Dear Dr. Garner,

I frequently experience severe headaches. I’ve gone to my doctor, who has done CAT scans and blood tests, and is unable to find any cause. He says I am suffering from tension headaches. Could you tell me a little about them and what to do? While I am happy there is nothing serious going on, it is beginning to get to me. Do you have any suggestions?

Head Hurting in Hillside

Dear Head Hurting in Hillside,

Unfortunately, women experience headaches more than two times as frequently as men. The most common type of headache experienced is known as a tension headache or stress headache. More than 90% of headaches are of this variety.

These headaches usually last from 30 minutes to several days. They begin gradually, and often occur in the middle of the day. They generally do not prevent a person from performing routine daily tasks.

There is no single cause for tension headaches. It is not inherited. In some people, it is caused by tightened muscles in the back of the neck and scalp. This muscle tension may be caused by fatigue, poor posture, emotional stress, anxiety, hunger and over-exertion. A theory is that the muscle contraction causes the blood vessels in the area of the scalp to narrow, limiting the oxygen supply to the area. This causes pain.

Common causes of stress that can precipitate a tension headache are:

• Family problems

• Having a new child

• Having no close friends

• Returning to school or preparing for tests

• Going away on a vacation

• Planning a wedding

People with tension headaches commonly report the following symptoms: mild to moderate pain or pressure affecting the front, top, or sides of the head; headache upon awakening; difficulty falling asleep; chronic fatigue; and irritability.

Unlike migraine headaches, there are no associated neurological symptoms, such as blurred vision or weakness in the hands. In addition, sensitivity to light, noise, nausea and vomiting are not symptoms associated with tension headaches.

Migraines usually affect one side of the skull, whereas tension headaches usually affect both sides.

Tension headaches are treated using medication such as pain relievers, muscle relaxants, and antidepressants. There are alternative treatments, including biofeedback, stress management, and acupuncture, which may be useful when drug treatment is not effective.

A very helpful therapy is acupressure. By pressing the web in-between the thumb and second finger of the right hand (left, if you are a lefty) for 60 seconds and then lying down for 15 minutes, more than 50% of tension headaches can be successfully treated.

Another very effective technique is biofeedback. Using this therapy, a person can learn to recognize signs of increasing muscle tension in the neck, and develop methods to reduce it. Small metal sensors called electrodes are attached to the skin and measure the amount of muscle tension. This information is then displayed in the form of numbers for the patient to see. With biofeedback, a person can influence blood flow to the brain and better manage a headache.

Events that increase anxiety and depression are associated with tension headaches. Stress management therapy is as effective as pain medication and is sometimes used in combination with antidepressants.

Acupuncture is an ancient Chinese technique that uses small needles, and causes the brain and body to make chemicals (endorphins) to ease a headache. One should always select a reputable physician who understands acupuncture and has certification in this area.

Fever few is an herbal medicine that has proven to be very effective in treating headaches, and may be useful in cases where traditional medicine does not work.

You should inform your doctor you are using this, as there are interactions and side effects which he will monitor.

Aside from tension headaches and migraine headaches, there are others I think readers would find interesting.

With the coming of summer, many of us look forward to enjoying ice cream on a hot summer’s day. Unfortunately, there is a headache known as the “ice cream headache.” Cold ice cream touches the back of the palate causing blood vessels in the brain to dilate, or widen, causing pain in the head. Patients with migraine headaches are particularly susceptible. It can cause intense pain for up to five minutes. Luckily, there is no need to abstain from ice cream, but merely to avoid prolonged contact with the palate. If a headache should arise, a lukewarm glass of water should help.

Another cause of head pain is the sinus headache. Recent studies show that antibiotics are not usually indicated for treatment as they are mostly caused by viruses, for which antibiotics are not effective. This is a major change as doctors frequently used antibiotics in the past. Symptomatic treatments with warm compresses, decongestants and antihistamines are the preferred method of treatment now.

A rebound headache is one which arises following prolonged use of painkillers such as aspirin or Tylenol. The body actually has withdrawal symptoms upon discontinuing the medication, causing a new headache to develop. Your doctor can help you treat these headaches.

Finally, there are migraine headaches, which usually present with throbbing on one side of the skull. They are often accompanied by nausea or vomiting, and one has visual problems, such as blind spots, or flashing lights. The newest treatment involves injecting Botox (this is made from botulism disease toxin). It is a mild strength and poses no harm to humans. It helps to relax the muscle, and is highly effective and lasts for three months. I highly recommend this for migraine sufferers, particularly those who are not well-controlled by traditional medicines.

Headaches may sometimes be a sign of underlying serious medical problems.

When a headache lasts more than 24 hours, or just “feels different,” or is “the worst headache of your life,” you must seek medical attention. This is particularly important if it is accompanied by blurring of vision, dizziness, vomiting or difficulty walking.

Sometimes medications that have codeine or other narcotics are prescribed. These can be dangerous as patients often become addicted. It is important to take these for a limited time and only as prescribed.

Exercise, a well-balanced diet, and adequate sleep all contribute to reducing the severity and number of headaches. When one feels a headache “coming on,” a nap in a dark, cool room may prevent the full-fledged headache from occurring.

Dr. Steven Garner is affiliated with New York Methodist Hospital, Park Slope. He is a Fidelis Care provider. He also is the host of the popular call-in cable TV show “Ask the Doctor,” seen locally on The Prayer Channel.