To ease a headache, you need to tackle the cause. And the cause may not be what you think it is

Tense, nervous headache? You're not alone. In any givenyear, up to 80 per cent of us will suffer what doctors call a "tension-type headache".

Tense, nervous headache? You're not alone. In any givenyear, up to 80 per cent of us will suffer what doctors call a "tension-type headache".

"Tension-type headaches" are not necessarily due to nervous tension and stress, as the name suggests; instead they can be broadly attributed to muscular pain, which can have a variety of causes. In this respect, they are distinct from migraines, caused by neurovascular pain, and from "secondary" headaches, where there is an underlying cause such as stroke, meningitis or brain injury.

So what makes so many otherwise healthy people suffer from headaches? This week, more than 2,000 doctors and sufferers from around the world are meeting for a conference in London, Headache World 2000, in order to pool their knowledge. Dr Timothy Steiner, director of the Royal Princess Margaret Migraine Clinic at Charing Cross Hospital, summarises what doctors currently know about the common causes of tension headaches and how to prevent and cure them.

The first thing to do, Dr Steiner advises, is look at the stress you experience and distinguish between good stress that helps you to perform at work and enhances your life, and bad stress which is unhealthy and makes you vulnerable to discomfort and disease. If you can't alter the causes of stress, you might be able to improve your techniques for coping with stress. That doesn't mean "pulling yourself together"; it means trying relaxation therapies. Biofeedback teaches patients to recognise the level of stress in their muscles, and yoga, massage and relaxation tapes may all help to reduce the adverse effects of stress.

Secondly, your posture may be causing the problem. If you feel discomfort in your shoulders or neck by the end of the day, you are almost certainly suffering as a consequence of bad posture, which may in turn lead to headaches. If you sit at a VDU, your employer has a legal responsibility to provide you with an ergonomic workstation; that means an adjustable chair and monitor at the correct height. If your posture is poor (and most people's is) then a physiotherapist can help by locating and loosening the muscles that have been under stress, and by teaching you relaxation exercises. The Alexander Technique, too, can retrain you to control your body posture.

Caffeine is implicated in many headaches. Unfortunately, the role it plays is not fully understood, and missing out on your morning cup of coffee may cause just as bad a headache as downing several cafetiÿres. This is why many of us suffer from "weekend headaches", at times when our caffeine consumption is lower than usual. Dr Steiner advocates moderation; if you drink six to eight cups a day, it's probably too much.

Some women swear that hormones are the cause of their headaches. This is only partly true, according to Dr Steiner. Hormonal changes themselves don't trigger headaches, but physiological changes in women who are premenstrual, menstrual or postmenstrual (isn't that all the time?) may interfere with the ways in which they normally cope with stress, making them more susceptible. Water-retention may contribute, too, and in extreme cases, diuretics may help to reduce this.

So what about painkillers? Surprisingly, Dr Steiner isn't a great fan of analgesics. They're fine if you get a headache once in a while, he says, but a staggering one in 25 of the population gets a headache every day of their lives, and many of these sufferers end up taking painkillers day in, day out, to cope. Over-consumption, however, seems to end up causing rather than curing the problem, and many of Dr Steiner's patients get over their headaches only when they quit taking painkillers altogether.