Only one person in 50 can claim never to have had a headache in their life and over 90 per cent of us suffer the occasional one. For most of us, the headache is gone in a few hours but for some people frequent bouts of debilitating pain occur on a more regular basis, even daily, which causes considerable distress and erodes the quality of home and work life.



Headaches are a challenging area in the field of medical research. Various theories abound but new understanding of the brain and nervous system seems to indicate that they arise from a chain reaction involving nerve pathways and blood supply to and from the brain.

THE TRIGGERS
`We can't be certain of the actual mechanism of a tension-type headache. We all get them from time to time and they're far more difficult to treat than migraine. There are lots of different theories. For example, if you associate your headaches with certain foods, such as cheese and chocolate, citrus fruit, tomatoes and dairy products, all known to trigger headaches, you may find that changing your diet makes them to fade away.

`Sugar itself can be the culprit if we snack on something sweet when we haven't eaten. The rapid rise in blood sugar prompts a flood of insulin, which eventually causes blood sugar to fall even lower than before, which can trigger a headache. Or you may have got into a cycle of taking daily doses of painkillers, which actually cause what is known as an analgesic-abuse headache.

`If you take a lot of painkillers for regular headaches, you will find that if you reduce your intake, headaches will become less frequent. One theory is that headaches are caused by the constriction and dilation of vessels supplying the brain with freshly oxygenated blood. If you can reverse this dilatation, then the pain will cease.
People who get migraine sometimes try to prevent attacks by taking extra amounts of their prescription drug ergotamine which constricts blood vessels throughout the body. But this can actually set off the headache mechanism by its action on the cranial arteries.

A WOMAN'S PROBLEM
Three times as many women as men get migraine and women suffer much more than men from all other types of headaches. In many cases hormones seem to play a part. But not all women are sensitive to hormonal fluctuations. The effect of the fall in oestrogen before a period, when many women suffer from migraine or headache, may be indirect. For instance, it may affect carbohydrate metabolism so that a headache is brought on by poor control of blood sugar or by fluid retention. Most probably, however, many different factors combine. Missing a meal may not normally cause you to get a headache but if you're tired and premenstrual and you've been stuck at a word processor all day, missing lunch may be the trigger. In such cases some medicines may help premenstrual syndrome, including magnesium, Evening Primrose oil and vitamin B6'.

Many women who get a lot of headaches find that they have a painfree mid to late pregnancy, when oestrogen levels are constantly high-which suggests that it's not the actual levels of the hormones which affect us so much as their fluctuations throughout the month. Headaches may also develop as a result of raised hormonal levels in women on the Pill.

Tension headaches may be caused by stress, though some neurologists have challenged the stress theory, suggesting that all headaches are in fact a result of an imbalance in brain chemistry caused by neuro transmitter activity-known to occur in a migraine attack.

Headache sufferers can make a few fundamental changes to their lifestyle. `Aerobic exercise is very important since it encourages transmission of oxygen to the brain, removes waste products, helps stabilize blood sugar and enhances well-being through the release of endorphins. A good diet with regular meals including lots of complex carbohydrate and plenty of sleep is also essential'.

PAINKILLERS
Aspirin and ibuprofen (Nurofen) are anti-inflammatory drugs which are effective at stopping headache, but both damage the lining of the stomach, may not be advisable for pregnant women and can provoke allergy. Paracetamol is extremely safe in very low doses but it does not take much to overdose and damage liver and kidneys. The cheapest way of taking painkillers is in plain unbranded tablets; two 300mg aspirin; two 200mg ibuprofen or two 500mg paracetamol. However, daily use of painkillers may prompt an analgesic-abuse headache, so don't take them too often.

SERIOUS CASES
When you get a really bad headache you may start to wonder whether you've got a brain tumor. The headache caused by malignant growth is progressive with a
distinctively slow build-up and is severe in the morning, preventing you from eating. Other unusual causes of headache include brain haemorrhage and meningitis. It can also be a symptom of temporal arthritis (of the cranium), shingles, Paget's disease (which affects the skulls of elderly people) or neuralgia (facial pain following the path of a nerve). But these are all uncommon.

TYPES OF HEADACHE

Migraine
True migraine affects 10-15 percent of the population and has specific symptoms. Severe pain, often on one side of the head only, may last up to three days and is accompanied by gastric upset and/or sensitivity to light and other visual disturbances. Stress and some foods (such as cheese, chocolate and citrus fruits) containing amines, which affect blood vessels, may trigger an attach. Treatment includes painkillers with anti-sickness drugs and the herb feverfew which dilates blood vessels.

Cluster headache
These affect men only and are very rare. The head pains are agonizing. They are located on one side of the head, last for an hour or so and then clear until the next headache in the group or cluster, which lasts several weeks and occurs regularly, sometimes at the same time each year. They occur in men who smoke and during the cluster, an attack may be provoked by alcohol. Treatment includes ergotamine, calcium channel blockers and oxygen.

Tension Headache
The pain is generally mild to moderate a sense of pressure like a hat that is too small, around, on top of or both sides of the head, sometimes accompanied by a rigid sore neck. The headache may come and go throughout the day, sometimes getting worse in the evening, sometimes lasting for days or striking regularly. Triggers include stress exacerbated by muscular tension, caused by long hours at a steering wheel or wordprocessor. Treatment includes massage, rest and painkillers.

Hunger headache
Low blood sugar can trigger a vague discomfort in the head that grows into a proper headache if nothing is eaten. People who don't eat breakfast may notice a morning headache that disappears with their mid-morning snack and crash dieters may have nagging pain on top of the irritability and lethargy caused by low blood sugar. Regular balanced meals and a healthy snack containing protein and carbohydrate will prevent hunger headaches.

Hangover headache
Too much alcohol will cause dehydration, which may be prevented by drinking water before going to bed. It results in altered quality of sleep (too much at the weekend can lead to a headache) and low blood sugar. Very little alcohol is needed for some people to develop a splitting headache the next day. Cheap red wine, beer, brandy and whisky all contain certain additives, called congeners, which provoke a headache. The drink least likely to result in a hangover is vodka.

Diet
Intense cooling of the mouth from an ice cream or cold drink may cause pain to be referred to other parts of the head causing a brief feeling of numbness and pain. Some people react badly to the nitrites (used in medicine to treat angina) in cured meat and to monosodium glutamate (used in Chinese food). Caffeine is the most widely used central nervous system stimulant in the world, found in coffee, tea, cola drinks and chocolate. The hallmark of an addiction is its withdrawal effect- a thumping head in case of caffeine. People who drink a lot of coffee during the week may notice a feeling of lethargy coupled with headache at the weekend, when they unwittingly abstain from their usual drug. Try to cut down your intake of caffeine during the week.

Environmental stress
Bright flickering lights (such as some fluorescent lights) or glare can interfere with natural brain activity and tire the eyes. Hot, stuffy or overcrowded rooms inhibit oxygen from reaching the brain. Fixed work positions build up muscular tension. And excessive noise and feelings of anxiety make relaxation impossible. A combination of any of these factors can trigger a raging headache which will only be relieved by rest, relaxation, massage and painkillers.

Physical triggers
Disorders of the eye muscles and eye strain, ill-fitting spectacles, toothache and sinusitis.

SEE THE DOCTOR

1. If your headaches have just begun, are becoming much more frequent or getting worse.
2. If you have nausea, sickness, dizziness or visual disturbances.
3. If you are increasing the amount of painkillers you take to relieve your headache or if you are beginning to take painkillers on a regular basis.

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