Muscle-contraction (tension) headache
Ninety percent of all headaches are classified as tension/muscle-contraction headaches.¹ The pain is generally described as a feeling of pressure being applied to the neck or head. The primary cause of pain in these headaches is believed to be sustained muscle tension, although restricted blood flow may also be a contributing factor. Acute tension headache is a temporary muscle-contraction headache caused by physical or emotional stress. The pain usually subsides after the period of stress is over. In contrast, chronic muscle-contraction headaches may last for weeks, months, and sometimes years. In many cases, these chronic headaches are caused by depression and anxiety. Acute tension headaches are generally treated with muscle relaxants or analgesics like aspirin and acetaminophen. For more severe cases, stronger analgesics, such as codeine, are sometimes prescribed. People with chronic muscle-contraction headaches are often treated with non-drug therapies such as biofeedback and relaxation training. Antidepressants may also be prescribed when headache is associated with underlying depression.

Classic migraine
The most common type of vascular headache is migraine. Migraine headaches are usually characterized by severe pain on one or both sides of the head, upset stomach, sensitivity to light and noises, and (at times) blurred vision. The two most prevalent types of migraine are classic and common migraine. The main difference between the two types is the appearance of neurological symptoms 10 to 30 minutes before a classic migraine attack. These symptoms, or aura, may include: visual sensations such as flashing lights or zig-zagging lines, temporary loss of vision, speech difficulty, weakness of an arm or leg, tingling of the face or hands, and confusion. The pain of a classic migraine is described as intense, throbbing, or pounding felt in the forehead, temple, ear, jaw, or around the eye. Classic migraine starts on one side of the head but may eventually spread to the other side. Attacks typically last 1 to 2 days.¹

Common migraine
The common migraine (a term that reflects the disorder's greater occurence in the general population) is not preceded by an aura, but some people experience a variety of vague symptoms beforehand, including mental fuzziness, mood changes, fatigue, and unusual fluid retention. During the headache phase of a common migraine, a person may experience diarrhea, increased urination, nausea, and vomiting. Pain may last 3 to 4 days. Both classic and common migraine can strike as often as several times a week, or as rarely as once every few years.¹ Although both types can occur at any time, some people experience migraines at predictable times, such as near the days of menstruation or on a Saturday morning after a stressful work week. Although both men and women may suffer from migraines, the condition is more common in adult women. Although migraines may develop as early as infancy, the disorder most often begins between the ages of 5 and 35.¹

Contributing factors
Although scientists are still uncertain about exactly what causes migraine headaches, it is generally believed that they result from changes in blood flow within the brain. People who get migraine headaches appear to have blood vessels that overreact to various triggers, resulting in abnormal constriction and dilation of blood vessels, impaired blood flow to the brain, and the release of pain-producing substances known as prostaglandins. This abnormality in the regulation of blood vessels appears to be inherited; many sufferers have a family history of migraine. Migraine attacks can be triggered by a variety of factors, such as hormonal changes (as may occur with menstruation, menopause, or the use of birth control pills), stress, food allergies, weather conditions, glaring or flickering lights, odors, or fatigue. Scientists report that people can develop migraine not only during periods of stress but also afterwards when their vascular systems are still reacting.¹

Conventional treatment
The most common methods of preventing and controlling migraine and other vascular headaches include drug therapy, biofeedback training, stress reduction, and elimination of certain "triggering" foods. Drug therapy focuses on preventing attacks and relieving pain when attacks occur. One of the most commonly used drugs for relief of migraine symptoms is ergotamine tartrate, a vasoconstrictor that helps control the painful dilation of blood vessels if taken during the early stages of a migraine attack. If a migraine has been in progress for over an hour, this drug probably will not help.¹ Drugs used for prevention of migraine attacks include methysergide maleate, which counteracts blood vessel constriction; propranolol hydrochloride, which stops blood vessel dilation; and amitriptyline, an antidepressant. A class of drugs known as MAO inhibitors may also help prevent migraine. These drugs block an enzyme called monoamine oxidase, which normally helps nerves cells absorb serotonin, a brain chemical that causes arteries to constrict. In recent years, drugs that mimic the action of serotonin have been developed for prevention of migraine, but many of these drugs can have adverse side effects. The natural serotonin precursor 5-HTP, which is sold as a dietary supplement, has been shown in several studies to reduce the frequency and severity of migraine attacks^2-6 and appears to have fewer, less serious side effects than many migraine drugs.^5,6

Nutritional/lifestyle considerations
Several dietary and lifestyle factors can contribute to migraines. Stress is believed to be a major contributor, and relaxation techniques such as yoga and biofeedback help many people reduce the number of migraine attacks. Regular exercise, such as swimming or vigorous walking, can also reduce the frequency and severity of migraine headaches.¹ Some people benefit from dietary measures such as the elimination of migraine-triggering foods and food additives. In some people, migraine results from hypoglycemia (low blood sugar), which may be controlled in many cases by consuming smaller, more frequent meals.¹ Certain nutrients may also play a protective role against migraines. In some studies, high doses (400 mg/day) of riboflavin produced significant reduction in migraine attacks in the majority of test subjects.^7-9 Other studies suggest vitamin D,^10,11 calcium,^10,11 and magnesium ^12-17 may also be useful in migraine prevention. Herbalists commonly recommend feverfew for migraine prevention, and recent studies indicate there may be some value in this traditional remedy.^18-22