Headaches are all too common with Americans. According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches.
About 20% of children and adolescents also have significant headaches.
There are several types of headaches. This article focuses on primary headaches. These are headaches not caused by other diseases. They include tension, migraine, and cluster headaches.
Secondary headaches are associated with other diseases. An example would be a headache caused by high blood pressure. There are various causes for each type of headache.
Tension headaches are by far the most common type of headaches. Most adults, as many as 90 percent have or will experience this type of headache. They are caused by tension in the muscles of the head, neck, shoulder, and face. These type of headaches are characterized by produces a generalized mild to moderate pain over your head. Many people describe the feeling to having a tight band around their head or pain in the back of your neck at the base of your skull.
Researchers now believe that tension headache may result from imbalances in certain brain chemicals such as serotonin. This is similar to migraine headaches. Therefore one may need to address root causes more than just tight muscles and poor stress coping mechanisms.
Cluster headaches are much rarer affecting 0.1% of the population. Approximately 85% of cluster headache sufferers are men. They can affect people at any age but is most common between ages 20 and 40. The symptoms are one-sided headaches that are intense for a number of days or weeks, or even months, and then disappear and reoccur later. As the name implies, they occur in a cyclical or cluster pattern. 10 to 15 percent of cluster headaches occur daily for more than a year with no remission or with pain-free periods lasting less than one month. Since the cycle of cluster headaches often follows the seasons of the year, researchers suspect dysfunction within a part of the brain called the hypothalamus. This is where the body’s biological clock is located which controls various hormonal and neurotransmitter rhythms of the body.
Cluster attacks typically occur with clock-like regularity during a 24-hour day. The cycle of cluster periods often follows the seasons of the year. These patterns suggest that the body’s biological clock is involved. In humans, the biological clock is located in the hypothalamus, which lies deep in the center of your brain. Among the many functions of the hypothalamus is control of the sleep-wake cycle and other internal rhythms.
Abnormalities of the hypothalamus may explain the timing and cyclical nature of cluster headache. Studies have detected increased activity in the hypothalamus during the course of a cluster headache. This activity isn’t seen in people with other headaches such as migraine.
Studies also indicate that people have abnormal levels of certain hormones, including melatonin and testosterone, during cluster periods. These hormonal changes are believed to be due to a problem with the hypothalamus. Other studies show activity in the hypothalamus during cluster attacks, but it remains unknown what causes these abnormalities in the first place.
Migraine headaches are the second most common type of primary headache. An estimated 30 million people in the United States will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. Most migraine sufferers are between the ages of 15 and 55. Migraine pain is severe and occurs on one side of the head. They often last from four to seventy-two hours. They usually have a pulsating or throbbing pain and are made worse from exertion. The may be accompanied by nausea or vomiting and/or oversensitivity to light and sound. About 20% of migraine sufferers experience an aura, which may be perceived as flashing lights, blind spots, wavy lines or dots in the field of vision. It should be noted that some people suffer from “mixed” headache disorders where tension headaches trigger migraine headaches.
There are several causes of migraine headaches that may include:
  • Changes in altitude, weather, or time zone
  • Dehydration
  • Fatigue
  • Sleep problems
  • Glaring lights or eyestrain
  • Head trauma, such as a car accident
  • Hormonal imbalances
  • Medications such as birth control pills or those used for erectile dysfunction
  • Overuse of migraine medications
  • Perfumes or other powerful odors
  • Stress
  • Nutritional deficiencies


Food sensitivities may trigger migraine headaches (and possibly tension headaches). Although one could be sensitive to any food that is triggering headaches, the following foods are most commonly involved. If you are commonly consuming these foods try omitting one or more at a time to see if your headaches improve. Dr. Stengler can test you for food sensitivities as well.
  • Alcohol, especially red wine and beer
  • Artificial sweeteners
  • Caffeine
  • Chocolate
  • Dairy products, especially aged cheese
  • Pickled foods
  • Shellfish
  • Wheat
  • MSG (monosodium glutamate), a flavoring often used in Asian cooking, packaged meats and vegetables, soups and snack foods
  • Nitrites, a type of preservative commonly found in bacon, sausage and hot dogs, plus smoked or cured deli meats, fish and poultry.
Dehydration—even mild levels—may trigger headaches. Make sure to drink adequate quality water throughout the day.
Migraine and tension headaches can also be triggered by hypoglycemia, or low blood sugar. Make sure to limit your consumption of refined carbohydrates and to eat regular meals and snacks throughout the day.
Regular exercise is helpful for many people in preventing headaches related to stress and muscle tightness.
Environmental allergies may trigger tension and migraine headaches. Dr. Stengler can help identify and treat these types of reactions.
Massage, chiropractic, acupuncture, craniosacral therapy, and other types of bodywork can be helpful therapies for all three types of headaches.
This water soluble B vitamin is involved in the metabolism of amino acids and fatsvitamin B6 (pyridoxine) and folic acid, to produce energy in cells (ATP).  Its’ mechanism in preventing migraine headaches is unknown. A Belgian study published in Cephalalgia: An International Journal of Headache involved 49 migraine patients who took 400 mg of riboflavin as a single oral daily dose for at least three months. Treatment resulted in an overall improvement of 68%. (Schoenen J, Lenaerts M, Bastings E. High-dose riboflavin as a prophylactic treatment of migraine: results of an open pilot study. Cephalalgia 1994;14:328-9.) In a follow-up trial by the same group, 55 migraine patients took either a placebo or 400 mg of riboflavin daily.
Frequency of migraine episodes and the number of days with headache decreased by at least half in 59% of patients in the riboflavin group, compared with 15% of patients in the placebo group.  (Schoenen J, Jacquy J, Lenaerts M. Effectiveness of high-dose riboflavin in migraine prophylaxis. A randomized controlled trial.Neurology 1998;50:466-70.) There is also some evidence that combining riboflavin with beta blockers (cardiovascular drugs sometimes given to reduce frequency and severity of migraines), may boost the drugs’ effectiveness without increasing adverse side effects.Dosage: Take 400 mg daily.
Safety: No toxic effects have been reported.