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Causes & Triggers "Headaches"

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Causes and Triggers of Headaches
There is no simple reason why some people are more prone to headaches than others.

In the final analysis, “Migraines”, for example, are a result of many factors. These can include hereditary reasons, hormonal issues (for example, menstruation in women), traumatic reasons (as in an auto accident or on the job injury). Environmental factors have been implicated (such as various fumes or perfumes). Certain foods and beverages have been known to trigger headaches (this is the reason we emphasize nutritional counseling in our program).

The role of stress is known in exacerbating head pain.  The underlying reasons for stress should be analyzed and dealt with accordingly. Stress can lead to excessive
contraction of the muscles of the head, neck and face. This process leads to pain and can then trigger migrainous pain.

Sometimes headache is known to coexist with jaw pain (tempomandibular disorders or “TMJ”). Often this occurs due to clenching and/or grinding of the teeth. The headache specialist must be sensitive to such issues as they are easily evidenced by careful physical exam. Trigger points in the muscles of chewing are easily treated, once located. (See Below)

Neck pain is a frequent complaint in migrainous head pain, but the cervical spine should be analyzed for any other intrinsic disease process. Again, trigger points in the neck are easily treated once located by physical exam.

Head pain often coexists with diseases such as fibromyalgia.

Hypoglycemia is associated with head pain; and should be addressed in the migraine patient.

Vitamins and minerals play a part. Supplementation is often helpful in dealing with head pain. Vitamin B and Magnesium are of special importance in migraine headaches.

Myofascial (muscle) pain syndromes are often present in the migrainous patient, especially involving the muscles of the head, neck and face. These syndromes often involve the presence of Trigger Points in the various muscles involved. Treating such points is crucial for patient improvement and often result in alleviation of head pain. Deep tissue mobilization can be a valuable tool to treat such trigger points successfully. Trigger point injection has been used and has been shown to be effective.

Iontophoresis is often used to treat trigger points and this is favored by patients who do not favor needle use.

Headaches and the Emergency Room
Severe head pain can be unremitting and therefore quite disruptive. Therefore, the headache patient must be treated with all due respect and compassion. Headaches, all too often, are underestimated and sadly, too many providers do not treat the patient with the required sensitivity. Like pain in general, it is not easy to see on an x-ray. Therefore, at times, it is not given the legitimacy it is due. This is especially true in
the Emergency Room setting. Sometimes, the patient with a severe headache may be mistaken for a “drug seeker”, which adds insult to injury. Therefore, this physician does not recommend using the Emergency Room as a solution for pain relief; on a crisis management basis. If headaches are severe, a prevention program is more appropriate for the long term.

Menstrual Headaches
Often the period before, during and after the menstrual
period can be headache ridden; due to hormonal fluctuations
in women. This category of patients needs to be treated with
even greater sensitivity, as it is often not treated seriously. Menstrual headaches can be effectively treated and are a unique entity in of themselves.

Migraine and birth control use is an issue of special importance and should be addressed individually with each patient.

Headaches and Chiropractic Care
It has been shown that Chiropractic care can reduce the intensity and frequency of chronic head pain, however this approach does not succeed for long term headache management. Most importantly, however, there is a known potentially fatal condition; namely vertebrobasilar artery dissection which can result from both cervical manipulation or mobilization. Therefore, for the chronic headache patient, there is a reason to pause, before contemplating Chiropractic management as a solution for alleviating head pain.

Primary Headaches other than “Migraine”
There are many other types of primary headaches other than “migraine”. For example, there are cluster headaches, occipital neuralgia headaches, “cervicogenic” headaches, migraine/cluster variant headaches, idiopathic paroxysmal hemicranial headaches, trigeminal neuralgia headaches, just to name a few. Our purpose here is not to overwhelm the reader, but rather to emphasize how imperative it is, that the treating provider must have the knowledge, training and experience to distinguish such unique entities and treat them as such. The proper diagnosis is key to appropriate management. Calling all headache presentations “Migraine” can be at best ineffective and, at worse, dangerous.

A Word of Sincere Advice for the Headache Sufferer
We now know that the longer a headache goes unsuccessfully treated, the harder it becomes to treat. Therefore, we highly recommend that the patient act as soon as possible to resolve their problem headache, before it becomes constant and intractable.

A Word of Caution
The field of headache has recently witnessed a marked increase in the number of providers who claim to be “headache experts”.

How does a patient know how to choose the special provider who is most likely to succeed in helping the headache patient?

For one thing, it helps to choose a physician who has the proper scientific training in the field of medicine. It is also important to have experience, a long track record of success; preferably many years.

Also important is the issue of individualization. In general, a program which attempts to be “all things to all people”, with a “blanket approach” – such a program should be viewed with suspicion. Most importantly, it is very critical to remember that not all primary headaches are “Migraines”, as mentioned above.

Good headache work is methodical and painstaking. It is important to choose carefully. All too often the patient spends thousands of dollars in programs which promise headache relief, only to discover that they have wasted their resources.