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Head Case

Live Better / November 2016

A headache can derail your plans and be a real pain in the you-know-what. Here’s our guide to the most common types and how to find relief

“More than 90 percent of the world knows what a headache feels like,” explains Dr. Christine Lay, director of the Centre for Headache at Toronto’s Women’s College Hospital. For anyone who often experiences headaches, know this: “There’s no such thing as a ‘regular’ headache and it’s not ‘normal’ to have recurring ones.” If you’re seeking treatment, it’s important you find the right kind.

TENSION HEADACHE
What it feels like: Officially called a “tension-type headache,” it feels just as it sounds: “It’s usually a dull squeezing sensation,” says Dr. Lori Montgomery, family doctor and medical director of the Chronic Pain Centre in Calgary. It’s more bothersome than painful and probably doesn’t impede your day too much.
Who gets them: Up to 70 percent of the population gets a periodic tension headache, making it the world’s most common type, so you’ll probably only make a trip to the waiting room if it’s affecting your daily life.
What causes it: Over the years, muscle tension, engorged blood vessels and even stress management have all been linked as possible causes, but nobody really knows. “If you did, you’d win a Nobel Prize!” says Dr. Montgomery.
How to deal: Lots of us will reach for Tylenol, but many tension headaches don’t require medication and will go away on their own. “Take a walk, have a nap, sip some tea and you’re probably fine,” says Dr. Lay. To prevent them from arriving in the first place, try breathing exercises and relaxation techniques, drink plenty of water and get the ergonomics at your work station checked.

MIGRAINE
What it feels like: Not always as bad as it sounds (see clusters, right), migraines are moderate to severe headaches with throbbing pain often accompanied with light or sound sensitivity and nausea that interfere with daily activities. Migraines tend to last between four and 72 hours.
Who gets them: Way more people than those who have been diagnosed experience migraines, says Dr. Montgomery. “We think around 20 percent of people get them, meaning they’re dramatically under-diagnosed.” Women are three times more likely to get migraines.
What causes it: Anyone with a genetic predisposition to migraines has “a threshold of how many triggers are tolerable before an attack,” says Dr. Montgomery. Some triggers are out of your control (like the weather) but most are absolutely in your power (like diet and sleep).
How to deal: See your doctor, who may refer you to a specialist. Then you’ve got two good options: “You can take acute meds for the individual attack or daily meds to prevent an attack, and always monitor your triggers,” says Dr. Werner Becker, a specialist at the Calgary Headache Assessment and Management Program. Red wine, processed meats and chocolate are common offenders.

CLUSTER HEADACHE
What it feels like: “Probably the most severe pain known to man,” says Dr. Becker. Clusters are on one side of the face and they come on fast and last less than three hours.
Who gets them: Less than 0.1 percent of the population, and they’re four times more common in men than women. They can run in families, however, and seem to be more prevalent among smokers. What causes it: Like tensions, no specific cause is known. Cluster sufferers often get eye pain, red (or droopy) eyes and tearing. But current research suggests the headaches arise in the hypothalamus, in the brain itself.
How to deal: Since the pain’s been called “worse than childbirth,” says Dr. Becker, you’ll likely need medication. A visit to your healthcare professional should help determine what the best course of action will be to manage your pain.

SINUS HEADACHE
What it feels like: This secondary headache—a symptom of another problem—is related to an infection in the sinuses. You’ll likely feel face pain rather than a headache.
Who gets them: Some people with a sinus infection may experience sinus headaches. But many people who think they have them are experiencing something else. “The pathway in the brain that causes migraines is also responsible for sinus headache. So if those pathways are fired off, they can result in a similar feeling in the sinus area,” says Dr. Montgomery. “If you think you get a lot of sinus headaches, you probably have migraines.”
What causes it: Sinusitis is most often a viral or bacterial infection, though allergies and air pollution can exacerbate the problem.
How to deal: If you’ve got a true infection caused by bacteria, you’ll likely need antibiotics. In the meantime, sit up (which tends to feel better than laying down), try a nasal aspirator to clear and soothe sinuses and, as always, stay hydrated.

REBOUND HEADACHE
What it feels like: “Medication-overuse headaches,” are dull and hangover-esque, and often arrive in the morning. “Then people pop another pill and do it all again,” says Dr. Lay.
Who gets them: “This is a problem mainly for migraine sufferers, who are prone to medicine overuse,” says Dr. Becker.
What causes it: Frequent use of painkillers (both prescription and over-the-counter) can leave the body in a state of withdrawal. Not only that, but taking the same type of pain killer for an extended period of time alters brain chemistry and changes the pain pathways. Even frequent use (more than twice a week) can cause rebounds.
How to deal: Talk to your doctor about reducing your medication. Hydration, healthy diet and exercise should get you through, but rebounds are no joke and may take a few weeks to alleviate.

Not sure which you have?
If you can’t describe your headaches, your doctor can’t help. “The helpfulness of keeping a headache diary cannot be overstated,” says Dr. Lay. It should mark your headaches, but also your menstrual cycle, the weather, what you ate and how you slept the nights before. “Track headaches for three months and you’ll know exactly how they behave and what causes them,” says Dr. Montgomery.