Headaches

Headache is a common condition and more than 96% population reports at least some degree of headaches during lifetime. Headaches can be triggered by over several dozen etiologies.

Chronic persistent (headaches occurring several times a week or month and lasting over 6 months) are caused by a handful of causes. Most common of these include 

  • Migraines

  • Stress or Tension Headaches

  • Hemicrania

  • Sinus headaches (during allergy seasons)

  • Medication overuse headaches

Below is an academic illustration of causes of headaches which span across various mechanisms. 

Headache Mind Map.jpg

Differences between Migraines and Tension Headaches:

It is important to first make an accurate diagnosis of primary cause of headache so that treatment can be directed accordingly. However, this may be a challenge in situations where there is an overlap in symptoms. Below are key differences among major types of persistent headaches.

Migraines:

  • One sided but can spread to whole head

  • Gradual onset

  • Throbbing, pulsating

  • Lasting 4-72 hrs

  • Accompanied by nausea, vomiting, photophobia, phonophobia etc

Headache

Stress or Tension Headaches:

  • Around temples or back of head (occipital)

  • Gradual onset

  • Band like

  • Lasting minutes to hours

  • Relieved by stress

Non Pharmacologic Ways to alleviate headaches:

Diet and Nutrition:

 

Proper nutrition and a healthy diet can improve neurotransmitter balance in the body and the brain and reduce frequency of headaches. Below are a few common nutritional deficiencies and diet related factors which lead to headaches,

  • Vitamin B2 (Riboflavin) deficiency 

  • Magnesium deficiency 

  • Diets high in sugar / simple carbs 

  • Diets high in processed foods 

  • Artificial sweeteners

  • Excessive alcohol intake

  • Dehydration 

 

Nutritional testing can help reveal some of these deficiencies. Easiest way to find out if you are dehydrated is by looking at your urine color. If it is not clear at least once a day, it indicates dehydration. 

In addition, food sensitivity testing can reveal individual triggers at personalized level. Different people eating similar foods may react differently. Food sensitivity testing helps identify these individual triggers and a customized diet plan can then help reduce the frequency of headaches. 

Most common culprits are

  • Dairy (milk, cheese, yogurt, creams)

  • Gluten and related grains (wheat, barley, oats)

  • Eggs 

  • Coffee

  • Chocolate 

  • Certain nuts

Sleep Hygiene: 

Sleep improvement can tremendously reduce frequency and intensity of headaches 

Stress Reduction: 

Stress reduction through various modalities such as mindfulness, yoga, meditation, massage, and acupuncture can tremendously reduce frequency and intensity of headaches 

Massage Oils

Exercise: 

Believe it or not, just like lack lack of sleep, too little physical activity or exercise can trigger headaches as well. This is because exercise is a powerful way to eliminate toxins from the body and sedentary lifestyle can compromise body's ability to do so.

Hormone Balance: 

Even in the absence of a diagnosed hormone imbalance condition such as endometriosis, PCOS, dysmenorrhea etc, slight hormone imbalance can exacerbate headaches. Women before menopause are particularly prone to this due to a range of hormone fluctuations related to their menstrual cycles. Hormone evaluation can help identify such triggers. Common culprits include,

  • Estrogen dominance 

  • Progesterone deficiency or lack of progesterone surge

  • Non-ovulatory cycles

  • Lack of efficient estrogen metabolism or detox metabolism 

  • Genetic factors such as polymorhisms in certain genes (MTHFR, COMT, CYP 1A2, CYP3A4, CYP1B1, which lead to in-efficient detox mechanisms 

Medications to Alleviate Headaches: 

Below are commonly prescribed medications which can help various types of chronic and persistent headaches.

  • Compound prescriptions in the form of creams. These typically include ingredients such as

    • vitamin B 

    • lidocaine

    • anti-inflammatory agents

    • neuroleptic agents

    • muscle relaxers

    • ketamine

    • CBD (approved form)

  • Over the counter meds such as ibuprofen, tylenol, excedrin etc.

  • Prescription medications for migraines such as 

    • For acute episodes

      • Imitrex or sumatriptan

      • Maxalt

      • Relpax

      • Ubrelvy

    • For prevention

      • Topamax 

      • Anti seizure meds

      • Blood pressure meds

      • Emgality

      • Anjovy