Headache Help (6 page)

COLD AND HEAT

Reusable ice packs or wrapped ice is probably the most consistently effective nondrug therapy for headache. Ice packs help the pain by reducing swollen blood vessels. Be sure that the ice doesn’t touch the skin directly but is wrapped with a layer of paper towel or a similar covering. Migraine Iceâ„¢ is a convenient method of using cold therapy.

Besides applying cold to the painful area, try placing it on the back of the neck, the top of the head, the forehead, temples, and so on. The earlier you use an ice pack to treat your headache, the better.

Heat (a very warm heating pad or a hot, wet washcloth) may be particularly useful during a headache to foster relaxation, increase blood flow, and relax your muscles.

Experiment to find out what feels good.

A COOL, DARK ROOM

Very often, simply taking a nap can give the brain an opportunity to get back to normal. Resting in the dark also helps because you may be particularly sensitive to light during a headache.

KEEPING A CALENDAR

So far, we’ve talked about ways to cope with a headache on the day it occurs. However, there are several strategies you can use to improve your headache situation in the long run. One of the most effective long-term strategies is to keep a headache worksheet, like the one shown here, for at least two months if you get frequent headaches. If you end up going to see a doctor, this will be an extremely valuable tool for assessment.

When filling in the “Trigger” column, consider the following list of triggers; they are listed in order of their importance and frequency among headache sufferers:

1. Stress
   
2. Weather changes
   
3. Hormonal changes: menstrual or premenstrual, birth control pills, pregnancy, menopause
   
4. Missed meal
   
5. Exposure to bright lights (particularly fluorescent or sun)
   
6. Lack of sleep
   
7. Foods eaten within twenty-four hours (check the list in Chapter 6)
   
8. Exposure to cigarette smoke
   
9. Exposure to perfumes or other odors 10. Letdown after stress xi. Too much sleep
   
10. Exercise or exertion
    
11. Seasonal change
    
12. Medications: oral contraceptives, etcetera.
    
13. Eyestrain
    
14. Travel by air, rail, car, bus
    

In the “Severity” column, enter a ranking from 1 to 10 using the following key:

PSYCHOTHERAPY AND STRESS MANAGEMENT

Although headaches are not psychological illnesses, there is little doubt that stress and anxiety can trigger the headache mechanisms that otherwise may have lain dormant and can turn a mild headache into a more severe one. Psychotherapy and stress management can teach coping skills to reduce stress. Hundreds of studies in the past decade have consistently acknowledged the power of an effective coping personality and an optimistic outlook on health. Learning how to cope and bounce back from a setback rather than imagining that it is a catastrophe really can reduce the negative effects of stress on your body and may even help you live a healthier and longer life.

E
NHANCING
C
OPING
S
KILLS

When you change your mind, you change your life. By changing negative attitudes and automatic, self-defeating thoughts, you can diminish stress and anxiety. You can learn to monitor negative or unproductive thoughts or behaviors and learn how to respond differently. For example, you may exaggerate a situation or imagine potential catastrophes. Thinking these thoughts makes you feel anxious, depressed, or out of control. Imagining the worst makes it difficult to concentrate on productive ways of dealing with the problem.

Learning to focus on the brighter side rather than the worst-case scenario can help you view the circumstances in perspective and prevent stress from building up.

You may want to read one of the excellent self-help books on cognitive therapy (such as
Feeling Good: The New Mood Therapy
by David D. Burns, M.D., and
Learned Optimism: How to Change Your Mind and Your Life
by Martin E. Seligman, Ph.D.) or consider working in short-term therapy with a cognitive, behavioral, or task-centered psychotherapist. These approaches, which challenge the way you think about things, can help you diminish your daily level of stress and therefore reduce the likelihood of triggering the headache response.

EXERCISE IN COPING SKILLS

INSTEAD OF THINKING THE WORST
:

“I think one of my awful and debilitating headaches is starting. That means I won’t get that report in on time, which will affect my performance evaluation and could even jeopardize my job! If I lose my job, I’ll never be able to pay the rent.”

TRY A POSITIVE THOUGHT
:

“My head is starting to hurt, but I know
1
can deal with it. I will practice my deep breathing and take a pain reliever. I just need to relax and I’m sure it will get better.”

INSTEAD OF THINKING THE WORST
:

“I’m all alone in this. Everyone thinks I’m a malingerer. No one is going to believe how awful I feel.”

TRY A POSITIVE THOUGHT
:

“Just because my daughter got angry that I couldn’t go to her soccer game again, I can’t jump to the conclusion that everyone’s giving up on me.”

INSTEAD OF THINKING THE WORST
:

“This pain is killing me. I can’t take it.”

TRY A POSITIVE THOUGHT
:

“This is a bad headache, but I must not panic. Relaxing will make it better. Remember to breathe deeply, in and out. Relax. The more I relax, the faster the pain will subside.”

By consciously avoiding the worst-case scenario and looking at the more realistic side, you can shift your point of view from feeling helpless and hopeless to feeling more in control and more resourceful. An important coping skill to learn is replacing automatic, self-defeating assumptions and interpretations with a more positive point of view.

HEADACHE HELP TIP: HELP YOURSELF!

Here are some tips to prevent headaches
:

• Avoid stressful situations if you can.
  
• Try taking herbs that help you stay calm (kava kava).
  
• Wear sunglasses when you are outdoors.
  
• Eat small meals or snacks throughout the day.
  
• Keep to a regular sleep schedule.
  
• Try to avoid foods that you think trigger your headaches.
  
• Exercise at least fifteen minutes a day.
  

PHYSICAL THERAPY AND CHIROPRACTIC THERAPY

In a recent poll of headache sufferers, physical therapy was identified as the most successful treatment after medications for helping headaches. Often, several sessions of learning about posture, exercise, neck stretches, position of the body throughout the day, and occupational hazards can be very worthwhile. For example, people who must bend their necks while on the phone all day often get one-sided headaches and neck pain.

Many people with headaches also have neck pain and increased muscle tension about the head. Chiropractic manipulation or physical therapy can be very helpful to relieve neck tightness and pain. Both of these treatments are discussed in more detail in Chapter 14.

COPING WITH STOMACH PROBLEMS

If you get frequent headaches, you might also have frequent stomach problems. Gastritis (irritation of the lining of the stomach), ulcers (eroding of the stomach wall), and esophageal reflux (too much acid backing up from the stomach into the esophagus, the tube leading from the mouth to the stomach) are all common problems that occur more frequently in people who get headaches. Often stomach problems are caused by aspirin-containing products and other NSAIDs (anti-inflammatories). Stress can also produce an upset stomach.

If you are taking aspirin-containing products or over-the-counter NSAIDs and are experiencing stomach pains, talk to your pharmacist, or better yet, your doctor about buffered products that can protect your stomach. If you have reflux (heartburn), avoid big meals late in the day and try an extra pillow at night to keep your head higher than your chest. Being overweight may aggravate your problem, since excess weight adds pressure from the stomach to the esophagus. Also, avoid coffee and, to a lesser extent, tea and carbonated drinks. Although caffeine should be limited to 200 mg per day or less, caffeine does not directly irritate the gastrointestinal (GI) tract; the coffee itself does that. Also, see if avoiding spicy foods and chocolate helps.

For stomach medications, most people rely on the H2 blockers. Over-the-counter products, including Tagamet (cimetidine), Zantac (ranitidine), Pepcid, and Axid, which is available by prescription, can settle an upset stomach. Tagamet and Zantac are available in generic form; all of these are safe and usually effective.

The stronger “proton pump inhibitors” are more effective for reflux; these include Prilosec, Prevacid, and Aciphex, which are effective but expensive. Prilosec, in particular, is extremely effective for reflux. However, there is some concern that these medications are too effective in removing unwanted stomach acid, possibly leading to gastric cancer. Discuss these medications with your doctor before you take them.

Also, you need to check with your doctor not only to choose the right medication, but also to determine the reason for the gastrointestinal pain or upset. Many people have
H. pylori
, a kind of bacteria, in their stomach, which is easy to test for and treat with antibiotics. The treatments and drugs in this area of medicine have shown vast improvements since the days of Maalox, Mylanta, or Turns every two hours.

COPING WITH SLEEP PROBLEMS

If you get frequent headaches, chances are you often have sleep problems as well. That’s because insomnia often coexists with headaches, probably because of inherited problems with serotonin regulation. If you do have sleep problems, here are some tips:

• Go to sleep only when sleepy.
  
• Get as much sleep as you need to feel refreshed and healthy, but not more. Curtailing the time in bed seems to solidify sleep; excessive time in bed seems to result in fragmented and shallow sleep.
  
• Set the alarm to get yourself up the same time every day to help you set your biological clock and circadian rhythms, which in turn can lead to a regular time of falling asleep in the evening.
  
• A steady, daily amount of exercise will probably deepen sleep; occasional exercise, however, does not necessarily improve sleep the following night.
  
• Occasional loud noises, such as aircraft flyovers or traffic, disturb sleep even in people who are not awakened by the noise and can’t remember it in the morning. Sound-proofed bedrooms may help you if you must sleep near noise. Sound machines that put out “white noise” can drown out outside noise.
  
• Although excessively warm rooms disturb sleep, there’s no evidence that an excessively cold room makes you sleep more soundly.
  
• Hunger can disturb your sleep; a light snack may improve your sleep.
  
• An occasional sleeping pill may help, but chronic use is ineffective in most insomniacs.
  
• Caffeine in the evening disturbs sleep even if you don’t realize it.
  
• Alcohol helps tense people fall asleep more easily, but the sleep that follows is fragmented.
  
• If you get angry and frustrated because you can’t sleep, don’t keep trying to fall asleep. Get up and do something else. Wait until you’re really sleepy before returning to bed. If sleep doesn’t come easily, get up and wait again. Repeat throughout the night as necessary.
  
• Use the bed only for sleeping and sex. Don’t read, watch TV, or eat in bed.
  
• The chronic use of tobacco disturbs sleep.
  
• Don’t nap during the day!
  
• Keep a night light on in the bathroom; bright lights will “wake up” your brain.
  
• Herbal supplements can be helpful (chamomile, valerian, kava kava, or a combination).