Headache

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Latest Edit: Hector 2014-4-10 (EDT)

Headache is a subjective feeling of discomfort that can be caused by numerous factors. The majority of headaches are self limiting and non-serious, with less than 1% due to a serious underlying condition. Despite the primarily benign nature of headaches, sufferers may be severely impacted by the affects of headache on work life, home life, and social life.[1]

Headache
Headache.jpg

Headache
Causes Dietary Factors, Caffeine, Dehydration, Stress, Injuries, Insomnia
See Also Neurological Conditions, Musculoskeletal Conditions, Hypertension, Depression, Anxiety, Hematoma, Cough, Perimenopause
Books Books on Head, Ears, Nose and Throat Conditions
Articles Articles on Head, Ears, Eyes, Nose and Throat Conditions

Contents

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With headaches, the causes are variable and include lifestyle and environmental factors. A detailed assessment is required to determine which factors are contributing to headaches.

Article Botanical Therapies for Headaches , NDNR; 2013 July
Article Caffeine's Contradictory Role in Headaches, NDNR; 2013 July [1]

Lifestyle

  • The foods more commonly reported as headache triggers were alcoholic drinks, chocolate and cheese.[2] Other food triggers include red wine, pork, MSG, and nitrites which are found in hot dogs and cold cuts.[3]
  • Over consumption of caffeine and caffeine withdrawal can contribute to the development of headaches.[4]
  • Food allergies and food intolerances are associated with headaches. There is a tremendous amount of independent variability as to the specific foods.
  • Sugar consumption is associated with increased risk of headaches.[5]
  • Dehydration is strongly associated with increased risk of headaches, especially after exercise.[6]
  • Headaches are commonly associated with intense exercise.[7], [8]
  • Regular exercise can be decrease the frequency of headaches.
  • There is a link between inadequate sleep and insomnia and the frequency and severity of headaches and migraines.[9], [10]

Social

  • Stressful events or a general increase in stress levels have been shown to contribute to the development of a headache.[11]
  • Perceived unfairness at school can be a significant predictor of frequent headache during adolescence.[12]
  • Sexual Activity
  • Intense or frequency sexual activity increases the risk of headaches.[8]

Environmental

  • H. pylori infection is strongly related to the outbreak and severity of migraines and headaches.[14]

External

  • Injuries
  • Trauma can lead to headaches from musculoskeletal origin, or associated with concussion.[15]
  • Sport injuries are a common cause of headaches.

Medical Interventions

  • Prescription Medications
  • Agents commonly used to treat headache, including acetaminophen and aspirin, can cause rebound headaches if overused.[4]
  • Headaches can be caused by overdosing on prescription medications.
  • Many prescription medications can cause headaches.
  • Treatments
  • Myofascial trigger points are discrete points in a taut band of skeletal muscle that are painful when compressed or stretched. The presence of trigger points in some muscles may contribute to headache presentations.[11]

Physiology

Genetics

  • Twin studies and general population studies suggest an increased genetic risk in chronic tension type headaches. Several genes have been implicated across different studies, suggesting a complex genetic etiology for headache risk.[11]

Diagnostic Testing

Establishing a diagnosis for headaches is routinely done through a history taking, focused physical exam including neurologic testing. If there are red flag symptoms such as neck stiffness, papilledema, cognitive impairment, or personality change further testing may be required including:

  • Imaging Studies:[16]
  • A CT scan is able to diagnose most serious causes of headache and is superior to MRI in evaluating subarachnoid hemorrhage, acute head trauma, and anatomic abnormalities.
  • MRI is more appropriate than CT for diagnosing vascular diseases, neoplastic diseases, and infections that may be causing headaches.
  • A lumbar puncture may be used following imaging to evaluate for meningitis, encephalitis, subarachnoid hemorrhage, or CSF pressure changes.

Related Symptoms and Conditions

Conditions related to headaches include:[4][17]

Characteristics

Headaches can be classified by both etiology and symptomology. A primary means of classification divides headaches into either primary or secondary. Primary and secondary headaches are defined as follows:[1]

  • Primary Headaches- primary headaches occur in the absence of structural or systemic pathology and account for over 90% of headaches. Primary headaches include migraines, tension-type headaches (TTH), cluster headaches, and other primary headaches.
  • Secondary Headaches- secondary headaches result from an underlying structural or systemic pathology and include infection, neurogenic, cardiovascular, and metabolic causes.

The following are common symptoms of headaches by headache classfication:[1]

Primary Headaches

  • Common symptoms of tension type headaches include:
  • bilateral pain
  • non-throbbing pressure
  • gradual onset
  • muscle pain
  • Common symptoms of cluster headaches include:
  • abrupt onset
  • unilateral
  • ocular pain
  • rhinorrhea
  • ptosis
  • Common symptoms of migraine headaches include:
  • unilateral throbbing pain
  • nausea and vomiting
  • rapid onset with peak pain within hours
  • aura may or may not be present

Secondary Headaches

  • Common symptoms associated with secondary causes of headaches include:
  • fever
  • tooth pain
  • malaise
  • orbital pain
  • sinus pain
  • ear pain
  • neck stiffness
  • visual changes
  • dementia-like symptoms
  • papiledema

*Symptoms associated with serious secondary causes of headache include: worst headache of life (thunderclap headache) with abrupt onset, low grade fever, and neck stiffness.[18][1]

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. The therapeutic strategy for headaches including providing symptomatic relief and identify and addressing the underlying causal factors.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.

Home Care

Home Care strategies include:[19]

  • Keep a diary to chart symptoms and the efficacy of treatments already undertaken.

Lifestyle

Lifestyle recommendations include:

  • Dietary recommendations
  • Avoiding foods implicated in triggering headaches is a key step in prevention of further headaches.
  • Consuming regular meals with a low glycemic index to prevent hypoglycemia.[10]
  • Drinking water can often improve headaches and decrease the length of headaches.[20], [21]
  • Regular exercise can decrease the frequency of headaches or migraines.[10]
  • Intense exercise may actually be detrimental.
  • Learning proper breathing techniques can decrease the frequency and severity of headaches.
  • Mind body therapies including relaxation training, biofeedback, and stress management have been shown effective in treating migraines, cluster headaches, and tension-type headaches.[22]

Naturopathic Therapies

The prescribing of naturopathic therapies requires the guidance of a naturopathic doctor as it depends on a number of factors including the causal factors, a person's age, prescription medications, other conditions and symptoms and overall health. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.

Naturopathic Therapies for headaches include:

  • Using niacin at the onset of a headache or migraine may decrease the severity or intensity of the episode.
  • The TCM patterns associated with headaches include: hyperactive liver Yange, blood and Qi deficiency, kidney Qi deficiency, blood stagnation, Tan Yin obstruction.
  • Several studies have demonstrated the effectiveness of acupuncture in the treatment of headaches.[11], [29], [25], [30]
  • Cold applications to the head and back of neck, hot foot baths, alternating hot and cold to the head and constitutional hydrotherapy have been found helpful in the treatment of headaches.
  • Naturopathic manipulation can be very effective in alleviating and treating headaches.[31]
  • Cervical Manipulation have been shown to decrease the intensity of pain associated with migraines and headaches.[32], [33]
  • Massage therapy can be helpful in acute management of headaches.[11]
  • Other Therapies
  • Transcutaneous Electrical Stimulation (TENS) - Patients with migraines and muscle tension headaches have been shown to experience improvement following TENS therapy.[34]
  • Electromyography biofeedback (EMG) therapy has been shown to be effective in reducing headaches.[11]
  • Cognitive Behavioural Interventions (CBT) including stress management, has been shown effective in individuals with stress-related headaches.[11]

References

Reviewed by Iva Lloyd, BScH, RPE, ND [2]

  1. 1.0 1.1 1.2 1.3 Dains JE, Baumann LC, Scheibel P (2007) Advanced Health Assessment and Clinical Diagnosis in Primary Care 3rd ed Chap 28 Headache Mosby
  2. Savi L, Rainero I, Valfrè W, Gentile S, Lo Giudice R, Pinessi L (Mar 2002) Food and headache attacks. A comparison of patients with migraine and tension-type headache. Panminerva Med.;44(1):27-31. PMID: 11887088.
  3. Boes CJ, et al (2008) Bradley: Neurology in Clinical Practice, 5th ed Chap 73 Headache and Other Craniofacial Pain Butterworth-Heinemann
  4. 4.0 4.1 4.2 McConaghy JR (2007) Headache in Primary Care Prim Care;34(1):83-97
  5. Kopyev VY, Lozner E (Sept 2000) How can fruits and sugar induce headache and hypoglycaemia? Postgrad Med J.;76(899):586, 592-3. PMID: 10964134.
  6. Armstrong LE, Ganio MS, Casa DJ, Lee EC, McDermott BP, Klau JF, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR (Feb 2012) Mild dehydration affects mood in healthy young women. 'J Nutr.;142(2):382-8. PMID: 22190027.
  7. McCrory P (Sept 2000) Headaches and exercise. Sports Med.;30(3):221-9. PMID: 10999425.
  8. 8.0 8.1 8.2 Pascual J, González-Mandly A, Martín R, Oterino A (Oct 2008) Headaches precipitated by cough, prolonged exercise or sexual activity: a prospective etiological and clinical study. J Headache Pain.;9(5):259-66. PMID: 18751938.
  9. 9.0 9.1 Alberti A (Dec 2006) Headache and sleep Sleep Med Rev.;10(6):431-7. PMID: 1687285.
  10. 10.0 10.1 10.2 10.3 Mann JD, Coeytaux RR (2007) Rakel; Integrative Medicine 2nd ed Chap 14 Migraine and Tension-Type Headache Saunders
  11. 11.0 11.1 11.2 11.3 11.4 11.5 11.6 Fumal A, Schoenen J (2008) Tension-type headache: Current research and clinical management Lancet Neurol;7(1):70-83
  12. Lenzi M, Vieno A, De Vogli R, Santinello M, Ottova V, Baška T, Griebler R, Gobina I, de Matos MG (Feb 2012) Perceived teacher unfairness and headache in adolescence: a cross-national comparison. Int J Public Health. PMID: 22314545.
  13. Hampson NB, Hampson LA (Mar 2004) Characteristics of headache associated with acute carbon monoxide poisoning. Headache.;42(3):220-3. PMID: 11903546.
  14. Hosseinzadeh M, Khosravi A, Saki K, Ranjbar R (Oct 2011) Evaluation of Helicobacter pylori infection in patients with common migraine headache. Arch Med Sci.;7(5):844-9. PMID: 22291830.
  15. McLeod TC, Register-Mihalik JK (2011) Clinical outcomes assessment for the management of sport-related concussion Sport Rehab: 20(1):46-60
  16. 16.0 16.1 Evans RW (2009) Diagnostic Testing for Migraine and Other Primary Headaches Neurol Clin 27(2):393-415
  17. 17.0 17.1 Graff-Radford SB, Teruel A, Kumar SKS (2010) Sleep and Headache Sleep Medicine Clin; 5(1);145-152
  18. 18.0 18.1 Gladstein J (2006) Headache Med Clin North Am;90(2):275-90
  19. 19.0 19.1 Prousky Jonathan (2008) Principles and Practices of Naturopathic Clinical Nutrition CCNM Press.
  20. Spigt M, Weerkamp N, Troost J, van Schayck CP, Knottnerus JA (Nov 2011) A randomized trial on the effects of regular water intake in patients with recurrent headaches. Fam Pract. PMID: 22113647.
  21. Spigt MG, Kuijper EC, Schayck CP, Troost J, Knipschild PG, Linssen VM, Knottnerus JA (Sept 2005) Increasing the daily water intake for the prophylactic treatment of headache: a pilot trial. Eur J Neurol.;12(9):715-8. PMID: 16128874.
  22. Sierpina V (2007) Mind-body therapies for headache Am Fam Physician; 76(10):1518-22
  23. Lu Henry (1986) Chinese System of Food Cures, prevention and remedies Sterling Publishing Co. New York.
  24. Gagnier JJ (2001) The Therapeutic Potential of Melatonin in Migraines and other Headache Types Alt Med Rev 6(4):383-9
  25. 25.0 25.1 25.2 Woolhouse M (Aug 2005) Migraine and tension headache--a complementary and alternative medicine approach. Aust Fam Physician.;34(8):647-51. PMID: 16113701.
  26. Lurie Vince, Tripodi Stephen (2000) Naturopathic Treatment Options CCNM
  27. Ernst E, Pittler MH (Dec 2000) The efficacy and safety of feverfew (Tanacetum parthenium L.): an update of a systematic review. Public Health Nutr.;3(4A):509-14. PMID: 11276299,
  28. Hershoff Asa (2000) Homeopathic Remedies, A Quick and Easy Guide to Common Disorders and their Homeopathic Treatments, Avery Publishing Group, New York
  29. Melchart D, Streng A, Hoppe A, et al.(2005) Acupuncture in patients with tension-type headache: a randomised controlled trial BMJ 331;376-382
  30. Manias P, Tagaris G, Karageorgiou K (2000) Acupuncture in headache: a critical review Clin J Pain;16:334-339
  31. Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E (Jun 2011) Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther.;34(5):274-89. PMID: 21640251.
  32. Parker GB, Tupling H, Pryor DS (1978) A controlled trial of cervical manipulation for migraine. Aust N Z J Med;8:589-593
  33. Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E (Jun 2011) Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther.;34(5):274-89. PMID: 21640251.
  34. Sudak N, Murray MT, Pizzorno JE. (2006) Pizzorno Textbook of Natural Medicine 3rd ed Chap 191 Migraine Headache Elsevier.
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