Headaches

Some people say they get headaches if they don’t drink enough water. Tea and coffee tend to take water out of the body, so don’t forget to drink plenty of plain water, herb teas or juices as well.

Summary
It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains.

The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

Summary
Many people who fast for a long period (for example, during the month of Ramadan) suffer headaches. According to Dr Elliot Shevel, Chairperson of the South African Headache Society, caffeine withdrawal, stress and low blood sugar can all play a part. People prone to headaches at other times are most likely to get headaches in Ramadan.

Dr Shevel says caffeine withdrawal is the most common cause of Ramadan headache. If you are someone who usually gets a headache when you fast, you might find you can prevent it by gradually reducing the amount of coffee you drink in the weeks leading up to the Ramadan month. If you are too hooked on caffeine to cut down, a cup of strong coffee just before the start of a one-day fast might stop you getting a caffeine withdrawal headache.

Low blood sugar can also trigger headaches in some people. But a meal with high sugar content can cause a rapid rise in blood sugar levels, followed by a fast drop 2-3 hours later. So ideally you should have a meal with low sugar content before the fast begins. This may help prevent headaches during the day.

Dehydration is common so do drink a lot before the fast begins. Other triggers include stress, over-tiredness and lack of sleep. Dr Shevel tells us that rest and sleep often ease Ramadan headaches, ‘and the pain often melts away when the fast is broken for the day’.

You may get similar headaches during fasting for other reasons, such as the 5:2 diet or other regimes. Adapt your regime accordingly!

Summary
Relaxation is likely to help with your tension headaches and there are many things that you can do to help you relax.

Simple relief exercises
Tension headaches often start in the muscles of the neck and shoulders. Particular neck exercises may help relax these tense areas. The following exercises are simple, but they need to be done every day:

1. You can relax tight muscles at the back of the head where it joins the neck with this gentle exercise. Tuck in your chin, interlace your fingers behind your head to provide some resistance, and gently press your head back into your hands, while keeping your chin tucked in. Hold this for a slow count of eight as you take a slow breath in. Breathe out slowly as you let the pressure go, and take a moment to notice the relaxation. Repeat four times.

2. When you have a headache, it can feel like your scalp is too tight. Ease this by putting your palms on top of your forehead with your fingers facing back over your head. Using firm pressure from the palms and your finger tips glide the skin of your scalp back and forward over your skull twenty or more times. You may feel like shifting your palms and fingers to different places a few times to give your scalp a good overall massage.

3. To relax tense facial muscles open your eyes as wide as you can at the same time opening your mouth as wide as it will go, and stick your tongue far out and down. Take a deep slow breath as you hold this position for about ten seconds. Let everything relax as you breathe out. Notice any tension at the back of your neck, and let it go.

4. Lots of people have a habit of jutting their chin out and holding their head forward as if they were looking up slightly. In this position your ears line up in front of your shoulders, rather than directly over them. This creates a lot of tension in the back of the neck. To check this out, try tucking your chin down into your throat, as if you were looking down a little. Notice how this lengthens out the back of your neck. Now let your shoulders drop, and breathe out completely and slowly. Then let your in-breath come on its own slowly without any effort, as you let our chin return to the neutral position. Notice the sense of relaxation in your neck, chest and shoulder muscles.

5. Try this exercise when you want to release the neck muscles. Sit straight up and let your shoulders drop comfortably down and back. Imagine your head is as light as a balloon, and let it rise up and back slowly until your ears are directly over your shoulders and your eyes are looking straight ahead. Once you get the idea of how this neutral position feels, repeat this movement often during the day, whenever you can remember to. This will help you train yourself to keep letting your head and neck find the neutral position.

Many of us spend many hours in positions that the body doesn’t find natural. If you work at a desk or a keyboard/screen, and it isn’t set up in an ergonomic (posture-friendly) way, this will eventually lead to all sorts of uncomfortable tensions in the muscles of your back, shoulders, neck and even your forearms.

For advice about workstation set-up, visit: ergonomic trends.

 See also our section on BACKPAIN.

Summary
It can be tempting to reach for stimulating drinks like tea, coffee, colas or so-called ‘energy drinks’ when you want to ‘clear your head’. They can give you a quick boost, but risk contributing to the hectic energies that caused your headace in the first place.

Note: A very small amount of caffeine is sometimes included in pain medications such as Panadol Extra and Anadin Extra. The aim of this is to make the painkiller slightly more effective.

Evidence
Research has shown that drinking a lot of coffee may make headaches more likely. Reducing caffeine and improving sleep can make headaches less likely.

Safety
If you are cutting down on large amounts of caffeine, headaches might be a problem for two or three days. It is better to reduce the amount of caffeine slowly over a few days.

Cost
There are no costs. In fact you will save money.

Summary
Cutting down on alcohol and stopping smoking are likely to improve your health generally and in certain circumstances may reduce metabolic factors that could contribute to headaches. 

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.

Evidence
Although the ‘hangover effect’ (nausea and bad headache) is all too obvious, the links between alcohol use and headaches are not clear. Some research studies have shown that heavy use causes more frequent headaches. and others have shown no effect.

Safety
Cutting down on smoking and alcohol is safe, but if you are cutting down from heavy use, there can be side effects including loss of appetite and difficulty sleeping. There are unlikely to be side effects if you are cutting down a moderate alcohol intake but if you are a very heavy drinker, it is better to get help with cutting down.

Cost
No costs are involved and think of the money you will save!

Further information
For more information, see the NHS information sensible drinking.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332.

Summary
Compared to 100 years ago when people didn’t have cars, washing machines or TV, most of us don’t do much physical work these days. Science tells us that our relatively lazy modern lifestyle is bad for our health. Being more active can keep you fit by making your heart and lungs work better, toning your muscles and strengthening your bones and joints. It also stimulates blood circulation to your brain and internal organs, boosts your immune system, helps protect against osteoporosis, and triggers brain chemicals that lift your mood and can generate a real sense of well-being. It can also be a very good way of meeting people, and it definitely makes a difference to all sorts of health problems.

Exercise can include aerobics such as cycling, stepping and walking, strengthening exercises such as lifting weights or using resistance machines and stretching for flexibility. Even simply taking a brisk half-hour walk every day will definitely boost your fitness and improve your mood!

Evidence
It isn’t clear whether exercising in general helps headaches, likely though this seems. But research has shown that headaches are more common in people who take very little exercise during the day.

Safety
If you’re not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn’t helping or that you’re getting worse in any way, check with your doctor. Anyone with severe osteoporosis, arthritis, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist.

Cost
You can exercise at home for nothing, remember walking and gardening are both forms of exercise. There will probably be a small cost, if you join an organised programme.

Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.

Summary
This is another way of relaxing the body and calming the mind. Because your body and mind are so deeply connected, your body responds to mental images. Guided imagery invites you to imagine all the details of a safe, comfortable place – maybe a beach or a garden. Gradually, you become more relaxed in both mind and body. Some researchers have found that that this relaxed state improves healing, creativity, performance and a person’s sense of well-being..

Evidence
In one study, 129 patients with chronic tension headaches listened to a guided imagery tape daily for a month. Guided imagery is an effective addition to any other treatment.

Safety
There are no safety problems with guided imagery..

Cost
You can buy guided imagery CDs in shops and pharmacies and some libraries keep them in stock.

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Evidence
Mindfulness (a particular form of meditation) may help with your health generally. Simple meditation can probably reduce headache frequency, although more research is needed.

Safety
There are generally no safety problems with meditation unless you have a severe or long-standing mental health problem.

Cost
Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.

Summary
Progressive muscular relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Get yourself in a comfortable position, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.

Evidence
Some small studies have shown that progressive muscular relaxation could help with tension headaches. In some cases it was not as effective as other treatments.

Safety
Relaxation techniques are generally safe unless you have a severe or long-standing mental health problem (see our section on Stress and Anxiety).

Cost
Progressive muscular relaxation can be learned from a book, CD, DVD or during exercise classes such as yoga classes (go to ‘Go see someone’ in this section for more information). No costs are involved, although you may need to buy a CD, DVD or book.

Summary
There is no evidence that special diets reduce tension headaches. But some people find that certain foods ‘don’t agree’ with them and try to cut out those foods to see if they have an allergy or intolerance. This is called an ‘exclusion diet’. If symptoms improve, this might suggest some intolerance to that particular food. To find out about your reactions to certain foods, it is helpful to keep a diary of what you eat and any effects each food has in the hours following the meal. But fasting or giving up particular foods can also trigger headaches if your blood-sugar gets too low (see below).

Evidence
We haven’t found any research to support the idea that special diets help tension headaches.

Safety
It can be quite difficult to exclude certain foods and still have a balanced diet. If you want to make big changes to what you eat, it may be important to see a dietician. They can help you make sure you are still eating a healthy diet and getting all the nutrients you need.

Cost
Eating a healthy diet and excluding some foods need not cost you anything. But if you consult a dietician there will be a charge, unless this is a service provided by your GP’s practice.