Headaches, a Real Pain in The…

(Originally posted on bcotoronto.com on Feb 16th, 2012)

Who out there can honestly say they’ve never had a headache? No one. It is one of the most common afflictions in the world. People all over suffer from headaches all the time. So why would it be a big deal for anyone? Aren’t headaches just something you take Tylenol for and it goes away? Well, as with most things in health, it is not that simple.

What many people do not know is that there are several different types of headaches. There are common ones that some people know of such as tension headaches and migraines. Then there are the less well known ones like cluster headaches. Let’s take a moment and look at these different headaches so that you can tell them apart and understand what we or other people are going through.

Tension type headaches are what most people think of when talking about a headache. They consist of pain in the forehead, temples, and/or back of the head which can sometimes all connect in a band-like ring around the head. This is the type of headache that will respond well to a simple over the counter pain killer like Tylenol or Advil, but if you analyze where the headache is coming from they can generally be avoided or treated without drugs. Tension type headaches are generally associated with muscular tension in the temples, jaw, or neck. This tension can come from any number of sources like posture, carrying heavy loads and straining in general, dehydration, whiplash or injury, stress, and many others.

Migraines are less common than tension type headaches but they have been getting more press recently and so are become a more common place name. Migraines are generally one sided with a preference to a certain side. They are usually described as throbbing, and intensely debilitating. The other thing associated with a migraine is called a “prodrome”. This is sensory or neurological symptoms that occur before the pain of the headache starts. These symptoms commonly include auras seen around objects, temporary loss of vision, dizziness, and sensitivity to light and sound. When a prodrome is present this is called a “Classic” Migraine but migraines without the prodome, “Common” Migraines, are much more, well…common.

The physiological mechanisms that cause migraines are not well understood but there are two strong theories with lots of research supporting each. The first categorizes migraines as a vascular condition where the blood vessels within the brain constrict, causing the prodome, and this decrease in oxygen then triggers an over-exaggerated dilation to compensate. This swelling of the blood vessels puts pressure on the surrounding brain tissue and causes the pain felt. This accounts for the throbbing nature of the pain as the blood pumps through the arteries and veins in the brain. Migraines respond very well to medications that alter blood vessel dilation.

The second theory is that a wave of uncontrolled neurological activation sweeps through the brain very much like a small seizure. This causes the prodome depending on which areas of the brain are affected and cause pain through the massive simultaneous stimulation. This is why migraines respond very well to anti-seizure medications.

Migraines are famous for having triggers, both environmental and dietary. Caffeine and alcohol, as well as chemical additives are common dietary triggers although many people must find their unique triggers. Environmental triggers commonly include changes in barometric pressure (like a storm front coming in) and strong smells. Migraines have also been linked with hormonal changes and cycles in both women and men.

The final type of headache I would like to discuss is Cluster headaches. These are rare and more often occur in men. They are massive and often described as explosive headaches that are localized in the affected area which is usually associated with a branch of the main sensory nerve for the face and temples, the Trigeminal Nerve. The most common area for this pain to occur is around or behind the eye. They are called cluster headaches because they happen repetitively within a period of weeks or months and then disappear for a while. These patterns have been linked to hormonal cycles and the biological clock (circadian rhythm) of the patient which stimulates the area of the brain called the hypothalamus which sends the signal on to the areas responsible for interpreting information from the trigeminal nerve.

The treatment options for headaches range depending on the type. Main-stream healthcare deals with all headaches through medication. This helps greatly with the pain and symptoms but does not deal with the root cause of the problem. Alternative healthcare is great at treating headaches of all kinds.

Chiropractic has significant research supporting its effectiveness in treating both tension and migraine type headaches but not as much research has been done around cluster headaches as they are so rare. There is a lot of research stating that chiropractic manipulation alters nerve firing patterns which theoretically can help with cluster headaches.

Naturopathy is very effective at treating hormonal imbalances through the use of nutrition and botanical medicines to promote balance within the body and help maintain proper hormone cycles and levels.

Some evidence exists to support the use of acupuncture to manage pain and treat headaches but researching acupuncture is a trial all by itself (this is a soapbox for another time).

So you can see how important it is to be able to identify the type and cause of our headaches to make it easier to find the proper care and management we need. Headaches can be debilitating and are a very common source of missed work or school. If you suffer from chronic or unbearable headaches, visit your healthcare professional and see what they can do for you.

Thanks for reading and good health to everyone,
Dr. Ben


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