Last week we discussed the importance of avoiding aspartame and artificial sweeteners due to the numerous deleterious effects on our bodies. One of the issues we addressed was the potential for headaches due to the use of aspartame. However, this is only one of the myriad of triggers for headaches.

When addressing headaches, it is important to determine the characteristics of your headaches. It is crucial to understand dangerous vs. safe headaches. I use safe as a relative term, because all headaches are painful and significantly impact our quality of life, but not all headaches are indications that a serious issue is going on. Headaches have been classified by the most common constellation of symptoms that occur with each type.

To begin, we will discuss the headaches that require emergent attention.

HEADACHES DUE TO BLEEDING IN THE BRAIN
A sudden onset of a severe headache, often described as the worst headache of my life is concerning for possible bleeding in the brain. These headaches can be associated with nausea, vomiting, visual changes, neurological changes and/or changes in consciousness. Especially if these headaches occur after a trauma or head injury, it is imperative to go directly to the emergency room for imaging studies to evaluate for any bleeding in the head. In addition, if you have a family history of individuals having bleeding strokes, you should be evaluated promptly.

Another headache that, if chronic, requires attention is a headache that presents upon waking up. Infrequent morning headaches are not generally worrisome especially if you have a cause, like a sinus headache, significant tension/stress, or an illness. However, if you have chronic morning headaches, which actually get better throughout the day it is a good idea to have these headaches evaluated by a health care professional. Especially if the headaches are associated with progressive neurological symptoms such as, but not limited too, numbness, tingling, weakness, word finding difficulties, visual changes, balance issues, and decreased coordination.

Finally, any headaches associated with fever, chills, light sensitivity, and neck pain should be evaluated promptly as these can be indications of infections in the brain and/or spinal cord.

TENSION HEADACHES
The most common type of benign headaches are TENSION HEADACHES. These headaches can be described as band-like in nature. Typically, there is dull aching pain around the temples. Often there is tightness or pressure in the forehead, sides or back of the head. In addition, you may have tenderness in the shoulder and neck muscles and even the scalp. Generally these headaches are brought on by stress and alleviated with stress reduction and relaxation. Exercise can be helpful to relieve tension headaches.

CLUSTER HEADACHES
These headaches are much less common and not very well understood. It is hypothesized that they are related to blood flow in the brain. These headaches by definition occur in groups or clusters. These headaches are always located only on 1 side of the face. Usually, they present around the eye but can radiate to the jaw, temporal region or forehead. They can be associated with symptoms on the side of the headache, such as eye tearing, nasal congestion, sweating, eyelid drooping, and pupil changes. These headaches can be worsened by alcohol consumption during the time when they are occurring. In addition, cluster headaches are associated with heavy smoking. These headaches tend to occur in groups (ranging from 1 time every other day, up to 8 times per day, by definition) and there can be periods of remission. Cluster headaches are more difficult to treat and require physician supervision for treatment and prevention.

MIGRAINE HEADACHES
Migraine headaches can also be described as the worst headache of ones life and therefore can be confused with headaches due to bleeding in the brain. Typically, migraine suffers have had a series of migraines and are able to tell the difference. In general, migraines can occur with or without an aura. An aura is a constellation of symptoms which presents before the actually headache ensues. For example, an aura can be visual changes, sensory changes (such as smells, strange lights,) or hallucinations (confusing thoughts). Migraines can be associated with nausea, vomiting, visual changes and even neurological symptoms. In addition, migraines can be associated with hormonal changes. Like Cluster headaches, Migraine headaches should be managed by your health care professional.

SINUS HEADACHES
These headaches are associated with sinusitis, or an infection/inflammation of your sinuses. Typically these headaches are associated with facial pressure, pressure above your teeth, congestion, and post-nasal drip. Treatment of these headaches should be focused on treating the sinusitis.

So what can you do to help alleviate your headache intensity and frequency?

Monitor your diet, because often headache triggers include foods. The most common offender is dairy. This can be because dairy leads to sinus congestion. However, other foods, such as alcohol, gluten, chocolate, bananas, sugar and artificial sweeteners can be implicated causes for headaches.

If you suffer from chronic daily headaches, keep a food diary and rotate your foods. Sometimes, headaches can occur even 1-2 days after eating the offending food. Try to eliminate foods and then re-introduce one food at a time every 2-3 days to determine if your headaches return.

Daily exercise also helps to alleviate most headaches, though you can get an exercised induced headache if you do heavy lifting, heavy exertion, or especially if you are dehydrated.

A few tips for preventing headaches:

• Stay hydrated – drink lots of water and eat foods with a high water content such as cucumbers and watermelon
• Coffee can help with headaches, however, caffeine withdrawal headaches are often a common cause of headaches
• Foods rich in B vitamins, or the addition of a B complex vitamin to your diet can help prevent headaches. Both vitamin B2 and B3 deficiencies have been implicated in contributing to headaches
• Foods rich in omega-3 fatty acids help prevent headaches (salmon, flax seed)
• Bananas and foods rich in potassium are helpful for headache treatment and prevention
• Magnesium containing foods or supplements are helpful in treatment and prevention of headaches (quinoa, spinach)
• Co-Enzyme Q10 and Selenium have also been useful for treating headaches (speak to your doctor first before beginning these supplements).

As always, if you suffer from chronic daily headaches, address these with your healthcare provider for optimal treatment and prevention.