Headaches can be caused by referred pain from the neck muscles and joints, raised or reduced intra-cranial pressure, and spasm and dilatation of branches of the external carotid artery. Also, diseases of the sinuses, temporomandibular joints, teeth, ears and eyes can all lead to headaches (Souhami RL, Moxham J, eds. Textbook of Medicine. Edinburgh: Churchill Livingstone, 1997: 1066).
Metabolic disturbances such as hypoglycaemia (low blood sugar), hypercapnia (abnormally high blood levels of CO2) and food sensitivities should also be ruled out as causes.
The origin of a headache is usually thus: contracting muscles, or their nerve supply, release vasoactive subs-tances such as lactate, serotonin, bradykinin and prostaglandins, which significantly lower the pain thresh-old. Descending tracts of cranial nerves V, IX and X, along with sensory fibres of the first and second cervical (neck) nerves, bring about excessive connective tissue tension in the suboccipital (brain/neck) and scalp areas, causing the release of the vasoactive substances there. The overall effect is a headache.
Civilization has inhibited our 'fight-or-flight' response, leaving us in an almost constant state of alert, thereby keeping us in a state of pathological tension (DiGiovanna EL, Schiowitz S. An Osteopathic Approach to Diagnosis and Treatment, 2nd edn. Philadelphia, PA: Lippincott-Raven, 1997: 96, 430-2).
Happily, a number of alternative therapies are effective against headaches.
The sedative herbs Scutellaria lateriflora (hoodwort, skullcap) and Betonica officinalis (stachys, betony) have traditionally been used in combination for neuralgic or tension headaches (Scientific Committee of the British Herbal Medicine Association. British Herbal Pharmacopoeia, Part I. Cowling, W Yorks: BHMA, 1976: 35, 183).
Although its long-term toxicity has not been confirmed, Panacetum parthenium (feverfew) inhibits the release of serotonin and histamine, the production of serine proteases and leukotrienes, and reestablishes blood-vessel tone (Lancet, 1985; 1: 1071- 4; Lancet, 1988; 2: 189-92).
Ilex paraguariensis (Jesuits' Brazil tea) can be effective against stress- and fatigue-induced headaches (British Herbal Pharmacopoeia, Part I. Cowling, W Yorks: BHMA, 1979: 97).
The analgesic herb Fang feng (Ledebouriella root) may be used in combination with the tranquillizing Tian nan xing (root of jack-in-the-pulpit) for headache (as well as toothache and earache). But beware: this herb is toxic if eaten raw (Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. Seattle, WA: Eastland Press, 1986: 32-3, 191-2).
An offbeat way to relieve recurrent headaches is to do as the African Zulus traditionally do-pound the leaves and bark of Ilex miti (Cape holly), mix it with water to work it up to a lather, and use it to wash your entire body (Ann S Afr Mus, 1917; 16: 1).
In European folk medicine, an infusion of German chamomile flowers, lavender flowers, leaves of lemon balm (Melissa officinalis) and liquorice root is the traditional treatment for headaches (Herget HF. Kopf- und Gesichtsschmerz. Cologne: K"one-mann Verlags GmbH, 2000: 57).
The B vitamin riboflavin has been found to successfully treat migraines. In one randomized, controlled trial, 55 migraine sufferers took either 400 mg/day of riboflavin or a placebo for three months. Riboflavin was significantly better than placebo in reducing the number of headache days and frequency of attacks (Neurology, 1998; 50: 466-70).
Another study found that 80 per cent of migraine sufferers treated with riboflavin reduced their monthly migraine days by 50 per cent or more (Cephalalgia, 1994; 14: 328-9).
This has proved more beneficial than orthodox medication for recurrent headaches when given for at least three months (J Neurol Neurosurg Psych-iatry, 1984; 47: 333-7).
People who have chronic tension headaches may be more sensitive to pain due to chronic muscle stimula-tion (Headache, 1998; 38: 10-7). This can be improved by a physiotherapy regimen that includes postural re-education, home exercises, massage and stretching of the cervical (neck) spine muscles (Headache, 1996; 36: 149-53).
Osteopathy and chiropractic have proved to be more effective in the long-term treatment of headaches than many of the more conventional therapies such as ice packs (Cephal-algia, 1990; 10: 241-50), amitriptyline hydrochloride (J Manipulative Physiol Ther, 1995; 18: 148-54), soft-tissue mobiliza-tion or even a brief rest (J Am Osteop Assoc, 1979; 78: 322-5).
An often overlooked but common cause of headaches is the so-called temporomandibular disorders, which also include pain in the temporo-mandibular joint (TMJ) (Head Face Med, 2006; 2: 25). Manual correction of TMJ dysfunction is often of genuine value in the treatment of tension headaches (Br Dent J, 1986; 161: 170-3).
Tiger balm, that Oriental cure-all combination of various essential oils, when applied topically to the temples may offer immediate-albeit short-term-relief from a tension headache (Aust Fam Physician, 1996; 25: 216, 218, 220 passim).
Harald Gaier, a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London, and the Irish Centre of Integrated Medicine, Co. Kildare (www.drgaier.com).