Solve the headache mystery: Play detective

Keep a diary and work with physician

Recurring headaches are a common health problem, with more than 45 million Americans suffering. Of this number, about 28 million have migraines annually.

For the millions who suffer from headaches, the most important thing they can do is to get a correct diagnosis, says Suzanne Simons, MS, executive director for the National Headache Foundation in Chicago. "That is a little more difficult than it sounds," she says. A study conducted by the foundation found that half of migraine sufferers are not diagnosed, and of those who are diagnosed, half are diagnosed incorrectly as having tension-type or sinus headaches.

To be properly diagnosed, people with recurring headaches should make an appointment with their physician specifically for headaches. They should never tag the complaint onto an office visit. "Don’t go in for an upper respiratory infection and say By the way, I have headaches,’" explains Simons.

To prepare for the appointment, keep a headache diary, she advises. It is important to write down how often headaches occur, where the pain is located, the intensity of the pain, and what precipitated the headache. People need to track what they ate and their emotional situation before the head-ache, says Simons. They also should track the medications they took, including how much was taken at what stage of the headache and how effective the medicine was at relieving the pain.

Often a pattern emerges on paper that people wouldn’t be aware of otherwise, says Simons. This information, along with a complete medical history, helps the physician in the diagnostic process such as determining what tests will be required.

"We advocate partnering with your health care provider, and that is important because it helps people become an informed health care consumer. They are educated about their condition," she says. If people are able to eliminate the headaches, or reduce the number or intensity, they have taken back some of the control over their lives and that is important, she says.

With the proper diagnosis, a physician can prescribe the right medication. A migraine sufferer may need preventive medication, acute medication, or both. For example, if a woman developed a migraine headache around the time of her menstrual cycle, she might be given a particular medication to take around this time of the month, says Simons.

"Once the medication has been determined, there are things that patients can do to help influence the number of headaches they do or don’t get," she says. For example, maintaining a regular wake/sleep cycle is helpful. If the alarm goes off at 6:30 a.m. Monday through Friday, then a migraine sufferer might benefit from getting up at the same time on the weekends. Eating nutritious meals at regularly scheduled times can be beneficial as well.

Relaxation techniques can decrease the intensity of headaches. "Different methods work for different people," says Simons. There are several methods a headache sufferer might try. These are a few suggested by the National Headache Foundation:

• Diaphragmatic breathing.

Breathing from the abdomen helps the lungs inflate, brings more oxygen into the bloodstream, and slows the heart rate. It has been known to lower tension levels. To master this technique, a person should lie on a firm surface placing his or her hand on the abdomen and focus on breathing from this area rather than the chest by watching the upward movement of the hand.

• Progressive muscle relaxation.

With this technique, a person tightens a group of muscles to a state of extreme tension for a few seconds and then relaxes them while focusing on releasing stress.

• Visualization.

When a headache develops, the sufferer can visualize being in a serene quiet place such as a hammock stretched between two trees near the ocean. This reduces stress.

• Meditation.

Learning to meditate or reach a calm state by focusing on inward silence and stillness can help the headache sufferer tune out the stress, which is causing the headache.

• Biofeedback.

With the aid of special equipment, people learn biofeedback techniques, which help them learn to read their body’s stress responses and counteract them.

• Exercise.

A walk or other form of exercise releases endorphins, which are the body’s natural painkillers.

• Massage.

Massaging the neck and shoulders can relieve tension. It’s important that people not self-medicate in an effort to reduce the intensity of headaches by taking prescription medications inappropriately or over-the-counter products in addition to what the health care provider prescribed, says Simons.

"Medications can cause rebound headaches if they are taken to excess, especially those that contain caffeine," she says.

Keeping a headache diary and working with a physician can bring the pain under control. How-ever, methods for preventing or controlling head-aches are very individual. What works for one person may not work for another. "People need to understand that it is not their fault if they can’t control headaches. Headaches are a legitimate biological disease," says Simons.


For more information about preventing headaches or controlling the intensity of the pain, contact:

  • Suzanne Simons, Executive Director, National Headache Foundation, 428 W. Saint James Place, Second Floor, Chicago, IL 60614-2750. Telephone: (800) 643-5552. Web site: