How to Find the Cause of A Headache

You’re the ultimate authority on what’s causing your head to pound.

by John R. Lee, M.D. and Virginia Hopkins

To say that headaches are common is an understatement. Almost everyone has a headache at some time or another. If they are infrequent and not severe, the tendency is to take a mild analgesic such as aspirin or ibuprofen and forget about it.

The causes of headache are legion. In fact, trying to figure out what’s causing chronic headaches in a patient can give a headache to a physician! As with all health problems, proper treatment should be based on finding and correcting the underlying conditions that are causing it. There’s simply no excuse for a doctor handing out powerful pain medications over the long term for headaches with an unknown cause. And there’s no such thing as a headache without a cause.

Muscular or Vascular?
Headaches are usually divided into two groups: muscular and vascular. Garden-variety headache is usually caused by increased muscle tone or tension, particularly of the scalp, eye, neck, or jaw muscles. In turn, the muscle tension may be caused by physical or emotional stress, eyestrain, head and neck postural strain, neck injuries, mis-aligned jaw or teeth, too-tight headbands, sleep deprivation, hypertension, cervical (neck) arthritis, or any combination of these factors. Computer use-related stresses and strains are an increasingly common cause of headaches.

Muscle tension can also be caused by accumulated toxins, or metabolic factors from sensitivities to food or scented products such as candles and laundry detergents, digestive problems, viral infections, sinusitis, allergies, red wine, and a wide variety of pharmaceutical drugs. Chronic muscle tension results in accumulation of lactic acid and other metabolic byproducts that stimulate local pain receptors.

The Stress Connection
Stress of any sort promotes the tightening of muscles. A 55-year-old man was referred to me for a condition thought due to environmental causes. He rode the bus daily to work, and when returning home each day by bus he experienced headache and some nausea. His doctor thought he was sensitive to the diesel exhaust of the bus.

When I questioned him, he reported that he never got a headache when riding the bus to work, only when he was headed home. I gently asked him if he had considered whether there might be some situation at home that bothered him. After a pause, he said, “You haven’t met my wife, have you?” I replied that I had not but perhaps some family counseling might be in order. Later that evening his wife called and gave me a long dressing-down for suggesting such a thing. After her harangue, my impulse was to reply, “I rest my case.” Fortunately they did receive family counseling and my patient’s headaches went away. Mind/body relationships are sometimes quite subtle to figure out, but can be powerful in their effects.

People under stress tend to grind their teeth during sleep (bruxism). In so doing, the powerful jaw muscles (temporal and masseter) place great pressure on the relatively small temporal/mandibular joints (TMJs) just in front of the ear. If one’s jaw or teeth are misaligned, the TMJ on one side receives more pressure than the one on the other side. The physical damage to the joint leads to pain that may be misinterpreted as a headache. The clue is that chewing will elicit the pain and the affected TMJ will be tender. This is known as TMJ syndrome. Treatment should involve stress relief and may also require some sort of correction of the jaw or dental realignment.

Headaches can also result when the blood vessels of the head and neck clamp down too hard (constriction) or open up too wide (dilation). These are called vascular (blood vessel) headaches and they are very common. Factors that may cause vascular headaches include solvents (such as acetone from nail polish remover), dehydration, altitude sickness, hormone imbalance and literally dozens of common prescription drugs. Estrogen dominance causes vasodilation, and this can usually be corrected by restoring hormone balance with physiological doses of transdermal progesterone.

Caffeine has an interesting role in headaches: it can cause them or cure them. Too much caffeine leads to vascular constriction, and the muscles in the walls of blood vessels react the same way skeletal muscles do: when tensed they accumulate lactic acid and become painful. On the other hand, headaches can occur when cranial blood vessels dilate. The tiny nerves that accompany the blood vessels become stretched by the dilation and this causes pain. Some people use caffeine’s vaso-constricting property to counteract this blood vessel dilation and cure the headache.

When I first started my family practice, a 40-year old woman came to my office complaining of chronic headaches. She had seen numerous other physicians without finding any cause or relief of her headaches. I did not feel very confident that I had much to offer her. In taking her history, however, I asked if she drank coffee. When she said yes, I asked her how much coffee. It turned out she had a 10-cup coffee maker and she went through four of these each day. I asked if she was strong enough to stop coffee drinking for two weeks. I told her she would likely have caffeine withdrawal symptoms, but I also pointed out that she might save a lot of money by avoiding expensive tests if quitting the coffee worked. Two weeks later, after a bad ten days of withdrawal symptoms, her headaches were gone. Finding the cause of the headache is the most important step in treating it.

Pick Your Treatment
Since there are so many causes of headaches, it is not surprising that no panacea exists. Each person’s headaches must be addressed individually. For the occasional headache, aspirin or acetaminophen may suffice. Other healing modalities that I have seen work include massage, stress management, change of diet, herbs, meditation, hypnotherapy, NSAIDs (non-steroid anti-inflammatory drugs), tranquilizers, antidepressants, exercise and physical therapy, magnesium salts, change of occupation, beta-blockers such as propranolol, acupuncture or acupressure, removing mercury fillings, magnet therapy, avoiding plastics, solvents and scented products, avoiding caffeine, psychiatric counseling, and opiates, if necessary to stop a pain cycle. In my experience, one of the most common causes of headaches in women is estrogen dominance, and achieving hormone balance is an effective cure.

Almost any pain medication used to stop headache pain will cause a rebound reaction if used for too long. In other words, if you take ibuprofen (for example) daily for more than a few days, when you stop it there's a good chance that you're headaches will come back with a vengenance. This is one of the reasons that it's so important to find the underlying cause of a headache.

Since there are so many possible treatments for headaches, once you figure out the cause, how you treat it will depend on your individual preferences.

Migraine Headaches
Migraine is thought to be due to unremitting over-dilation of blood vessels in the head. Three factors seem to be necessary for this to happen: genetic predisposition, stress, and some sort of stimulus, usually a food sensitivity or allergy. Neither stress nor the specific stimulus is sufficient by itself to cause migraine; they must occur together, and then only in a person with a genetic predisposition for it. The result can be observed on sensitive brain scans.

Migraine tends to occur in early adulthood. Each attack may be preceded by a brief aura in which flashing lights appear off to the side, or vertical zigzag striping is seen in the visual field. The headache is pounding and severe, almost always one-sided. It may last for days.

Migraine is more common in women than in men, suggesting a hormonal connection. Estrogen dominance is known to cause vascular dilation, while progesterone restores normal vascular tone. In my practice, I routinely recommended transdermal progesterone products for women with migraine problems. At the first sign of the aura, immediate application of transdermal progesterone to the temples and back of the neck would often abort the coming migraine attack. The doses can be repeated every hour or two for three applications. This treatment is especially effective in women with cyclical migraines that occur at or just before menstruation. I have known other people who find migraine relief from acupuncture or acupressure.

It is possible to eliminate migraine headaches if stress can be relieved by meditation or other relaxation techniques, or if the offending stimulus can be found and eliminated. These stimuli are often food proteins such as shellfish, turkey meat, or even food coloring agents. Food sensitivity testing rarely reveals the offending agent (since it is active only during times of stress). More often it is found by playing Sherlock Holmes, and reviewing what was eaten before the migraine attack.

Temporal Arteritis
Temporal arteritis, also called giant cell arteritis, is an inflammatory process affecting the muscle layer of the arteries between the skull and the scalp. While uncommon, it primarily affects middle-aged or older women. The underlying cause may be an autoimmune process and/or genetic factors.

When the temporal artery (a branch of the external carotid artery which runs up the side of the neck) is involved, the patient experiences severe temporal headaches (on the side of the head). Gentle palpation of the temporal artery, just in front the ear, will cause severe pain. If the internal carotid artery is also affected, it may involve the ophthalmic (eye) artery. In my experience, temporal arteritis is often misdiagnosed as simple stress headaches. Since a misdiagnosis and failure to treat this condition properly can result in permanent blindness, it’s important to check the temporal artery for tenderness.

Headache with Projectile Vomiting
A rather sudden onset of severe headache with uncontrollable vomiting may be a sign of acute cerebral hemorrhage (bleeding in the brain) and/or acute brain swelling. This is not a time to wait and see. This is a time to dial 911 or get quickly to a good hospital emergency room.

How to Help Yourself
Because headaches can be caused by so many factors and combinations of factors, even with your doctor’s help it may ultimately be up to you to play detective and figure out what is triggering your headaches. There are many ways to do this. Keeping a daily journal of what you’ve done and what you’ve eaten can be helpful in finding common threads that lead to a cause or causes.

As soon as you feel a headache start to come on, write down everything that you have done in the past 12 hours. After a few episodes you should be able to find some common threads. It can literally be something as simply as getting a whiff of a perfume that you’re sensitive to, or eating a breath mint that contains aspartame.

You can also read the book Healing Back Pain by John Sarno, M.D. His excellent suggestions for healing back pain also can apply to headache pain.

This article was originally published in the John R. Lee, M.D. Medical Letter. Although the Medical Letter is no longer published, you can find many articles from it on this website. Here's where to find a List of Articles by Subject .

Note to Reader from Virginia Hopkins
Dr. John Lee was my great friend, mentor, co-author and business partner. This website is dedicated to continuing the work that Dr. Lee and I did together to educate and inform women and men about natural hormones, hormone balance and achieving optimal health. Dr. John Lee was a courageous pioneer who changed the face of medicine by introducing the concepts of natural progesterone, estrogen dominance and hormone balance to a large audience of women and men seeking answers to their hormone questions. Dr. Lee has left us a wonderful collection of writings from his newsletters that are, in large part, freely shared on this website. Enjoy!

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