More than 47 million Americans have experienced a severe or debilitating headache in the past three months. Migraines alone affect 9 percent of the U.S. population and costs $1 billion a year in direct medical expenses.
There are the obvious choices for zapping the pain, such as nonsteroidal anti-inflammatory drugs (Motrin and Aleve, for example). People with migraines often take beta blockers or antidepressants to prevent headaches, and triptans, such as Imitrex or Relpax, once symptoms start.
But if your headaches are persistent or other medications just aren't cutting it, here are some other approaches you can consider.
Biofeedback uses electronic sensors to monitor body functions such as muscle tension, skin temperature, heart rate, and blood pressure. Data are fed back to the patient through sounds or computer images. The goal is to teach people how to control bodily responses -- easing tight muscles, for example -- to prevent headache pain.
Studies show biofeedback could be effective for migraine and tension-type headache. A recent analysis published in Headache suggests behavioral therapies, such as biofeedback, are more cost-effective over time than prescription drugs.
In acupuncture, thin needles are inserted under the skin to realign the flow of energy, orqi, in the body. In general, treatments run $60 to $120 per session, according to Acufinder.com, an acupuncture referral service.
An expert analysis, known as a Cochrane review, found acupuncture could help prevent acute migraines as well as drug treatments do and with fewer adverse side effects. Evidence also suggests that acupuncture could help people with frequent episodic or chronic tension-type headaches, they say.
For temporary relief, try rubbing your temples or getting a neck, back, head, or shoulder massage.
"You feel better for a little while, but then you have to have it again and again," says Salwa H. Hanna, M.D., owner, founder, and medical director of the Headache Clinic of Denver.
In a small study, people with migraines who had six weekly massage sessions had less frequent migraines and better sleep during the massage weeks and the three following weeks than a control group.
Headache-relieving stretches can get at muscle tension that contributes to pain. Add them to your workout or use them when a headache looms.
Try these three: neck range of motion (chin forward, upward, and toward each shoulder); shoulder shrugs (shrug up, up and forward, and up and back); and neck isometrics (press palm into forehead and hold; press hand on each side of the head).
Stretch twice a day for 20 minutes per session. Hold the stretch for five seconds, relax for five seconds, and repeat each stretch three to five times.
Regular aerobic exercise, such as brisk walking, biking, or swimming, can reduce migraine intensity and frequency, according to the National Pain Foundation.
In a small study in the journal Headache, migraine patients who were not regular exercisers engaged in a 12-week indoor cycling program. Participants improved their quality of life and reduced the number of migraines they had, as well as the intensity of the pain.
Various meditation techniques can be used to focus attention and quiet the mind from distractions such as chronic pain.
At this point, there is little data on the effect of meditation on migraines. Researchers at Johns Hopkins School of Medicine, in Baltimore, are involved in a clinical trial that will try to determine if Vipassana -- an ancient Indian meditation technique that focuses on mind-body connectedness -- can reduce migraine frequency and severity and improve overall quality of life.
One small study of people with migraines found that spiritual meditation reduced headache frequency and improved pain tolerance more than secular meditation and muscle relaxation.
Could striking a camel pose ease your aching head?
Yoga combines physical postures, breathing exercises, and meditation to boost relaxation and balance the mind, body, and spirit, according to the National Center for Complementary and Alternative Medicine.
In a small study in Headache, two groups of migraine patients were randomly assigned to three months of yoga therapy or self care. Compared with the control group, the yoga participantshad less frequent and less painful attacks, as well as less anxiety.
Deep breathing, relaxing to music, or using mental imagery can help people unwind and possibly help with headache too. Additional research is needed, however.
A study of 90 people with tension headaches found that relaxation training improved their sleep more than acupuncture.
Edmund Messina, M.D., medical director of the Michigan Headache Clinic, in East Lansing, teaches a 20-minute muscle-relaxation technique. Patients lie still, breathe in and out slowly, and use a mantra to keep the mind from wandering. They then contract and relax various muscle groups, working from toes to head. "The idea is to consciously tense and relax your muscle groups," Dr. Messina says.
Heat and cold
Anyone can use this no-risk headache therapy -- even pregnant women.
To alleviate neck tightness, apply heat to the back of the neck, Dr. Messina says. For a pulsating headache, however, skip the heat and try icing the temples.
The artery that supplies blood to the dura (the lining of the brain) sits behind the thin bone at the temple, Dr. Messina explains. "That dura gets mighty angry and inflamed when you're having a migraine," he says. Lowering the temperature of the blood passing through that area "seems to relieve some of the throbbing."
Avoid nitrates and nitrites
Dr. Hanna recommends avoiding headache-inducing substances, including nitrites and nitrates in processed meats and monosodium glutamate (MSG) used in foods as a flavor enhancer. Some heart medicines also contain nitrate.
Caffeine, alcohol, phenylethylamine (found in chocolate and cheese), tyramine (found in nuts and fermented meats, cheeses, and soy), and aspartame (in many artificially sweetened foods) are headache triggers for some.
Some doctors support taking riboflavin (vitamin B2), magnesium, and coenzyme Q10, among other supplements, as part of a headache-relief strategy. But the evidence is scarce on their effectiveness, and they do carry risks of side effects.
Better known as a wrinkle-reducer, Botox injections are FDA-approved for treating adults with chronic migraine.
Multiple injections, at a cost of roughly $350 per injection site, are given around the head and neck every 12 weeks. Some insurance companies cover the injections for people who have failed to get relief from other migraine medicines.
Two large studies funded by Allergan, the maker of Botox, show reductions in the frequency of headaches. But groups that received placebo injections showed improvement too.
Skeptics continue to question the therapy's value. "Botox produces euphoria in those who bill for it, but I've never seen it work," Dr. Messina says.
Transcranial magnetic stimulation
Delivering magnetic pulses to the brain may become a useful therapy for zapping migraines, research suggests. A recent study found that when patients treated a migraine with transcranial magnetic stimulation, they got better relief than those who treated their pain with a placebo device.
This noninvasive treatment takes one or two hours and is conducted in a clinic by placing an electromagnetic coil near the head to deliver the pulses.
Transcranial magnetic stimulation, however, is still considered an experimental therapy for treating migraines.
People with intractable headaches may one day rely on electrodes implanted in the neck or brain to provide pain relief.
One such therapy, called occipital nerve stimulation, appears promising in the treatment of cluster headaches and migraines, studies show, although larger studies are needed.
In this treatment, an electrode is surgically implanted at the base of the skull, near the occipital nerve. A power source is also implanted (near the collar bone or elsewhere in the body) to deliver electrical impulses via a wire to the electrode.