Sometimes you know exactly what's causing that pounding in your skull. Other times, you're blindsided. Headacheswhether debilitating migraines or less-painful-but-still-annoying tension headachesare often set off or made worse by a key trigger, says Brian Grosberg, MD, director of the Inpatient Headache Program at Montefiore Headache Center in New York City.
Here, the seven most common pain provokers, and how to head off the hurt. (See your doctor if these DIY fixes don't do the trick; for those plagued by headaches, prescription meds may help.)
Stress accounts for 80 % of all migraines, according to a study in the journal Cephalalgia. That's because it causes fluctuations in cortisol and adrenalinethe fight-or-flight hormoneswhich can lead to pain and nausea, says Sheena K. Aurora, MD, medical director of the Headache Center at Swedish Medical Center in Seattle. Stress can also make you clench your jaw and neck muscles, causing neck pain that, in turn, can set off tension headaches.
Trigger Tamer: Meditation, deep breathing, yoga, and massage can help. Or consider a mind-body technique called biofeedbackget more information from the Association for Psychophysiology and Biofeedback.
The dip in estrogen that occurs just before your period can lead to migraines. Similar hormonal fluctuations can also trigger headaches during pregnancy, perimenopause, and menopause.
Trigger Tamer: Take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like naproxen or ibuprofen two days before you expect your period, when the headache is likely to happen. If you're experiencing headaches during pregnancy, ask your doctor to recommend a pain-relief plan.
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The weather's changing
Migraine sufferers may be more likely to be hit when temperatures are high, according to a study in the journal Neurology. Shifts in barometric pressure (the density of the air in the atmosphere) may lead to sinus headaches, too.
Trigger Tamer: Do your best to avoid headache triggers on hot daysand keep an NSAID on hand, just in case.
You didn't sleep well
Insomnia is associated with low levels of the hormone serotonin. That causes blood vessels in the brain to dilate and activate the trigeminal nervethe main nerve involved in migraines, Dr. Grosberg saysleading to inflammation and the release of pain-causing chemicals.
Trigger Tamer: Go to bed and get up at the same time every day (even on weekends!), cut down on caffeine, and exercise regularly.
You sniffed bad cologne
"The trigeminal nerve has projections in the lining of the nose," Dr. Grosberg explains. When you detect a noxious smell, the nerve can release substances involved in producing headaches.
Trigger Tamer: Avoid using perfume or scented cleaning products, soaps, or candlesand steer clear of stores that reek of them.
You're blinded by the light
Bright lightfrom fluorescent bulbs, computer glare, or even the suncan set off that pesky trigeminal nerve.
Trigger Tamer: If possible, switch from fluorescent lights to softer incandescent bulbs, Dr. Grosberg says. Place a nonglare screen over your computer, and try to cut back your usage. If you're working on a computer in a room with fluorescent bulbs and white walls, hang pictures up on the walls to absorb excess light, advises Paul-Henri Cesar, MD, director of headache medicine at Columbia University.
You're eating the wrong things—or not eating enough
The most likely offenders: Foods that contain the amino acid tyramine (like red wine and aged cheeses), nitrates (hot dogs, deli cold cuts, and other processed meats), or the amino acid phenylalanine (chocolate). All three substances cause blood vessels to constrict and then expand, causing migraines. Skipping meals triggers them, too, because the brain is hypersensitive to fluctuations in blood sugar, Dr. Aurora says.
Trigger Tamer: Eat and drink water regularly, and make sure those meals high in protein to help keep you satiated and maintain blood sugar levels. It's also crucial to figure out which, if any, foods bother you, and ban them from your diet.
New relief for migraines
Though doctors have been using Botox off-label as a treatment for chronic migraines for years, recent approval by the U.S. Food and Drug Administration (FDA) means insurance companies may now be more likely to cover the shots.
The average treatment is 31 injections in seven areas across the head and neck, performed every three months. That may seem extreme but it's well worth it to many patients in serious pain, says Stephen D. Silberstein, MD, director of the Jefferson Headache Center at Thomas Jefferson University.
One caveat: Don't go to a dermatologist or walk-in clinic for this treatment, he says. Instead, make an appointment with a neurologist who can study your migraine history and make sure you're a good candidate. Kimberly Holland