Headaches are one of the most common of all health complaints. Approximately 90 to 95% of all people have at least one unprovoked headache per year.

There are four major types of headaches: tension-type headaches, cluster headaches, sinus headaches, and migraine headaches.

Tension-type Headaches affect anywhere from 30 to 78% of the population. They are typically bilateral, affecting both sides of the head. They are usually typified by pressure or a type sensation without throbbing. They may occur with or without muscle tenderness and generally cause no nausea, light or sound sensitivity. Tension headaches are commonly associated with migraines.

First onset for cluster headaches usually occurs between ages 20 and 40. These headaches have a prevalence that is 3 to 4 times higher in men than in women. Cluster headaches occur on one side of the head and are usually associated with red eyes, tearing, stuffy nose, and a small pupil in the eye on the same side as the pain. Cluster headaches usually last 15 minutes to 3 hours but occur in clusters, from which they derive their name. A person with this type of headache is often restless and tends to pace.

The third type of headache, the sinus headache is usually located in the mid-face, behind the eyes, and in the forehead. It is typified by pressure and/or congestion in the mid-face area. Symptoms which occur with this headache include pain in the upper teeth, and a bad taste and/or smell. Persons with sinus headaches may also have associated allergy symptoms and discolored nasal discharge.

The fourth major type of headache is the migraine headache. Migraines occur on one side of the head and are often associated with nausea and sometimes vomiting. People with migraines often have symptoms of light and sound sensitivity and a throbbing or pulsating quality.

Many migraine sufferers experience auras with their headaches. These are visual symptoms and often include flickering lights, spots and loss of vision. Symptoms of migraines can also include sensory changes, such as a sensation which might be described as "pins and needles" or numbness. Speech changes can also occur.

Some studies suggest that prevalence of migraines is increasing in the United States. 18% of women have migraines. 6% of men have migraines. The American Migraine Study in 1992

• 23 million in US have severe migraines
• 25% have 4 or more severe attacks/month
• 35% have 1-3 attacks/month
• 40% have 1 or less attack/month
• 1/3 have severe disability during an attack, many needing bed rest

This translates to $1.2 to $17.2 billion in annual cost in lost productivity.

• Brain cell hyper-excitability in between attacks
• "Cortical spreading depression" with restriction of cerebral blood flow
• Triggers the trigeminal nucleus to perhaps cause dilation of the blood vessels through a cascade of chemicals
• Central sensitization

• Cured or Processed Meats
• Aged Cheese
• Alcoholic Beverages, especially red wine
• Aspartame
• Avocados
• Beans
• Brewer's Yeast, found in coffee cakes, donuts and bread
• Caffeine (in excess)
• Canned Soup
• Chocolate or Cocoa
• Cultured Dairy Products
• Figs
• Lentils
• Meat Tenderizer
• Monosodium Glutamate (MSG)
• Nuts & Peanut Butter
• Onions
• Papaya
• Passion Fruit
• Snow Peas & Pea Pods
• Pickled or Preserved Foods
• Raisins
• Red Plums
• Sauerkraut
• Seasoned Salt
• Soy Sauce

• Menstrual migraines
• Estrogen binds directly to receptors in the brain
• Prostaglandins produced in response to changes in estrogen and progesterone

• "Triptans"
  • Activate specific serotonin receptors to combat the results of trigeminal activation
• Ergotamines
• NSAIDs
• Caffeine
• Other pain medications

• Blood pressure medications
• Anti-depressants
• Seizure medication
• Menstrual migraines
  • NSAIDs
  • Magnesium
  • Ergotamines or "triptans"
  • Continuous estrogen

• Headaches >15 days/month
• Characteristics a combination of tension-type headaches and migraines
• Duration of >3 months
• Resolution in 2 months after stopping drug
• Can occur with any pain medication

• Keep a headache journal
• Eliminate things in your diet that may cause headaches
• Dietary Supplements
• Stress management
• Exercise
• Get adequate sleep

Author: Anna S. Tseng
Neurology Consultants of Dallas, P. A.
www.neurologydallas.com