Need More Than Aspirin?: Treating headaches depends on the type of pain

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Tim Dhabalt, 13, has been experiencing headaches since he was 9 years old. Wendy Wiebke has been battling migraines for 17 years. Abby Rose, 44, wakes up with a headache almost every day of the week.

They are just a few of the 45 million Americans who experience cronic, recurring headaches, according to the National Headache Foundation. About 28 million people suffer from mi-graines, which are most commonly experienced between the ages of 15 and 55. In a recent NHF survey, nearly 30 percent of the respondents admitted they missed up to five days of work each month due to headaches; and 45 percent said they had missed at least five family or social events in the past year because of a headache.

Headaches are generally classified into three categories—tension head-aches, migraines and cluster headaches —according to doctors at Mayo Clinic. Each causes a different kind of pain. Tension headaches usually cause a dull, squeezing pain that may involve the forehead, scalp, back of the neck and both sides of the head. Most migraines occur on one side of the head, but some people feel pain on both sides of the head. Cluster head-aches usually occur on one side of the head, and some describe the pain as a stabbing sensation in the eye.

“There are primary-type headaches like migraine headaches or tension headaches without serious underlying disease,” says Dennis McManus, a neurologist at Southern Illinois University School of Medi-cine. Secondary headaches are caused by diseases such as brain tumor, stroke or infections such as meningitis.
Genetics and the environment play a role in migraines and cluster headaches, Dr. McManus says. “Hormones definitely play a role depending on the headache type. Migraines are more common in women and cluster headaches are more frequent in men,” he says.

Still, with so many people suffering from headache pain of one type or another, no definitive diagnostic test currently exists for migraines.

Wiebke has seen several physicians and she still suffers from headaches at least twice a week. Doctors have told her that hormones and foods are the primary reason for her headaches. She was instructed to keep a food journal, which turned up inconclusive. On another occasion, she sought a chiropractor to find some relief. He instructed her to sleep on her side, not her stomach. She currently takes over-the-counter pain medication with minimal success. She avoids certain foods, but still finds herself seeking bed rest in a dark place when her headaches occur.

Dhabalt’s physician believes his problem is food related. “I avoid chocolate, processed meats and cheeses, except when I am at the Cubs game and food choices are limited,” he says. When he gets a headache, he is usually in bed for three hours. Occasionally, orbs of light precede his headaches. He might drink a caffeinated soda, which sometimes stops the headache in its tracks.

Dr. McManus explains that different headaches require different remedies.

Migraine headaches respond very well to triptan-type medications like sumatriptan, rizatriptan, almotriptan, eletriptan and nonsteroidal drugs such as ibuprofen or naproxen, he says. Tension headaches respond to muscle relaxants and antidepressant-type medications.
The Food and Drug Administration has approved at least three over-the-counter products to treat migraines: Excedrin Migraine, Advil Migraine and Motrin Mi-graine Pain. Though these are available without prescription, specialists caution that patients should check with their doctors before taking any medication.
Lifestyle can also improve headaches, including exercise and diet, Dr. McManus says. “Migraine and tension headache patients have less headaches and feel better the healthier they live their lives,” he says. “The use of too much medicine leads to more headaches. Exercise, proper diet and a moderate lifestyle all contribute to fewer headaches.”