The most common headaches are classified as migraine or tension-type. The cause of headaches is not completely understood, especially why certain people have a higher predisposition toward getting them. Women are three times more likely to suffer from chronic headaches than men. Allergies are the most common triggering source for headaches. The second most common cause of headaches is a hormonal imbalance. An excess or deficiency, in almost every hormone, can be related to headaches. Hormones are what cause us to perceive pain. The hormones serotonin and histamine act as neurotransmitters and induce pain responses at nerve endings. Endorphins block these neurotransmitters and prevent the sensation of pain. An overproduction of prolactin has been linked to headaches. Too much or too little thyroid production has also caused headaches. The most common hormones associated with headaches in women are the sex hormones. Headaches are very common when sex hormones are fluctuating. They are common in puberty, perimenopause, menopause, and postpartum. They also are common in women on oral contraceptives and with women who suffer from PMS. Most cyclical headaches occur in women right before their menses or during their menses. Fluctuating estrogen levels are what is usually responsible for these headaches. It is the sudden drop in estrogen that is most symptomatic. Women experience a drop in estrogen prior to menses, and estrogen levels are at their lowest point during menstruation. Women on oral contraceptives make very little of their own estrogen, secondary to the high doses of synthetic hormones they are taking. I have found estradiol cream, balanced with progesterone, to be very effective in treating headaches. Every woman responds differently to her individual hormones, so the same treatment does not work on everyone.

Migraine headaches are classified as with or without aura. Migraines with aura have neurological components. Visual auras are the most common aura. Seeing bright light, usually in one eye, followed by obscured vision is the most common symptom. Numbness is the second most common aura, usually on one side of the face. Migraine headaches are secondary to vascular changes within the brain. To be classified as a migraine headache, certain other symptoms have to be associated with the headache. Symptoms of migraines are severe pulsating pain on one side of the head. Migraines are often initiated by exercise, and associated with nausea and photophobia. If none of these symptoms are present, then it is not a migraine headache. Migraines often have a heredity link. They can be triggered by changes in hormones, diet, sleep, and stress. Mild migraines at times will respond to over-the-counter aspirin, acetominophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDS), caffeine, or a combination of these drugs. The triptan drugs were a medical breakthrough in the treatment of migraine headaches. Sumatriptan (Imitrex) arrived in the U.S. in 1993. At first it was only available as an injection, and now it is available in a nasal spray and tablet. Now there are six other triptan drugs available: almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), and zolmitriptan (Zomig). They are available in tablet form and have different effectiveness and different half-lives. Axert, Repax, and Maxalt were shown to be the most successful from a meta-analysis of clinical studies. The above drugs are good at alleviating migraines once they set in, but there are other drugs that have been shown to be preventative. Propranolol, a beta-blocker commonly used to treat hypertension, has been shown to be a reliable migraine prophylactic. Depakote, an anti-epileptic drug, has also been successful. Amitriptyline, a tricyclic antidepressant, is reliable but it has a sedating effect. These drugs are usually taken daily by patients who have multiple recurrences monthly. Tension-type headaches can either be classified as episodic or chronic. Having more than 15 days per month of symptoms is described as chronic and less than this is episodic. These headaches are much milder than migraines and they do not prohibit activities. A dull, non-throbbing pain occurs on both sides of the head and nausea is not associated with them. Tightness in the scalp and neck is often associated with this type of headache. Photophobia may occur but much less often than with migraines. Unlike migraines, they are not exacerbated by exercise. Episodic tension-type headaches usually respond to the traditional over-the-counter analgesics described above. Chronic tension-type headaches also respond to these analgesics, but excessive abuse of these drugs can result in analgesic-abuse (rebound) headaches. Chronic headaches are best treated with a preventative medicine like amitriptyline. This drug does not completely eliminate the headache, but it will lessen its severity.

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