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Health Information Five Things You Should Know About ... Headaches

Know your triggers and get enough sleep to help keep headaches away.

The holidays bring a lot of joy. But they can also cause a lot of headaches — extra bills, jam-packed stores, holiday traffic, toys that require "some assembly."

While holiday-induced headaches typically vanish by Jan. 2, for many people there is no relief from headache pain. According to the National Headache Foundation, roughly 45 million Americans experience chronic, recurring headaches and 28 million Americans experience migraines. If you're one of those people, you're aware that the pain can severely affect your quality of life.

But whether you have migraines, tension headaches or cluster headache (severe pain located in one eye and associated with tearing, redness and sometimes a droopy eyelid), you don't have to suffer in silence. Discover Rush Online spoke to Laura Jadiwzik, MD, a neurologist at Rush University Medical Center, who revealed five things you should know about this common problem — including tips for getting a handle on your headaches.

Migraines are often underdiagnosed or misdiagnosed. The National Headache Foundation reports that 52 percent of all migraine sufferers are underdiagnosed — meaning their migraines are diagnosed less often than they are actually present — by health care providers. In addition, the foundation says migraines are misdiagnosed as tension or sinus headaches almost as frequently as they are correctly diagnosed. One possible reason: The symptoms of migraine vary greatly from person to person, and some of the symptoms — including facial pain and congestion — are also associated with other types of headaches.

Migraines often, but not always, occur on one side of the head and are usually throbbing or pounding in quality. They may start out mild but generally reach moderate to severe intensity over hours. They can last anywhere from hours to days and typically occur one to four times a month. Other telltale signs include increased pain when moving or bending over, nausea, vomiting, light sensitivity, sound sensitivity and aura (the perception of a strange light, an unpleasant smell or confusing thoughts or experiences that occur before the actual headache). "The classic description of a migraine sufferer is a person seeking a dark, quiet room in which to lie down," says Jadiwzik.

One way to determine whether it might be a migraine: Look at your family history. Headaches, and migraines in particular, tend to run in families. For instance, when both parents have a history of migraines, there’s a 70 percent chance the child will also develop them; and even if only one parent is a migraine sufferer, the risk is still 25 to 50 percent that the child will be, too. Additionally, women are three times more likely than men to suffer from migraines.

Eliminating your headache triggers can help. Tension headaches, the most common types of headaches among adults and children, typically occur on both sides of the head and are characterized by a mild to moderate tightness or pressure; you may feel like a tight band is wrapped around your head. "But this pain doesn't just happen," Jadiwzik says. "Tension headaches are typically triggered by an external source." Common triggers for tension headaches include the following:

  • Eye strain
  • Clenching or grinding your teeth
  • Missing meals
  • Neck and back strain due to poor posture
  • Overworking
  • Overuse of over-the-counter medications, including aspirin and acetaminophen
  • Poor sleeping position
  • Stress

Tension and other types of headaches, including migraine, can also be triggered by specific environmental factors in your home or workplace, such as secondhand tobacco smoke, strong odors from household chemicals or perfumes, pollution (including vehicle exhaust), pollen or excessive noise.

"Knowing your triggers, and avoiding those things as much as possible, may actually help to reduce the frequency and severity of your headaches," says Jadiwzik. Because triggers vary from person to person, it's best for people to keep track of what factors provoke their particular headaches. Jadiwzik suggests keeping a headache diary: "Every time you get a headache, write down the things that may have triggered it, along with the location, duration and severity of the pain," she says. "It will be useful information to discuss with your physician."

Food is often a factor. In addition to all of the aforementioned triggers, certain foods have headache-causing potential, such as those containing caffeine (withdrawal from caffeine can also cause headaches), tyramine, nitrates (a preservative) and monosodium glutamate, or MSG (a common food additive).

  • Examples of foods that may contain tyramine: alcohol (especially red wine), chocolate, foods with vinegar (ketchup, salad dressings, etc.), organ meats (kidney, liver), sour cream, soy sauce, yogurt
  • Examples of foods that may contain nitrates: bacon, bologna, canned ham, corned beef, hot dogs, pastrami, pepperoni, sausage, smoked nuts
  • Examples of foods that may contain MSG: Chinese food, dry roasted nuts, frozen food, mayonnaise, potato chips, salad dressings
  • Examples of food that may contain caffeine: sodas, coffee, tea, chocolate, cocoa

Get your ZZZs to minimize your migraines. While people with migraines often complain that the headaches interfere with a good night's sleep, research suggests the opposite may also be true: Lack of sleep may be a trigger for migraines. One study showed that adopting the following good sleep habits can effectively reduce the number and severity of migraines:

  • Scheduling eight hours of time in bed each night and going to bed/waking up at approximately the same time every night/day.
  • Not reading, watching television, using electronic devices such as gaming systems, laptops or tablets, or listening to music in bed.
  • Consistently eating dinner four or more hours before bedtime.
  • Limiting fluid intake starting two hours before bedtime to avoid waking up to go to the bathroom.
  • Using visualization techniques to help fall asleep quickly.

In the study, migraine sufferers who did these things reduced their headache frequency by 29 percent and their headache intensity by 40 percent compared to those who didn't change their sleep habits. The key to success, though, is incorporating all of the above steps into your sleep routine: Study participants who kept three or more bad bedtime behaviors did not see an improvement in their migraines.

Napping isn’t the answer for tension headaches. "As is the case with migraines, a good night’s sleep can help minimize tension headaches," Jadiwzik says. Napping, however, does not, according to a 2009 study by researchers at Rush. The study found that napping to cope with chronic pain caused by tension headaches could actually lead to chronic insomnia, which, in turn, could lead to more headaches.

Eighty-one percent of the study participants who were confirmed as having tension-type headaches said they used sleep as a way of managing their headaches; this method was also rated by participants as the most effective self-management strategy for pain. But while napping can relieve the pain temporarily, it could also lead to a vicious cycle of insomnia and headaches. That's because napping may decrease the brain's need for sleep at night, causing sleep disturbances such as difficulty falling or staying asleep. Not only are night-time sleep disturbances frequently identified as a trigger of tension headaches, but prior studies have identified sleep disturbances as a risk factor for developing chronic headaches.

If you're experiencing both insomnia and headaches, talk to your doctor or a sleep expert right away. He or she can assess your daytime napping behaviors and help determine strategies for managing your headaches that don' involve sleep.

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Please note: All physicians featured in Discover Rush Online are on the medical faculty of Rush University Medical Center. Some of the physicians featured are in private practice and, as independent practitioners, are not agents or employees of Rush University Medical Center.

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December 2012-January 2013 


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