USC Health Now

According to the American College of Physicians, 45 million Americans suffer from chronic headaches, while seven in ten Americans have at least one headache a year. If you or someone you love suffers from headaches, our experts offer tips on identifying the type and finding relief.

by Mel Cowan

Whether brutal and unforgiving like the jack-hammer of a road repair crew behind your eyes or merely annoying like a traffic jam in your temple, a headache is never welcome.

In the worst cases, pain can become chronic and debilitating, which may exacerbate mental disorders or cause people to overmedicate and develop additional health problems.

According to David Ko, M.D., associate professor in the Department of Neurology at the Keck School of Medicine of USC, identifying the type of headache is important in determining treatment or lifestyle modifications. Popping an aspirin may work for one kind of headache, but not for another. In addition, by identifying the ache, contributing factors can be isolated and avoided in the future.

The most common headache that people seek treatment for is the migraine. According to the International Headache Society, more than 28 million Americans suffer from migraines each year. Migraines, lasting in some cases up to three days, are usually a throbbing on one side of the head and are often accompanied by nausea, light and sound sensitivity and dizziness. Sufferers also often report an "aura" or visual disturbances at the onset of a migraine.

Women are three times more likely to suffer from migraines than men, due often to hormonal changes associated with the menstrual cycle and oral contraceptives, says Ko. Certain foods can act as triggers, including aged cheese, smoked meats and red wine. Changes in sleeping patterns, as well as altitude and weather can also bring on attacks.

Steven Richeimer, M.D., associate professor in the Department of Anesthesiology at the Keck School, has a simple mantra for headache prevention: "Do what your mama told you, which is to eat right, sleep right and exercise." Richeimer says this is the basic core approach used to encourage patients.

A major component to this approach is regularity, he says. Eating at the same time each day is just as important as what you eat. A regular sleep schedule is tied to your circadian rhythms, and research indicates that breaking these rhythms can induce headaches. Richeimer even says that exercise should be done at the same time each day. "It doesn't matter when you do it, whether morning or evening, but we encourage patients to keep a regularly scheduled exercise time."

Another common, yet less serious, headache is the tension headache, which usually manifests as a sustained dull pain in the head and neck and can result from many of the same triggers as a migraine. More often, a tension headache is caused by stress and poor posture, which can result in spasms and contraction of the neck muscles that result in blood vessel constriction.

Another more insidious type of headache is the rebound or chronic daily headache, which is usually caused by overmedication. The International Headache Society defines this type as having a headache 15 or more days each month.

"Over-the-counter medications (such as ibuprofen and aspirin), if overused, can lead to 'rebound headaches' because of a withdrawal reaction when the medication is not taken," advises Ko.

Because of the cyclical nature of the rebound headaches, Richeimer suggests that you inform your doctor if you take OTC headache medication more than 2-3 times a month, even if the headaches themselves are not serious.

Fortunately, not all headaches are as difficult to identify and treat: some are straightforward, caused by one specific factor that can usually be easily moderated or avoided. For example, caffeine, or lack thereof, can often cause headaches. If you need to quit caffeine, it is important not to go cold turkey, but taper off your intake gradually. Other examples include the nitrites in hot dogs, overexertion during sex, eyestrain from too many hours in front of the computer or an overly ambitious bite of ice cream.

While headaches may not be caused by an underlying physical problem, it is best to inform your doctor of recurring or chronic headaches, as well as any family history of headaches. If necessary, make a separate appointment to discuss the specifics, as opposed to mentioning it as an afterthought during a general visit.

"The best guideline for seeking care is if the headaches are disabling and hard to treat," says Ko.

Rare as they are, if any of the following symptoms appear, Ko recommends you see your doctor or go immediately to an emergency room:

• abrupt onset headache

• headache accompanied by a stiff neck, seizure, numbness, speaking difficulty

• worsening headache after a head injury

• chronic headache associated with exertion or coughing

• loss of consciousness