Stop your headaches: our three-part quiz reveals surprising ways to outsmart the pain—before it starts

Shape, Sept, 2005 by Alexa Joy Sherman

Georgina O'Hara's severe headaches began in 1998. At first, they only occurred every couple of months. But they gradually increased in frequency and after a year, the Philadelphia-based attorney experienced two headaches a week--some moderate, some more extreme--prompting her to see a neurologist. Prescriptions for a variety of triptans, a class of pain-abortive migraine drugs, followed. "They didn't work-or I'd have to take two or three [doses] before they did," recalls O'Hara, 35.

Soon she was waking up to moderate pain almost daily, which she'd self-medicate with Tylenol or Advil and lots of coffee. Because the attacks still weren't under control and were sometimes accompanied by decreased sensation on one side of O'Hara's body, a new neurologist prescribed a daily dose of verapamil--a calcium channel blocker available under a variety of brand names that helps prevent migraines but is more commonly used for blood pressure and heart conditions. That helped with the severity and frequency of the pain, but also exhausted O'Hara and prevented her from trying to become pregnant because of potential risks to a fetus.

So O'Hara sought the help of yet another neurologist--David Buchholz, M.D., an associate professor at Johns Hopkins University School of Medicine in Baltimore. He suggested that she eliminate all possible dietary triggers, including caffeinated beverages, wine and such surprising culprits as onions, certain citrus fruits and yogurt, and cut her verapamil dosage in half. "Within six months, I was off medication and my headaches were drastically reduced," O'Hara says. Now the mother of a baby boy, she's down to one or two headaches a month, if any, which are easily relieved with Advil or Tylenol.

A prevalence of pain

O'Hara's story is not uncommon: According to the American Council for Headache Education (ACHE), the patient-information arm of the American Headache Society in Mount Royal, N.J., approximately 90 percent of Americans experience at least one headache annually. Of those, 25-30 million people (75 percent of them women) are believed to suffer from migraines--described as severe, throbbing headaches on one side of the head, often accompanied by nausea or vomiting, sensitivity to light and/or sound and other extreme symptoms like sensory "auras" (i.e., flashing lights, tingling or numb hands and feet).

However, because people often have mixed headache patterns, some experts argue that labels such as migraine and tension are misleading and unnecessary. In their view, a tension headache is really just a mild migraine. It certainly appears that tension and migraine headaches, the two most common forms, behave in similar manners. Tension-type headaches were once thought to result from muscle contractions in the head and neck area. Along with migraines, they're now believed to be caused by a variety of triggers, including stress or certain foods that cause changes in brain chemistry and can lead to the painful constriction and expansion of blood vessels in the head. The bottom line: If most headaches--from mild to severe--are triggered and experienced in similar ways, most of them can potentially be prevented and treated in similar ways.

Hope for all headaches

If your pain is infrequent, managing it with over-the-counter (OTC) medication is probably easy enough. But even then, as with more severe cases, understanding how your pain is triggered can help you avoid headaches altogether, says Buchholz, author of Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain (Workman Publishing, 2002). Our three-part quiz, based on Buchholz's book, might just help you to uncover clues about your pain--and find solutions.

Part 1: Your medication MO

Mark each of the following statements as true or false.

* I take some type of medication for mild or moderate headaches at least twice a week.

True

False

* I take some type of medication for severe headaches at least twice a month.

True

False

* My headaches return as soon as my medication wears off, at which point I take more.

True

False

* Medication no longer works on my headaches.

True

False

* I frequently have a headache when I wake up in the morning.

True

False

* I usually consume caffeine to help squelch my headaches.

True

False

If you answered "true" to one or more questions above, see the discussion below. Otherwise, proceed to Part 2.

According to the London-based International Headache Society (IHS)--a group of physicians and health professionals devoted to the study of headaches--a substantial percentage of headache sufferers overuse medication, in some cases causing chronic daily headache syndrome, also known as "rebound" headaches. Rebound-causing OTC drugs include decongestants (Sudafed, Tylenol Sinus) and nonsteroidal anti-inflammatory drugs (NSAIDs) that contain caffeine (Excedrin, Anacin). Prescription drugs that can cause rebound include opioids and similar drugs (Tylenol with codeine, Percocet), butalbital compounds (Fiorinal, Fioricet), isometheptene compounds (Midrin), ergotamines (Ergomar, Wigraine) and triptans (Imitrex, Maxalt).