Headache

Latest Edit: Hector 2014-05-15 (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.

Headache

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

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

• Dietary factors

• The foods more commonly reported as headache triggers were alcoholic drinks, chocolate and cheese. Other food triggers include red wine, pork, MSG, and nitrites which are found in hot dogs and cold cuts.
• Over consumption of caffeine and caffeine withdrawal can contribute to the development of headaches.
• 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.
• Dehydration is strongly associated with increased risk of headaches, especially after exercise.

• Exercise

• Headaches are commonly associated with intense exercise.,
• Regular exercise can be decrease the frequency of headaches.

• Breathing

• Breathing disorders appear to be linked to headaches.

• Sleep

• There is a link between inadequate sleep and insomnia and the frequency and severity of headaches and migraines.,

Social

• Stress

• Stressful events or a general increase in stress levels have been shown to contribute to the development of a headache.
• Perceived unfairness at school can be a significant predictor of frequent headache during adolescence.

• Sexual Activity

• Intense or frequency sexual activity increases the risk of headaches.

Environmental

• Environmental Toxins

• Headaches can arise due to a number of environmental toxins and heavy metal exposure including lead and arsenic.
• Exposure to carbon monoxide will cause headaches.

• Infections

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

External

• Injuries

• Trauma can lead to headaches from musculoskeletal origin, or associated with concussion.
• 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.
• 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.

Physiology

• Both constipation and diarrhea can contribute to the onset of headaches.

Genetics

• 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.

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:

• 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.

• Laboratory Studies:

• Lab Tests|Blood tests]] are typically indicated for most headaches, yet for more complex conditions that following tests may be recommended: C-Reactive Protein (CRP), erythrocyte sedimentation rate, CBC, monospot test, lyme antibody test, liver function test, Thyroid Stimulating Hormone (TSH), creatinine, and serum calcium.

Related Symptoms and Conditions

Conditions related to headaches include:

• Hypertension
• Depression
• Anxiety
• Stress
• Sleep Apnea
• Insomnia
• Hematoma
• Musculoskeletal Conditions
• Cough
• Perimenopause

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:

• 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:

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.

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:

• 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.

• Water

• Drinking water can often improve headaches and decrease the length of headaches.,

• Exercise

• Regular exercise can decrease the frequency of headaches or migraines.
• Intense exercise may actually be detrimental.

• Posture

• Addressing postural misalignment can decrease the frequency and severity of headaches.

• Breathing

• Learning proper breathing techniques can decrease the frequency and severity of headaches.

• Sleep

• Proper sleep hygiene and adequately addressing sleep issues such as insomnia, are important in the treatment of headaches.,
• Avoid either excess or inadequate sleep.

• Rest and Relaxation

• Mind body therapies including relaxation training, biofeedback, and stress management have been shown effective in treating migraines, cluster headaches, and tension-type headaches.

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:

• Nutritional Foods include:

• Herbs and spices that can assist with headache include: sweet basil, peppermint, spearmint, rosemary.
• Vegetables, Roots, Nuts & Gourds such as celery, green onion leaf, radish.
• Fish & Shellfish such as grass carp
• Other foods such as tea, tobacco

• Clinical Nutritional Supplementation includes:

• Vitamins such as vitamin B2, vitamin B3, vitamin C, vitamin D, vitamin E, vitamin B12

• Using niacin at the onset of a headache or migraine may decrease the severity or intensity of the episode.

• Minerals such as magnesium, calcium
• Other supplements such as Coenzyme Q10, Melatonin, Quercetin, Omega-3 Fatty Acids

• Herbs such as Feverfew (Tanacetum parthenium), Centaury (Centaurium erythraea), Celandine (Chelidonium majus), Dandelion (Taraxacum officinale), Dong Quai (Angelica sinensis), Cayenne (Capsicum annuum), Lavender (Lavandula stoechas), Gelsenium (Gelsemium sempervirens), Passionflower (Passiflora incarnata), Valerian (Valeriana officinalis), Black cohosh (Black cohosh), Passionflower (Passiflora incarnata), Jamaican Dogwood (Piscidia piscipula), Rosemary (Rosmarinus officinalis), Willow Bark (Salix spp), Ginkgo (Ginkgo biloba), Ginger (Zingiber officinale), Mistletoe (Viscum album), Oats (Avena sativa), Oregano (Origanum vulgare), Skullcap (Scutellaria lateriflora), Vervain (Verbena officinalis)

• Gemmotherapies such as Acer campestre, Citrus limonum, Corylus avellana, Rosa canina, Tilia tomentosa

• Homeopathy

• Classical homeopathics: Belladonna, Bryonia, Gelsemium, Iris versicolor, Nux vomica, Sanguinaria, Natrum muriaticum, Lachesis, Pulsatilla, Sepia, Silica, Sulfur, Tuberculium, Cocculus, Argentum nitricum
• Complex homeopathics are often used in the prevention and treatment of headaches.

• Traditional Chinese Medicine & Acupuncture

• 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., , ,

• Hydrotherapy

• 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.

• Physical Medicine

• Naturopathic manipulation can be very effective in alleviating and treating headaches.
• Cervical Manipulation have been shown to decrease the intensity of pain associated with migraines and headaches.,
• Massage therapy can be helpful in acute management of headaches.

• Other Therapies

• Transcutaneous Electrical Stimulation (TENS) - Patients with migraines and muscle tension headaches have been shown to experience improvement following TENS therapy.
• Electromyography biofeedback (EMG) therapy has been shown to be effective in reducing headaches.
• Cognitive Behavioural Interventions (CBT) including stress management, has been shown effective in individuals with stress-related headaches.

References

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