Jerome Burne and Dr. Thomas Stuttaford

If you have an occasional headache, aspirin and ibuprofen are useful treatments, but if taken more than twice a week, there is the risk that your headaches could become worse and more frequent (so-called rebound headaches). Other options for treating these, and migraines, include:

PINPOINT THE CAUSE

Regular headaches are often the result of a trigger — it could be your experience at work, a particular food or even a smell. Keep a diary of what you have been doing, where, and who was there before each attack. Common food triggers include processed meats, ripened cheeses, monosodium glutamate and nuts.Eighty per cent of people who think they have sinus headaches actually have migraine, according to a study published in the Archives of Internal Medicine. If you suffer from regular headaches, facial pain and congestion, migraine treatment may help — see www.headachequiz.com .

ACUPUNCTURE

A study published in the BMJ last year recommended that acupuncture should be available on the NHS to treat migraine. www.acupuncture.org.uk

CHANGE YOUR DIET

Riboflavin or vitamin B2 may help to protect against migraine. Those who took 400mg (the RDA is 1.6mg) found that after three months the frequency of attacks fell on average by 50 per cent , according to a study in the European Journal of Neurology.Caffeine may cause headaches: regular coffee drinkers are less likely to have headaches than occasional ones and some studies have shown that a single cup of strong coffee, which is a vasoconstrictor, can get rid of mild headaches (caused by sudden expansion of blood vessels). But caffeine is also regarded as the number one trigger.

HERBAL REMEDIES

Butterbur is used in Germany to treat migraines. Trials have shown that an extract of the root can reduce symptoms and attacks by 40 per cent. Butterbur is thought to work by reducing spasms in muscle tissues, including blood vessels. However, there are concerns about possible liver damage.Feverfew is an antiinflammatory that can ease pain and may reduce the severity, duration and frequency of migraine attacks.

STATIC MAGNETS

These iron-attracting magnets have long been used to treat pain, possibly by working on iron molecules in the blood to improve circulation. See www.nccam.nih.gov/health/magnet/magnet.htm#appendix3

BOTOX

An Ohio plastic surgeon found that the anti-wrinkle treatment also improved his patient’s migraines. Research has shown that patients who suffered a headache at least 15 days a month found that this fell to 4.2 a month if they had an injection shot every three months. Some clinics in the UK offer it.

PSYCHOTHERAPY

Suppressed anger, a lack of openness and sexual difficulties have all been linked with a raised risk for severe headaches.

RELAXATION TECHNIQUES

Various tension-reduction techniques such as progressive relaxation, a form of self-hypnosis known as autogenic training, and stress management, have all been shown to help with tension headaches.

MASSAGE AND MANIPULATION

Aromatherapy can help with headaches caused by blocked sinuses, colds and tension, according to research from Exeter University. One theory is that the oils affect the brain’s emotional centre. www.aromatherapy-regulation.org.uk

HIGH-TECH TREATMENTS

Transcranial magnetic stimulation (TMS) is at the high-tech end of migraine treatments. Last year Robert Fischell, a researcher at McMaster University Hospital in Ontario, Canada, announced that he had developed a gun-like device that “fired” magnetic pulses (known as TMS) into the brain, which prevented migraines in about 80 per cent of patients. He is now trying to produce a marketable device.

Another treatment involves implanting electrodes to deliver electrical pulses along nerves to the brain. This appears to “reset” the abnormal electrical firing that can trigger epilepsy and migraine. Other electromagnetic approaches, such as Tens machines, work by blocking the flow of pain messages. ()

Identifying your type of headache

Headaches are common and the doctor’s role is to separate the occasional one that has a sinister cause and needs immediate treatment from those that are part of everyday life. These include the many forms of migraine that require different treatment. Although not usually dangerous they are disabling. An even greater number are tiresome and upset the usual pattern of life without totally disrupting it, such as tension headaches.

The primary headaches include migraine (this is divided into five different types), tension headaches, cluster headaches and those that are caused by unassociated problems such as a cold, coughing, exertion, sex, etc. The secondary headaches are those that are the province of the neurologists or GP and are symptomatic of medical conditions including tumours and cerebral arterial disease that need treatment.

The diagnosis of headaches is dependent on a series of standard questions as well as clinical examination. Fortunately, such important causes as brain tumours or leaking blood vessels are so rare that most peoples’ worries are misplaced. It is said that 98 per cent of headaches severe enough to have prompted a doctor’s visit are caused by migraine, tension, or sinus problems.

However, cerebral tumours do occur and these may betray their presence by the headache being a new symptom that is present most days, but is gradually increasing in intensity and length. They tend to be worse in the mornings, after lying flat all night, so that the patient may wake with them.

The headaches last progressively longer. They are often associated with nausea or vomiting, alterations in vision, dizziness and changes in the sensation or strength of the limb or loss of balance. Personality changes are common. The most important type of headache from cerebral bleeding is the so-called thunderclap headache, usually described as “the worst headache I have ever had in my life”.

It is accompanied by dizziness, even loss of consciousness, neck pain and stiffness. In three cases out of four, it is associated with a bleeding aneurysm (weak patch) in an artery that needs urgent treatment.

Other forms of headache with important clinical significance are those related to temporal arteritis — inflammation of the arteries around the temporal area of the skull, the scalp and the artery leading to the eyes. The scalp will be very tender. Simple treatment within a few hours will save the patient’s sight.