- Brian Sass
How to Stop Headaches
This blog will review different types of headaches, the underlying mechanisms of each type of headache, and different treatment approaches for each type of headache. Treatment can range from prescription drugs and over-the-counter medications (anti-inflammatory drugs like acetaminophen, ibuprofen, etc.) to natural treatment and therapies. Many times, natural therapies for headaches can be just as effective, if not more effective, when compared to the effect of prescription drugs. Natural therapies also have far less side effects than the prescription drugs, making them a desirable option for most people. These natural therapies are grounded in biological mechanisms that target the source of the headache – for example, there are natural therapies that can affect muscle tone if the headache is being caused by a muscle spasm, or other natural therapies can target the autonomic vasoconstriction/vasodilation of arteries and veins that can cause other types of headaches. How do you know what type of headache you have and the underlying triggering mechanism of it? What is the right type of natural therapy for you to help stop your headaches? Let’s break it all down.
Different types of headaches arise from changes in different types of tissues in the head and/or neck area. One of the key points to reducing and stopping your headache is to first determine which type of tissue is causing your headache. There are a few different tissues involved in headaches; one type of tissue that can cause headaches are muscles (spasm/constriction of muscles in the head and face usually cause tension-type headaches) and another are the meninges. Meninges are a type of tissue that line the outside of the brain, and reside between the brain and the skull. The meninges and a fibrous tissue called the dura mater form a durable, protective coating around the brain. When blood vessels become dilated (get larger in size), it can create a pressure between the brain and meninges against the skull (think of your brain expanding in size relatively speaking against the skull). While the brain itself does not have pain receptors, the surrounding tissues do (this includes dura, meninges, and blood vessels). If there is more pressure in the tissues surrounding the brain from dilation of the blood vessels in the brain, you can develop pressure-type headaches and pain as a result.
Headaches can also arise from other mechanisms; neurological triggers and inflammatory triggers. Headaches that arise from a neural mechanism are called cluster headaches. Cluster headaches feel like a deep pain inside the skull, usually behind one or both eyes. Cluster headaches are usually very painful. The particular nerve involved in cluster headaches is the trigeminal nerve, or the 5th cranial nerve. The trigeminal nerve has three branches, each innervating different areas in the face. When someone feels pain behind one or both eyes, the headache pain is caused by irritation or inflammation of one of the branches of the fifth cranial nerve. Inflammation can also cause headaches that have a different character than the previous headaches discussed. When a particular type of tissue in the head and neck area starts releasing molecules that cause inflammation (known as inflammatory cytokines), these molecules send signals to the surrounding area that something is wrong (could be in response to a toxin, virus, or foreign particles, etc.). If the inflammatory response is active in the head/neck, it will usually affect the sinuses, causing sinus headaches (think congestion headaches). Remember that the inflammatory response is systemic; it may get triggered in one area but may have effects far away in the body due to how the body releases inflammatory molecules. So, if the inflammatory response is active from a bacterial or viral infection in the gut, it can still lead to the activation of pain receptors on muscles, nerves, and neural tissue in the head and neck area leading to many different types of headaches. Inflammation is a global response and sometimes is the hidden trigger of headaches that gets overlooked.
Any time you feel pain, it is neurological in nature; regardless of the cause of the pain, the nervous system will cause the perception of pain. So, if you have a headache, it is neurological in nature at least to the extent that the nervous system is now perceiving a stimulus somewhere in the body that is abnormal and the result is a headache pain. Understanding the type of headache you experience, targeting the mechanism and tissues likely causing the headache, and knowing what treatment can specifically target those tissues, give you the best shot at quickly and effectively eliminating your headaches. Let’s break each headache type down into more detail.
Tension headaches usually start as a “halo” or “head-band” type of pain around the head (above the eyebrows). This type of headache can be in the jaw and neck area as well. More often than not, lack of sleep, stress, and lifestyle factors can cause tension headaches. Tension headaches don’t commonly affect the face, but the head and neck areas are usually involved and is sometimes more one-sided.
Migraine headaches are defined as a headache that is recurring (repeating cycles) over time. Migraines can be very debilitating and severe. Although women suffer from migraine headache almost 3x more than men, migraine headaches do not seem to have a hormonal origin (it appears to be independent of the menstrual cycle). It is common for people to experience an aura or pre-migraine feeling that warns that the headache is starting. This unique “warning” perception leads experts to believe that the origin of migraines is deeply rooted within the nervous system. Migraines are also characterized by the excessive vasodilation (widening) of arteries, as well as photophobia (severe light sensitivity). Both of these characteristics lead to specific treatment options for those suffering with migraine headaches.
Cluster headaches are usually one-sided, and feel as if it’s coming from the inside out. Inflammation of the trigeminal nerve is involved in the origin of these headaches. Cluster headaches can last anywhere from 30 minutes to three hours, and are usually extremely painful. Cluster headaches can occur during sleep, and it is thought that the circadian rhythm is involved in the triggering of the headache. Sometimes people can have a drooping eyelid, have a small pupil, or excessively tear on the side of the headache as a result of the trigeminal nerve involvement.
Headaches can also occur as a result of hormonal changes. Hormone-based headaches are usually involved with the steroid hormones (estrogen, testosterone). Steroid hormones can affect genetic information within the cell, but can also act on the surface of cells. In particular, when there is a scenario of low estrogen and low progesterone it can create a headache via the vasodilation/constriction system and inflammatory response. These hormonal headaches are most common to occur on the first to fourth days of menstruation for women because this is the most likely time that estrogen and progesterone can both be low.
Headaches can occur from concussion and traumatic brain injury. It is thought that swelling of the tissues surrounding the brain (dura and meninges) can contribute to the headache involved after traumatic brain injury. Headaches after concussive injuries can be episodic and severe, or can be constant and low-level pain. Symptoms of a concussion can be varied and numerous, and requires in-depth examination and specific treatment to facilitate healing of the brain. However, there are still options that can help the headache symptoms of a traumatic brain injury. Let’s discuss treatment options for the different kinds of headaches.
For headaches caused by traumatic brain injury, there has been evidence that taking Creatine can both decrease the frequency and intensity of headaches. Creatine has often been used in athletics and endurance-based activities for performance enhancement. Traditionally, taking 5-10 grams of creatine monohydrate (based on your bodyweight) can increase creatine phosphate stores in muscles, increase water uptake in muscles, and increase strength and endurance of muscles. Creatine has evidence in the literature that it can reduce headaches, specifically after traumatic brain injury or concussion injuries (the title of the peer-reviewed article is “Prevention of traumatic headache, dizziness, and fatigue with creatine administration”). Neurons rely on calcium to communicate with other neurons – calcium becomes dysregulated after traumatic brain injury. Creatine (specifically phosphorylated creatine) can be stored in the brain tissue, specifically in the frontal lobe (cognitive) areas. By increasing creatine stores in the brain, it can help increase brain function as well as help reduce symptoms. The clinical dose recommended is much higher than for sports performance; one particular study had patients take 0.4 gram of creatine monohydrate per kilogram of bodyweight (for a 220 lb individual, that would be roughly 40 grams of creatine per day). This particular study found a drastic reduction in headache, dizziness, and fatigue in patients taking creatine vs the control group. Creatine monohydrate may be an important factor in the treatment of headaches, even if you have headaches not associated with a traumatic brain injury.
For tension headaches, migraines, and hormone-related headaches, there has been evidence that omega-3 fatty acids, specifically EPA more than DHA, have significant effects on reducing headache frequency and intensity. Omega 3 fatty acids have been shown to improve cardiovascular function, immune system function, brain function, and mood. Omega 3 fatty acids are a potent anti-inflammatory; they can be found in food (specifically certain kinds of fish) or can be supplemented. Most studies had patients increase their omega 3 fatty acids while decreasing their omega 6 fatty acid intake (specifically linolic acid found in seed oils). Omega 3 fatty acids are thought to reduce headaches by both an analgesic (reducing pain) and anti-inflammatory mechanisms. There is some discrepancy of how much omega 3 fatty acid supplementation is needed to be beneficial in the treatment of headache, but most sources are around 1 gram of EPA per day (remember that some supplements will clump EPA and DHA together as Omega 3 fatty acids – if possible, you want to try to get at least 1 gram of EPA per day).
There are also strategies for light sensitivity (photophobia) and aura symptoms. Auras (usually a visual halo-like warning before a migraine) usually occur with light sensitivity before a migraine, but there are times that people may have one without the other. Auras are thought to occur when different part of the brain start to decrease in their activity, and the spreading lowering of neuronal activity creates the aura preceding the migraine headache. Light sensitivity occurs when neurons in the eyes begin to trigger pain-sensing tissue surrounding the brain (meninges), creating signals the brain interprets as a headache. Typically, blue lights (from screens) and fluorescent lights from certain light bulbs trigger these neurons in the eyes more than other types of light, and when those neurons in the eyes become sensitized, it can cause a significant headache and associated pain. One practical way of dealing with both of these symptoms (aura and light sensitivity – even if the light sensitivity isn't associated with headache) is to change the type of light entering the eye to a longer wavelength light by wearing red or orange tinted glasses. You can also buy red light bulbs to use for a specific room or when needed. There are times when people can still work or finish school work with red lights instead of regular light in the room as they are working. For most people, using red light or red tinted glasses allows people to continue with their daily activities and not increase their symptoms, instead of just dimming the lights or staying in a dark room in fear of increasing symptoms.
For the very common tension headache, most people rely on non-steroidal anti-inflammatory drugs (NSAIDS) like Tylenol or Motrin. Sometimes this can be effective, but for some people it doesn’t reduce their headache at all. There are also times where these medications will help initially, but over time gets less and less effective in reducing the person’s headache. There are herbal and essential oil treatments that have been shown to be effective for tension headaches – there have been studies that have shown to reduce the frequency and intensity of headaches significantly more than NSAIDS. One study demonstrated that peppermint and eucalyptus oils were highly effective in reducing headache frequency and intensity (the study would sponge-apply the oils to the temples and forehead of people with headaches). It was found to be the most effective when these oils were applied to the skin at the areas of pain and muscle tightness (not ingesting the oils). The proposed mechanism of these essential oils appears to be shutting down pain and temperature neurons on the skin that relay those signals back into the brain, resulting in an analgesic effect. There are certain herbal remedies that have been demonstrated to treatment migraines and headache as well. The most potent herbs in reducing migraine and headaches (especially pressure headaches that cause vasodilation) is caffeine (when the person doesn’t typically consume caffeine every day or in large quantities) and curcumin (turmeric). Caffeine can lead to both vasoconstriction and vasodilation in different situations; but caffeine seems to have the best effect on headaches when taken in the morning and when you are well-rested. If you consume a large amount of caffeine daily (high tolerance), consuming caffeine will usually not help reduce a headache unless that headache is a caffeine-withdrawal headache. Turmeric is a very potent anti-inflammatory; dosages usually range from 25 mg per day to around 100 mg or more per day. Turmeric has shown to have good effects in reducing pressure-type headaches, especially when combined with omega 3 fatty acids.
In addition to the above-mentioned therapeutic options, there are also neurological training exercises and therapies that have been shown to improve headache frequency and intensity. At our clinic, we have two unique tools that can be beneficial for the treatment of headache; vestibular rehabilitation and a muscle therapy called ARP wave therapy. Some headaches originate in the neck (called cervicogenic headaches), and muscle therapies like the ARP wave that reduce spasms/tightness in the neck muscles (especially the suboccipital muscles) is usually a very effective therapy for reducing headaches, both short and long term. Other people experience vestibular migraines, which are headaches induced by improper processing of head/body motion, visual motion, gravity, or a combination of these signals. In this case, vestibular rehabilitation is a highly effective option for reducing headache frequency and intensity. See our other blogs for more information on our vestibular rehabilitation therapies and Gyrostim equipment.
Our mission at Great Lakes Functional Neurology is to help you understand your injury and get you back to normal, healthy living. We strive to equip you with the tools needed for a full neurological recovery. If you would like to know more, we would be happy to discuss our services in more detail with you. You can reach us at (616)-581-1558 or visit our website at www.greatlakesneurology.com and schedule a complimentary phone consult with one of our doctors.
Some of the content in this blog was put together using information from Dr. Andrew Huberman’s podcast entitled “How to Stop Headaches Using Science-Based Approaches”. Dr. Huberman is a Professor of Neurobiology and Ophthalmology at Stanford School of Medicine. He has made numerous free videos focused on practical, low-cost options and methods to improve your health and life using principles of neurology and science-based tools. Visit www.youtube.com/@hubermanlab/playlists to learn more from Dr. Huberman!
MEDICAL DISCLAIMER The content above is for informational and educational purposes only. It is not intended to provide medical advice or to take the place of such advice or treatment from a personal physician. Great Lakes Functional Neurology does not take responsibility for possible health consequences of any person or persons reading or following the information in this educational content. We recommend readers that are taking prescription or over-the-counter medications consult their physicians before starting any nutrition, supplement or lifestyle program.