Headaches are commonplace, of course, even on mundane occasions. Many people experience them simply as a symptom of some other ailment—the flu, for instance, or eyestrain. But an estimated 40 million to 60 million Americans (70 percent of them women) suffer from chronic headaches not associated with any other illness. "Headaches are no longer considered a psychological illness, "says Saper, a leading authority on headaches and the author of five books on the subject. "We now know that headache-prone people have extremely sensitive biological systems that overreact to various stimuli." In fact, the most promising new headache drug, sumatriptan, works by influencing nerve cells within the brain to modify these overreactions.
Born and raised in Joliet, Ill., Saper—who never gets headaches himself—graduated from the University of Illinois medical school and received his neurological training at the University of Michigan. The Head Pain Institute, which he founded in 1978, conducts headache research and to date has treated more than 20,000 sufferers. Saper, 48, is married and has three children. He spoke with correspondent Julie Greenwalt about the causes and cures of the holidays' least merry side effect.
Why are headaches more prevalent around the holidays?
It's a time when the body is subjected to many stresses. People are rushing from store to store during lunch hours; there's often the frustration of trying to please unpleasable people. Also around the holidays people change their schedules. Your body is used to being home watching the news at 6 o'clock, and instead you're out shopping. You stay up to party or to wrap gifts. There is growing evidence that when headache-prone people experience a change in patterns their bodies will often react by getting a headache.
What causes this reaction?
We're not absolutely certain, but the most recent evidence points to the defective functioning of cells or chemicals deep within the brain. Serotonin—a neurotransmitter that affects mood, sleep and pain and partly controls the dilation and contraction of blood vessels—is now receiving increased attention.
We do know that headaches, which are thought to be a by-product of a biochemical malfunction, are usually triggered by exposure to certain stimuli. Of the hundreds of potential activators of headaches, the most common are biological cycles, weather changes, anger, hormonal ups and downs, and hunger. Some less common but surprising triggers include orgasm, exhilaration and sleeping later than usual.
What is the effect of diet?
Some foods known to provoke headaches are those that contain the chemical tyramine. They include chocolate, aged cheeses, sour cream, yogurt, yeast extracts and vinegar in sauces. Non-tyramine foods to watch out for include citrus fruits, milk and milk products, onions and fatty foods. Remember, though, that susceptibility is highly variable.
And then there's alcohol.
Right. In general, alcohol affects brain chemistry, which plays a role in headaches. But some people also react badly to specific ingredients in some alcoholic beverages. If you are headache-prone, avoid beers because of the yeast and other ingredients that might be activators. Red wines, sherry, port and brandy all contain chemicals that can induce a headache. The drinks that seem most benign are white wines and, in the liquor category, vodka.
How should alcohol-induced headaches be treated?
Most people require some form of medication, ranging from over-the-counter remedies to prescription migraine drugs. Old-fashioned home treatments—such as resting in a cool, dark room or putting an ice bag over the forehead or neck—sometimes work well too.
So much for the immediate effects of alcohol, but how about the dreaded morning after?
You don't have to be headache-prone to get a hangover. The hangover headache occurs six to eight hours after consumption, when the body has already metabolized most of the alcohol in the bloodstream. We know that specific biological changes—including those in brain sugar levels and neurotransmitters—occur after too much alcohol. These can result in a headache that has the features of a severe migraine, including throbbing, light and sound sensitivity and nausea.
Is there any way to prevent a hangover?
The best way, of course, is not to drink too much. Don't drink on an empty stomach. Drink plenty of water before you sleep. Some research has indicated that ibuprofen or other anti-inflammatory agents, taken before imbibing, may help prevent a hangover. This treatment, however, has not been widely tested.
Everyone has a favorite hangover remedy. Are any of them effective?
There are things that work for some people, but not for everyone. You should drink a lot of fluids the next morning, including noncitrus fruit juices. Alcohol induces diuresis—you urinate a lot—so there may be a relative dehydration. Sugar products are very helpful because one of the biochemical changes that alcohol may induce is the depletion of sugar in the brain. Some people swear by vitamins or raw eggs, but I know of no data that support that.
For nonalcoholic holiday headaches, what's the best medicine?
The range of treatment includes everything from over-the-counter analgesics to stronger prescription drugs. For people suffering from migraine headaches, there are already many excellent drugs, such as ergot-amine, DHE and Midrin. And, of course, the new drug, sumatriptan, could be available early next year. This drug stops pain and nausea in 70 to 80 percent of the migraine sufferers studied, even when the headache has been present for many hours. It may also help people with other types of headaches.
In the meantime, what is your advice for making the holidays headache-free?
Anticipate the stress and pace yourself. As much as possible, keep to your normal daily rhythm. Temper your indulgences. And, above all, keep things in perspective. Don't expect to please everybody—if you spend the holidays with a headache, you are unlikely to please anybody.
Eat, drink and be merry this holiday season, says neurologist Joel Saper, and chances are good you'll wind up with a headache. Not that he expects anyone to take his word for it. "Holidays," notes the founder of the Michigan Head Pain and Neurological Institute in Ann Arbor, Mich., "are a time of special indulgences."