Headaches are a pain, and not just for those who suffer them. More than £3 billion is lost to the UK economy through sick days and doctors’ visits because of headaches, and the problem is growing fast.
“They’re an epidemic of the 21st century: on any day of the week at least one patient in my waiting room will have come to see me about chronic headaches,” says Dr Carole Hungerford, a GP who has been researching the subject for 20 years and is the author of a new book, Headache.
She believes that stress and overwork are behind the explosion in numbers: “A lot of us are pushing ourselves to the limit and beyond. Many people are working too hard because they don’t want to lose their job. There’s also a social stigma, and sufferers are viewed with suspicion — a feeling that if I can work long hours and skip lunch, and still not develop a headache, why can’t others?”
The most common type of headache is the “tension-type” on the top of the head and neck, suffered by up to 80 per cent of us. But migraines — headaches on one side accompanied by photophobia and nausea — are also on the rise. “Seven or eight years ago, one in eight people suffered migraines; now it’s one in six,” says Dr Hungerford, who has practices in Sydney and rural New South Wales. “That’s a steep rise in a short time. What I think is happening is that we now have more of everything that matters to headaches — more stress, more food additives, more junk food, more perfume, more salt. All these factors are linked to migraine and headaches.” Even children are suffering: one study among 1,000 12 to 15-year-olds in Exeter found that one in five had a headache at least once a week. Again, researchers linked it to stress and anxiety.
When seeing a patient for headache, it’s vital to rule out serious conditions first. “I will check behind the eye to make sure I am not missing a brain tumour, and do a blood pressure check because high levels can cause headaches,” says Dr Hungerford. She’ll also check for subdural haematoma (a bleed on the brain) usually caused by a head injury that might have happened weeks before. “That’s why it’s so important to consult your GP if you have frequent headaches,” she says. “It’s foolhardy to treat yourself without first ensuring that the ‘migraine’ you are suffering from is not in fact a brain tumour.”
What’s causing your headache?
According to the International Headache Society, the “tension headache” is by far the most common kind, accounting for about 90 per cent of a GP’s headache workload. Unlike migraine, the pain occurs at the back of the neck, on top of the head and sometimes down into the forehead. “Patients often describe the pain as like a band, or in more severe cases a vice, and it’s usually accompanied by a stiff neck,” says Dr Hungerford. Poor posture, jaw clenching and chronic stress are considered triggers for a tension headache, which is defined as “episodic” when it happens at least twice a week but less than 15 days a month and “chronic” when it occurs more than 15 days a month for at least six months. “Quite often a patient will say: ‘It can’t be a stress headache – I’m not stressed.’ But dig deeper and you will usually find the source of the stress.” You will know if it’s a tension headache if it disappears as soon as you drink alcohol, she says. “That’s because the alcohol relaxes the head and neck muscles which are so important to the central nervous system. Alcohol is obviously a poor choice of treatment, so I advise my patients to try regular yoga, meditation and relaxation exercises. Some may have to make difficult choices about whether to give up a job that is causing them so much stress.”
Alcohol and coffee
Both have complicated relationships with headaches: it only takes a unit of alcohol to cure a stress headache but drinking too much will cause one – usually because of dehydration or because alcohol dilates the blood vessels, a known migraine and headache trigger. Some people get a headache after only one glass: red wine is a big offender. It’s likely these people are sensitive to chemicals in the drink such as tyramine. It’s largely genetic, says Dr Hungerford: “Some livers are better at processing chemicals than others.”
It’s similar with coffee: some people will get a headache and can’t sleep after one cup; others are unaffected. “Generally, coffee is unlikely to cause a headache; it’s when you miss your regular hit of caffeine that you are more likely to suffer one,” she says. “A lot of people will actually say their headache gets better when they drink a cola or coffee. It’s to do with the caffeine acting on the adenosine receptors in the brain.” The chemistry is complex, but essentially coffee stimulates nerve cells and also causes pain-relieving constriction of the brain’s blood vessels – the opposite of alcohol’s dilating (and headache-inducing) effect. That’s partly why many painkillers include caffeine.
Is it hereditory?
“Your family history is very important when it comes to headaches, especially migraines,” says Dr Hungerford. “There’s no one headache-causing gene, but those who have variations of a handful of particular genes are 8.6 times more likely to suffer migraine than those with a no-risk genetic profile.” One of the most important is MTHFR, located on chromosome 1, which essentially helps determine how the body deals with folic acid. Studies have shown that if you give those people high-strength folic acid supplements, plus vitamin B6 and B12, headaches become fewer. Another gene, ACE D, which helps the body’s balance of potassium and sodium, can mean a high-salt diet will give you a headache. “These genes have existed in the human genome for many thousands of years, probably with minimal impact, but modern life exposes them,” says Dr Hungerford. “The genes are the gun, but without bullets it cannot fire. Our lifestyle puts the bullets in the gun. If you have the ACE D it essentially makes you sensitive to salt, so that gene is telling you, please don’t use salt – certainly not the 10g that the average person eats per day.”
Too much processed food
A diet high in sodium (salt), bad fats and sugar — all present in processed and pre-prepared food — can cause headaches and migraine, particularly if you have the genes making you susceptible. “When we ate a primitive paleo diet we were getting all the minerals and vitamins we needed. Even two generations ago we were eating meat and three veg, some of which we’d grown ourselves. But now we’re eating ready meals and stirring in readymade sauces — and some essential nutrients, particularly potassium, magnesium and B vitamins, are missing or out of balance with sodium intake,” says Dr Hungerford. “This lack of balance is at the root of many headaches. I have seen more headache sufferers benefit from changing their diet than from any other single manipulation.”
An allergic reaction
Being allergic to certain foods may cause headaches (and more serious problems like anaphylaxis), but you don’t have to be allergic for a reaction to occur. A food intolerance or sensitivity can cause a headache up to several days later. The delayed reaction can make it harder to detect the offender. Dr Hungerford advises patients to try an elimination diet to find the trigger causing their headaches; this is best done with a nutritionist. Strip the diet back to its most basic state: grains, seeds, green vegetables but not legumes, oils and herbal tea, plain meat and fish with no sauce. After two weeks headache-free, start reintroducing foods one at a time. “I always say start with the thing you miss most, which for many is milk or cheese. If you get a humdinger of a headache after that you know what’s been causing it. Leave it four or five days to recover then reintroduce other foods, one at a time.” Studies show the most common food triggers are milk, wheat, egg, chocolate, citrus, peanuts, soy, tomato, yeast, mushrooms and additives.
Doctors call it “the Friday night headache” because it’s the one you get after a prolonged stressful period comes to an end. “The Friday night headache is very unfair but very common,” says Dr Hungerford. “All week you are dealing with huge pressures — deadlines, stress, long hours — and your body is marshalling all the adrenalin it can possibly find to help you through. Then on Friday night you can finally relax and the headache starts. It’s the withdrawal of adrenalin that is causing it. I often suggest to my patients that they get into the habit of doing relaxation exercises through the week to deal with the adrenalin, or try yoga to avoid it. Once you have it, all you can really do is sleep it off.”
Additives — especially monosodium glutamate
Some of us show little reaction to additives, but for others just a tiny amount of their trigger chemical can bring on a severe headache or, in the case of children, wild behaviour. “Food additives should have no role in the diet of a headache sufferer or a child with behavioural difficulties,” says Dr Hungerford, herself a former migraine sufferer. “MSG is the big one for headaches, plus yellow, red and green food colourings. I used to get a headache drinking some brands of Scotch and not others; it turned out it was the caramel colouring used in the darker whiskies that triggered the headaches. Now I can drink two or three standard nips of paler varieties and I’m fine.” Studies show that the worst offenders for headaches are monosodium glutamate (often called hydrolysed protein on the label), benzoic acid (a preservative, E210), tartrazine (yellow food colouring, E102) and sulphites (often used in preserving pre-packaged salads).
Grinding your teeth at night
“Even if a dentist knows nothing of someone’s history, they will often say, ‘I know this patient gets headaches,’ because of the state of their teeth – they’re worn down,” says Dr Hungerford. This can happen from repeated grinding, where the pressure exerted on the teeth can be 600 psi (pounds per square inch), compared to the 30-50 psi from eating. (In severe cases a dentist may recommend a brace to wear at night to prevent grinding.) But clenching your jaw repeatedly when stressed can produce levels of pressure which are almost as bad. “The pressure on the teeth will feed into the trigenimal nerve then up into the brain stem then into the headache centre to produce a headache.”
Too many painkillers
Painkillers may get rid of occasional headaches, but if taken regularly they can become the cause not the cure. It doesn’t much matter which drug you use (morphine derivatives are the worst, but paracetamol and ibuprofen can both cause dependency), the resulting headache is a sign that your body is craving another dose. You don’t even need to take them every day: even two to three times a week can cause a problem, maintains Dr Hungerford. The sign of a painkiller headache is that it’s worse when you wake up in the morning. “That’s when your body has been waiting longest for the drug. I’ve known patients who set the alarm for 4am so they can take their headache tablets to avoid the headache they think is coming.” It’s thought that the increase in children’s headaches may be in part down to over-use of infant formulas of paracetamol and ibuprofen; dependency headaches can begin after regular use over only two to three weeks. “These kinds of headaches are a huge problem for GPs. People often think drugs like paracetamol are fairly harmless, but of course they are not.”
Perfume and air fresheners
Headache sufferers are usually highly sensitive to smells and tastes; the theory goes that the odours we find offensive may be alerting us to harmful chemicals in the environment. “We’re living in a kind of petrochemical smog now,” says Dr Hungerford. “Perfume is everywhere; it’s becoming hard to avoid. Even bin liners and nappies are perfumed, and if you go into a hotel bathroom you’ll find an automatic air freshener on the wall firing out goodness knows what chemicals every 15 minutes. When you look at some of the ingredients common in air fresheners — formaldehyde, oxidants and sanitisers such as triethylene glycol — it’s little wonder they can give us headaches.”
Headache by Dr Carole Hungerford is published by Scribe at £14.99
Researchers at the University of Maastricht found that seven glasses of water (1.5 litres), regularly sipped through the day, were enough to ease the pain of most headache sufferers, even those suffering only mild pain.
Changing your lightbulbs
Energy-saving compact fluorescent lightbulbs can be a trigger for migraines in some people, says Dr Hungerford, even when the flicker is below the detectable threshold. Consider changing to LED lighting. And don’t have too many blue-white lights in the house because evening exposure can stop melatonin production, essential to a good night’s sleep. Go for soft, yellow-toned lighting in rooms you use during the evening and in bedrooms, she advises.
This may work both for both migraine and stress headache sufferers. A small study this month in North Carolina showed that regular yoga and meditation cut the severity and frequency of migraines. “I often recommend yoga to my patients, even if we are not sure exactly why it works,” says Dr Hungerford. “Meditation and yoga are recognised as having neuromodulatory effects, even by hardline advocates of Western medicine. Yoga can also bring down blood pressure, which can cause headaches.”
If you are one of those people with a well-developed sense of smell who reacts strongly to certain perfumes, it’s possible that perfume is causing your headache, especially if you use it every day. Dr Hungerford advises giving it up for two weeks and monitoring the effect. Also experiment with perfume-free deodorant, cosmetics and sanitary products, and avoid using air fresheners. “When I advise my female patients to give up their daily perfume it’s amazing how often their headaches stop.”
Taking small pockets of time to relax throughout the week can prevent those Friday night stress headaches. The method doesn’t much matter, says Dr Hungerford, as it will vary from person to person. Popular ones include prayer, listening to music, hypnosis, tai chi and artistic or craft work.
Studies have shown that massage of the cranial and cervical muscles in the neck and head gives effective relief from chronic tension headaches. One study found that eight 30-minute sessions from a qualified massage therapist over four weeks cut the frequency and duration of the headaches within a week of the trial starting. Neck pain was still reduced six months later.
Taking a magnesium supplement
“Anyone with frequent headaches should be taking a magnesium supplement,” says Dr Hungerford. “An ancient, healthy diet contained high doses of magnesium but today’s diets are hugely deficient in them, so a balance needs to be restored. The glial cells, the housekeepers in the health of brain cells, need magnesium to maintain their normal potassium balance.” Foods high in magnesium include spinach, brown rice, nuts, fish, meat and wholegrains.
Forget the old excuse of “Not tonight, I’ve got a headache” because scientists at the University of Munster discovered that sex could be more effective than painkillers in curing migraine. One in five was left with no pain at all. Researchers speculated it could be because sex triggered the release of endorphins, the body’s natural painkillers.
Giving up cured meat
Many people report headaches after eating cured meats like ham, bacon and salami. The so-called “hot dog headache” is usually accompanied by facial flushing within half an hour of eating. It’s thought to be caused by the nitrites in cured meat (which are also linked to gastrointestinal cancers) which dilate the blood vessels.
What the doctor says
It’s estimated that six million adults in Britain get migraines; every day 200,000 people will have one. Contrary to popular opinion, your headache can still be classified as a migraine if you don’t see flashing lights (known as aura). A migraine is defined as a unilateral headache (one side or the other), along with sensitivity to light and vomiting/nausea. It can occur with aura or without.
Children can also get migraines, but they are less likely to complain of a headache (half of all migraine sufferers have their first attack before the age of 12; 20 per cent before five). “A child who complains of a sore tummy, or goes through bouts of vomiting for which there is no obvious cause, is often suffering from ‘atypical’ migraine,” says Dr Hungerford. “We need to ask, could this be early migraine?”
Recent research has emphasised the importance of genes in migraine. The key ones are MTHFR (those affected were found to be helped by taking B6, B12 and folic acid in recent Australian research); MTRR; ESR1 and PGR (linked to women’s hormonal migraine) plus EAAT2 (which may make some people more susceptible to glutamates in food).
“The advances in genetics and migraines is hugely exciting,” says Dr Hungerford. “After being plagued by migraines for many years I had a gene test done, and discovered that I was designer-made to experience migraine. Nowadays if I saw anyone with genes like these, I would recommend adequate vitamin D levels, vitamin B12, natural folic acid, vitamin B6 and magnesium.” She has found many migraine sufferers can lessen the frequency and duration of headaches with alterations to their diet. “Very often people will lose their migraine once they remove milk or wheat. It amazes me how quickly people work out what is causing their headache.”