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How to Stop Tension Headaches

by Pain Doc | Sep 3, 2010 | Headaches

Headaches come in many different forms; too many to include in one post.

The causation can be neurological, vascular, mechanical, chemical and even psychosomatic. Diagnosis can be challenging, as most headaches have the common symptom of, well, head ache. The factors that vary include duration, location of pain (back of head, front of head, one side of head), pain pattern (constant, pulsating, repeating), and accompanying symptoms (dizziness, nausea, sensitivity to light and sound, auras).

This post is about tension headaches, perhaps the most common type.

Symptoms include constant, pressure like pain often described as a tightening band around the head. The muscles of the back of the neck and tops of the shoulders are usually hypertonic (tense and taught). Pain is felt behind the eyes. Tension headaches can be mild to the point where the person goes on about his day until it wears off; or they can be intense and incapacitating, causing the person to take aspirin or Tylenol.

It is generally believed that tension headaches can be triggered by stress, dehydration, working in front of a bright computer monitor for extended periods; looking at a screen (TV, computer, movie screen) that has constantly moving images with changing light; and engaging in heavy mental tasks (studying, calculating numbers, reading conceptually-complex material like law cases, etc.).

More esoteric causes are previous trauma that affected the neck, like a car crash, and environmental stimuli (pollen, mites, carpet fumes, atomized copier toner, exposure to hazardous chemicals).

In my experience, people who have a history of severe whiplash from a car accident are more likely to have recurring tension headaches. Even if the accident was ten or more years ago.

Whiplash is the violent, alternating extension and flexion of the neck due to a short but powerful impact force or short acceleration-deceleration. Low impact car accidents and a jerky roller coaster ride are common examples.

The accident can leave the cervical (neck) vertebrae out of proper position relative to adjacent vertebrae, and change the dynamics of neck movement. Nerves that regulate muscle contraction in the neck and and back of head can get injured or stretched as a result, and can cause the muscles to stiffen during certain times.

TREATMENT:

If you are engaging in heavy mental activities, give yourself a couple of hours break. Turn off the TV; stay away from the computer and all screens for that matter. Basically, you want to shut off excessive visual stimulation.

Seek silence and solace. Find a nice park, go for a nature hike. Another option– meditate in a dark room; concentrate on deep breathing and relaxing the muscles in the back of your neck and throughout your body. Drink water throughout the day. No coffee or cigarettes; they are stimulants. No alcohol.

Place an ice pack on your forehead (put kitchen towelette on your forehead to prevent ice burn), OR one under your neck with a cervical roll supporting it (DON’T do both, the coldness may be too much stimuli).

If you have a history of a whiplash car accident, and you get tension headaches quite regularly, there’s a very good chance you have misaligned cervical vertebrae affecting your cord and/or nerve roots. Probably a “reversed” curve, which looks like a “kink” or sudden angle change on a side-view neck x-ray. You will want to do exercises to stretch the neck and get it back to a lordotic curved shape.

Use a neck roll to bend your neck into a lordotic (reverse C- shape) curve while lying on your back on the floor. Simply touch the floor with the back of your head ten times by arching your neck over the roll. Then, turn and stretch your neck to the left and hold for 2 seconds; then to the right and hold for 2 seconds; 10 times to each side. Do 3-4 times throughout the day.

You may also consider getting evaluated by an experienced chiropractor, and definitely getting a neck x-ray to visualize the shape of your cervical spine. Adjustments, exercises, and lordotic traction can help bring your neck into proper alignment, and reduce pressure to your nerves, saving you from those annoying headaches.

Lastly, consider using red light and pulsed EMF to eliminate tension headaches. This is a good investment if you have recurring headaches.

Red light therapy is using 630 nm wavelength light to reduce pain and inflammation. Light at this wavelength gets absorbed by cell structures and basically increases circulation, vasodilates blood vessels and dampens inflammation. Some tension headaches are vascular in nature, so this should help reduce symptoms.

Pulsed EMF is the application of weak electromagnetic fields to the body, to provide extra energy for cells needing it. It tends to improve cell membrane transport of nutrients and waste, and improve molecular transport including red blood cell mobility.

Watch this video I made that explains how to do it:

What Happens When You “Pull” Your Leg Muscle?

by Pain Doc | Sep 1, 2010 | Leg Pain

The Achilles' tendon. PD image from Gray's Ana...

Image via Wikipedia

If there’s one thing that can stop you dead in your tracks, it’s a pulled calf muscle. The word “pulled muscle” usually refers to an involuntary, painful spasm that occurs without a single, forceful impact which characterizes a typical muscle sprain/ strain.

You’ll feel your calf muscle contract by itself, and sometimes oscillate (twitch) reflexively causing you to quickly bend your knee to stop the progressing contraction. A deep, painful sensation is felt at the myofascial junction that eventually forms the Achilles tendon. If you’re lucky, sometimes you can prevent it from spasming if you immediately stop what you are doing at the first sign of the spasm (jerky, involuntary twitching) and focus on relaxing the leg.

Basically, pulled calf muscles occur after prolonged exercise of the legs, such as in long distance running, cycling, swimming, and uphill climbing. Muscle contraction is mediated by a complex biological pathway that involves electrolytes, mainly calcium, phosphorus, and sodium ions. These ions need to be available in order for the actin and myosin fibers to “ratchet” properly during contraction and relaxation. Prolonged leg exertion, without replenishing lost electrolytes can lead to muscle spasms. This is why sports teams use Gatorade to hydrate the athletes, and protect against muscle injuries.

Nocturnal (night) calf muscle spasms are a common occurrence in 2nd and 3rd trimester pregnant women. It it thought to be caused by low electrolytes as a result of the pregnancy. Eating foods rich in calcium and phosphorus can reduce these symptoms.

Lactic acid buildup in the myofascial sheath can also be a contributing factor to pulled muscles. If more lactic acid is created that can be neutralized by the body, it can affect muscle contraction.

TREATMENT:

If the spasm got you before you could stop it, don’t panic. The pain will work itself out in about 30 minutes. If it is still present after an hour, see your doctor.

Drink an athletic sport drink to replenish your electrolytes. If you have multivitamins at home, take 2 tablets with water.

Wrap an icepack around your calf, especially over the end of the muscle belly (that’s the start of the Achilles tendon); hold in place for 20 minutes.

Gradually, extend your knee; if you feel twitching again, stop and return to flexed knee position, ice applied; give it another 10 minutes.

When you can extend the knee fully without pain (all this is done sitting on the floor), gently test the calf muscle by bending your foot upwards toward your knee (called dorsiflexion). Do this very slowly, and hold the stretch for10 seconds; repeat five times.

Next, attempt to walk. That should be the end of your painful episode! In the future, before you engage in arduous exercise involving a lot of legwork, load up on foods rich in electrolytes. Most of those sports snacks include them, like Cliff Bars and others. Try to get the healthy ones.

Aneurysmal Bone Cysts

by Pain Doc | Aug 30, 2010 | Bone Pain

(Updated 3/9/2021

An aneurysmal bone cyst (ABC) is a painful condition in which an aggressive, cystic (fluid filled cavity) lesion develops in a bone, usually following a fracture or trauma, sufficient to alter the venous circulation of the bone. It can also develop from pre-existing bone tumors. It is typically found between the ages of 10-30, with the peak age of 16. The most common site is the knee region (proximal tibia), followed by the arm bones, spine, and upper leg (femur). ABCs have also been documented in small tubular bones of the foot, and skull.

The symptoms of an aneurysmal bone cyst depend on the affected area. A common presentation is relatively fast onset of pain that rapidly increases in severity over 6-12 weeks.

The skin surface temperature over the cyst may increase, a hard, bony swelling may be felt , and movement in an adjacent joint may be restricted.

Spinal lesions may cause radiating nerve pain or quadriplegia, and patients with skull lesions may have moderate to severe headaches.

Although aneurysmal bone cysts are relatively rare, I decided to address this disorder because the symptoms may be wrongly interpreted as a sprain or strain, especially for ABCs that affect the posterior elements of the spine. A wrong diagnosis will lead to the wrong treatment prescription, such as ongoing chiropractic adjustments or physical therapy, which can worsen the condition.

If you have a teenager who complains of sudden, focal pain around a bone, frequently the knee, it’s best to take your child to his/her primary care physician, who should order a skeletal X-ray. X-rays are the preferred imaging study to diagnose ABCs.

aneurysmal bone cyst knee xray

There are several treatment options for aneurysmal bone cysts. Surgical curettage, which is basically scraping out the cyst; embolization of the cyst (blocking its feeding veins and arteries), and injection of drugs to inactivate the cyst.

Aneurysmal bone cysts are not serious conditions at the same level of osteosarcoma, but they should be dealt with as soon as possible to prevent worsening. They reduce the strength of bones and often lead to bone collapse/ fracture that could be dangerous.

There are surgical interventions that involve reducing the cyst. You may want to try pulsed electromagnetic field therapy (PEMF) over the lesion. PEMF is the external application of electromagnetic field energy into the body. The field is low frequency and low amplitude and is similar to the natural magnetic fields produced by your body. It is known to enhance cell membrane transport and improve red blood cell flow within the small capillaries. For more information on Pulsed EMF, click Here.

How to Tell if Your Pain is from Arthritis

by Pain Doc | Aug 28, 2010 | Arthritis, Bone Pain, Hand and Wrist Pain

Image via Wikipedia

If you have deep, achy pain in a joint that doesn’t go away with time it’s likely some form of arthritis. Lower back pain can be arthritic in nature (as opposed to muscle) if it behaves similarly– deep, achy, doesn’t seem to ever go away entirely; and you have a history of repetitive, physical impact to your body such as construction workers/ laborers, martial art practitioners and gymnasts. However, with rheumatoid arthritis (explained below) no history of trauma is necessary.

Most people associate arthritis with the elderly. But did you know it can affect younger people as well?

The word arthritis translates to “joint inflammation.” There are several forms of arthritis, the two most common types being rheumatoid arthritis and osteoarthritis.

Image via Wikipedia

Rheumatoid arthritis (RA) is an auto-immune disorder, where the body’s white blood cells attack the synovium of synovial joints. Synovium is the inner lining of a synovial joint— encased (capsular) joints like in the spine, hips, knees and shoulders. The synovium produces synovial fluid, which lubricates the inner surfaces of the joint as it moves.

People suffering from rheumatoid arthritis will have bouts of severe joint swelling, redness, heat and pain. RA is typically bilateral; meaning, for the extremities it strikes both sides, not just one. It is an awful condition that can can severely impact mobility. Those with rheumatoid arthritis in the knuckles of the hand will have difficulty gripping things and doing fine dexterity movements such as writing and buttoning a shirt. Areas commonly affected by rheumatoid arthritis are the hands, spine, and feet.

Currently, drugs are the only medical treatment for RA including non-steroidal anti-inflammatories– NSAIDS (aspirin, Motrin, Tylenol, Ibuprofen), corticosteroids and immunosuppressives.

Palliative care to manage pain levels include acupuncture, yoga, and chiropractic. Cannabis (medical marijuana) is a popular choice for many sufferers.

Osteoarthritis (OA) is described as joint pain and inflammation from wear and tear of the cartilage. It is usually found in people who have suffered repeated joint trauma, like football and basketball players. Marathon runners can develop it in the knees and hips as well. OA is found in the weight bearing joints of the feet, ankle, knees, hips, lower spine and neck.

When repeated trauma impacts a weight bearing joint, over time it creates tiny fissures in the cartilage, which thins the cartilage and exposes the bone underneath. From there, the bone forms bone spurs called osteophytes. Radiologists describe these changes (disc degeneration plus osteophytes) as spondylosis of the joint.

Both types of joints can be painful, with RA being more acutely painful. The symptoms are pain, joint stiffness and reduced range of motion.

MAKING BONE BROTH SOUP FOR ARTHRITIS PAIN:

In both cases, eating a low-inflammation diet will be helpful: reduce sugar intake including high fructose corn syrup; limit carbohydrates to 150 grams per day; emphasize protein and fat, especially fish with high Omega 3 content; nut oils (walnut, almond, Brazil nuts), virgin olive oil, and raw plants (green leafy salads, lightly steamed vegetables). Raw milk and butter from grass fed cows, and coconut oil are also good for an anti-inflammatory diet.

Eating bone broth soup every day will give your body the constituents for rebuilding cartilage: Visit your local butcher and ask for the large beef and pork joints. They can saw these in little pieces in the back and give them to you in a bag; they price them pretty cheap; too!

You’d be amazed as to how cow/ pig knee and hip joints look very much like a human’s. If you want to understand the anatomy of these joints, this is a great way to do it. You will see and feel the smoothness of the cartilage on the femur head. You’ll see the anterior and posterior cruciate ligaments (ACLs and PCLs). You will see the patella, fat pad; and collateral ligaments, condyles and meniscus. Make sure to eat all of these parts in addition to drinking the broth to get all the proteins needed to rebuild tendons, ligaments and cartilage.

MAKING THE BROTH:

Add a couple of pieces of joints into a tall pot; fill half-way with water; add salt. For extra bone-building strength add some eggshells (from cracked RAW eggs– You want the inner shell membrane to be intact; with boiled eggs the nutrient-rich membrane sticks to the egg). Bring to a strong boil; reduce heat to low and cook for 60 minutes. Steep out the eggshells, and drink the soup. Eat any pieces of tendon stuck to the bones, and eat the bone marrow as well. You can add spinach to the soup the last minute of boiling for more variety. (chicken and turkey carcasses and whole fish bones work well, too).

The calcium and cartilage nutrients you get from this bone broth can help your joints feel better.

HOME THERAPY FOR ARTHRITIS

Arthritis pain comes from inflammation and stimulation of pain receptors in damaged cartilage by the inflammation and also by physical abrasion.

Pulsed electromagnetic field therapy (Pulsed EMF or PEMF) can help by energizing the affected cells. The electromagnetic field produced by PEMF machines are similar to the naturally-occurring fields produced by the biological activity of your cells; adding an external source helps those cells function better. The few cells that exist in the cartilage and ligaments and tendons have more energy to synthesize matrix and collagen which goes towards joint rebuilding. Use in conjunction with red light therapy for maximum effect. Red light at around 660 nm wavelength initiates photobiomodulation, which also gives cells more energy to function, much like photosynthesis in plants.

For temporary relief, heat works best with chronic pain and stiffness. An infrared heat lamp is a good choice, as it is easy to set up and penetrates all the way down to the affected tissue, unlike a hot pack which only heats the skin. Heating is not advised for rheumatoid arthritis when it is in a flare-up, hot and acute phase.

As far as medical care, joint replacement is a more drastic option but can effectively reduce pain while preserving some joint functionality. There are also experimental procedures that involve culturing cartilage cells in a lab and injecting them into the joint space, hoping that they will bond to existing cartilage and thicken, but results are mixed at this point.

If you don’t have arthritis, do things that will help prevent you for getting it. Build up your joint strength with the diet mentioned above, and avoid repetitious trauma to the weight bearing joints (activities that involve jumping and landing on a hard surface). Strengthen surrounding ligaments of your knee and hip joints with exercises like weightless squats, knee bends, and simple uphill hiking.

Your joints are the most neglected part of your body; we often take them for granted. But when one is injured or develops arthritis, you will realize very quickly how important they are to your happiness and well-being. Don’t wait until it is too late; strengthening and nurturing your joints should be a definite part of your fitness routine.

When You Get Whiplash Neck Pain from a Car Accident

by Pain Doc | Aug 26, 2010 | Neck Pain, Sprains and Strains

Ever get rear-ended while waiting in traffic or at a stop sign? It’s a scary moment: the calmness of being out in your car is viciously interrupted by screeching tires and a loud crash and bending metal. It’s over in two seconds, but a lot happens to your body in that one second.

If a high speed camera was available to record your mishap, it would show your body violently moving forward with the car, back sinking into your car seat, your head slowly arching backwards at an unnatural angle; your neck muscles tense up; your head coming to a stop in its backwards path and then reversing directions to move forward again, through a complete arc until your neck is fully flexed forward in an unnatural position; coming to a stop again, and then reversing directions and fully extending a few degrees less than before, and then reversing and flexing forward again, then righting itself. That is your basic whiplash injury.

You’ll notice your neck become stiff, but very gradually. You may be a bit dazed, and have a headache come on in about an hour. You’ll likely feel tired.

As the day wears on, your neck is getting increasingly stiff and painful. You may feel the onset of soreness in your upper shoulders and upper back; even your lower back. You may have pain in your chest wall where the seatbelt dug into.

2-3 days after the accident your neck will reach maximum stiffness. You will have difficulty turning your neck. You’ll find yourself turning your whole body in order to see to one side.

So what is happening? You have sustained what’s called a cervical acceleration-deceleration sprain strain injury; commonly known as whiplash. Car accidents are a common cause of whiplash, but they can occur on roller coasters and similar jerky rides, horse riding, sky diving, and even wild dancing. When this happens, tiny tears develop in the muscle tissue and fascia (muscle covering) which starts to release the inflammatory products of swelling. The swelling is gradual, like a pinhole leak, which explains why it takes 2-3 days to reach max pain. What makes a whiplash worse than other sprain strain injuries is that, due to the flexibility of the neck, spinal ligaments also incur damage.

When your neck flexed violently forward, the capsular ligaments and interspinous ligaments likely got damaged. The capsular ligaments hold your neck bones together from the back; the interspinous ligaments hold them together at the spinous processes (the bumps you feel along your spine are the tips of the spinous processes).

interspinous ligament rupture

When these ligaments injure, the swelling goes inside the joint space, building up pressure essentially splinting (immobilizing) the joint. In severe cases, the ligaments can rupture (tear) causing dangerous instability, and you have a very serious condition that requires a visit to the ER. A head halo support or neck brace is usually attached to prevent the instability from causing damage to your spinal cord.

TREATMENT:

Obviously, it’s a good idea to go to the hospital if you were involved in a significant car accident and feel you’ve been injured. The ER doctor will rule out serious conditions like ligament rupture, bleeding in the brain (subdural hematoma), and bone fractures. Once those are ruled out, he/she will diagnose you as having a sprain strain injury and will usually prescribe pain meds (anti inflammatories and muscle relaxants). You will be given home care instructions.

With whiplash, the goal is to first reduce the pain and swelling. You will do this by applying an ice pack to your neck. Here’s a YouTube video on Whiplash Home Care – icing and stretches that illustrates the information to follow.

Buy two gel ice packs at your local drugstore (9″ x 6″ size); put in freezer. Make a cervical roll using a small bath towel or hand towel: roll it up tightly into a cylinder 1′ long with a radius of five inches. Place it on the floor.

Place one ice pack on top of the roll, and one right under (next) to it. Put a kitchen towlette on top of the ice to prevent iceburn. Lie down, face up with the center of the back of your neck on top of the cervical roll/ice pack. The other ice pack is for your upper back muscles. Put a pillow under your knees for comfort, dim the lights and rest for 20 minutes. Repeat this every two hours, for 2-3 days.

On the second day, while icing slowly turn your neck to the right as far as you can, then to the left, then to center. Then, arch your neck and touch the carpet with the crown of your head and hold for 20 seconds. Repeat these motions ten times. Do this for each of your icing session, still at 20 minutes every 2 hours. This helps to regain full neck range of motion.

On the 4th day, alternate ice with 10 minutes of moist heat using a hot water bottle with 150 degree water heated on your stove, and a wet face towel for heat conduction, on your neck and back muscles.

As the pain decreases, engage in active stretching exercises. About two weeks post crash, or when the pain has gone down 90% and you have full range of motion in your neck, do neck strengthening exercises. It is important to do these rehab exercises as they help align the reparative tissue in the axis of contraction of the muscles. This will help reduce the chances of chronic pain and loss of range of motion following the accident.

Since the original publication of this article, I’ve researched a new modality called Pulsed Electromagnetic Field therapy, or Pulsed EMF, or PEMF for short. The link explains it in detail, but basically it is the external application of low frequency, low amplitude electromagnetic fields, similar to the natural EM fields your body produces, to impart energy to them. EM fields are used to drive movement of molecules in and out of the cells, which includes nutrients, waste products, proteins and other factors involved in life processes. When cells are sick or injured, this process is not efficient. Pulsed EMF imparts a boost of energy (in fact, it is considered “Energy medicine”) which helps injured/sick cells perform their biological functions more efficiently, promoting accelerated healing and improved symptoms (less pain).

Apply PEMF to your neck three times a day for 15 minutes, for 2-3 days following the accident. You should experience a noticeable reduction in pain each time, an hour or so after treatment.