Non-Drug Therapies for Headaches

It pounds, it throbs, it brings life to a halt when it attacks. Each day, tens of thousands of headache sufferers lose days of productivity. Some headaches are migraines, resulting from abnormal spasm and dilation of blood vessels in the head. Other headaches are caused by stress-induced spasm of the scalp muscles. Still others come from sinus congestion, lack of sleep or dehydration.

Drug companies are well aware of the disabling effects of headaches. In fact, tens of millions of dollars each year are spent each year promoting the effects of migraine drugs, pain relievers and neurological medications. And, for the most severe headache sufferers, these drugs can seem like life-savers. But, for the majority, they become yet another bottle (or more) of pills decorating the dresser or medicine cabinet, and

The first issue to explore with the patient who has migraines is that of diet, and specifically, food sensitivities. Estimates of food allergy and sensitivity as a trigger for migraines have been as high as 70%. Wheat and dairy seem to be the most notable culprits, as they are in many other food-related conditions, and withdrawing both at once seems to be easier than doing one at a time, since many of our common foods (bagel and cream cheese, cereal and milk, pizza, pasta with cheese, etc.) are wheat and dairy based. We ask the patient to completely withdraw wheat and dairy foods for a three week minimum. Then, the patient "challenges" with a wheat or dairy meal. Many times, a migraine will be activated by this challenge, implying that the food is a trigger. Aspartame (Nutrisweet © ) and various preservatives and additives can also effect a migraine history, so a patient should withdraw those, and the common migraine-associated foods (chocolate, red wine, etc.) as well.

The second piece to look for is a structural imbalance. Most patients with a diagnosis of migraine have muscle spasm that makes the pain worse, and some have other musculoskeletal problems such as a misalignment of their neck vertebrae or ligament strains. To find this, we press along and beside the cervical spine, looking for painful areas. We can also find areas of tenderness along the back of the skull, and in the trapezius and shoulder muscles.

Some of these tender points can actually send pain to the areas of the migraine; these are called trigger points. Trigger points were first described by Dr. Janet Travell, who was President Kennedy's back physician. These points in the muscles can refer pain to the top of the head and to the temples. The jaw is another area of tightness and pain that can worsen a migraine. Although migraine is thought to be a vascular phenomenon, it is surprising how much the problem can be modified by good body work, chiropractic and/or osteopathic adjustments.

In fact, there is increasing research into the positive effects of pressure on pain areas, particularly the head muscles. In one study, increased pressure around the head reduced headache pain by an average of over 80%. Other studies have demonstrated what patients already know, that a headache can be relieved by pressure around the scalp and head.

Other research has been done to look into another common folk remedy for headache: cold applications. We all know that, when cartoon figures get headaches, they strap ice bags on top of their heads. Even ancient Egyptians used ice packs (along with pressure) to treat maladies of the head. So, it's no surprise that sides of “cryotherapy” (the application of cold) for headaches show a uniformly positive effect. Interestingly, so do the studies that employ heat packs to help headaches.

One company has developed an ingenious device to take advantage of the positive effects of pressure, ice and heat on the pain of headache. This device, called the Headache Relief Band™ , is made of cloth in an adjustable elastic band that wraps around the head. It holds gel packs which then create a cold pressure application around the head. The Headache Relief Bands™ are highly effective, inexpensive and easy to use. They can be found at www.HeadacheReliefBand.com.

The next area to investigate is whether there is a hormonal variation. Quite commonly, a female patient comes in whose migraines appear at ovulation and at the beginning of menses, or premenstrually. Other symptoms can also occur, suggesting a relative estrogen/progesterone imbalance. Documenting this imbalance can be difficult since standard blood tests give only a single snapshot of the hormones. Recently, salivary assays have been developed to measure estrogen and progesterone over the course of a monthly cycle. Most commonly, it is the progesterone that is relatively deficient. We sometimes treat this with topical progesterone cream, although oral progesterone is also useful and might have more reliable absorption. For relative estrogen deficiency we might use black cohosh extract, soy-based phytoestrogens, or (if other symptoms co-exist) natural estrogen preparations.

Chinese medicine gives a good framework for understanding and treating migraine, and we look for certain patterns in evaluating the patient. These patterns, if present, suggest that the patient is a good candidate for acupuncture and/or Chinese herbs. In Chinese medicine, Wood energy (characterized by the Liver and Gall Bladder channels) is associated with "wind" conditions. Wind is the quality that brings a symptom rapidly and furiously into being, and migraines frequently are associated with wood patterns of imbalance. Patients with wood imbalances tend to have a feeling of frustration, of impatience, and (sometimes) of underlying anger. Physically they can manifest spasm of the digestive organs, abnormal menstrual cycles with crampy periods, and lack of musculoskeletal flexibility. Migraines also tend to be "yang" illnesses, that is, they are sharp, pounding, and hot in nature. Thus a frequent treatment of migraines in Chinese medicine involves "cooling" the Liver Yang which has risen to the head, giving pain in the Gall Bladder channels which run along the temples and parietal areas.

Since symptoms hardly ever happen in a vacuum, we frequently see migraines associated with other signs of a neurological or circulatory system that is hyper-functioning. For instance, there might be high or labile blood pressure, cold hands and feet, palpitations or other signs of nervous system imbalance. The portion of the nervous system that controls these activities is called the autonomic nervous system, and includes the fight-or-flight response. There is a body of literature on using biofeedback to retrain the autonomic nervous system, and on its use in migraines specifically. Commonly, we send patients for biofeedback training after the acute phase of migraine treatment is completed.

Even simple relaxation techniques can be effective in warding off migraine. Yoga, meditation and qigong exercises all can be useful in quieting down a hyperactive nervous system, provided they're done regularly.

Article by:

Glenn Rothfeld, M.D., M.Ac.

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