Headaches - Ask Dr. P - The Pain Doc

How to Reduce or Eliminate Tension Headaches

by Pain Doc | Oct 5, 2015 | Headaches

Tension headaches are common to millions of people. While most cases are not debilitating (enough to incapacitate the sufferer), they still can impact one’s ability to perform and produce.

The cause of headache pain is difficult to pinpoint as there are currently no diagnostic tests that can provide a definitive answer. But there are definite, known triggers of headaches including certain food allergies, food additives, chemical fumes and noxious visual stimuli.

With careful investigation, one can trace the cause of his or her headaches and take steps to minimize their occurrence or eliminate them entirely.

Those who get tension headaches describe a sensation of a tight band wrapping around the head, constricting it. There is pressure around the temples and behind the eyes, or in the back of the head and neck but the pain can be anywhere in the head area.

The onset is usually slow, but is definitely noticeable once it starts. You’ll feel a gradual tightening of muscles (although it may not be the muscles, but a nerve or vascular sensation mimicking tight muscles) around the head especially forehead; and sometimes back of neck. When it is at its peak, you feel like closing your eyes and stopping what you’re doing. At this point, most people will take an aspirin or Ibuprofen.

Aspirin works by blocking an enzyme called COX (cyclo-oxygenase) that is used form a substance called prostaglandins, which amplify pain signals and help initiate inflammation. Reduce pain signals and reduce inflammation, and you can reduce the pain from headaches. But the problem with aspirin is that it can make your stomach prone to bleeding, as prostaglandins help protect the lining of stomach from stomach acid.

Ibuprofen is a non-steroidal anti-inflammtory drug that doesn’t have the risk of stomach bleeding like aspirin does, but is known to cause damage to the kidneys in high doses or frequent use.

If you are prone to getting tension headaches i.e. get them regularly, then chances are you are doing something on a regular basis that is triggering them. Your goal is to identify these triggers and eliminate them.

Here are the steps:

Take a food allergy test. You can get a home food allergy test kit to determine if you are allergic to a particular food. “Allergy” in this sense does not only refer to sinus-related symptoms like sneezing and a runny nose. It refers to an immune response to eating a certain type of food that may manifest as headaches, GI upset, fatigue, joint pain and a wide variety of other symptoms. Once you identify one or more foods that trigger a response, eliminate them immediately.
Keep a daily log of your activities— places you go/things you do regularly during your week and potential headache triggers that may be in those environments. Things to look for: heavy machinery, office machinery, paints, chemical fumes, food, drinks, and high energy electronics. See if your headaches coincide with visiting any of these environments.
If you work with a computer/laptop, try reducing the screen brightness. Try your best to unplug two hours minimum before bed time.
Tension headaches can be caused by periods of continuous concentration. If you have a job that requires this, have you heard about the Pomodoro Technique? The Pomodoro Technique is an innovative time management system that basically advocates breaking up your activities into 2o minute chunks, separated by short rest periods. This enables your brain to recharge itself for more work. More info can be found here.
If you tend to hyperventilate, or have a low respiratory rate, you may be building up higher than optimal levels of blood CO2. This causes blood vessels to constrict, which can trigger headaches. To solve this, practice Butkeyo breathing.
Lastly, regular tension headaches may be caused by neck bones being out of place. The neck bones, or cervical vertebrae can easily shift out of place from accidents and poor postural habits, changing the biomechanics of your cervical spine (neck). This can cause the neck alignment to straighten or reverse, as opposed to having a nice arc for balancing. One or several vertebrae may be rotated or tilted to one side, causing muscle strain and abnormal pressure to the joint surfaces (see if you have a head tilt). An abnormally aligned neck can also irritate the spinal cord and/or spinal nerves that exit down to the arms and back muscles. All these factors can lead to tension headaches, among other things. Read my previous post on how to self-treat neck problems here.

If your neck feels out of place; i.e. you can’t turn or bend it fully and/or you feel neck tension, then consider getting checked by an experience chiropractor. Chiropractic adjustments can help restore movement and alignment to your neck and potentially reduce or eliminate your headaches, if the cause is due to abnormal neck alignment.

Tension Headache Remedy

by Pain Doc | Mar 10, 2011 | Headaches

Tension headaches are those thought to be triggered by prolonged muscle contraction in the neck, jaw and head. This can be voluntary and subconscious (nervous or habitual), or involuntary in response to stressful situations.

Oftentimes when I take a history from a patient complaining of frequent tension headaches, I discover that the patient also has jaw pain. This could be a sign that the patient is grinding his/her teeth either during sleep or throughout the day. Worn down tooth surfaces in the molars are also a sign of grinding teeth.

When one grinds or clenches the jaw, two bilateral (both sides of the head) muscle groups are engaged: the masseter, which is the thick muscle you can palpate right over the angle of the jaw; and the temporalis, which anchors to the side of the head and attaches to the mandibular notch. These two muscles elevate the mandible (lower jaw).

When a muscle is under tension (also referred to as hypertonic or hyperactive) it is basically malfunctioning. Muscles control joint movement, and if the muscle is not working properly it can activate tiny nerves called mechanoreceptors and nociceptors embedded around the joint, causing pain.

When the temporalis muscle is under tension, it can affect blood flow around the scalp, which can also develop into a headache.

So, what can one do? Here’s a simple remedy that has anecdotal evidence to support it: open your jaw and relax it. To make it easier, insert a pencil or pen in between your teeth (but don’t bite down on it!) and hold it in place for a few minutes. This action inactivates the masseter and temporails muscles somewhat by activating their agonist pair, the pterygoid muscles.

Give it a try next time you feel a tension headache coming on. But better yet, focus on eliminating the environmental or emotional triggers that cause you to clench your teeth or tense up your neck and head muscles.

Melatonin for Migraine Headaches

by Pain Doc | Feb 10, 2011 | Headaches

Image via Wikipedia

If you suffer from migraine headaches, take note: a small study done in Brazil concluded that taking melatonin 30 minutes before bed time can reduce migraine frequency and intensity.

The study involved 34 subjects; 29 of which were female. The participants reported experiencing 2-8 migraines per month, on average. Some had migraines with auras– visual disturbances such as seeing wavy lines, spots, or sparks.

Of the 32 participants completing the study, more than two-thirds said their migraine frequency was reduced by half or better after taking melatonin for three months.

This included eight patients who reported no migraines, seven who reported a 75% drop in migraines, and 10 who said their migraine frequency decreased by 50% to 75%.

The findings, which come from a team of researchers led by Mario F.P. Peres, MD, PhD, of Hospital Israelita Albert Einstein in Sao Paolo, Brazil, show that melatonin may be used as a preventive therapy for frequent migraine sufferers. However, since it was a small study with no control group, the researchers suggested a controlled study to test the idea further.

What Makes a Migraine a Migraine? (everydayhealth.com)
Could oxygen help a migraine? (zocdoc.com)
Migraine Surgery Seems To Have Nearly 90% Success (lockergnome.com)

Reduce Headaches with Peppermint Oil

by Pain Doc | Dec 21, 2010 | Headaches

Peppermint (Mentha piperita L.) is one of the most widely consumed single ingredient herbal teas. Medical research shows that peppermint oil can reduce spasm of smooth muscle (the type of muscle that comprises the esophagus, stomach, lungs, intestines) and can therefore provide some relief for conditions like IBS (irritable bowel syndrome), esophageal spasm, and spastic colon. In lab tests, peppermint has significant antimicrobial and antiviral activities, strong antioxidant and antitumor actions, and some antiallergenic potential.

Animal model studies demonstrate a relaxation effect on gastrointestinal (GI) tissue, analgesic (pain reducing) and anesthetic (nerve desensitizing) effects in the central and peripheral nervous system, immunomodulating actions and chemopreventive potential.

: Image via Wikipedia

The effects of peppermint oil and eucalyptus oil preparations on headaches and cognitive function were investigated in 32 healthy subjects in a double-blind, placebo-controlled, randomized cross-over design.* Four different test preparations were applied to large areas of the forehead and temples using a small sponge and their effect was evaluated by comparing baseline and treatment measure. The combination of peppermint oil, eucalyptus oil and ethanol increased cognitive performance and had a muscle-relaxing and mentally relaxing effect, but had little influence on pain sensitivity. A significant analgesic effect with a reduction in sensitivity to headache was produced by a combination of peppermint oil and ethanol (rubbing alcohol). The essential plant oil preparations often used in empiric medicine can thus be shown by laboratory tests to exert significant effects on mechanisms associated with the pathophysiology of headache.

The evidence suggests that peppermint can somehow relax smooth muscle. Since blood vessels are also comprised of smooth muscle, and some types of headaches are caused by spasms in the blood vessels that lead to the head, taking peppermint either as a tea or concentrated oil may provide relief.

*Göbel H, Schmidt G, Soyka D, Effect of peppermint and eucalyptus oil preparations on neurophysiological and experimental algesimetric headache parameters. Cephalalgia. 1994 Jun;14(3):228-34; discussion 182.

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: