Few afflictions are more common than headaches. Statistics (themselves the cause of many headaches) show that in the U.S., up to 50 million people go to the doctor for headaches annually.

They’re continuing an ancient tradition. Around 5000 B.C. in China, acupuncture was the treatment of choice. About 160 B.C., the Greek physician Galen recommended purging and bloodletting for headaches, advice followed by the Romans and medieval European doctors for centuries thereafter. Still, it could have been worse: in pre-Columbian Peru, the Incas drilled holes in the skull to release the evil spirits they thought caused headaches.

When your head hurts, it may feel some ancient shaman is drilling a hole in YOUR skull. Brain tissue itself can’t feel pain: the discomfort arises in the membranes lining the brain or in the nerves of the upper neck and cranium. The International Headache Society (sounds like a fun-loving bunch!) classifies headaches as either tension headaches, caused by muscle spasms, or vascular headaches, caused by the expansion of blood vessels in the head. Diseases such as meningitis can also cause headaches, but disease-related headaches make up only about two percent of headaches suffered.

Ninety percent are tension headaches, usually caused by stress, fatigue or too little (or too much) sleep, but also triggered by bad posture, teeth-grinding and even gum-chewing. Often the muscles in the upper neck feel knotted: it’s not known whether this causes the pain directly or whether the tight muscles bring on the headache by restricting. Recurring tension headaches can be a sign of depression: some people get headaches because they’re depressed, while some get depressed because they’re having headaches.

The most common vascular headaches are migraines and cluster headaches. The word “migraine” comes from the Greek, and means “half a skull”: migraines almost always occur on only one side of the head.

About one-third of migraine sufferers report zig-zag flashing lights, blind spots, numbness and distorted visual images before the onset of a migraine. These early warning signs, called an “aura,” are something I’ve experienced myself, though my headaches are very mild.

As someone susceptible to migraines, I’m in good company: migraine sufferers have included Thomas Jefferson, Sigmund Freud, Ulysses S. Grant, Karl Marx, Charles Darwin, Lewis Carroll and Virginia Woolf. Studies indicate that overachievers and women are particularly at risk. Migraines also seem to run in families.

Migraines can be triggered by stress, fatigue, changes in the weather, and foods such as cheese, alcohol and chocolate, all of which contain substances that affect the blood vessels. Severe cases can completely incapacitate the unfortunate victim, who may also suffer nausea and sensitivity to light and noise.

Cluster headaches most often occur in males. They’re short, severe attacks of pain centered over one eye that may recur in clusters, several times a day, for several months. The pain may go away, but return months or years later. Cluster headaches are sometimes misdiagnosed as a sinus disorder, because they’re usually accompanied by tearing, nasal congestion and a runny nose. As with most headaches, their cause isn’t clear.

I’d be remiss if I didn’t also mention the “ice-cream” headache, which many people get when they eat something cold. Although, again, the exact cause isn’t clear, the best guess is that the cold causes blood vessels in the roof of the mouth to contract, which dilates the vessels higher in the head, resulting in a headache.

For a long time doctors thought that migraine sufferers were most susceptible to ice-cream headaches, and that eating something cold could even trigger an attack. To test that, London Migraine Clinic researchers fed vanilla ice cream to 70 migraine patients and 50 medical students (my kind of study!) Only 17 percent of the migraine patients suffered a headache while 46 percent of the medical students did. So, migraine sufferers, enjoy that slurpee without fear!

Today, very few doctors prescribe drilling holes in your head to relieve your headache. (Here’s a hint: if your doctor has a selection of power tools in his office, change doctors.) Treatments range from over-the-counter painkillers to potent prescription drugs to massages, ice packs and heating pads to techniques such as relaxation training and biofeedback.

It’s fortunate, since they’re so common, that most headaches are insignificant. But just try telling that to someone who has one!

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