Headaches: What causes them and how to treat them

Migraine headache
Location
Occurs most often on one side of the head, but may affect both sides.

What it feels like
Throbbing, pulsating pain usually on one side of the head. May be felt around the temples, or behind one eye or ear. "Migraines make it painful to move your head," says Becker. Other symptoms may include vomiting, sensitivity to light or noise, nausea, and numbness or tingling on one side. About one in seven migraine sufferers experience auras (visual disturbances that include flashes of light, zigzag lines or blind spots) before a headache begins.

Prevalence
Women are three times more likely to suffer migraines than men. About 25 per cent of Canadian women and about eight per cent of Canadian men get migraines during their lifetime. "Migraine headaches are the type that bring patients to doctors most often by far," says Becker, because attacks affect an individual's ability to function.

Frequency and duration
About 60 per cent of migraine sufferers experience one or more attacks per month, while 25 per cent have attacks at least once a week. Headaches last from four to 72 hours.

Triggers 
Stress, fatigue, skipping meals, hormonal changes, glaring or flickering lights, loud noise, weather changes, overexertion, caffeine, chocolate, red wine, beer, nicotine, aged cheeses and flavour enhancers or preservatives are just some triggers. "The most common trigger is stress," says Becker. "A given trigger may not cause a migraine every time, but combined with another trigger they add up to reach your migraine threshold."

Treatments
Migraine-specific triptans, such as sumatriptan (Imitrex) and zolmitriptan (Zomig), are the drug of choice for treating severe or frequent migraines. Triptans prevent the swelling of blood vessels and inflammatory response that accompanies migraines, notes Becker. OTC pain relievers, such as acetaminophen, ibuprofen and ASA, may be effective for mild or moderate migraines, but taking these drugs too frequently can lead to rebound headaches. (Overuse involves taking OTC pain relievers on more than
15 days per month or taking more than the recommended daily dose.)

Resting in a dark, quiet room and applying an ice pack to the base of the skull may ease pain during an attack. Massage, biofeedback (a type of alternative medicine designed to enable you to use your thoughts and will to control your body) and other relaxation techniques may provide relief, too.

Prevention
Combining lifestyle changes with preventive medication is the most effective treatment for frequent migraines. Certain cardiovascular drugs (beta blockers, such as propranolol, and calcium channel blockers, such as verapamil) can help prevent migraines. Tricyclic antidepressants, such as amitriptyline, and anticonvulsant drugs, such as topiramate (Topamax), are also effective in preventing migraines. "With preventive medications, patients have to be realistic. A 50 per cent reduction in frequency and intensity is considered to be a successful treatment," says Dr. Rose Giammarco, a neurologist and director of the Hamilton Headache Clinic, noting that a preventive drug must be taken for at least six weeks to see if it's effective. Botox injections reduce migraine and tension headaches in some people.

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