Lithonate

You know it's beginning to look a lot like Christmas when your forehead feels tighter than your belt.

Far too many of us can count on headaches during the holidays as surely as eating too much and not having enough batteries. Stores aglitter, children a-twitter, and parties a-plenty bring lots of joy--and pain.

An estimated 40 million people are known to get headaches, but that's really just a good guess, says Dr. Morris Levin, a neurologist and director of the Lahey Hitchcock Clinic Headache Center in Nashua, New Hampshire. "The vast bulk of the headache problem is hidden. You don't get much credit for complaining about a headache, so people take an aspirin and tough it out."

But you don't have to tough it out. There are solutions if you know what kind you've got. Just as there's no one source for headaches, there's no one type. Most common are tension, migraine, and cluster--each with its own symptoms, preventive measures, and treatments.

Tension headaches. The stress of extra time commitments and visiting family can often trigger tension headaches, caused by tightening of the muscles of the neck and scalp.

To avoid them, pare down your entertaining and decorating dreams and try not to overindulge in rich foods or alcohol, says Pamela Walker, a clinical psychologist at the Cooper Aerobics Center in Dallas. Reduce your after-hours workload by asking your spouse or kids to help wrap gifts, write cards, and cook.

Walker has found that Christmas shopping alone--in one day, early in the season--can reduce tension headaches for many of her clients.

So does daily exercise. "Exercise is the equivalent of letting your body do what stress prepares it to do, which is to move," she says. Exercise releases endorphins, the body's natural painkillers, while stretching loosens the muscles creating that vise around your forehead. A quick walk around the block for a breath of fresh air can help.

Relaxation techniques may also do the trick. Take a warm bath or simply stop what you're doing as soon as you feel a headache coming on, says Jim Spira, director of the Institute for Health Psychology in San Diego.

"Sit in a quiet place, dose your eyes, and focus on the moment. That way, you can calm your mind, reduce physiological stress, and increase the blood flow to the brain. This allows the headache to diminish."

A deep-tissue massage helped Ruth Quillian, whose holidays used to lead to one long headache. A few years ago her husband sent her to a professional massage therapist.

"The massage took care of the pain," says Ruth, a clinical health psychologist at the Duke University Center for Living. Now she schedules at least one massage during the holidays. "It makes a difference in my headaches for six weeks."

Once a tension headache has begun, take a nonsteroidal antiinflammatory, such as ibuprofen, acetaminophen, or naproxen. For added help, swallow it with a cup or two of coffee. Researchers at the Diamond Headache Clinic in Chicago found that the combination of 400 milligrams of ibuprofen and 200 milligrams of caffeine (about 2 cups of coffee) led to longer relief of tension headaches--four times as long as taking ibuprofen alone. Caffeine works with most analgesics to make them more powerful, says Dr. Seymour Diamond.

Migraines. These headaches arise from the swelling of blood vessels and tend to involve intense, throbbing pain on one side of the head. Migraines can last several hours to several days, and are often accompanied by vomiting and sensitivity to light and noise.

"Typically, patients have to go to bed in a quiet, dark room for a day or two," says Dr. Robert Kunkel, of The Cleveland Clinic.

At least one in five Americans--of which two-thirds are women--suffer migraines. They often strike at the onset of a menstrual period, due to dropping estrogen levels.

They're also common during holidays. "They used to be called `vacation' headaches because people would sleep late on weekends and get a migraine," says Jack Sandweiss, a research associate at the California Medical Clinic for Headaches in Encino. "They also strike after a stressful event when people relax."

Judy Madura's post-holiday migraines were as certain as credit card bills in January. But Judy, of Grayslake, Illinois, had her first pain-free Christmas last year after a strategic plan that included daily walks, shopping early, and getting help with holiday preparations.

She also learned to avoid foods high in nitrites, such as bacon, and tyramine in red wine, sharp cheese, and chocolate. Both substances can trigger a headache. Judy kept a diary to learn what affected her.

A new study by Loma Linda University shows that the fattiness of holiday meals may worsen migraines. Patients who ate a 10 percent fat diet (20 or fewer fat grams a day) for 12 weeks saw the length, frequency, and intensity of their migraines drop by about 70 percent. "Fat in the bloodstream damages platelets, which can lead to the serotonin loss in the brain that precipitates migraines," says lead researcher Dr. Zuzana Bic.

If you experience three or four migraines a month, Dr. Kunkel recommends asking your doctor about preventive medicines, including the epilepsy drug Depakote or bloodvessel-stabilizing beta-blockers and calcium channel blockers.

Women who get migraines around the time of their periods can temper the pain by taking ibuprofen, naproxen, or aspirin daily the week before menstruation. These pain relievers thwart the release of prostaglandins, which a woman's body produces before her period as the uterine lining sheds and blood vessels dilate.

You may shut a migraine down quickly just as it hits by getting arteries to contract with ice packs, cold baths, or caffeine, says Spiral Even taking four or five deep, slow breaths can make a difference, calming your heart and head. As you breathe in, let your stomach expand. Hold it for a second or two, then exhale slowly, focusing on relaxing your face, shoulders, and arms.

If these techniques don't lessen the pain, ask your doctor about Imitrex, a prescription drug that constricts blood vessels in your head. Imitrex is available in tablet, nasal spray, and injection form. For the few migraines that don't respond to Imitrex, other useful drugs include Midrin and lidocaine nose drops, a speedy anesthetic.

The future holds promise for faster and longer relief from new drugs such as Zomig, Migranal, Maxalt, or Amerge, says Dr. Alan Rapoport, director of The New England Center for Headache in Stamford, Connecticut. The drugs, all tablets except for Migranal, which is a nasal spray, are expected to be approved by the Food and Drug Administration in early 1998.

Cluster headaches. If you have one or more headaches every day for weeks and then go months without having one, you may be suffering from cluster headaches.

Caused by swelling blood vessels in the head, cluster headaches generally hit fast and hard, and almost always come from one side of the head. They can last 30 minutes to two hours and often wake people up in the middle of the night with pain around one eye. Almost all cluster headache sufferers are men, but experts don't know why.

"Cluster headaches are often so severe that many of these guys can't sit or lie still," Dr. Kunkel says. "They pace the floor."

Unfortunately, there's little you can do to prevent cluster headaches other than avoid alcohol and heavy smoking. Preventive drugs--such as cortisone, Calan (an angina medicine), and Lithonate (a mood-swing drug)--may provide relief. Imitrex also may help reduce the pain.

Many cluster sufferers get relief from breathing oxygen from a tank. It helps constrict blood vessels, stopping the pain within 10 minutes. Ask your doctor about it The best medicine, however, is time. The pain eventually does fade.

COPYRIGHT 1997 Meredith Corporation