The Foundation also reports that more than $4 billion is spent annually on over-the-counter pain relievers for headache and that 70% of all migraine sufferers are women.

Studies have reported that 5-10% of the population seeks medical aid for the relief of disabling headaches. A 2003 Marketdata Enterprises pain management programs study found that 8.6% of pain patients were treated for this condition (vs. 9.5% in 2001).

Types of Headaches

Headaches fall into three main categories: muscle contraction, vascular, and those organically caused.

Tension...  Stress, fatigue or hidden depression may act as catalysts. Some get tension headaches occasionally, while others experience them daily. Doctors may treat chronic tension headaches with anti-depressants or beta blockers.

Vascular headaches...  occur when blood vessels in the scalp expand and contract to produce a throbbing pain, often synchronized to the pulse. Migraine and cluster headaches are the most common type.

Migraine Headaches...  Currently, an estimated 28 million Americans suffer from migraine headaches (compared with 17 million in 1997, 11 million in 1993 and 5.6 million in 1980), and the rate of occurrence per 1,000 persons has risen, according to the National Center for Health Statistics.  The National Headache Foundation says that 70% of migraine sufferers are women, aged 15-45 most often. 

About 70% of migraine sufferers have a family history of the condition.  The majority of migraine sufferers are women in the stage of life between their first menses and menopause, when flux in hormonal levels is frequent.  The prevalence of migraine decreases with age, beginning in the 30s for males and in the late 40s for females.  This appears to result from the fact that new cases are not reported in later years.

This is a condition that is not only frequently misdiagnosed as sinus headache or some psychological problem, but often lands sufferers on a path of diagnostic testing, heavy medications, and folk remedies, with little result.  Even the criteria that physicians use to diagnose migraines may miss many patients who have unusual types of migraine.  Like back pain, the condition arises for different reasons in different people: heat or cold, changes in altitude, loud noises, bright lights, and menstrual periods are powerful triggers, for example (which explains why 75% of sufferers are women).  A growing number of neurologists believe that migraine is an inherited hypersensitivity in the brain to certain sights, sounds, smells, and other cues.

Black male migraine sufferers generally report more frequent severe headaches, but less frequent disability from their severe headaches than white males.  Diet, stress, and other factors associated with low income may also precipitate migraine attacks.  Females between the ages of 30 and 49 years from lower income households are at an especially high risk of having migraines and are more likely than other groups to use emergency care services for their acute condition. 

Cluster Headaches

Cluster headaches — which involve a stabbing pain on one side of the head — are relatively rare, affecting less than 1% of people, according to the Mayo Clinic. 85% of those affected by cluster headaches are men. Cluster headaches are much less common than migraines, but the pain is considerably worse.

Although a cluster headache can be temporarily debilitating, it causes no permanent harm. The condition doesn't cause complications or lead to other disorders. Treatments can't stop you from getting cluster headaches, but they can help decrease the severity of pain and shorten the duration of the headache.

Although the cause is unknown, research suggests that abnormal activity in the part of the brain called the hypothalamus may be the source of cluster headaches. The hypothalamus controls body functions such as eating, sleeping and sexual behavior, maintains body temperature and chemical balance, and regulates many hormones. The hypothalamus appears to be active during a cluster headache attack on the side of your head in which the pain occurs.

For patients with chronic cluster headaches, lithium or calcium channel blockers may be used. However, the medication of choice is methysergide (Sansert).  Histamine desensitization and surgical intervention may be considered for chronic cluster headache patients who have not responded to other forms of standard therapy.

 Headache Causes

According to headache specialists, headaches may have thousands of causes, the most common of which are tension and anxiety.  Migraines are generally hereditary conditions. Attacks last several minutes to several days.  People who suffer from them are unable to process a brain chemical called serotonin, which then causes migraine pain. Other causes include "trigger" foods and beverages, and erratic sleep and exercise patterns.

In addition, some types of aged foods such as cheese, yogurt, and some cured meats have been known to cause headaches.  Regular exercise helps most people to maintain good health and to avoid chronic headaches, but very strenuous physical exertion can actually have the opposite effect.

Treatment ranges from relaxation to the use of ice packs to analgesics and drugs that constrict blood vessels. To counter attacks, sufferers can take prescription medications such as: ergotamine (Cafergot), naproxen sodium (Anaprox), triptans, corticosteroids, and isometheptene (Midrin).  Other medications used include:  propranolol (Inderal LA), beta-blockers, antidepressants, anti-seizure drugs, and MAO-inhibitors, to prevent migraines from happening in the first place.  Some migraine sufferers may benefit from using biofeedback, which trains a person to control the muscle contraction and swelling of blood vessels that commonly cause the headaches.

According to the National Headache Foundation, important elements of treatment are the non-drug general measures recommended for the majority of migraine patients.  The patient should be cautioned about a diet restricting substances which may contribute to their headaches. (aged cheese, chocolate, hot dogs).

For the acute migraine attacks, certain abortive agents may be considered, such as the ergotamine preparations and sumatriptan.  The ergotamine preparations are available for several routes of administration (oral, rectal, and sublingual).  Dihydroergotamine (DHE) may be used for self-injection.

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