That's a relief

Headaches are a pain, but reaching for the aspirin might only make things worse. Hester Lacey looks at the causes of headaches and reports on a natural alternative

Headache? Tense, nervous headache? Nearly half of us get at least one a month. Women are particularly prone, with more than half suffering at least once a fortnight. And these days we expect a pill for every ill and a quick fix for every twinge - so the manufacturers of over-the-counter painkillers are cashing in. During 2002, we spent more than £300m on pain relievers, according to the Pharmaceutical Association of Great Britain. The market researchers at Euromonitor put the current figure even higher and predict that by 2006 the market will be worth £483m. And the makers are on to a winner because, ironically enough, excessive use of painkillers can actually cause chronic headache. A cure that provokes the symptoms it alleviates must be a manufacturer's dream.

So what exactly is a headache? "We don't know for sure, though we are getting to the bottom of it," says Dr Stephen Silberstein of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. Migraine pain, he says, seems to originate from a chemical imbalance in the brain, tension headaches from the muscles and joints. And the brain itself can generate pain. "If pain paths are activated, signals that don't normally produce pain can do so." Headache, says Dr Silberstein, is an evolutionary mystery. "What is the benefit of the headache for evolution? Again, we don't know." There is speculation, he explains, that headaches stopped primitive man from going out when he was physically under par, thus reducing the risk of the hunter becoming the hunted. It's not that we're necessarily getting more headaches today, he adds; rather that we're more aware of them and expect to be able to cure them instantly.

Dr Anne MacGregor is director of clinical research at the City of London Migraine Clinic, a medical charity working in conjunction with St Bartholomew's Hospital. She says that the cause of headaches is multiple. "Migraine is linked to changes in brain chemistry, and a sinus infection or the dehydration and alcohol after-effects of a hangover cause headaches. In most cases, it's the muscles that are hurting. Driving, bad posture, sitting slouched at a keyboard all day, not eating regularly, carrying heavy bags can all lead to a tension headache."

A headache is one of the most common reasons to visit the doctor, and 90 per cent of headaches that cause a trip to the surgery are diagnosed as tension headaches. Curing a headache is problematical, however. Amanda Kirby, a GP, says that many of her patients are worried about taking regular doses of over-the-counter pain remedies - and with good reason. Regular high doses of aspirin or ibuprofen can cause stomach ulcers and bleeding, while paracetamol can cause liver damage. And, says Dr Kirby, many of her patients suffer from "rebound headaches" if they take too many painkillers.

"Medication overuse is a major risk factor for daily headache," explains Dr Silberstein. "You might think that if you use painkillers regularly, you'd have no pain and no problems. But the body gets used to them and its own natural painkilling systems get turned off." Dr MacGregor agrees. "The body produces natural painkillers; if you're taking external painkillers, why would your body keep producing? If you suppress nature's pain control, once you stop taking the tablets, bang! You get a headache."

Pills may be one way to knock back pain; but there is now an alternative. 4head is a little white stick with a pink label, about the size of a lipstick, tiny enough to fit easily into handbag or pocket. When a tension headache threatens, whip it out and rub it across your forehead. Within a few moments, you feel a pleasantly cool tingle. In theory, your muscles and veins are relaxing and the pain is being cured. It's also possible that levomenthol, the active ingredient in 4head, somehow targets the brain's pain receptors, though no-one is quite sure how. Levomenthol is a harmless natural form of mint, so 4head is suitable for frequent use by tension headache sufferers of all ages. "I was sceptical to start with, says Dr Kirby, "but it does seem to block the pain receptors. If you use it early in the onset of a headache, it makes a difference, and if you use it two or three times it can break a chronic pattern."

I have been waiting for a headache for the past week to try 4head out for myself; and in the end I got impatient and decided to induce one with the help of a bottle of wine. 4head was surprisingly effective on my morning-after head. Other guinea pigs are enthusiastic too. Marika Larson is 25, and works as a stylist. "I'm a freelance so I never know how much work I'll have to do; I'm working on lots of shows, so I'm running around like a maniac. I always have a thousand thoughts in my head, I can't eat regularly, I pour down the coffee, and I do get a lot of tension headaches."

Marika became alarmed by how much her intake of painkillers had escalated. Until recently, she says, she was buying a packet of painkillers nearly every day. "I seemed to be taking an awful lot of pills, and I didn't like that. I don't like taking pills and putting chemicals into my body and, also, they are bad for your stomach. But I have to stay on top of things and I have to have something to calm my headaches." So she was only too glad to try a natural alternative. "If I feel a headache starting to come I use 4head immediately. I've also recommended it to my sister, who's pregnant and doesn't want to take tablets."

Craig Cornock, 35, creative director of Lucid Graphics, is another who suffers from chronic tension headaches. "We are quite a new company, with only three staff, so we all pitch in and do everything; it can get quite hectic," he says. Craig spends long hours at his computer; he gets a tension headache a couple of times a week. He has had to abandon taking painkillers because he has a sensitive stomach. "I used to take over-the-counter remedies a lot, but either they didn't work very well or they upset my stomach. So rather than take tablets I'll usually suffer in silence." Craig has now ditched aspirin and silent suffering in favour of 4head. "I'm not sure how it works but it does seem to. I haven't taken a painkiller pill in ages."

Charlotte Smith, 33 and a primary school teacher, is another 4head fan. "I get so many headaches that my friends tease me about it. I can't have pills or liquid in the classroom, and anyway, I wouldn't pop pills in front of the kids. I used to dab muscle relaxant on my forehead, but it was really greasy and it stinks! 4head goes on dry, which is great, and smells nice; and it has never failed to work for me." She is sufficiently hooked to dab on 4head even if she doesn't have a headache. "I use it as a pick-me-up at the end of the day, too, the smell is lovely and relaxing." A stick of 4head retails at £5.95, which seems steep, but each dispenser provides more than 100 applications (depending, presumably, on the width of your brow).

Dr MacGregor thinks that 4head sounds plausible enough. "People have been using herbal headache remedies such as rosemary, eucalyptus and lavender for donkey's years," she says. "The proof of the pudding is in the eating and if it doesn't work, people won't buy it; the principle is something we've used for hundreds of years, and it certainly can't do any harm." Dr Silberstein is less convinced. "People have been putting ice packs on their heads for hundreds of years. If you want a feeling of coolness, why not get a can of soda out of the cooler and use that instead?"

Dr Silberstein and Dr MacGregor both point out that prevention is better than cure. To avoid headaches, they both recommend the universal panaceas: a good diet, plenty of fluid, regular exercise, moderate alcohol consumption and enough sleep. "If you get headaches, look at the reasons why," says Dr MacGregor. "They don't usually come out of the blue. Long-term prevention means treating the root cause, not using painkillers all the time."

If you must take a painkiller, says Dr Kirby, the cheapest, generic pills are as effective as any branded variety. "Slick packaging doesn't make any difference." And, she adds, if you suffer from recurrent headaches, particularly if they don't respond to pain relief medication, you should see your doctor; in rare cases, they can be a symptom of a serious underlying cause such as a brain tumour.

4head is available from supermarkets and independent pharmacies. 'Headache in Clinical Practice' by Stephen Silberstein, Peter Goadsby and Richard Lipton will be published by Martin Dunitz Ltd in July 2003, £29.95