" your chronic

headaches, is just not telling you the truth.

© 2009, Douglas Hanna All Rights Reserved

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2. General Information about Headaches

Did you know that the brain itself is not sensitive to pain? This is because it

lacks pain-sensitive nerve fibers. There are several areas of the head that

can hurt, including a network of nerves that extends over the scalp, and

there are certain nerves in the face, mouth, and throat that can hurt.

However, the meninges and the blood vessels do have pain perception. As a

result, irritation of the meninges and blood vessels can result in headaches.

The muscles of the head may also be sensitive to pain.

Pain in the neck or upper back may also be interpreted as headache. It ranks

among the most common of local pain complaints.

What Causes Headaches?

There are a wide variety of headache causes. These range from eyestrain and

sinusitis to life-threatening conditions such as encephalitis, meningitis,

cerebral aneurysms and brain tumors.

In some cases it is very easy to determine what is causing your headaches. If

you suffered head trauma and now have chronic headaches, it is easy to

figure out what caused them.

On the other hand, the causes of many other types of headaches are still not

well understood.

At one time, scientists and doctors believed that migraine headaches were

caused by the constriction and dilation of blood vessels and that tension

headaches were caused by muscle contraction.

While scientists still believe that these play a part in causing headaches, a

much more complicated explanation is beginning to emerge.

Many scientists now speculate that both migraine and tension headaches

have the same origin in the brain.

© 2009, Douglas Hanna All Rights Reserved

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One New Theory

One new theory holds that headache pain begins with the trigeminal nerve.

This nerve, the largest in the head, is located in the brainstem and carries

sensory impulses to and from the face.

When this nerve is stimulated by a certain headache trigger, it releases a

burst of neurotransmitters. This normally prompts the release of yet another

neurotransmitter called serotonin.

Serotonin acts as a filter, screening out important things such as familiar

background noises and other people's conversations, while admitting signals

that demand attention, such as a baby's cry or your name being called.

The more serotonin, the greater the screening action, which is why high

serotonin levels correlate with sleep.

It is thought that, under normal circumstances, increased serotonin levels

counteract pain signals from the trigeminal nerve.

But, serotonin levels often prove to be too low in people suffering from a


In fact, scientific tests have proved a clear relationship between headaches

and serotonin levels.

In one experiment, test subjects got headaches when injected with a drug

that depleted their serotonin level.

Likewise, the headache went away when they were injected with serotonin.

A lack of serotonin has also been implicated in depression and sleep

disorders -- two problems that afflict many of those suffering from chronic


Another theory holds that teeth clenching may be the main cause of migraine

headaches as teeth clenching causes a chronic contraction of the temporalis,

or temporal muscle.

It has also been shown that patients with chronic tension-type headaches

show increased muscle and skin pain sensitivity.

© 2009, Douglas Hanna All Rights Reserved

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And, the hyper-excitability of central noriceptive neurons in the trigeminal,

spinal nucleus, thalamus, and cerebral cortex, is believed to be involved in

the cause of chronic tension-type headaches.

Headaches and Hormones

There is strong evidence that there is a relationship between hormones and

migraine headaches because women get this type of headache more than


Another important fact supporting this theory is that women do not get

migraine headaches until after puberty when they begin to produce higher

levels of female hormones.

Also, sixty percent of women with migraines report that their headaches

happen more often before, during or after menstruation which is when

hormone levels change.

This type of headache is sometimes called a “menstrual migraine”.

Third, these headaches tend to lessen in number during the second and third

trimesters of pregnancy and the headaches often stop, or get worse, for

menopausal women – again proving a relationship between hormones and


© 2009, Douglas Hanna All Rights Reserved

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3. Types of Headaches and Their Symptoms

There are four basic types of headaches. They are vascular,

muscular/myogenic, traction and inflammatory.

The most common type of headache, the migraine headache, is vascular.

This type of headache is usually characterized by severe pain on either one

or both sides of the head, an upset stomach and, at times, vision problems.

The second most common type of vascular headache is the "toxic" headache

produced by fever.

Cluster headaches are also a kind of vascular headache. So are the rare type

of headaches caused by high blood pressure.

Tension headaches are the most common form of muscular/organic

headaches. They appear to involve the tightening or tensing of facial and

neck muscles, and may radiate to the forehead.

Tension and inflammatory headaches are generally symptoms of other

ailments such as stroke or sinus infection.

Non-chronic types of Headache

There are other types of headaches, which are non-chronic; they occur only

once, or once in a long time.

Included among these are:

· Ictal headache

· Ice cream headache

· Thunderclap headache

· Toxic headache

· Coital cephalagia or sex headache

· Sinus headache

Medication overuse headaches

© 2009, Douglas Hanna All Rights Reserved

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Major Types of Headaches and Their Symptoms

Migraine Headaches

Migraines are clearly the most common type of severe chronic headache.

Statistics suggest that that more than 6 million Americans suffer from

migraine headaches.

How can you tell if you’re suffering from migraines? Migraine headaches are

marked by pain that can be almost unbearable – to the point where all you

want to do is lie down and wait for them to go away.

In addition to this pain, there are other symptoms that typify migraines.

Nausea and vomiting

Sensitivity to light and sound

Cold-like symptoms

Inability to function normally or below normal at work and at home

when suffering the headache

Head pain that has a pulsating or throbbing quality

Moderate to severe pain --possibly on only one side of your head,

although it can occur on both sides

Pain so intense it interferes with your regular daily activities

Pain that becomes worse if you engage in physical activity

Feeling of being nauseated with or without vomiting

A heightened sensitivity to light and sound.

If you do not treat a migraine headache, it will typically last from 4 to 72

hours. But, how often the migraine occurs will vary from person to person.

You might experience a migraine headache as often as several times a month

or just several times a year.

Some migraines are accompanied by auras and some are not. If you do

experience an aura, it will most likely occur about 15 to 30 minutes before

your headache begins. In some cases, the aura may continue after your

headache starts or can even continue after it ends.

© 2009, Douglas Hanna All Rights Reserved

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These auras may include:

Blind spots in your vision that slowly spread

Dazzling zigzag lines in your field of vision

Sparkling light flashes

A sensation of tingling or a pins-and-needles sensation on one arm or


In rare cases, weakness or language and speech problems.

You may also have one or more sensations which indicate an imminent

migraine headache. These sensations are called Prodromes and may occur

several hours to a day or so before your headache actually begins.

The sensations can include:


Irritability or depression


Cravings for sweets

Feelings of elation or intensive energy

Cluster headaches

The main symptom of cluster headaches is described by its title – headaches

that occur in a cyclical pattern or cluster.

These clusters may last from weeks to months, followed by periods during

which the headache attacks stop completely. While the cluster pattern can

vary from one person to another, most cluster headache sufferers have one

or two cluster periods a year. Then, during remission, they may experience

no headaches for months or even sometimes years.

Only about 1% of the U.S. population suffers from cluster headaches, which

is a good thing as it is one of the most painful kinds of headache.

Unlike migraine headaches, cluster headaches affect more men than women.

People of any age can be affected by cluster headaches, but it is most

common for people between adolescence and middle age.

© 2009, Douglas Hanna All Rights Reserved

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Cluster headaches usually strike quickly and without warning.

If you suffer from cluster headaches, you know how the excruciating pain can

develop in minutes. Typically, this pain will develop on the same side of the

head throughout a cluster period.

The pain can switch to the opposite side of the head in the next cluster but

this happens only infrequently. The pain can also switch sides from one

attack to another but this is very rare.

Those who suffer from cluster headaches often describe the pain as sharp, or

penetrating. They will say that the pain feels like a hot poker being stuck in

the eye or that their eye is being pushed out of its socket.

A cluster headache will always trigger a response from your autonomic

nervous system. As you might know, your autonomic nervous system

controls many of your vital activities without you having to consciously think

about them. For example, this system regulates your blood pressure,

heartbeat and body temperature. If your response to a cluster headache is

swelling, tearing and redness of the eye on that side of your head affected by

pain, then you’re experiencing the most common autonomic response to a

cluster headache.

Cluster headaches also show these symptoms:

Pain that typically lasts three hours or less

Headaches that occur usually at night

Headaches triggered during the active periods by alcohol

high altitude, air travel, bright sunshine, exertion or foods, especially

foods that are high in nitrite.

These signs and symptoms can also accompany cluster headache:

Red, flushed face

Reduced pupil size

Stuffy or nasal discharge from the nasal passage on the side of the

face where you are experiencing the pain

© 2009, Douglas Hanna All Rights Reserved

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Drooping eyelid

Swelling around the eye on the side of the face where you feel the pain

These signs and symptoms normally last only as long as your cluster

headache lasts. However, for some people, a drooping eyelid and reduced

pupil size may linger long after the attack.

A cluster headache may also be accompanied by some migraine-like

symptoms, such as nausea, sensitivity to light and sound or even an aura.

Chronic Daily Headaches

An estimated four to five percent of all adults in America experience

headaches nearly every day. These headaches are known as chronic daily


Chronic daily headache can be classified as either primary or secondary.

People who have had migraine or tension-type headaches for many years

often develop primary chronic daily headaches. These headaches can

gradually increase in frequency over time until they appear almost daily. On

the other hand, secondary chronic daily headaches are caused by an

underlying disease or condition.

Chronic daily headaches are among the most disabling of headaches because

of their incessant nature.

The most common symptoms of a chronic daily headache are:

Pain that is dull and moderate most of the time

Headaches that occur more than 15 days a month

Headaches that are present for at least six months of the year

Headaches accompanied by nausea, sleeplessness or irritability and

feelings of squeezing, burning, pounding or drilling.

While the signs and symptoms of these headaches vary, depending on the

specific type, here are some common ones:

Chronic daily migraine headache. When a migraine gradually become

more frequent until you experience them nearly every day, this is known as a

transformed migraine. There may be steady pain on one or both sides of

© 2009, Douglas Hanna All Rights Reserved

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your head, as well as pain in the in the neck and face. You may notice that in

common migraine, symptoms of nausea and sensitivity to light and sound

fade, but you may continue to experience the occasional acute migraine.

But, it is also common for people who suffer from this type of headache to

also experience depression, sleep disturbances, anxiety and panic.

Chronic tension-type headache. Tension-type headaches will occasionally

become daily headaches. In this case, the pain will involve both sides of the

head and the back of the head and neck.

Those who suffer from this type of headache often describe the pain as a dull

ache or band of pressure around their head. The pain of the headache may

vary throughout the day. Those who suffer from these headaches report that

they occasionally also experience depression, sleep disturbances, anxiety and


New daily persistent headache. This type of headache begins abruptly in

people with no headache history. They can be triggered by infection, surgery

or a stressful life event. In other cases, there is no recognizable trigger.

Sufferers often describe the pain as throbbing, dull, achy, stabbing or

burning, or as a tightness or pressure. This pain typically continues

throughout the day. Some new daily persistent headaches will stop within

several months. Unfortunately, others will continue for years or even


Hemicrania continua. This is a fairly rare type of chronic daily headache. It

is marked by pain that occurs on one side of your head and varies in severity

without ever disappearing completely.

Most suffers describe the pain of a Hemicrania continua headache as

“moderate,” but this type of headache may include jolts of severe pain that

last less than a minute. Tearing or redness of the eye on the side of your

head experiencing the pain may accompany this flare-up or jolt. There may

also be swelling or drooping of the eyelid and a stuffy or runny nose – again

on whichever side of your head has the pain.

© 2009, Douglas Hanna All Rights Reserved


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Tension-type Headache

At some time during their lives up to 88 percent of women in the U.S. and up

to 69% of men experience tension-type headaches.

Despite the fact that this type of headache can impair job productivity and

interfere with family and social time, it is easily the most misunderstood

headache type.

This is because the word “tension” implies that this kind of headache can be

attributed to tension or stress, which will eventually go away and, along with

it, the headaches.

Also, many doctors think of tension-type headaches as mild, benign, self-

treatable conditions due solely to stress.

However, in 1988, the International Headache Society

developed the classification “tension-type headache”

as a condition characterized by bilateral, mild to

moderate pain and pressure that is often described by

sufferers as having “a clamp around the head.”

Some patients with these type headaches

experienced severe pain and a serious disability.

While no clear cause of tension-type headaches has ever been found, they

are manageable – with a balance of healthy habits, finding effective non-drug

treatments and using medications appropriately.

This type of headache can last from 30 minutes to a whole week. They can

occur occasionally or nearly all the time. If they occur 15 or more times a

month for several months, they are considered chronic. Even worse, chronic

tension-type headaches can sometimes persist for years.

The symptoms of a tension-type headache are:

A dull ache or sensation of tightness in your forehead or at the sides

and back of your head

© 2009, Douglas Hanna All Rights Reserved

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Headaches that are either episodic or chronic (episodic tension

headaches occur less than 15 days a month, whereas chronic tension-

type headaches occur 25 days or more a month)

Headaches that typically last four to six hours

Being unable to walk upstairs and then forward without the headache

getting worse

The inability to eat when you have a headache

Pain that is usually mild or moderately intense

Pain that starts soon after you wake up in the morning or early in the


Some tension-type headache patients say they experience neck or jaw

discomfort or a clicking sound when opening their jaws.

There may also be:

Difficulty sleeping (insomnia)


Tenderness on the scalp, neck and shoulder muscles

Loss of appetite


Difficulty concentrating

Tension-type headaches are not usually accompanied by visual disturbances

(blind spots or flashing lights), nausea, vomiting, abdominal pain, weakness

or numbness on one side of the body or slurred speech.

Physical activity will not make them worse as it does a migraine headache.

Rebound Headaches

While you may have learned to rely on pain relievers when you feel a

headache coming on, and you do this more then two or three days a week,

you may actually be contributing to your headaches rather than treating


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It starts when you take too much medication –more than the label instructs

or your doctor prescribes. What happens is that your body soon adapts to the

medication. You may not even realize that you are overmedicating until you

miss a day and your head starts to hurt again – sometimes more intensely

than before.

This headache type tends to occur every day, sometimes waking you up in

the early morning and continuing throughout the day.

The pain may be most severe at first, as your medication begins to wear off.

The pain of a rebound headache will sometimes be a dull ache. At other

times, the pain may be throbbing or pounding.

These headaches may have other signs and symptoms, including:


Restlessness, irritability and difficulty concentrating



Memory problems

Trouble sleeping

© 2009, Douglas Hanna All Rights Reserved


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4. Headache Triggers

Almost everyone has had or will get a headache sometime in their lives.

However, if you experience headaches on a regular basis, you may be

predisposed to them because of your genetics, your life's stress, or your

body's own metabolism.

If you have been experiencing headaches for some period of time, you

probably already know what can trigger them. While headache triggers are

different, depending on a person's situation, there are several factors that

are almost universal when it comes to triggering headaches.

One hundred and ninety-nine chronic headache sufferers recently filled out a

questionnaire about the conditions that they experienced just before a


The results of this survey were that the most frequently cited triggering

factors in order of frequency were:

· Anxiety

· Glare

· Noise

· Anger

· Medications

· Hormones

· Physical exertion

· Emotional triggers

It has been found that emotions can bring on

headaches, keep them going, and even make them worse.

This is because, while headaches are not caused by emotions, they can make

you more vulnerable to them. When the body is influenced by the mind, the

result is called a psychosomatic condition. This term has been used

negatively to describe people who believe they have illnesses that are not

really there.

© 2009, Douglas Hanna All Rights Reserved

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However, this is an incorrect use of the word. Psychosomatic simply means

that the state of the mind can influence the biological mechanisms of the

body. Besides headaches, other examples of psychosomatic conditions

include peptic ulcer disease, asthma, and some irregularities of the heart


It is also interesting to note that in one study, scientists used the Minnesota

Multiphasic Personality Inventory (MMPI) to test headache sufferers and

concluded that they are exceptionally prone to depression, denial, and

preoccupation with their symptoms.

The interesting thing is that these researchers were not sure whether these

tendencies were the cause of headaches or the result of headaches. In either

case, it is possible that people who are prone to headaches may view stress

as more overwhelming than those who don't get headaches.

These scientists also found a difference between tension headache sufferers

and migraine sufferers. Those in the study who had migraine headaches

scored higher in the section of the test that was devoted to depression, while

those who suffered from tension headache scored higher in those sections

that had to do with symptom preoccupation, anxiety, and denial.

This led the researchers to conclude that people with tension headaches

might be more emotionally vulnerable than those who suffer from migraine

headaches. The scientists involved in this study speculate that the greater

impact of emotions in this group could be due to the higher density of tension


Another recent study of headaches and emotions found that depression was

strongly related to disability, as defined by the individual’s feelings of

disruption in his or her daily life.

This study of 139 patients also found that expressed anger did not produce a

perceived disability, but that anger that was not expressed did. This led

researchers to suspect that unexpressed anger may amplify the feelings of

depression among chronic headache sufferers.

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Eating and Sleeping Patterns

It has been found that fasting or skipping meals is a major headache trigger.

In one study, it was found that for a majority of 2000 women with migraines,

the lack of food for five hours during the day or for 13 hours overnight was a

primary factor in triggering their headaches.

It is not completely understood why this is so. Maybe it is the fact that

fasting can affect the level of neurotransmitters, and how low blood sugar

from lack of food can cause the blood vessels to dilate, which then triggers a


It has also been found that night-time sleep and sleep during the day may

trigger headaches. Too much sleep or too little sleep can trigger headaches in

those who are prone to get them.

Environmental Factors

If you work in a place where you inhale fumes or toxins you may have

already found that this can lead to headaches.

Environmental substances that can trigger headaches include turpentine,

carbon tetrachloride, benzene, formaldehyde, heavy metals (especially lead)

and carbon monoxide.

Other workplace conditions that can trigger headaches are bright lights,

glare, noise and eyestrain.


Eyestrain and diseases of the eye can lead to headaches, though headaches

related to eye disorders actually occur less frequently than you might


For example, if you strain your eyes through excessive reading or if you

spend many hours squinting at a computer screen, the muscles controlling

your eye movement can become fatigued. You may also suffer headaches

related to eyestrain if you continually work under flickering fluorescent lights.

However, it is difficult to separate tension headaches from eyestrain

headache. This is because sitting in the same position for a long time while

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reading or working on a computer can strain your neck and shoulder muscles

as well as your eyes.


Headaches can actually be triggered by some medicines used to treat

illnesses. If you are taking nitroglycerin for heart disease, medication for high

blood pressure, or medication used to dilate blood vessels, you should talk

with your doctor about switching to another non-headache provoking drug.

However, do not stop taking any of these medicines without the prior

approval of your doctor.

Contraceptives (the Pill) may or may not cause headaches, and may or may

not make headaches worse, depending on the individual.

It is difficult to determine whether or not the Pill causes headaches in women

because most women who take it are in the age range for headache onset.

So, the Pill might be “guilty by association”.

However, headaches in women could be triggered by the Pill or by varying

levels of estrogen delivered by triphasic oral contraceptives (those that

supply different doses of hormones each week).

Physical Exertion

Physical activity and exhaustion may trigger a migraine attack in people who

have a history of migraine headaches. In most cases, the trigger is the result

of activity that is more strenuous than usual or excessively prolonged.

Exercising without warming up first, not drinking enough fluids, and

exercising in locations that are at a higher altitude or temperature may also

be contributing factors.

Diet and Foods

Diet can also be a headache trigger. Some headache sufferers say that

certain foods trigger their head pain.

This may be because many foods contain substances that can provoke the

release of the neurotransmitters implicated in causing headaches.

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Headaches can be triggered by foods containing the substance, Tyramine,

which is a member of the amines group of organic chemical compounds. It

may influence the release of the neurotransmitter serotonin.

Common foods that contain tyramine include:


Aged cheese

Vinegar (relish, salad dressings,

sauces, catsup)

Organ meats (kidney, liver)

Alcohol (especially red wine)

Sour cream

Soy sauce


Yeast extracts


Headaches can also be triggered by foods containing nitrates as

preservatives. It is estimated that in the United States there are

12,000,000,000 pounds of nitrite currently used to give meats a pink color

and enhance their taste.

Foods that contain nitrite include:

Smoked fish

Corned beef




Canned ham


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Monosodium Glutamate

This additive, which is frequently called MSG, may also cause headache pain.

It is a flavor enhancer that is often sold under the trade name Accent.

An estimated 20,000 tons of monosodium glutamate are used yearly to add

flavoring to foods such as:

·Dry roasted nuts

·Soups and sauces

·Potato chips

·Diet foods

·Chinese foods

·Salad dressings and mayonnaise

Processed or frozen food

Other Foods

There are a number of other food items that can trigger headaches. These

include citrus fruits, dairy products, soybeans, wheat products, onions, fatty

foods, seafood, and artificial sweeteners ( such as aspartame or


Non-food Headache Triggers

Alcohol – beer, wine, champagne, and


Vitamins – high doses of vitamins can trigger


Water (lack of) – the simple lack of water or

dehydration is a major cause of headache,

especially migraine headaches

Caffeine – can be a friend or foe. It is used as an ingredient in most

pain relievers because it enhances the intestinal absorption of the

© 2009, Douglas Hanna All Rights Reserved

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drug. But it can also trigger headaches in sensitive people and in those

who drink too much coffee or any other beverage containing a high

amount of caffeine.

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5. Getting the Right Diagnosis

If you do not know what kind of chronic headaches are affecting you, the

first, important step is to get a correct diagnosis.

You can read the information found in Chapter 3 to get an idea of what kind

of headache is affecting you. However, this will give you only a “rough”

diagnosis by symptoms. To get a totally definitive diagnosis you must see a

doctor experienced in treating people with severe headaches.

You should also see a doctor when:

· Your headaches have changed in nature or frequency

· You develop a new type of headache

· Your headache treatment isn't working

A Headache Diary

Before you see your doctor you should keep

track of your headaches with a headache diary.

This can help both of you pinpoint the cause or

causes of your headaches.

Information to record in this diary would

include “who,” “where,” “when,” and “why.” It might also include“how.”

The “Who” is who you were with before the headache started? Was it

someone who made you angry or irritated or hurt your feelings?

What” is what if any medications were you taking to treat the headache?

Were you taking other medications at the time? What symptoms did you

experience in conjunction with the headache?

Where” is where you were before the headache started? Were you at work

under glaring lights or were there loud noises or fumes? Were you at home

resting after a stressful day?

The “Why” is why would your headaches start? Did you eat a particular food

or drink something such as alcohol? Did you get enough sleep or more sleep

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than usual? How about skipping meals? Did you forget breakfast, lunch or

dinner? Or did your headache start after some physical activity?

The “How” is how did the pain feel? Would you describe it as a throbbing

pain, on one side of the head, on both sides of the head, or stretching across

the temples? How do you cope with the headache? Did you have to miss