“Her head felt like elephants were doing the merengue on her cerebellum,” author Susan Fanetti wrote about a headache. If you are familiar with these dancing pachyderms, here is good news: Even the most painful, chronic headaches can be cured or lessened in intensity and/or frequency.

“The good news is that there is lots of available options, and lots more coming down the pike. If you haven’t had success in the past, keep checking in because new ways are being developed and studied,” says Lawrence C. Newman, MD, director of The Headache Institute, attending neurologist at Mount Sinai Roosevelt Hospital Center, and president of the American Headache Society. New therapies to prevent migraine attacks include a novel class of prevention medications (containing antibodies that target certain receptors in the brain) and externally-worn headbands that stimulate certain branches of nerves in your brain.

He adds that the hard part is finding someone who can make the right diagnosis. The World Health Organization reports that a minority of people with headache disorders worldwide are diagnosed appropriately by a health-care provider. Once you have the diagnosis, the treatment will follow suit. If you haven’t had luck dealing with primary headaches – headaches that aren’t the result of underlying disease such as stroke, brain tumor or meningitis – see a neurologist or headache specialist.

Name That Headache According to the World Health Organization, headaches are among the most common disorders of the nervous system. Primary headaches come in three forms:

• Tension-type: Your garden variety headache, characterized by two of the following: Pain on both sides of the head, is pressured but not throbbing, is mild to moderate, isn’t worsened by routine activity, and not more than one of the following: light sensitivity, sound sensitivity, or nausea.
• Migraine: Tends to be one-sided, throbbing, moderate to severe pain, and worse with routine activity. Associated with nausea and/or vomiting; if neither of those two, then light or sound sensitivity. Only 20% of people with migraine have the visual aura or tingling or numbness, says Dr. Newman.
• Cluster: For a one- to two-month cluster period, headaches appear up to once every other day to eight times per day. The headaches are in, around, or behind the eyes. Patients describe it as an ice pick stabbing into the eye or a balloon behind the eye, pushing it out. It’s excruciatingly severe.

Headache Causes
There are many different causes of primary headaches, based on an individual’s unique physiology, but in general, they are caused by problems with pain receptors in your head, such as over-sensitivity or over-stimulation. Or it can be a combination of that with chemical activity in your brain, the nerves or blood vessels of your head outside your skull, or muscles of your head and neck.

How can you prevent them?

• Limit caffeine intake. Small amounts of caffeine may help headaches, but excessive use can result in caffeine overuse headaches. “Less than 200 mg of caffeine should be used per day (about two cups), but some people with migraine may be especially sensitive and may want to drink less or not at all,” explains Teshamae Monteith, M.D., a Miami-based spokesperson for the American Academy of Neurology.
• Avoid alcohol. Alcohol may cause headaches or trigger migraines, adds Dr. Monteith. Wine, specifically red wine is a common cause of alcohol-induced migraines.
• Take riboflavin or vitamin D. “There is a lot of research on the use of high doses of these at 400 mg per day to help prevent headaches. The nutrient works by increasing nitric oxide, which in turn keeps the blood vessels dilated,” says Laurie Steelsmith, ND, a Honolulu-based naturopath and author of Natural Choices for Women’s Health.
• Figure out your food triggers. Some people are very sensitive to chocolate, cheese, NutraSweet, MSG, and nitrites, because they contain chemicals that can produce migraine attacks through a variety of physiological changes, says Dr. Monteith. Once you know what yours are, avoid them entirely.
• Drink plenty of water. Dehydration can trigger headaches. Strive for seven to eight 8-ounce glasses a day, advises Dr. Newman. “It is not really clear how hydration works, but headache has been thought of as an evolutionary advantage, in part due to its role as an indicator to prevent things like dehydration,” adds Dr. Monteith.
• Keep a regular sleep schedule. Don’t sleep in on the weekends. Get up at the same time you do during the week. “We’re not sure why this works. We can postulate that since the migraine brain is overly sensitive and responds poorly to change, by keeping your environment relatively stable, you lessen the chance of headache occurrence,” says Dr. Newman.
• Exercise. At least 30 minutes three times a week of aerobic exercise, more is better. Dr. Monteith explains: “The release of the body’s natural pain generating system, called endorphins may be one reason why exercise helps migraines. Other potential benefits may be related to stress reduction, mood, or general brain wellness, but this is speculative.”
• Yoga. A recent study published in the Journal of Headache Pain found that practicing yoga four times a week for 60 minutes significantly reduced headache frequency, medication use, symptoms, anxiety and depression in people with migraines.
• And if you have chronic migraines, Botox, says Dr. Newman. According to the Migraine Trust, it’s not really known yet why Botox works, but a theory is that it blocks the release of pain neurotransmitters, which then stops the stimulation of the central pain processing systems.

What to Do Once the Headache Starts
Step 1, take medication immediately at the sign of the first symptom. “NSAIDS, migraine medications, all work better the sooner you take them because you want to get the headache as it’s developing. Once the headache has peaked, it’s going to take a lot longer for the medication to work,” says Dr. Newman.

For others, magnesium may be the answer. “Once a person has a migraine, a natural solution is to get an I.V. of magnesium. Magnesium is a vasodilator, so it opens up the blood vessels,” says Dr. Steelsmith. This would have to be administered by a naturopath or medical doctor in a health care setting. (Dr. Steelsmith adds that you can take 500-1,000 mg of magnesium tablets orally at home as a preventive.) Be aware that some people get diarrhea from the mineral.

Lastly, medication-free therapies—such as cognitive behavioral therapy, including biofeedback, meditation, and relaxation therapies—may do the trick for you. Physical and mental stress can make headaches worse, according to the American Headache Society. CBT can be used to lessen the stress—and thereby lessen the duration of a headache—but once you’ve learned to use these techniques, you can employ them as a preventive as well.

Signs That You Should See a Doctor According to Dr. Newman, red flags are headaches that:

• Come on really fast, like an explosion out of nowhere. This could be a sign of bleeding in the brain.
• Are precipitated by coughing, straining, lifting weights, sexual activity. This could be a warning sign that something bad is happening in the brain, such as a stroke.
• Are clearly related to other neurologic disturbances, such as weakness or numbness on one side, trouble speaking or seeing. This may be a stroke or a brain tumor.
• Are associated with stiffness of the neck or other signs of feeling ill. Could be meningitis or other infectious diseases like Lyme Disease.
• Begin or change after age 50. “As we get older, we are more likely to have more serious types of conditions causing headaches, such as an inflammation of the blood vessels in the skull. Look for changes in your usual headache patterns,” says Dr. Newman.