One of the conditions causing people great discomfort is the headache. Some headaches may be the result of injury or brain disease, but most are caused by distress, tension, anxiety, and environmental factors. Tension headaches are the most common. Caused by involuntary contractions of the scalp, head, and neck muscles, tension headaches may be precipitated by anxiety, stress, and allergic reactions. Tension headaches can often be relieved by massaging the scalp and muscles in the neck. Aspirin or other pain relievers usually alleviate tension headaches.

Migraine headaches are characterized by throbbing pain that can last for hours or even days. Nausea and vomiting occasionally occur. Migraines seem to be initiated by stress and range from mild to severe. The exact cause of migraines is unknown, but most experts believe that chemical disturbances in the brain are responsible. An abnormal drop in serotonin (a brain chemical that regulates blood vessel changes and controls pain) causes blood vessels near the surface of the brain to dilate, prompting nerve sensations that are perceived as pain. People who experience migraines may have advance warning symptoms, such as dizziness, sensitivity to flashing lights, the appearance of a blind spot, and an indescribable feeling that a headache is coming.

Cluster headaches usually cause a knifelike pain behind the eye that quickly spreads to the forehead. The pain can spread to the neck, back of the head, and even into the teeth. The nose often runs, and the involved eye tears. The pain is often described as one of the worst pains a person can endure.

Cluster headaches get their name because they occur in clusters, at least one each day and sometimes several attacks daily. The attacks begin suddenly and may last from several minutes to several hours. In extreme cases they may last a few weeks or several months. Individuals may be symptom free for weeks or months. The cause of cluster headaches is unknown, but they also appear to be related to arterial constriction and dilation.

A wide range of environmental factors may trigger headache pain. Exposure to smoke (including second-hand smoke), carbon monoxide (automobile exhaust, defective furnaces), alcohol, caffeine, and/or certain foods causes headaches in many people. Alcohol causes blood vessels to dilate, adding blood flow to irritated nerve endings. Caffeine in small amounts may help relieve headache pain by constricting blood vessels; in larger quantities (more than two cups), blood vessels dilate, which may lead to rebound headaches. Heavy coffee drinkers may experience withdrawal headaches if they try to cut out caffeine cold turkey. A progressive reduction in caffeine over the course of a week or two should serve as an appropriate acclimatization. Food triggers are most likely to be those containing amines. Amines cause blood vessels to constrict and dilate. Common dietary sources include aged cheeses, red wine, citrus fruits, and chocolates. Food additives, such as nitrates in hot dogs, smoked foods, and cold cuts, and flavor enhancers, such as monosodium glutamate (MSG), are often accused of provoking headaches.

Many illnesses can cause a headache. Sinusitis, teeth and gum problems, high blood pressure, hypothyroidism, acute anemia, Cushing’s disease, and Addison’s disease are common offenders. A complete physical exam can help identify specific medical causes. A headache should be evaluated by a physician if it is chronic, associated with a fever, accompanied by numbness or paralysis, associated with a stiff neck, interferes with thinking or memory, and/ or continues to get progressively worse.

Treatment of headache pain includes a full gamut of interventions. Techniques such as deep breathing, progressive relaxation, biofeedback, meditation, and visualization seem to help relieve the pain in some sufferers. Others stand to benefit from recently developed prescription drugs, such as sumatriptan and dihydroergotamine mesylate (DHE), which are designed to stop immediately a full-blown migraine headache. New drugs that block headache pain without negatively affecting other parts of the body are in the final stages of testing and could become available in the near future.