Headaches

Headaches (HA) are a common condition that many people suffer from. Headaches are sometimes the sign of a more serious medical condition, but often they are not serious in themselves. There are different classifications of headaches; the common ones are tension headaches, migraine headaches and cluster headaches. However, it is been postulated that headaches are on a continuum and perhaps more related than originally thought. Many believe that changes in the neurotransmitter serotonin are the basis for most headaches regardless of type. These changes may be triggered by food sensitivities, stress, hormones, medication or other chemical toxicities.

Differentiation of Headaches

Also called muscle contraction headache, tension headaches are a common type of headache. They are usually caused by tightening and strain of the muscles of the face and neck. The muscle tension and the decrease in blood flow contribute to the increased sensation of pain.

It is still not truly known what causes migraine headaches (MHA). Some theories are that they are caused by blood vessels changes in the head; another theory is that there is a change in the electrical function of the nervous system. There are 2 main classifications of MHA: a classic migraine with an aura, and a common migraine without an aura. MHA types that are more rare are ophthalmoplegic which can produce double vision and eye pain (also called ocular or retinal migraine), menstrual (also called catamenial) migraine, and basilar migraine which has symptoms of brainstem dysfunction similar to a stroke (also called hemiplegic). Over 50% of people with MHA have a family history of them. Most people develop MHA between the ages of 10-40 years old, and women suffer MHA more often than men. Estrogen is thought to play a role in migraines, and especially the use of oral contraceptives.

Cluster HAs are more commonly experienced in males, men are affected seven to eight times more often than women; and hereditary factors are usually absent. Many people with cluster headaches are heavy consumers of alcohol, and alcohol consumption has been reported to bring on cluster headache attacks. Cluster HAs are thought to be a vascular headache syndrome much like a migraine.

Stress is also a factor; it is the most frequent cause reported by migraine suffers to trigger a MHA. Certain foods can sometimes trigger MHA: Foods containing the amino acids tyramine or phenylalanine, aged cheese, wine, chocolate and cashew nuts; and monosodium glutamate. Changes in weather, especially barometric pressure, can also trigger a MHA.

Symptoms of Headaches

Tension headaches usually have a pulsating, type of pain that is generally felt on both sides of the head. Many people describe the pain as if it were a vise- like pressure sensation around the head like a band or a hat. The pain can last from half an hour to approximately a week, and is usually not associated with any digestive disturbance or sensitivities to light, sound or smell. Episodic tension headaches are defined as tension headaches occurring less than 15 days a month, whereas chronic tension headaches occur 15 days or more a month for at least 6 months.

MHAs can start with small flashes of light, known as auras, on the periphery of vision. Sometimes in an aura the visual disturbance will appear as dark spots instead of light. Depression, irritability, restlessness or digestive disturbance may be present as well. MHA’s are typically one sided, with pain that can be described as throbbing, stabbing, and severe. The pain is worse with movement and exertion, and there is increased sensitivity to smells, noises and bright light. Most people will experience nausea and some also experience vomiting episodes. Other symptoms that are more uncommon include speech problems, numbness and paralysis. MHA’s usually last 4 hours and longer, sometimes 2-3 days.

In cluster HAs the pain comes on suddenly with intense severity on one side of the head by an eye or temple. The pain is usually short in duration, lasting 15 minutes to 2 hours, but can happen up to 8 times a day for several weeks, with periods of abatement in between. Frequently on the side of the HA there is also redness and tearing of the eye, with nasal stuffiness. Onset of pain is at night in about 50% of the cases, and then the pain usually awakens the patient within 2 hours of falling asleep.

Lifestyle and Dietary Modifications

Diet has been linked to the onset of a HA, especially migraines, by clinical cases as well as documented by epidemiological studies. Hypoglycemia, which is low blood sugar due to infrequent eating or eating irregularly with a high amount of refined sugars, can trigger MHA. Foods high in dietary amines, specially tyramine, a byproduct of amino acid breakdown, can also trigger MHA. A partial list of high tyramine foods includes aged cheeses, yogurt, aged and pickled meats, chocolate, and soy sauce.

Food allergies are common in people with HA, and the recurring nature of the HA can be linked with the continuous ingestion of specific foods that one may be intolerant to. Common food allergies include dairy products, wheat, egg products.

Stress management is very important for those with any type of HA. Relaxation and hypnotherapy can significantly reduce headache intensity and duration in chronic tension-type headache sufferers.

Nutritional Factors Shown to be Beneficial

Riboflavin (vitamin B2)

Riboflavin is a water-soluble vitamin needed to process amino acids and fats, and is involved in the body’s metabolic processes for energy. It is most helpful in migraine type headaches.
Does: 400 mg / day

Magnesium

Magnesium is an essential mineral and is needed for muscle relaxation. Very useful in all types of headache, but especially MHA or HA that may be hormonally related.
Dose: 300 – 500 mg / day

Butterbur (Petasides hybridus)

This herb has been studied in Germany for the prophylactic treatment of migraines.
Dose: 50 mg twice a day of the standardized extract

Feverfew (Tanacetum parthenium)

Feverfew can work as an anti-inflammatory similar to aspirin, but with additional benefit that it may inhibit the secretion of serotonin.
Dose: for a total of 250 mcg the standardized extract per day

5-Hydroxytryptophan (5-HTP)

5-HTP is a precursor to the neurotransmitter serotonin and may be helpful for tension-type headaches.
Dose: 50-100 mg three times a day

Acupuncture

Acupuncture can significantly help with the pain and management of headaches.

Diagnosis and Pharmaceutical Interventions

Diagnosis of a headache is generally straight forward, with a patient history and examination. Usually the pain from a tension headache is made worse or better by applying pressure to trigger points on the head and neck, relieving the tension that the muscles are holding. Natural health care practitioners may offer alternative testing to determine the cause of the headache, such as hormone panels to evaluate estrogen and or cortisol levels. Diagnosis can also be helped by food tolerance testing. Many HA sufferers have food sensitivities, and HA can diminish in both frequency and severity when the offending foods are discovered and avoided. Researchers have found that standard blood tests used to evaluate allergies may not uncover food sensitivities associated with HA, because HA food sensitivities may be different than true allergies.

Testing for food sensitivities can be done by using a food tolerance test that combines IgE, the first antibody produced in an immediate allergic reaction, with IgG, the antibody produced in a delayed hypersentivity reaction. Delayed hypersentivity reactions are not true commonly tested for by a standard clinician, and reactions cans take up to several hours, days, or even weeks to appear.

Most practitioners may perform some testing not only to establish a baseline for treatment but to fully evaluate the condition. Some of those tests may include fasting blood sugar, a complete blood count, a chemistry panel including lipid panel, and a urinalysis.

Some headaches that seem to be a type of headache but should be evaluated further to rule out other conditions are:

Headaches that are worse stretching the neck and flexing the back, or with a stiff neck Headaches that are worse with a bearing down movement, cough or bowel movement Headaches that start abruptly in the middle ages or later life Headaches after trauma or motor vehicle accident Headaches that wake you from sleep Abrupt changes in headaches patterns

Pharmaceutical interventions

Selective 5HT receptor agonists

An example is sumatriptan (Imigran) This increases activity of the neurotransmitter serotonin, which causes changes in the blood vessels of the head, leading them to constrict.

Ergotamine alkaloids

Ergotamine is historically the main drug in this class used for MHA, is found in the medications Cafergot is commonly used and contains caffeine. Ergotamine causes the blood vessels in the head to constrict; Ergotamine is contraindicated for use in headaches that have diagnosed as basilar or hemiplegic migraines. Ergotamine is contraindicated for use with people that have peripheral vascular disease, kidney or liver dysfunction or a serious infection known as septicaemia. Women who are pregnant, considering getting pregnant or breasting are also contraindicated to use ergotamine.

All of these medications are contraindicated for use for people with cardiovascular disease, taking the MAOI antidepressants, ergotamine alkaloids, or other serotonin agonists, including the nutritional supplement 5-Hydroxy tryptophan (5-HTP) a serotonin precursor.