Headaches are a very common condition that many Americans suffer from on a daily basis. More than 23 million Americans have admitted to suffering from headaches in their lifetime. Furthermore, 57% of men and 76% of women report having at least one significant headache per month.1 Many people will connect their headache to several different factors (too little sleep, being hungover, too much/little caffeine, drug use, etc). Because of this, most do not feel the need to visit a doctor's office and resort to taking over the counter medication. In fact, headaches may be the most common reason given for taking over the counter medication.3 According to analysis completed in 2017, headaches carry a huge economic burden. When the cost of headache treatments, medication, and other expenses related to headaches like lost productivity, wages, and disability expenses are added up, the average person suffering from chronic headaches spends between $8,500 to $9,500 annually.2 This information shows that most Americans are stuck in an endless cycle of headaches. Hopefully the information provided in this post will help break this cycle and empower you to take control of your headaches and finally find relief.

Not All Headaches are Created Equal

Not every headache is the same and in order to get the best result, a proper diagnosis must be made. Headaches are best classified by the pattern they follow. Headaches are first broken into two different groups: Primary Headache and Secondary Headache. The Primary Headache group is where most people fit into. This group is subdivided into three different categories. These categories include: Migraine, tension-type, and cluster headache. The Secondary Headache group covers headaches due to trauma, metabolic disease (cancer), toxic effects (drugs), infection, and intracranial pathology. These headaches are often the sign of a serious underlying condition that needs to be managed by a healthcare professional.

What's Going on in my Head?

The most recent research suggests that the older theories of headaches being purely a vascular issue does not explain how headaches occur in their entirety. In primary types of headache, there does appear to be a neurologic event that occurs that causes an imbalance in the levels of serotonin in the body.4-7 Serotonin is one of the most studied neurotransmitters when it comes to headaches. That's because this neurotransmitter is responsible for the constriction (tightening) and dialiation (widening) of blood vessels. Changes in serotonin may precede the vascular and muscular changes of migraine, tension-type headaches, and possibly cluster headaches.8 The question researchers are trying to answer now is what neurologic event causes serotonin levels to go haywire.

The Battle Within

There is a constant battle inside your brain and nervous system between sensory pain input and pain inhibitory processing centers. Pain is perceived from the body through sensory nerves that bring information to the main processing center of the brain (the thalamus). Think of these sensory signals as "pain" signals. Sensory nerve information from the neck (cervical spinal nerves C1-C3) and the trigeminal nerve come together to form the trigeminocervical nucleus, and is the main source for a referred pain mechanism to primary headaches.9 On the other side of this battle is the nucleus raphae magnus (and other midbrain and pontine nuclei). This part of the brain works to inhibit pain signals from reaching the processing center by releasing the neurotransmitter serotonin. From there, it is the job of the thalamus to process the information given and send out a proper response. If the sensory signals coming from the trigeminocervical nucleus are not strong enough, they can be cancelled out by the raphae magnus. When this occurs, no pain is perceived. If the pain signals coming in are stronger than the nucleus raphae magnus's ability to inhibit them, then pain is perceived and you feel the symptoms of a headache. There seems to be a threshold for pain inhibition. Every person is believed to have a specific threshold set by the raphae magnus.

Triggers vs. Threshold

Headaches can only manifest after you breach the threshold of your body's ability to inhibit the incoming pain signals. Think of this like a volume knob. The more triggers that are present, the louder the signal is. Given this model, there are two different approaches to relieve a headache. Either lower the amount of triggers in the body, or raise the threshold. There are many triggers that have been identified that exacerbate the symptoms of headaches. These include postural imbalances (forward head position and rounded-shoulders), dietary triggers, medication triggers, stimulants and diet pills, hormones, vasodilators, and sleep patterns.

Avoid the Rebound Effect

Many patients are unaware of the negative after effect of taking certain drugs, both prescription and over the counter. Quick fixes like this work by artificially constricting the blood vessels around the head, which swell with vengeance once they wear off causing your headache to not just return, but worsen! If you are looking to better manage your headaches long term and avoid the endless cycle of the rebound effect, avoid these medications.13

1. Caffeine containing anaglesics -- Exedrin, Anacin, Vanquish, B.C. Headache Powder, Fiorinal, Fioricet, and Esgic Plus

2. Isometheptene -- Midrin and Duradrin

3. Decongestants -- Sudafed, Tylenol Sinus, Dristan, Afrin, and Entex LA

4. Ergotamines -- Ergomar, Wigraine, Megranal, and D.H.E. 45

5. Triptans -- Imitrex, Amerge, Zomig, Maxalt, and Axert

6. Opioids -- Tylenol with Codeine, Percocet, Darvocet, Stadol NS, Oxycontin, Ultram and many others. Note: These drugs do not follow the vasodilation mechanism for rebound effect, but long term opioid use can lead to dependence and drug addiction.

How to Best Manage Headaches

Reducing your biomechanical triggers is an important step. We go through a very detailed history and exam in our office to determine whether there are any musculoskeletal abnormalities and/or any dysfunctional motion of the head and neck that could contribute to your headaches. Correcting these issues through chiropractic adjustments and corrective exercises has been proven to decrease the intensity and frequency of primary headaches. Recently, several randomized studies indicate improvement with chiropractic care over the use of medication in the treatment of chronic tension-like and migraine headaches.10-12

We also work with you to eliminate other triggers in your daily routine through a headache diary. There are many free templates online but we recommend the migraine diary by CreateSpace (check out the link below). This diary's simple layout makes it easy to track your headaches, giving you the best chance to find your pattern and eliminate the necessary triggers. There are many nutritional supplements that have proven to be helpful in reducing and eliminating headaches as well. Click here to check out my list of recommended supplements for headache relief.

Unfortunately, there is no quick fix when it comes to healing chronic headaches. In order to take control of the problem, you must take the long term approach and make some lifestyle changes. In summary, the best management practices are to reduce your headache triggers, visit a trusted chiropractor, and look into a natural supplement to better control your symptoms and find long lasting relief.

References

1. CDC. Prevalence of chronic migraine headaches: United States, 1980-1989. Morbid Mortal Weekly Rep. 1991;40:331-338

2. Gooch, C. L., Pracht, E. and Borenstein, A. R. (2017), The Burden of Neurological Disease in the United States: A Summary Report and Call to Action. Ann Neurol.. Accepted Author Manuscript. doi:10.1002/ana.24897.

3. Osterhaus JT. Measuring the functional status and well-being of patients with migraine headache. Headache. 1994;34:337-343.

4. Takasha T, Shimomura T, Kazuro T. Platelet activation in muscle contraction headache and migraine. Cephalgia. 1987;7:239.

5. Anthony M, Lance J. Plasma serotonin in patients with chronic tension-like headache. J Neurol Neurosurg Psychiatry. 1989;52:182.

6. Rajiv J, Welch K, D'Andrea G. Serotonergic hypofunction in migraine: a synthesis of evidence based on platelet dense body dysfunction. Cephalgia. 1989;9:293.

7. Lance J, et al. 5-Hydroxytryptamine and its putative aetiological involvement in migraine. Cephalgia. 1989;9(suppl 9):7.

8. Marcus, Dawn A. "Serotonin and its role in headache pathogenesis and treatment." The Clinical journal of pain 9.3 (1993): 159-167.

9. Bogduk N. A neurological approach to neck pain. In: Glasgow EE, Twomey IV, Seall ER, Klehnhams AM, Edzack D, eds. Aspects of Manipulative Therapy. 2nd ed. New York: Churchill Livingstone; 1985:136-146.

10. Boline P, Kassak K, Bromfort G, Nelson C, Anderson AV. Spinal manipulation vs amitriptyline for the treatment of chronic tenion-like-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18:148-154.

11. Nelson CF, Bronfort G, Evans R, et al. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophlaxis of migraine headache. J Manipulative Physiol Ther. 1998;21:511-519.

12. Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000;23:91-95.

13. Buchholz, David. Heal your headache: The 1-2-3 program for taking charge of your pain. Workman Publishing, 2002.

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