Headaches are one of the most common health complaints for Canadian women. Here's the rundown on five types of headaches: what causes them, how to proven them and how to feel better faster.
Headache type: Tension
If you've ever experienced a headache—and who hasn't?—this is probably one you've had. "It's your regular garden-variety headache, with aching around your whole head and more steady pressure than migraines," says Dr. Michael Zitney, the director of the Headache & Pain Relief Centre in Toronto. You're not likely to have any nausea, and there won't be sensory sensitivity. "You can usually still watch TV or work at your computer, for example, through a tension headache," he explains.
Why they happen: Doctors used to think tension headaches were caused by too-tight muscles in the neck, shoulders, face and head, but experts now believe they might be due to inflammation of the lining and main nerve areas in the brain. "Some of the triggers can be similar to migraine triggers," says Dr. Farnaz Amoozegar, a neurologist in Calgary. These include stress, sleep and dietary factors.
Treatment options: Most tension headaches will go away on their own, but taking ibuprofen, acetaminophen or acetylsalicylic acid (Aspirin) can help. There are also preventive medications that can help reduce the frequency or severity of chronic tension headaches, ones that occur more than 15 days a month; your doctor might recommend a muscle relaxant or an antidepressant (amitriptyline and nortriptyline are a couple of the common forms), though the latter needs to be gradually increased and can take a few weeks to start working.
Headache type: Migraine
These headaches, which typically last four to 72 hours, are one of the most common in women—about one-quarter of us suffer from them, compared to about eight percent of men. The diagnostic criteria are very specific, says Dr. Sian Spacey, a neurologist, physician and director of The University of British Columbia's Headache Clinic in Vancouver. Patients must have two of the following characteristics: throbbing, moderate to severe pain, unilateral pain (on one side of your head) and pain that worsens with activity. They must also experience nausea and vomiting, or sensitivity to light and sound.
Why they happen: Frustratingly, it can be hard to pinpoint the cause, but it seems to be a mix of genetics and environmental factors. If you have a family history of migraines, you might be more prone to them. And there are common triggers, says Dr. Zitney. These include substances found in foods (MSG, nitrates and other preservatives, aspartame, alcohol and ca eine), lifestyle factors (skipping meals, dehydration and getting too much or too little sleep), weather changes, stress and fluctuating hormone levels thanks to our menstrual cycles.
Treatment options: Dr. Zitney recom-mends three stages of treatment. "The simplest and easiest thing to use is an anti-inflammatory," he says, adding that over-the-counter ibuprofen is a good option, as are prescription medications such as naproxen. If those don't o er relief, the second stage is triptans, migraine-specific medications that target pain at its source. "Migraine pain develops from a circuit of neuronal pathways and molecules in the brain,"says Dr. Amoozegar. "Once these path- ways were discovered, scientists began working on medications that specifically target them." There are seven triptans approved for use in Canada. They're available by prescription and come in oral, injectable and nasal-spray forms— but they're not an option if you have heart problems, as they can increase your risk of a serious cardiac event. You can also use a triptan and an anti-inflammatory in combination, as they approach pain in different ways. The last stage is a stronger painkiller, used sparingly—and only if you aren't at risk for addiction.
It's also worth asking your doctor about preventive meds, like antiseizure medication, beta-blockers and even Botox (which works by inhibiting the release of pain-related molecules). And if your menstrual cycle triggers migraines, you can also look into hormonal manipulation. "If it's safe for you to use the birth control pill or the hormonal IUD, you can fool your body into not having periods, which stops menstrual-related migraines," says Dr. Zitney.
Headache type: Medication-overuse
Formerly known as rebound headaches, these tend to occur in patients who have a high frequency of headaches and take a lot of painkillers, says Dr. Amoozegar. Folks who get migraines tend to be more prone to this type of headache, especially those who take medication for their migraines more often than they should.
Why they happen: It's the headache we cause ourselves due to regular, long-term use of painkillers, says Dr. Zitney. "If you take medications too often, they can turn around and bite you," he adds. "The head- aches start to come more often. Then, when the medication wears off, you have to take more, which brings on another headache. It's a pattern that's very hard to get out of once you're in it." As a general rule, it's OK to use medication (either over-the-counter or prescription) to treat headaches about 10 out of every 30 days. But if you find your-self using drugs more than 15 days out of the month for three consecutive months, see your doctor.
Treatment options: Education is key. "People need to know that their meds are the culprit," says Dr. Amoozegar. "Depending on what they're using, they need to gradually stop taking painkillers and start taking preventive medication." Beta-blockers and antiseizure medication aren't painkillers, but they can help reduce the frequency of migraines.
Headache type: Cluster
This is a rare, distinct type of headache. Cluster headaches are often seasonal or occur during the same time every year (or every couple of years). "These are shorter headaches that last from 15 minutes to three hours. They're unilateral and accompanied by symptoms like tearing, a droopy eyelid, a change in pupil size and nasal congestion on the side of the face where the pain is," says Dr. Spacey. This is the most severe type of headache you can get, and it's been dubbed the "suicide headache" because of the sufferers who have either committed suicide or thought about it during a cluster attack. Though they're more common in men than women, a 2012 study in the Journal of Neurological Sciences found that when women do get cluster headaches, they tend to have more daytime attacks and worse pain during nighttime attacks.
Why they happen: Causes haven't been pinpointed, but there's evidence that suggests abnormalities in the hypothalamus (the part of the brain that regulates sleep- wake cycles) could be part of the problem. Cluster headaches usually occur in the spring or fall, and triggers vary widely. Alcohol can worsen an attack.
Treatment options: Over-the-counter drugs won't make a dent in treating a cluster headache, nor will triptans (the attack is usually over before they kick in). For the drugs that do offer relief, opt for injections or nasal sprays, which are often faster acting. Giving the sufferer oxygen via a mask can also help some patients.
Headache type: Sinuses
You know those throbbing headaches where you also have a fever, a runny nose, congestion, an icky green discharge and pain in your face? That sounds like a sinus headache, says Dr. Amoozegar. But, she adds, they're often misdiagnosed. Many headaches that occur in the face are actually migraines; it can only be a sinus headache if you also have a sinus infection or another serious sinus issue.
Why they happen: Blame inflammation of the sinuses (a.k.a. sinus- itis), which is caused by anything that stops them from draining properly, such as a cold or flu, allergies or respiratory infections.
Treatment options: The first step is a visit to the doctor's office to confirm you have a sinus infection. If you do, you'll likely get a prescription for antibiotics. Ibuprofen, acetaminophen or acetylsalicylic acid can help ease the pain while you're waiting for the meds to kick in.
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Learn the basics of setting your dinner table with these helpful tips from The Marilyn Denis Show's Charles the Butler.
While fashion in table settings has changed over the centuries, affecting the flatware, glassware and china we use, the method of setting a table remains exactly the same.
This is the basic method I recommend:
1. Set just one place setting first. Don't try to set the entire table at once as there will only be more to undo if you don't like how it looks. Make sure the placement is correct and that you are happy with it.
2. Next, take the rest of the chargers or main course plates and place them around the table where you want to position all the other place settings. Keep the spacing between settings equidistant. Once they are properly positioned, organize utensils and glassware around them.
3. Check for symmetry. Why do we care so much about this? Because the human eye loves symmetry. When things are not symmetrical our eye sees imperfection. Use the butler stick (a specialized yard stick designed for precise place settings) for this!
The North American place setting
In this table setting, the glasses form a diamond shape above the cutlery, with the first glass placed directly above the main course knife (inside, right). The dessert spoon and the fork are at the top of the plate, and above them is the place card. Guests use the cutlery from the outside moving in. This place setting starts with a soup course (spoon, outside right), moves on to a salad (fork, outside left), a fish course (middle fork and knife) and a meat course (inside fork and knife).
The Asian place setting
In Asia, unlike the Western world, there is no standard for formal place settings at tables. In fact, the focus is on the food rather than the place setting. The diagram shows a typical place setting, but it can easily be changed to suit your needs without making any errors of etiquette.
Using a butler's stick
One of the first rules of formal table setting is the 24-inch rule. This refers to the ideal amount of space from the centre of one plate to the centre of the next plate, allowing each guest plenty of elbow room. You may need to decrease the distance if your table is not large enough to allow 24 inches between settings.
A trend in Asian table settings is to provide two sets of chopsticks: an inner set for personal use, and the outer set to be used by guests when helping themselves to communal food.
The ideal distance from the back of a chair to the edge of the table is also 24 inches. This allows guests to sit comfortably. A good butler will use his or her butler stick to take these two measurements.
Today, few people use butler sticks to set their daily dinner tables, and to be truthful, even the contemporary butler doesn't necessarily use the tool every day. But when there is a special occasion—such as an important family birthday or anniversary—the butler stick can be of use.
This is how a professional butler would set the dining table with a butler stick:
Align the bottom of the butler stick with the edge of the table. The baseline for a place setting should be about one inch from the edge of the table—the width of the butler stick.
Align all the cutlery, the plate and the napkin to touch the top of the butler stick. This will create the perfect straight edge for your place setting. The plate should be centred at the 0, the centre of the butler stick.
Ideally, place the first knife 1 to 1.5 inches away from the plate. Continue using this same metric for the rest of the cutlery so that it is all equidistant. You may choose to reduce the amount of space between items of cutlery if your table space is limited. What's important is to keep everything consistent.
As you move around the table creating each place setting, use the same measurements.
To help achieve a beautiful place setting, strive for accuracy, and horizontal and vertical symmetry.
Excerpted from The Pocket Butler: A Compact Guide to Modern Manners, Business Etiquette and Everyday Entertaining by Charles MacPherson. Copyright © 2015 Charles MacPherson. Illustrations courtesy of Charles MacPherson Academy Inc. Published by Appetite by Random House, a division of Random House of Canada Limited, a Penguin Random House Company. Reproduced by arrangement with the Publisher. All rights reserved.
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