By Robert Bonakdar, MD, Scripps Health
Recently, an entertainment reporter made headlines for her garbled, confused speech during a live broadcast. While many people guessed that she had suffered a stroke on the air, it turned out that her speech problems were a side effect of a severe migraine headache.
While such extreme symptoms may be unusual, many headache sufferers can relate. Headaches affect 90 percent of people, and can range from mild discomfort to debilitating pain. The pain can feel like throbbing, stabbing, pressure or a dull ache. It can last from a few hours to a few days. Severe headaches can also be accompanied by speech or vision problems, nausea, muscle aches and insomnia.
The fact that there are so many types of headaches makes them a difficult beast to treat. Often, we have the most success by taking a comprehensive integrative approach with multiple tools. This often means receiving consultation and overview of available preventive and acute strategies. These discussions can help to best determine what approaches, including lifestyle change, medications, diet and supplements, physical and mind-body therapies, as well as procedures such as acupuncture or various injections, may be most appropriate for your particular circumstance.
The first step is to determine what type of headache you are having and what may be causing it. Tension-type headaches, for example, may be the result of tight muscles caused by too many hours at the computer. Migraine headaches may be triggered by foods, strong odors, changes in the weather, bright lights and hormonal fluctuations. Being overweight can increase headache duration and intensity. Stress can be a culprit in all types of headaches.
Diet is a very common trigger. Alcohol (especially red wine), foods with monosodium glutamate (MSG), excessive caffeine, preserved meats with nitrates and nitrites, and foods that contain tyramine (such as aged cheeses) are among the common triggers. Skipped meals and dehydration can bring on headaches as well. In cases where diet is a factor, we have patients meet with a nutritionist to identify triggers and develop a diet plan that avoids or minimizes them. Also, studies have shown that up to a third of patients who have frequent headaches may be low in certain nutrients, such as magnesium, riboflavin, and CoQ10. Since it may be difficult to compensate for these low levels through diet alone, w may recommend supplements as well.
Paradoxically, exercise can help some types of headaches and trigger others. A lack of exercise can contribute to headaches in some patients; many find that cardiac exercise that gets the blood flowing can help relieve headache pain by increasing blood flow and oxygen to the brain. For others, however, a rapid change in heart rate or blood flow can set off a migraine. In these cases, we help people learn to exercise correctly to obtain the health benefits without triggering headache. For example, patients may ride stationary bicycles while we guide them through slowly increasing their heart rate, maintaining it at a safe rate, and then slowly cooling down.
Sleep is another very important factor. Too little or too much sleep can trigger headaches, as can disruptions to your usual sleep schedule or hormonal changes that affect sleep. Ideally, we like to see patients obtain at least seven hours of sleep. Often, meeting with a sleep therapist can help improve your sleep habits and get much-needed rest to prevent headaches.
In addition, several complementary therapies can help. Extensive studies have found that acupuncture treats and can prevent frequent migraine and tension headache; a series of eight to 12 sessions lasting twenty to thirty minutes each provided headache relief that may last for several months following treatment.
Biofeedback is another highly effective treatment. Patients learn to identify and recognize potential triggers such as muscle tension, shallow breathing and stress; at that point, they can initiate breathing exercises or other relaxation techniques that they have learned to prevent a full-blown headache. Biofeedback can be very empowering; patients learn the techniques over four weeks and have these valuable tools for the rest of their lives.
Because some studies have found that over 90 percent of headaches have some type of muscle knots and soreness in the soft tissue, known as trigger points, we often collaborate with physical therapists to use techniques such as myofascial release, massage, and cranial sacral therapy to reduce tension and improve range of motion of the neck and upper back. Yoga can also be a marvelous tool to retrain the muscles in a mindful and relaxed environment with the goal, similar to biofeedback, of noticing and preventing patterns that contribute to headache. Lastly, various techniques, including trigger point, occipital nerve and botox injections that reduce muscle and nerve abnormalities associated with headache, can also provide relief.
There is no one “best” solution to headache pain; what works for one patient may not work for another. Often, a combination of these therapies is the most effective plan to relieve and prevent headaches.