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To start at the top, headaches are one of the primary causes of sleep disturbance. Specifically, the culprits are vascular headaches—those that involve blood vessels—as opposed to tension headaches, which involve muscles and occur primarily during the day.

Migraine is a form of vascular headache, characterized by searing, throbbing pain. Usually a migraine seems to occur in the entire head, although occasionally it is confined to one side. Some victims perceive an aura or a visual disturbance that signals the imminent arrival of a migraine, which is often first felt in or near the eyes. Attacks can last for hours, even for a day or more. A sufferer may experience nausea and vomiting; so debilitating is an attack that one patient remarked that she actually looked forward to the third episode of vomiting because she knew her migraine would soon be over. Examination generally reveals no neurological signs; a physician may order X rays, brain scans, or an EEG to rule out organic disease. Prevention is usually the best approach, as unfortunately there is little relief available once a migraine attack begins. Prevention may be achieved with medication such propranolol (marketed as Inderal) or methyser-gide (marketed as Sansert). The acute attack may be treated with ergot derivatives, or with mild analgesics such as aspirin or stronger analgesics such as codeine.

It should be remembered that these strong analgesics have addictive potential, and should be used with great care, if at all, in people with a history of substance abuse.