Despite how common they are, headaches are somewhat mysterious. Unlike, say, diabetes it isn’t know exactly what produces that particular kind of pain. Making the condition even more strange, there are in fact many different types of headaches.

Migraines afflict about 28 million Americans, in a ratio of about three to one women to men. Yet, despite occurring fairly regularly to 10% of an enormous population, the causes (and cures) still remain unknown. Contemporary research suspects the interaction of serotonin (a neurotransmitter) with nerve cells is responsible, but no one knows for sure.

Cluster headaches, which attack only about a third of one percent of the population, are even more intense than migraines. Yet, here again, scientists have only tantalizing hints as to the cause of this stabbing pain localized behind an eye or temple. They tend to occur around the same time every day for weeks or months, lasting an hour or less, then disappear for long periods. No one knows why, though some suspect a defective hypothalamus is responsible.

Ordinary or tension-type headaches are the most common, yet even here the causes are only partly understood. There are many common contributors - stress, diet, posture and over 300 different medical conditions - yet precisely what produces that dull ache remains a mystery.

Fortunately, even though the causes - and many times even accurate descriptions - are hard to pin down, there are an abundance of treatments. Though none are perfect, several are safe and effective for the vast majority of headache sufferers.

Ergots used to be the typical treatment for migraine patients, but to a large extent that has given way to triptans. The first generation had some drawbacks, but the new designs are safe, effective and have few side effects. No miracle cure, they can be taken at the onset of symptoms and reduce or eliminate the intense, throbbing pain familiar to so many.

Preventive medications have come a long way as well. Beta blockers or CCBs (Calcium Channel Blockers), anti-depressants, anti-seizure medications and a variety of others used to treat other illnesses turn out to be very effective. For many, they can keep headaches from occurring in the first place. In many cases, they don’t eliminate the possibility, but reduce the frequency. Even that can be welcome relief, however.

Then there are the traditional over-the-counter remedies - aspirin, acetaminophen (or paracetamol) and ibuprofen. The first two have been around for over 100 years and continue to provide millions with safe, effective relief. In fact, for such a simple compound, aspirin is a near wonder drug given how many medical conditions it can safely treat.

Naturally, both prescription and over-the-counter medications do carry some risks and the possibility of side effects. Gastrointestinal bleeding, stomach upset and other common conditions are likely for some, unlikely for others. In rare cases, those taking them can have vomiting, bloody stools and even a headache (usually from overdosing).

But seeking medical advice, which oddly only about half of migraine sufferers ever do and those suffering from tension headaches almost never, is still a good idea. An occasional mild headache may not warrant the time and expense. But for chronic or intense headaches, there may well be an underlying medical condition that should be diagnosed and treated. So-called ’secondary headaches’ are common.

Pregnant women in particular should pay close attention to diet and medications consumed. Large hormonal and other changes commonly intensify the discomfort and frequency of headaches. A proper diagnosis and treatment regimen should be sought right away.

It may be some time yet before the fundamental causes of headaches are identified and better treatments developed. In the interim, attending to controllable lifestyle choices is a good idea. Keep stress low, exercise regularly and consume a healthy diet. Work on maintaining a positive attitude - headaches are common even in mild depression.

Even when the causes are unknown, the treatments can be (at least partly) a matter of choice.

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