You know the feeling. The twinge in your temple. The pain in your head that’s dull, throbbing, stabbing, jabbing, searing, twitching, vice-like, jolting, electric, or pounding.
You’ve got a headache, and you’re not alone—it’s the most common form of pain that people experience.
Headaches can range from annoying to downright incapacitating.
In a basic sense, headaches are a subjective neurological indicator that something is wrong.1 Various kinds of headaches can occur for a number of reasons, like poor diet or hormone imbalance, but one thing’s for sure—no matter what type of headache you have, it’s important to discover the root causes in order to rid yourself of them for good.
What Exactly are Headaches?
Since the brain itself lacks pain receptors, the cause of pain is from structures within the brain or head such as nerves, blood vessels, organs, mucous membranes, the lining of the skull, sinuses, subcutaneous tissue, or muscles.
Current government health statistics report that headaches and migraines are the leading causes of outpatient and emergency room visits in the US today.2
Migraines alone account for as much $13 – $17 billion in healthcare costs, which creates a heavy economic burden.2
Although headaches affect people of all ages, the highest prevalence is in women during their reproductive years.4
There are a wide range of types, with migraines and tension-type headaches being the most common.3
Identifying the underlying “trigger” (e.g., food, stress, medication, etc.) is often the key for implementing a successful treatment plan. Despite numerous research studies, there remains considerable controversy in the medical community regarding the events and mechanisms involved in generating headache pain.4
Although the causes remain debatable, uniformity has been established for identifying the many facets of headaches and migraines.5
How Do Headaches Occur?
Most headaches occur when there is an irritation in the nerves, blood vessels, meninges (lining of the brain), or muscles of the head and neck. The irritation can be due to a variety of reasons:
Biochemical: Hormone and neurotransmitter imbalance, as well as cytokines or histamines generated in the inflammatory and immune response, can result in headaches. When altered hormone and neurotransmitter activity causes irritation to the nerves or blood vessels in the brain, a headache can manifest.
Dietary: Food allergies and sensitivities that generate an inflammatory response such as gluten, dairy, soy, nuts, and eggs are common causes of headache. Additionally, the histamines, tyramines, nitrites, and sulfites in foods, especially aged and fermented foods, may also cause a headache. Alcohol and caffeine are also triggers.
Noxious stimuli: Exposure to cold, altitude change, or an extreme pressure change can produce headaches. Pressure on nerves from tight muscles is the major cause of tension headaches.
Stretching or traction on the blood vessels or meninges (lining of the brain) may also cause headaches (as in meningitis). Tumors place pressure on structures of the brain and increase intracranial pressure, resulting in pain.
Exertional: When you work out too hard or over-exert, biochemical and inflammatory changes occur that can cause headache.
Medications and supplements: Birth control, estrogen replacement therapy, asthma medications, stimulants, and blood pressure medications such as nitroglycerin or nitrates can cause headaches. Opiates and barbituates are also known triggers. Rebound headaches can occur with frequent use of NSAIDs (nonsteroidal anti-inflammatory drugs) such as Advil, Aleve, Excedrin, and Tylenol, which are used to treat headaches.
Physical trauma: Trauma of any kind causing the destruction of tissues and increasing pressure in the brain can cause headaches.
Types of Headaches
There are numerous criteria to consider when identifying a specific headache, like location, duration, and type of pain.
In order to account for these and other variables, the International Classification of Headache Disorders (ICHD-3) was developed to standardize classification and diagnostic criteria.4
The most important initial distinction to make is between a primary and secondary headache:
A primary headache is one that is associated with an underlying cause or condition.9 Migraines, tension-type, and cluster headaches are examples of primary headaches.
A secondary headache is one that is caused by another distinctive condition. A review of your medical history and characteristics of the headache with a doctor can usually provide insight as to whether or not another medical condition exists. Eliminating the potential for a secondary headache is “an important first step in developing an effective treatment plan” according the the American Headache and Migraine Association (AHMA).5
According to current criteria, there are over 150 diagnosable types of headaches. In most cases, a headache will fall into one of the following categories: cluster, tension-type, or migraine.
However, there are some that can be a combination of two types, like a cluster and tension. There are also a small percentage that do not fall into one of these categories.
Some of these less common types include spinal headache, hemicrania continua, post-transplant headache, and idiopathic (unidentified cause) stabbing headache.6
It’s important to note that headaches with sudden onset, feeling like a thunderclap, and described as “never having felt this pain before” should be considered medical emergencies, as they may suggest bleeding in the brain, a mass or tumor, vascular malformation such as an aneurysm, temporal arteritis, or meningitis.
Types of Headaches: Cluster
Cluster headaches are one of the most painful and difficult to treat, according to pharmacist Suzy Cohen, author of Headache Free.
She describes them as “feeling like you have an ice-pick going through your eye.”7 The severe, stabbing, unilateral pain is usually associated with the nasal, eye, or sinus area.
The pain may start in the middle of the night and be a response to high histamine levels.7 For this reason, Cohen recommends eliminating high histamine foods, like avocados, cider, vinegar, red wine, coffee, and dried fruits.
Removing histamine-releasing foods like shellfish, chocolate, and alcohol is also advised. Cluster headaches are not very common with few identifiable triggers, and occur most often in men.8,9
There are two types of cluster headaches:6
Episodic is when clusters lasts 4-16 weeks followed by a cluster-free period lasting anywhere from six months to years.
Chronic is when a patient is headache-free for less than one week of a 12-month time frame.
Types of Headaches: Tension-Type (TTH)
Tension-type (TTH) headaches are considered to be one the most neglected health disorders, yet they are the most common type of headache.3
Like cluster headaches, TTHs can be experienced as a single episode or repeatedly, as with chronic conditions making them more difficult to treat.10
A tension-type headache is characterized by a tight bilateral band-like pain that is of mild to moderate intensity.
Although the exact cause isn’t clear, neurotransmitter imbalances are believed to play a central role.6
One study confirmed that chronic TTH patients had a sensitized central nervous system, as confirmed by generalized pain hypersensitivity both in skin and in muscles. Similarly, in cases of muscle disorders, patients will have a lower pain threshold, resulting in increased TTH suffering.11
Research indicates certain personality types are more prone to chronic TTHs. Specifically, those with various neuroticisms and high levels of anxiety showed a correlation with chronic TTH.12
Accordingly, attributes such as stress, tension, posture, and depression are known contributors.6 Dr. Alan Gaby, author of Nutritional Medicine, reports that reactive hypoglycemia and/or food allergies are often causing the problem.
Types of Headaches: Migraine
More than 10% of the population suffers from migraines, with women being three times more likely than men to experience them.6
They’re often a hereditary disorder for which an estimated 3-13% of the US population is on preventative therapy.13
The onset is known to be associated with neuronal activation; however, the specific genesis of an attack remains a debate within the scientific community.13
Some of the many clinical classifications of migraines are with or without aura, familial or sporadic hemiplegic, and basilar type.
Anyone who has experienced one knows that it’s more than just a bad headache. They can be severely disabling, with throbbing pain, nausea, and light sensitivity, and can even cause vertigo or stroke-like symptoms.14
Suzy Cohen notes that most are caused by hormones, gluten, dairy, and histamines.7
Clinical research has also demonstrated an inverse correlation between childhood abuse and chronic headaches or migraines.15
Treatment with pharmaceuticals can be effective; however, they can cause rebound headaches as well as lead to drug dependence. In Dr. Alan Gaby’s experience, approximately two-thirds of patients minimize, if not eliminate, their headaches with diet and supplements.6
Triggers of Headaches
Not be confused with root causes, triggers are the conditions that activate the headache response as a consequence of an underlying condition.16
The physiology as to how a trigger activates the response is speculative, with multiple hypotheses. The various models center around neuronal pathways that may be inflamed or sensitized.
There is, however, a diverse list of common triggers that cannot be disputed even if the physiology is controversial.
The list of triggers includes stress, sleep deficiency, changes in ovarian hormone levels, food products, environmental toxins, and weather changes.16 Some of the other triggers that will be reviewed more closely are:
Food additives and preservatives: Many headaches can be minimized or eliminated by addressing diet. This includes additives, preservatives, or artificial sweeteners.
Food sensitivities/allergies: Often a food that is considered “healthy” causes a subtle adverse response, such as a headache, due to a sensitivity.
Food allergies can also trigger headaches, although it is an immune-mediated response mechanism, not a food sensitivity.6
Medications: For many, medicine is the way to fix a headache, not cause one. However, medicine-induced headaches are becoming more recognized in literature.
For instance, nitroglycerin infusion is a reliable trigger of a headache or migraine.16 The overuse of medications can create a complex chronic headache condition that may require an extensive detoxification process to cure.17
Infections: Several types of infections are associated with headaches, such as Lyme disease, other tick-borne illnesses, and mosquito-borne illnesses.7
Trigger of Headaches: Foods
Science has been researching the role of food in headaches since 1900.19 The findings continue to indicate a strong association between diet and the onset of a headache.
Experts agree that it’s worth the effort to identify dietary triggers and that elimination of these foods does not always have to be permanent.
Dr. Alan Gaby recommends considering hypoglycemia for all migraine patients, especially those who eat a diet high in refined sugars.6 Some of the biggest offenders are:
Aspartame (NutraSweet): An artificial sweetener commonly found in sodas. During commercial manufacturing and storage processes, the additive undergoes chemical changes that can result in adverse effects. Studies based on aspartame alone are not accurate assessments of its chemistry in food products.6
Caffeine: Can alleviate headache pain, although it is also a known trigger, such as during withdrawal.
It has a stimulatory effect and acts by antagonizing neuronal receptors in the brain.
Dr Mark Hyman advises minimizing coffee intake due to its effects on insulin resistance, increased cortisol, and reduction in serotonin, all of which can play a role in headaches. It has also been shown to increase urinary excretion of magnesium, calcium, and potassium, which can lead to headaches.20
Histamines: Cause blood vessels to dilate as part of the immune response. Eating more than the body can tolerate will result in a buildup, which can bring on a headache for those who are sensitive. Histamine intolerance can be a result of gut issues (like dysbiosis or leaky gut).21
Monosodium glutamate (MSG): A flavor enhancer often found in Chinese foods and certain soups. Research indicated that it is the buildup of glutamate which underlies the headache response.22
Nitrites: Preservatives found in processed meats such as hotdogs and lunchmeat that act as vasodilators.23 The effect of vasodilation can be the onset of a migraine.
Tyramines: Naturally-occurring compounds in wines and aged cheeses that are known to trigger migraines, especially if magnesium is low.23
Phenylethylamine: A stimulant found in chocolate, garlic, nuts, seeds, and raw onions.23 These are what are known as “vaso-active” amines. They cause your blood vessels to constrict, followed by dilation, which can then trigger a headache.24
Non-allergy mediated food sensitivities: Foods like eggs, citrus, dairy, or gluten may trigger a headache but are not an allergy.6
Citrus, for instance, has a chemical called synephrine, to which certain people are sensitive.24
Dr. Joel Furhman describes that the headaches begin after the food has been eaten and the detoxification process has begun as the body is trying to break down and remove the “injurious agent.”25
Additionally, the immune response generated as a result of the sensitizing food produces inflammatory chemicals that mediate headaches.
Dr. Fuhrman’s list of foods to avoid are: coffee, caffeinated teas, chocolate, alcohol, wine, dairy products, red meat, processed meats, sweets, commercial baked good, processed foods, food additives, and temporarily, nuts, dried fruit, and avocado.
Trigger of Headaches: Gluten
The role of gluten as a headache trigger is not as commonly recognized as some of the other known food triggers, but this is starting to change.28
One published multi-center study found chronic headaches in 56% of those individuals with gluten sensitivity and 30% in those with Celiac disease.28
Dr. Tom O’Bryan has been a leader in informing the public of the many symptoms that gluten intolerance can cause, and headaches are high on the list.
A gluten-free diet can not only minimize headaches, but also potentially repair damaged brain tissue. He explains that “approximately 36% of people with headaches have lesions in the brain, and for some of them, headaches are the culprit. By implementing a gluten-free diet, the tissue damage may be reversed.”29
If you suspect that gluten may be causing your headaches, the easiest approach is to eliminate it from your diet and see how you feel.30
Trigger of Headaches: Medication Overuse Headaches (MOH)
Medication overuse headaches, known as MOH, are a worldwide health problem with a prevalence of 1%-2%.26
Chronic headaches coupled with overuse of different headache medications are the underlying characteristics of MOH.26
Dr. Joel Fuhrman explains that although the drugs offer temporary relief, they stop the liver’s detoxification process and allow the tissue irritants to be stored within the central nervous system.25
Eventually, MOH patients may require a detoxification program in order to get off of the medications and effectively manage the withdrawal process. An inpatient program has been shown to be the most efficient and effective means of handling the situation.17
Insight as to the cause of the chronic condition is hypothesized as being the result of neuronal hyperexcitability, the cause of which stems from the medications deranging the modulating control system of the 5-HT (5-hydroxytryptophan, which is the precursor to serotonin) dependent system.27 Ultimately, this process becomes a perpetual cycle if intervention is not initiated.
Medications may offer temporary relief but they also interrupt the body’s natural detoxification process without addressing the root cause.
Many headache and migraine sufferers struggle to get by with over-the-counter or prescription drugs; however, there are associated risks. Dr. Suzy Cohen warns of some of the problems.7
Acetaminophen, when overused, can lead to a glutathione deficiency.
Glutathione is the most significant antioxidant in the body and is key in the liver’s detoxification process. For those who already have compromised liver function due to certain conditions (impaired MTHFR, daily alcohol use, or liver disease), acetaminophen may result in heightened effects.7,18
Ibuprofen may contribute to leaky gut or cardiovascular issues and vessel constriction, which may cause headaches.7
Dr. Hoffman also adds that some of the newer, stronger drugs are responsible for increased fatigue and impaired mental clarity.18
Trigger of Headaches: Infections
Headaches are secondary to infections as a part of the body’s immune response. Sometimes the type of headache can provide insight into the type of condition that a person has.
Suzy Cohen, author of Headache Free, notes that the unique type of headache associated with Lyme disease can provide an important clue for proper diagnosis.7
She describes a headache that moves around the head within seconds or minutes and is often dismissed by the patient and doctor. However, recognizing this symptom may be paramount for identifying this disease, which is often difficult to diagnose.7
Other tick-borne illnesses such as Ehrlichiosis, Babesiosis, and Bartonellosis, as well as mosquito-borne illnesses like West Nile virus and many varieties of encephalitis are also known to cause headache.
Researchers note that timely recognition of headaches as being secondary to serious infections such as meningitis, encephalitis, brain abscess, and subdural empyema can mean the difference between life and death.37
Root Causes of Headaches
Identifying the root causes of a headache is the first step toward successful treatment.
The following root causes are important to identify and correct in order to start seeing some headache relief:
Nutrient deficiencies can cause inflammation, vascular constriction, muscle tension, or mitochondrial dysfunction.
All of these reactions can be minimized with sufficient nutrient intake. A headache can be the signal that there is a deficiency in a particular nutrient.35
Hormone imbalance is especially pertinent for women and their reproductive cycle. There is a delicate balance between estrogen and progesterone levels, and when estrogen naturally decreases before menstruation, many women are prone to headaches.41
Stress has a strong link to headaches. When the body is under stress, it inhibits other bodily processes in an effort to address the “stressor.” A common repercussion of the body’s stress response is a headache.32
Inflammation occurs as a result of the body’s immune response to pain, injury, illness, diet, or toxins. The chemicals produced can mediate headaches.
Dysbiosis occurs when there is an imbalance in the the body’s microorganisms, especially in the gut, which can perpetuate inflammation, food sensitivities, increased toxin load, and imbalanced neurotransmitters that all play a role in headaches.
Root Cause of Headaches: Nutrient Deficiencies
The causes of nutritional deficiencies are numerous. A deficiency can be attributed to anything, from stress, alcohol, illness, leaky gut, and medications to an imbalanced diet.
As they relate to headaches, there are some specific nutrients that can have a significant impact if they are lacking.
Many of these key nutrients are ones that provide mitochondrial support (the part of the cell where energy is produced).
Magnesium is described as the “relaxation” mineral. For those headache sufferers who are deficient, this may be all it takes to cure the problem. Author Dr. Alan R. Gaby reports one case study of >3000 female migraine patients who were treated with 200 mg/day of magnesium (from amino acid chelate) with an 80% success rate.
Magnesium plays a significant role in mitochondrial function, which is often impaired in migraine patients. It is a safe and simple method of treatment.6
Riboflavin (vitamin B2) is another form of mitochondrial support whose effectiveness in reducing migraines dates back to the 1940s and ‘50s. Unfortunately, its effectiveness on migraines was forgotten until recently.
The latest research indicates that it is dose-dependent and stresses that higher doses should be reserved for those who do not find relief with moderate ones.6
Vitamin D, which has gained recognition for its importance in recent years, is also meaningful when it comes to headaches. Although limited in scope, some research shows an inverse relationship between headaches and a vitamin D deficiency. This may be due to the fact that low vitamin D contributes to poor sleep quality, which can in turn result in frequent headaches.
Other mitochondrial support supplements that have demonstrated benefits in minimizing the frequency and/or severity of migraines include alpha-lipoic acid, CoQ10, folic acid, vitamin C, and B-12.6
Root Cause of Headaches: Hormonal Imbalance
Hormonal imbalances are often secondary to stress and primarily affect women during their reproductive years.41
The HPA-axis regulates the stress response (“fight or flight”), and the hypothalamus-pituitary-gonad HPG-axis is responsible for reproduction.
During a stressful event, when you need that burst of adrenaline, cortisol is released and all other bodily systems are essentially put on hold. When the event is over, the body deactivates the stress response and all is well. The problem occurs when the body is constantly under stress (real or perceived), and it never gets to rebalance.
Since the reproductive system is not considered to be essential when you are running from a lion, cortisol acts as an “off” switch for the HPG axis. If the HPG axis is deactivated long enough, it will produce decreased amounts of the sex hormones.42
This imbalance is indicated by the research to be the underlying cause of the headaches. Although the specific mechanisms are still being evaluated, a drop in estrogen levels has been implicated as the cause for migraines.43
Other causes of hormone imbalances include oral contraceptives, hormone replacement, and the natural hormonal fluctuations that occur throughout a woman’s life.41
Root Cause of Headaches: Stress
Retrospective research studies show that “upwards of 80% of migraine patients report stress as a headache precipitant.”32
Cortisol levels are connected to sleep patterns and blood sugar. The HPA axis is the pathway where cortisol is released during periods of stress.42
With continued high stress and cortisol release, the body maintains a high blood sugar level in order to preserve a readily-available energy source for dealing with a stressor.
This becomes a problem when stress continues for long periods of time, in which case it compromises sleep patterns, the immune system, digestive health, and blood sugar regulation. This can lead to headaches from the imbalances.
Dr. Mark Hyman advises that by decreasing stress, ensuring sufficient sleep and exercise, and limiting alcohol, sugar, flour, and starches, the imbalances in the HPA axis can be corrected.35
Root Cause of Headaches: Inflammation
Inflammation is the body’s immune response to pain, injury, or illness. Simply put, this response is a complex cascade of events that recruits immune cells which produce chemicals, antibodies, and free radicals in an attempt to resolve what it perceives to be a problem.
This complex system can become an issue when the normal resolution of the inflammatory response doesn’t occur. Thus, the body ends up in a continually responsive state known as chronic systemic inflammation.
Poor diet, food sensitivities, stress, toxins, and dysbiosis are contributors to chronic inflammation. The more often your body perceives these, the more the chronic inflammation is perpetuated, resulting in an increased likelihood of getting a headache.
The pro-inflammatory condition also impacts the nervous system, altering levels of neurotransmitters and pain receptor function, which can result in headaches.
Root Cause of Headaches: Dysbiosis
Dysbiosis occurs when there’s an imbalance in the body’s microorganisms where the beneficial organisms are in lower numbers that the harmful ones, especially in the gut.
When the bad bacteria outnumber the good bacteria, inflammatory chemicals are produced and leaky gut can occur.
A leaky gut, or increased intestinal permeability, allows foreign substances into systemic circulation, which causes an immune reaction. This reaction produces inflammatory chemicals, in addition to the ones being produced in the gut. This progressive increase in systemic inflammatory load can lead to headache, because the liver cannot clear the inflammation fast enough.
Another important point is that the gut largely regulates the immune system, and it is also where many neurotransmitters are produced, thereby making the gut a focal point for a wide variety of conditions (including headaches).
Poor diet, antibiotic and NSAID use, toxins, and stress are all means by which the gut microbiota becomes altered, which can also lead to nutrient deficiencies.7
Natural Relief from Headaches
Addressing root causes and avoiding headache triggers are key to minimizing headaches. However, there are some other things you can do in the short term for prevention and/or immediate treatment:
Gentle massage, stretching of the head and neck muscles, postural exercises, myofascial trigger points, and chiropractic adjustments can reduce muscle tension. An accurate assessment of the type of headache lends itself to the greatest therapeutic benefit.11
Sleep is imperative. Some of the causes of headaches also cause sleep issues. Taking vitamin D and magnesium can improve sleep as well as reduce inflammation and stress.
Acupuncture has been used for over 3,000 years, and studies today continue to support it as an effective measure against migraine attacks.38
Yoga has been shown to reduce frequency and intensity of headaches. For headache suffers, yoga is one of the better exercise options. Although other forms are generally considered to be beneficial to the headache patient, they can also generate a headache in some cases.39
Avoid hypoglycemia by eating regularly and ensuring sufficient protein (without overdoing it) on a consistent basis.40
Butterbur is an herbal remedy that has been shown to significantly decrease headache frequency.38
Feverfew (Chrysanthemum parthenium) or Gingko Biloba can be taken as a supplement or tea to improve circulation to the head.40
Rosemary extract can ease the blood vessels and provide relief.39
Ginger, boswellia serrata, and turmeric are all potent anti-inflammatories.
White willow bark is a natural pain reliever often found in combination with these anti-inflammatories.
Hydrate with water frequently. Insufficient hydration can trigger a headache or make the one you have last longer.
Drink two glasses of water to start taking the edge off the headache.40
Serratiopeptidase is a proteolytic enzyme that, when taken on an empty stomach, helps to degrade proteins in circulation that may be causing an inflammatory response.
This enzyme has a fibrinolytic effect, meaning that it reduces clot formation. Proteolytic enzymes are good for reducing total inflammatory load.
Antioxidants in the form of brightly-colored fruits and vegetables are important for controlling inflammation. Supplementally, resveratrol and pycnogenol are good options that modulate inflammation and blood pressure.