6. Try any of those "energy drinks." The verdict isn't in on most of them, but it's a cheap option to try. I seem to get something from ones with Ginkgo Biloba in them.

7. Get better sleep. As long as you get at least five hours of sleep, quality seems to be more important than quantity.

8. Exercise. This is a longer term solution, but many people notice an increase in their energy level when they get regular aerobic exercise.

9. Take a hot and cold shower. One minute of hot water, one minute of cold, alternating for six minutes. This isn't for those with weak hearts, but it will wake you up. Incidentally, research shows that this also revs up immune system.

10. Go outside. Sometimes a little sunshine and fresh air can be very energizing.

By all means try to find reasons for your tiredness or fatigue. In meantime, though, why not try some of energy-boosting methods here? None of them are expensive, and you just might have more energy, starting today.

For people with recurring or continuous pain there is a tendency to live moment-to-moment without a view of longer-term pattern. A recording system helps capture big picture. It would be a mistake to judge effectiveness of any treatment by what happened with symptoms in just last few days. Generally, a month or longer is required to judge fairly and accurately.

So now that we have decided to consider a preventive treatment for our headaches and have put in place a system for measuring treatment's outcome, what specific remedies are available?

It depends, of course, on kind of headaches being treated. Let's discuss two of most common types—migraine and tension-type headaches.

For prevention of migraine, best-studied and most effective drug treatments are available by prescription only in U.S. These include propranolol (brand name Inderal), amitriptyline (Elavil), divalproex (Depakote) and topirimate (Topamax).

Riboflavin (vitamin B2) at 400 milligrams per day was shown in one controlled study to have migraine-preventing actions. (At this dose—far higher than what is needed to treat vitamin deficiency—riboflavin should be considered a drug rather than a vitamin.) The herb feverfew has also shown benefit in controlled trials, but it is important to remember that this, too, is a drug and can have side-effects. As is case with other drugs, it should not be used during pregnancy.

Non-drug strategies of proven effectiveness in migraine prevention include therapist-supervised programs of stress management, relaxation, biofeedback and cognitive-behavioral therapy. Studies of acupuncture have shown mixed results. Avoiding individually determined triggers for attacks carries no risk and can reduce attack rate.

For tension-type headaches amitripyline is best-studied drug for prevention of attacks. Note that this drug is also a leading treatment for migraine, so people unlucky enough to have both kinds of headaches can obtain benefit from just one drug. Unfortunately, even at low doses used for headache prevention, amitriptyline can cause daytime drowsiness (even when administered at bedtime) or annoying oral dryness. Because of this, substitution of a better-tolerated, though less-studied drug in amitriptyline's family (tricyclic antidepressants) is sometimes required. Tizanidine (Zanaflex) has also shown benefit in controlled trials.

Non-drug strategies for tension-type headache have also been proved effective. These include similar behavioral interventions to those mentioned for migraine—stress management, relaxation, biofeedback and cognitive-behavioral therapy.

It would be wonderful if preventive treatments stopped headaches entirely. If they did, a measurement system would not be necessary. But a more realistic goal for preventive treatment is to reduce overall headache symptoms by at least half, or to an extent that an individual patient finds meaningful. When this occurs, a preventive approach can be a valuable addition to a program of headache management.

(C) 2005 by Gary Cordingley