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A headache is the most common complaint known to mankind. But there are several types and many different triggers. How can you tell what sort of headache you've got, and what can you do to relieve it?

Headaches are among the most common reasons for patients to consult their doctor. In fact, only one person in 50 can claim never to have had a headache in their life. For most of us, a headache is gone in a few hours, but some people suffer pain frequently - even daily.

There are a number of different types of headache, and most of the recurrent ones are either migraine, tension headaches - half of all adults get these at some time - or cluster headaches. Statistics show that women suffer more than men from all types of headache, and get three times more migraines.

Although doctors know headaches arise from a chain reaction involving nerve pathways and the blood supply to and from the brain, the precise mechanism is unknown.

The pain does not come from the brain, but is thought to be caused by the constriction of blood vessels surrounding the brain or by tension in the scalp and muscles.

Neurologists suspect that the constriction of blood vessels is caused by an imbalance in brain chemistry - a result of neurotransmitter activity. Neurotransmitters are chemical substances, similar to hormones, which act on the brain and aid communication throughout the nervous system.

Medical research into headaches has focused on one called serotonin, which has a narrowing effect on blood vessels.

Usually, it is not difficult to work out what caused a headache, for example a poor night's sleep, a row at home, or stress at work.

In many cases, your headache may be caused by one or more of several factors. The following list may enable you to determine what has triggered your headache.

Hunger: Low blood sugar can cause discomfort in the head which grows into a headache if no food is eaten. People who don't have breakfast may notice they develop a morning headache that disappears with their first snack. Crash dieters often have headaches because of low blood sugar.

Red wine, beer, brandy and whisky: These alcoholic beverages contain certain additives called congeners. Research indicates that congeners can trigger headaches in sensitive individuals, even if they haven't drunk very much.

Hangover: Too much alcohol (often combined with smoking) results in dehydration and poor quality sleep. It's the dehydration, not just the quantity of alcohol you've had, that causes the hangover headache the next morning.

Caffeine: Drinking less coffee, tea and cola than usual, or occasionally drinking more, for instance over the weekend or on holiday, can cause a thumping headache.

Sexual activity: Orgasm can be an unusual and distressing trigger for an intense headache. Pain at the back of the neck may also develop from arching the spine.

Environmental stress: Flickering fluorescent strip lighting or glare can interfere with natural brain activity and tire the eyes. Also, hot, stuffy, fume-filled or overcrowded rooms or excessive noise can trigger a raging headache.

Physical triggers: Simple actions such as wearing a too-tight hat or hair band, as well as physical conditions such as eye muscle disorders, eye strain, and toothache can all prompt a painful head.

The weather: People who are sensitive to climate may find they develop a headache just before a storm or in close, humid weather. Cold weather, particularly with a biting wind, can cause head muscles to contract and cause pain.

Cinema and television: Any activity that involves a fixed focus for long periods of time can cause head pain. For instance, many people come out of the cinema with a headache. You may find sitting further back from the screen helps.

Smoking: Heavy smoking and breathing other people's smoke can trigger a headache. And, if you're giving up smoking, you'll probably find you get headaches for the first couple of days.

Painkillers: It may seem odd that tablets taken to relieve a headache can cause another the next morning. But painkillers are thought to neutralize the body's naturally-occurring opiates (endorphins) which act as our own painkillers. People who take 30 or more aspirin, paracetamol or ibuprofen a month often suffer what are called analgesic headaches. A week off all drugs usually brings dramatic relief.

A really bad headache may make you wonder if you've got a brain tumour. However, the headache that is caused by a malignant growth is progressive, with a distinctly slow build-up. It's more severe in the morning, often preventing you from eating. Less than three per cent of brain tumours cause headaches at the time they're diagnosed.

Other very unusual causes of headache include brain haemorrhage and meningitis. A headache can also be a symptom of temporal arteritis, in which the arteries in the scalp over the temples become inflamed; shingles; Paget's disease, which affects the skulls of elderly people; or neuralgia (facial pain following the path of a nerve); but these are rare.

If you suffer from recurrent headaches, see your doctor. You might find it helpful to keep a note of your headaches, as he'll want to know all about them, for instance when and how often they occur, how long they last, and any other symptoms, for instance nausea or blurred vision. You'll probably be asked to describe the pain and what treatment you've been trying.

If a diagnosis cannot be made, you may be referred to a neurologist, who may want you to have a brain scan. Although brain scans will not usually show up any sign of a headache, they can indicate an underlying physical cause.

Most headaches respond to over-the-counter painkillers like aspirin, paracetamol and ibuprofen. You may find the soluble versions work more quickly to relieve pain, and are less harsh on the stomach.

In addition to a painkiller, tension headaches may require a muscle relaxant as well. These are only available on prescription from your doctor.

People who regularly suffer headaches can often find relief from alternative therapy. Acupuncture, aromatherapy, and manipulative techniques such as osteopathy and chiropractic have all been shown to help the pain of headache.


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