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Harvard Commentaries
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Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School


Man to Man Man to Man
 

Men and Headaches


January 24, 2013

By Harvey B. Simon M.D.

Harvard Medical School


For most men, an occasional headache is nothing more than a speed bump in the course of a busy day. But for some of us, headaches are a bigger problem. Learn more about the major types of headaches — among the 200-plus varieties — and how lifestyle changes and non-prescription medication can ease their impact on your life.

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Tension-Type Headaches

Tension-type headaches are the most common type of headache. They are usually mild to moderate in severity. But some men get severe tension headaches, and some have them 3 or 4 times a week.

The typical tension headache produces a dull squeezing pain on both sides of the head. You feel like your head is in a vise. Your shoulders and neck can also ache. Some tension headaches are triggered by fatigue, emotional stress, or problems involving the muscles or joints of the neck or jaw. Most last for 20 minutes to 2 hours.

You can treat occasional tension-type headaches with over-the-counter pain relievers such as acetaminophen, aspirin or ibuprofen. (Always follow the directions on the label, and never take more than you should.) A heating pad or warm shower may help; some people feel better with a short nap or light snack.

If you get frequent tension-type headaches, try to identify triggers so you can avoid them. Don't get overtired or skip meals. Learn relaxation techniques. If you clench your jaw or grind your teeth at night, a mouth guard may help.

If these methods don't work, your doctor may prescribe a stronger pain killer or a muscle relaxant to control the pain, or a tricyclic antidepressant to help prevent frequent attacks.

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Migraines

Migraines occur less often than tension-type headaches but they're usually much more severe. In the course of a year, about 6% of men will have at least one migraine.

Neurologists believe that migraines are caused by changes in the brain's blood flow and nerve-cell activity. Genetics play a role, since 70% of migraine sufferers have at least one close relative with the problem.

Although a migraine can come on without warning, it is often set off by a trigger. Triggers vary from person to person, but a migraine sufferer usually remains sensitive to the same triggers. Some men can prevent migraines simply by avoiding triggers. Major migraine triggers for men include

  • climate changes, such as rising humidity or heat
  • lack of sleep or oversleeping
  • fatigue
  • emotional stress
  • sensory triggers, such as bright or flickering lights, loud noises and strong smells
  • dietary triggers, such as missing a meal, alcohol, especially red wine, chocolate, nitrates in cured meats and fish, aged cheese and an increase or decrease in caffeine.

A typical migraine involves a severe throbbing or pulsating pain on one side of the head, often centered on the eye or temple. Migraines often begin in the evening or during sleep. In some men, the attacks are preceded by several hours of fatigue, depression and sluggishness, or by irritability and restlessness.

About 20% of migraines include symptoms called the aura, which may include flashing lights, temporary loss of vision, halos, sparkles and wavy lines. The aura may also produce numbness or tingling on one side of the body, especially the face or hand. Some patients develop aura symptoms without getting headaches.

The pain is often severe and is described as throbbing or pulsating. Nausea is common, and many migraine patients have a watering eye, a running nose or congestion. If these symptoms are prominent, they may lead to a misdiagnosis of sinus headaches.

Without effective treatment, migraine attacks usually last for 4 to 24 hours. When you're suffering a migraine, even 4 hours is far too long — and that's why early treatment is so important.

If caught in its earliest stages, you may be able to control a migraine with non-prescription pain relievers. Acetaminophen, aspirin, ibuprofen, naproxen and combinations of pain medications and caffeine are all effective, as long as you take a full dose very early in the attack.

Sometimes it takes prescription drugs to stop a migraine. Most doctors turn to the triptans, which are available as tablets, nasal sprays or as injections that patients give themselves. Triptans provide complete relief within 2 hours for up to 70% of patients; the response is best if treatment is started early. Because the triptans can affect blood flow to the heart as well as the head, men with coronary artery disease or major heart disease risk factors should not use them. People who take antidepressants in the SSRI family cannot use triptans.

Older migraine medications may have a role for some men. Others need anti-nausea medication, stronger prescription painkillers or even a short course of steroids. Remember, though, that overuse can lead to rebound headaches and a vicious cycle of drugs and headaches.

If you suffer frequent attacks — 2 or 3 a week — consider preventive medications. The most effective types of drugs are beta blockers, certain antidepressants and certain antiseizure medications. Your doctor will choose a medication based on your overall medical condition. You may need to try several drugs or a combination of agents. Some men may benefit from a referral to a headache specialist.

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Cluster Headaches

Cluster headaches are less common than tension-type or migraine headaches and affect men about six times more frequently than women. The typical patient is a middle-aged male smoker. The headaches come in clusters, with 1 to 8 attacks a day occurring over a 1- to 3- month period. The pain centers on one side of the head, particularly the eye, which may become red and watery. The eyelid may droop, and the nose runs or is blocked. Cluster headaches start abruptly and last for 30 to 60 minutes. Most sufferers become restless and agitated during the attack. They are unable to sit still so they pace or jog in place. Oxygen inhalation therapy can help. A triptan drug is often effective, particularly when given by injection. Medications that can help prevent attacks include verapamil and lithium.

Red Flags
A minor headache is little more than a nuisance. But if your headache is severe or unusual, you may worry about strokes, tumors or blood clots. Although such problems are rare, here are the warning signs that a headache needs urgent care:
  • Headaches that first develop before age 5 or after age 50
  • A major change in the pattern of your headaches
  • An usually severe "worst headache ever"
  • Headaches accompanied by fever, stiff neck, confusion, decreased alertness or memory, or neurological symptoms such as visual disturbances, slurred speech, weakness, numbness or seizures
  • Headaches accompanied by a painful red eye
  • Headaches accompanied by pain and tenderness of the temporal regions of the scalp
  • Headaches that follow a blow to the head
  • Headaches that prevent normal daily activities
  • Headaches that come on abruptly, especially if they wake you up
  • Headaches that get steadily worse
  • Headaches in patients with cancer or impaired immune systems

Other Causes of Headaches

Sinus infection. Acute sinusitis causes pain over the forehead, around the nose and eyes, over the cheeks or in the upper teeth. Stooping forward increases the pain. Thick nasal discharge, congestion are also common symptoms. When the acute infection resolves, the pain disappears. Sinusitis is not a common cause of chronic or recurrent headaches.

Ice cream. Some men develop sudden, sharp head pains when they eat anything cold. The pain is over in less than a minute. If you are bothered by ice cream headaches, try eating slowly and warming the cold food at the front of your mouth before you swallow it.

Exercise and sex. Sudden, strenuous exertion can bring on a headache. Gradual warm-ups or treatment with an anti-inflammatory medication before exercise can help. Sexual intercourse may also trigger a headache; the medications used to prevent migraines can help.

Medication. Many drugs can cause headaches as a side effect. If you think a medication is causing your pain, check with your doctor, but don't stop treatment on your own.

Overuse of painkillers. Rebound headaches are caused by overuse of painkillers and other headache medications. If you take too many drugs, your body becomes used to them. As they wear off, a headache comes on, so you take another dose. To control this vicious cycle, taper your headache medication slowly with your doctor's help.

Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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