Last updated: Jan 29, 2008
Youve been staring at the computer for hours. Youve worked late all week and have in-laws coming this weekend. You have a raging case of PMS. Eyestrain, stress, and hormonal shifts are fairly common causes of headaches, which afflict 45 million Americans (most of them women). But sometimes the usual suspects dont explain that pain in your head. Thats because some triggers are just plain weird—like perfume, storms, earrings … or even orgasms. Heres how to identify the source of your headache so you can send it packing.


Perfume
“Strong scents bother me instantly,” says Bethany Hegedus, 35, a writer and receptionist from Brooklyn, New York. She can get a headache from a whiff of Lovely by Sarah Jessica Parker or a stroll past a Yankee Candle. Her sense of smell is so acute that she can sniff out whether a co-worker has changed laundry detergents or hand lotions, a degree of sensitivity common among scent-driven headache sufferers. The headaches can be fleeting if exposure is brief—or they can last all day.

Why it hurts: Strong odors may activate the noses nerve cells, which stimulate the nerve system associated with head pain. Ironically, the offending scents are often pleasant, says Vincent Martin, MD, a headache specialist at the University of Cincinnati College of Medicine.

What to do: Avoid perfumes, strong household cleansers, fragranced soaps and shampoos, and air fresheners. Thats a challenge when just about everything these days is “Clothesline Clean” or “Citrus Fresh,” but Hegedus does her best with unscented laundry detergent and deodorant, and wears no fragrances. At the office, she politely asks colleagues not to wear heavy perfumes. And if all else fails? “I keep a bottle of Excedrin Extra Strength at my desk,” she says.

That remedy has aspirin, acetaminophen, and caffeine, a combination endorsed by several medical organizations for migraine and tension headaches. However, you might want to try aspirin or acetaminophen individually rather than mixed together with caffeine, says Andrew Charles, MD, director of the Headache Research and Treatment Center at the University of Calofirnia, Los Angeles, School of Medicine.

Frequent use of medicines with caffeine can lead to dependency and “rebound” headaches, the kind that come right back as soon as the meds wear off. Aspirin, ibuprofen, and naproxen treat pain and the inflammation often associated with headaches. Acetaminophen fights pain, but not inflammation. (Another caveat: If over-the-counter meds dont help, a trip to the neurologist may be needed, Martin says.)


Weather
Studies show that the headache-prone are especially attuned to changes in barometric pressure, rising temperatures, high humidity, lightning, and cloudy skies. Rebecca Kinney, a 31-year-old librarian from Newton, Massachusetts, calls herself a human barometer. Gray skies and rain-on-the-way trigger excruciating pain. “The headache is usually on one side of my head, and it pulsates, as if someone is drilling into me,” she says.

Why it hurts: The meteorological shifts are thought to trigger chemical and electrical changes in the brain that irritate nerves—sometimes causing fairly dramatic pain. In fact, “50 to 60 percent of migraine patients will identify a weather change as the trigger for their headaches,” Martin says.

What to do: On bad-weather days, Kinney puts an ice compress on her eyes in the morning. “Sometimes I can catch the headache before it gets worse,” she says. Another trick: Record your symptoms and the weather to piece together patterns. Then check out the “Aches and Pains” forecast on Weather.com; it breaks down how the day is dawning in terms of temperature, barometric pressure, and wind patterns. Pretreat with 400 milligrams of ibuprofen a day or two before expected weather changes, says Mark W. Green, MD, director of headache medicine at Columbia University. (Naproxen or aspirin may work, as well.)

Earrings, headbands, and ponytails
Some people say the roots of their hair hurt when they get a headache. Kinney describes it as a “hair cramp.” Other women swear that their earrings can lead to head pain. And theyre all … correct!

Why it hurts: The muscle groups around your scalp dont have pain fibers, but their connective tissues do. “Ponytail headaches” result when tightly pulled hair irritates the muscle system. And your swingy up-do isnt the only thing contributing to your pain: Tight-fitting hats, headbands, and heavy earrings are also culprits, says Stephen Silberstein, MD, director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. Why earrings? Its possible that earrings can pull on that same connective tissue. But some studies suggest that skin sensitivity around your scalp, face, and ears often accompanies a migraine. The earring supersensitivity could be a sign that a migraines coming, but not the cause of the headache.

What to do: It probably didnt take a study in the journal Headache to tell you that loosening your ponytail relieves a ponytail ache. Researchers have found that this simple action decreased headache pain within 30 minues, and, in some cases, instantly. Kinney makes a conscious effort to reposition her ponytail throughout the day. Typically, the thicker your hair or the heavier your headwear, the more likely youll experience this type of headache. Best bet: Save tight up-dos and heavy earrings for nights out, when you wont be wearing them for long.


Hunger
Theres a reason some nutrition gurus recommend that we eat several small meals a day: It keeps our blood sugar on an even keel. Dieting, fasting, skipping lunch—they all can cause you to bottom out, which may trigger a headache.

Why it hurts: Experts believe low blood sugar may stimulate nerve pathways that bring on these common headaches, but the exact mechanism is murky.

What to do: Uh, eat? Exactly. But remember that what you grab may play a role in whether your headache returns. “Sugar headaches” may occur when we binge on sweets on an empty stomach. The spike in blood sugar ratchets insulin levels, which eventually cause blood sugar to sink even lower. Instead, balance a protein with a complex carbohydrate, such as fish and brown rice, or a snack of whole-wheat toast with almond butter. Martin adds that eating foods rich in magnesium (spinach, beans, nuts, and seeds) and riboflavin (dairy products, lean meats, leafy greens, enriched breads and cereals) may prevent and alleviate head pain. Riboflavin is a B vitamin; large doses are thought to help prevent migraines.

Bear in mind, too, that cheese, chocolate, lunch meats, caffeine, and additives such as monosodium glutamate (MSG) may trigger headaches. In general, if you suffer from moderate, severe, or frequent headaches (more than two a week), consult a headache specialist about your diet. You may need to keep a food diary to hunt for culprits.

Sex!
“Coital headaches” (not the “Not tonight, honey” variety) can occur during foreplay or right before orgasm. Marked by a general head pain, these headaches typically last from a few minutes to an hour.

Why it hurts: Its probably a type of “exertion headache,” Silberstein says. During arousal, the culprit is likely pressure building up in the head and neck muscles. And orgasm sometimes requires a lot of “work.” Running, coughing, sneezing, even straining during a bowel movement, can lead to similar pain.

What to do: Most exertion headaches can be pretreated with ibuprofen or naproxen, Martin says. But be careful: An orgasmic headache, if its your first, may point to an underlying condition, such as an aneurysm, that merits a doctors attention. If your headaches occur during G-rated workouts, an activity switch can help—from aerobics, say, to biking. These headaches usually arent a reason to quit having fun. “Just ease into it,” Silberstein says.