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Fifty million of us are gripped by chronic headaches. Yet most of us could get relief if our pain was identified correctly. Migraines, for example, are misdiagnosed more often than not by general physicians, according to the National Institutes of Health.

Putting a name to the pain might seem secondary when your head is pounding like a lead-filled maraca, yet knowing the difference between, say, a sinus problem and a cluster headache makes treatment a surer thing. It might help to avoid all possible headache triggers, but a life without stress, tension, anxiety, alcohol, hunger, dehydration, exertion, poor sleep, bright lights, dairy products, preserved foods, sex, and genetic predispositions might be tough to arrange.

To help us out, the International Headache Society has a new classification system that will more accurately pinpoint which type of headache is behind your misery. "There will now be worldwide agreement among specialists," says Robert B. Daroff, president of the American Headache Society. "And that will help patients."

People can help themselves, too. While there are serious drugs for serious head pain, "much of what you can do to control headaches is in your own hands," says David Buchholz, M.D., associate professor of neurology at Johns Hopkins University in Baltimore.

relieve your headache

the migraine quiz

More than half of headache sufferers have migraines that aren't being treated as such. How do you know if your headache is actually a migraine? Doctors at the American Academy of Neurology designed the quiz by asking 443 random headache patients to answer a survey. An analysis of the answers revealed that three questions best predicted a migraine diagnosis. If you answer yes to two out of three of these questions, your headaches are probably migraines.

1. Has a headache limited your activities for a day or more in the last three months?

2. Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

rebound headaches

There was a time, recalls 33-year-old Sarah Smith (not her real name), when she would take over-the-counter pain medications several times a week for headaches. "Then I switched to a prescription drug," she recalls, "but I got little relief. I'd still wake up every morning with a headache."

Smith suffered for several years before finding a doctor who accurately diagnosed her rebound headache, one that recurs shortly after treatment. Experts believe that this common type of head pain is caused by several years of using headache medications, especially painkillers and sinus medications containing caffeine.

The cycle works like this: Blood vessels swell with a headache, drugs reduce the swelling, the drugs wear off and the vessels swell again to an even greater degree.

To stop the medication-pain cycle, cease using all caffeine-containing medications, says Buchholz, author of Heal Your Headache: The 1, 2, 3 Program for Taking Charge of Your Pain. At the same time, try to identify and eliminate headache triggers. Your headaches may worsen temporarily, but the idea is to endure short-term suffering to break the rebound habit.

Smith tried Buchholz's suggestions on giving up substances that triggered her headache, such as chocolate, caffeine, cheese and alcohol. And she made a point of not becoming overly tired or stressed. "It's difficult in the beginning" to avoid triggers and not take pain medication containing caffeine, she says. "But you get used to it. And it's worth it."

3 natural remedies to try

Natural substances that have had some success against headache include homeopathic remedies, vitamins, minerals and herbs. Some common ones include:

1. Nux vomica.

A homeopathic remedy from the Strychnos nux-vomica evergreen tree, it's best known for treating hangover headaches. Doses typically range from 0.02 grams to 1 gram in a tablet allowed to dissolve under the tongue.

2. The combination of vitamin [B.sub.2], magnesium and feverfew. All three substances have mechanisms of action that may reduce headache frequency. Magnesium relaxes blood vessels, while vitamin [B.sub.2] assists in nerve-cell functions and feverfew helps the body use the brain chemical serotonin more effectively. They may work best together, and herbal formulas that mix them are available. Typical combinations offer 400 mg of vitamin B2, 600 mg of magnesium, and 100 to 300 mg of feverfew.

3. Butterbur.

According to a study in the journal Headache, this herb helped reduce the frequency and severity of migraines. A 50 mg pill taken twice daily is thought to reduce muscle and blood-vessel spasms. It is most often recommended for prevention, not after a headache begins.

foul-weather headaches

You may wonder why you notice a headache brewing whenever a storm is on the horizon. Doctors aren't sure why it happens, but various types of weather--especially barometric and temperature fluctuations and extreme conditions like high humidity--can cause headaches in some people. According to a 2001 study from the New England Center for Headache, about 50 percent of migraine sufferers are sensitive to changes in the weather.

prescription drugs to prevent Headache

Some drugs you wouldn't think of for headaches can work quite well for prevention, experts say. The medications include:

* Calcium channel blockers. Typically used to lower blood pressure, these drugs (Calan, Isoptin, Cardizem) can prevent headaches by increasing levels of the brain chemical serotonin.

* Antidepressants, like Elavil and Pamelor, work by altering certain brain chemicals, such as serotonin, that nerves use to communicate.

* Anticonvulsants, such as Depakote and Topamax, suppress electrical activity in the brain's nerve cells.

* Beta blockers, normally used to treat abnormal heart rhythms, can effectively prevent some headaches. Brands include Inderal and Lopressor.

* Continuous birth-control pills. Taking a low-dose pill regularly for up to three months can reduce menstrual migraine--headaches brought on by hormonal changes. Seasonale is the first FDA-approved continuous contraceptive pill.

stopping migraine before it gets a head start

When triptans were approved a decade ago, they were heralded as a miracle drug for migraine sufferers. Taken at the first sign of an attack, triptans prevent the headache from developing. There are now seven migraine-busting triptans on the market (Imitrex, Zomig, Amerge, Maxalt, Axert, Frova and Relpax) that can be taken in many different forms, from nasal sprays to injections.

70% of migraine sufferers are women. They are also more likely to have tension headaches.

90% of people who suffer from cluster headache--a mysterious, intense headache of unknown cause--are men.

pressure points

Gentle but firm pressure for a minute or two on the indentations on either side of the neck, where it meets the skull, is said to cause the release of pain-relieving endorphins. Massaging the point in the fleshy web between the thumb and the forefinger is also thought to relieve headache.

biofeedback help

Headache specialists don't recommend learning to do biofeedback on your own, even though portable equipment is available. To find a professional to work with you to get control of your pain, contact a headache clinic, the Association for Applied Psychophysiology and Biofeedback (aapb.org) or the Biofeedback Certification Institute of American (bcia.org).

less stress, less pain

The National Institute of Neurological Disorders and Stroke has found that stress reduction is as effective as an antidepressant in preventing chronic tension headaches. And a recent expert review of alternative medical therapies by the National Headache Foundation concluded that massage, biofeedback, imagery, acupressure and acupuncture may be helpful for headache prevention.

hangover headache

what works

* Fluids containing salt and minerals, such as sports drinks or chicken broth, enhance hydration.

* Honey or tomato juice can help metabolize alcohol.

* Ibuprofen reduces pain.

* Caffeinated coffee eases dilated blood vessels.

what doesn't

* Over-the-counter hangover remedies, many of which haven't been tested.

* Beta blockers, like propranolol.

* Hair of the dog (i.e., more alcohol).

* Avoiding food,

COPYRIGHT 2004 Weider Publications
COPYRIGHT 2004 Gale Group