July 2001Newsletter

FHN Complementary Medicine Monthly Newsletter July 2001

This month we will talk about headaches. Almost everyone at some point suffers from headaches. 30-40% of the adult population have headaches at least once per month. 3-5% of the population have “chronic” headaches. Headaches can have many different causes so it is helpful to breakdown headaches into different types. That actually is not as easy as it sounds. Different organizations break them into different categories and your symptoms may fit into several different categories. So categories are some what arbitrary but useful for discussion, diagnosis and treatment.

Headache types:

Tension Type

Cervicogenic

Migraine

Cluster

Hormone

Detox

Organic

Other

Each of these types of headaches may have different causes, requiring different treatment approaches. Some may share some common causes, allowing for common treatment strategies. Whenever we discuss treatment we must have 2 goals.

1. Abortive (pain relief)

2. Preventive

So lets look at some of the types of headaches and some alternative treatment strategies.

Organic Headaches

While this type of headache is one of the smallest in terms of prevalence (<5%) style=""> for any intense or chronic headache. Organic headaches can be from brain tumors, aneurysm, hematoma, meningitis, abscess, infection, hemorrhage, or encephlitis (to name a few). The underlying cause needs to be ascertained by the appropriate diagnostic measure and then dealt with accordingly.

Tension –Type Headaches (TTH)

The most common type of headache is the tension headache. 20-30% of adults have one or more per month. 3% have chronic (15 or more per month ) headaches. Obviously, ‘stress’ plays a roll in these type of headaches, however, it does not explain a good percentage of them. There was a recent discovery (1995) by some dental researchers at the Univ. of Maryland. They discovered a band of connective tissue that connects a small muscle in the back of the head/neck (rectus capitis posterior minor) to the outside of the spinal cord (the dura matter). This happens at the occipital/atlas junction and the atlas/axial junction. This new anatomical understanding can help explain how former head and neck trauma (leading to scar tissue) can be part of the cause of these type of headaches.

Traditional preventive treatment traditionally include:

NSAID’s

Antidepressants

SSRI’s

Etc.

Traditional abortive treatment include:

NAID’s

Muscle Relaxants/analgesics

Some alternative treatments that have been shown to be as effective as amitriptyline include:

Relaxation techniques

Biofeedback

Chiropractic manipulation

(Boline et al 1995)

Chiropractic manipulation additionally had a more sustained benefit in terms of decreasing frequency and intensity.

Additional treatments include:

Acupuncture

Massage

Nutritional/Herbal therapy (ie magnesium, calcium, valerian root, hops, passion flower)

Cervicogenic Headaches (CGH)

This type of headache by definition has a neck (cervical) cause and or component. (We could add TMJ induced headaches in this category.) CGH and Migraines are about equal in prevalence and are the 2^nd most common types of headaches. 17-18% of adults suffer from this type of headache ( 5 or more days per month).

This type of headache is often very resistant to traditional treatment

A study done at Duke University showed that manipulation is the most effective form of treatment for CGH headaches.

Acupuncture, massage, and physiotherapy were also looked at in this study. All were deemed to need more study to show effectiveness.

Dental bite plates additionally have been used for TMJ problems.

Migraine Headaches

Again, the second most common type of the headache (along with CGH). This type of headache is most responsible for job absenteeism and disrupted family life. 28 million americans suffer from migraines, with women have 3 times as many as men (which may suggest a hormonal component to some of the migraines). Part of the problem is that everyone who suffers from them seem to have there own brand of symptoms. Migraines can be with or without ‘auras’. The headaches seem to be vascular in nature. Which leads us to some of the detective work involved with treatment of the headache….finding triggers that precipitate the vasodilatation (blood vessel distension).

Preventive treatment must include understanding those triggers.

Some of those triggers include:

Stress

Fatigue

Hypoglycemia

Caffeine

Chocolate

Alcohol

Hormonal Changes

Candidisis

Food Sensitivities

Additives

Some helpful tools in assessing some these triggers include:

Food allergy testing that includes both immediate (IgE) and delayed mediated sensitivities. We use an ELISA blood test for those purposes.

Hormone testing that looks at hormone levels over a complete 28 day cycle. We use a saliva test that can be done at home. This assesses not alone hormone levels but also hormonal timing which can be as important as levels.

Reactive hypoglycemic testing ( ie 5 hr GGT)

Cellular Energy testing which assesses metabolites of cell energy production. (Krebs cycle intermediates )

Comprehensive Digestive Stool Analysis which not only assesses parasitology, but imbalances in normal flora (helpful in assessing candidiasis) .

Alternative abortive treatment include:

Acupuncture with needles and with microcurrent stimulation to the ear.

Herbs: feverfew, Chinese fumewort, butterburr root , ginger root ( for naseau)

Cranial suture manipulation/pressure.

Cluster Headaches

It is estimated that less than one percent of the population are victims of cluster headaches, thank goodness because they are nick named the suicide headache. They encounter the headache somewhere between the ages of 20 and 45. More men (about five to one) than women suffer from cluster headaches. Cluster headaches frequently surface during the morning or late at night; the cluster cycle can last weeks or months and then can disappear for months or years. Clusters often occur during spring or autumn and, thus, are often incorrectly associated with allergies. Sufferers, however, usually do have a history of chronic smoking, and alcohol frequently triggers a cluster headache.

Traditional Preventive Treatment usually include:
As you review these, remember that all medications have side effects, and you should discuss them with your doctor.

Verapamil
Prednisone
Ergotamine tartrate
Methysergide
Lithium carbonate
Divalproex Sodium
Histamine acid phosphate

Traditional Abortive Treatment include:
Some of these medications come in various formulations, such as nasal sprays, injections and tablets.

Oxygen
Dihydroergotamine
Sumatriptan
Lidocaine

Alternative Therapies

Stress reduction techniques, such as yoga, meditation, and regular exercise.

Vitamin C and the bioflavonoids quercetin and bromelain (pineapple enzyme).

Supplementation with essential fatty acids (EFA) will help decrease any inflammatory response.

Physical medicine therapies such as adjustments of the spine, craniosacral treatment, and massage at the temporomandibular joint (TMJ) can clear blockages.

Acupuncture.

Nervous system relaxant herbs: a few herbs to consider for relaxation are valerian ( Valeriana officinalis ), chamomile ( Matricaria recutita ), rosemary ( Rosemarinus officinalis ), and skullcap ( Scutellaria baicalensis ).

Hormonal Headaches

Although only women suffer from "hormone headache," both men's and women's headaches are prompted by hormones. You would not feel pain without them, because it is the hormones that induce the pain response. Actually, the headache may be protecting you or warning you of something more damaging in the same way that touching a hot stove alerts you to the heat and protects you from burning yourself.

Your endocrine and nervous systems are responsible for the thousands of automatic responses that regulate your bodily functions. They decide, for example, whether you will respond to a potential headache trigger with an actual sensation of pain.

Let’s look at some different types of hormonal headaches.

Menstrual migraines affect 70 percent of women with migraines. They occur before, during or immediately after the period, or during ovulation. Menstrual migraines are primarily caused by estrogen, the female sex hormone that specifically regulates the menstrual cycle fluctuations throughout the cycle. When the levels of estrogen and progesterone change, women will be more vulnerable to headaches.

The PMS headache occurs before your period and is associated with a variety of symptoms that distinguish it from the typical menstrual headache. These symptoms usually disappear when menstruation begins.

Migraine headaches are the most common side effect reported by women taking birth control pills, and many women stop taking them because of the headaches. The birth control pill tends to increase the frequency, duration, severity, and complications of migraine by intensifying the fluctuations of female hormones in the body.

Menopause Headaches: About half of all women do experience slight physical or emotional changes as they progress through menopause. Another 25 percent may suffer irregular heartbeat, joint pains, flushing in the upper torso, and headaches.

Treatment:

All treatment needs to be focused at normalizing hormonal function. As such gynecological problems that effect hormones need to addressed ( ie endometriosis, cysts, tumors, etc.).

Again assessment of hormone levels especially over the whole cycle can help in treatment strategies. We use a saliva test that take samples over the course of the period to help with hormonal assessment and timing. Menopausal women can do a five day test to assess their current hormonal levels.

Alternative preventive treatments include:

Herbal remedies – blue and black cohosh, wild yam creams, licorce , ginsengs , dong quai

Nutritional Support: Calcium /magnesium, adrenal support , Vitamin C

Physical medicine therapies such as adjustments of the spine, craniosacral treatment

Acupuncture

Detox Headaches

We could divide these into withdrawal type headaches and rebound type headaches. Everyone who drinks coffee is familiar with the headache they get if they stop drinking coffee for a day or more. This is your bodies detoxification process in the liver getting rid of metabolic waste it has been storing. The headache can last for hours to days. If you are constantly intoxicating your liver with substances such as caffeine, or alcohol, etc., you may be in a viscous cycle leading to frequent detox type headaches.

Rebound headaches can come from over medicating OTC type analgesics (taking more than recommended) on a regular basis. Many times the therapeutic dose and the toxic dose of these substances are not that far apart, which could lead to the bodies detox mechanism upregulating and causing the viscous cycle to start.

Some prescription medications such as fiornal and ergotamines are well known for their rebound type effects.

So what do you do? If the headaches are due to withdrawal type symptoms STOP the offending substance.

During the withdrawal phase several things may be helpful.

Alkalize yourself with buffered vitamin C (ester C) or bicarbonate of soda (alkaseltzer gold).

Withdraw gradually adding water in place of the coffee or tea or whatever.

Antioxidents especially glutathione and N acetyl cystiene to help the liver detox processes.

Herbs silymarin (milk weed thistle) and bupluerum, again for liver support

If you are over medicating you need to talk to your doctor !

Other type headaches

The majority of headaches that fall into this category are sinus headaches, which will be the subject of another newsletter on sinusitis.

As you can see the causes and treatment of headaches vary greatly. It is a piece of detective work many times. If you are a chronic headache sufferer it may benefit you to look into alternative treatments so that you might be able to reduce frequency, dependence on meds, and intensity of headache.

Dr. Glenn Smith

Dr. Julie Smith

Complementary Medicine