Headaches & Migraines
About 90 percent of all headaches fall into three categories: tension headaches, migraines, and cluster headaches. The remaining 10 percent fall into the category of secondary headaches. Probably about 90% of headaches are caused by trigger points (hyperirritable spots in skeletal muscle) in the neck, head, and face. Over time, trigger points cause a self-perpetuating cycle that converts periodic headaches into chronic tension headaches. Even if the original initiating factor causing episodic headaches is eliminated, the cycle can continue and worsen on its own.
Tension Headaches
Tension headaches are by far the most common type of chronic headache. People who experience migraines typically also have tension headaches in between their migraines. Tension headaches usually affect both sides of the head and last from thirty minutes to several days or more. They’re usually characterized by a mild to moderate level of “pressing” pain or a dull, steady ache, though the intensity may also be severe.
The most common causes of tension headaches are muscular problems and associated postural problems. Tension headaches are often aggravated by stress, anxiety, depression, fatigue, noise, and glare, but they can also be associated with arthritis, disk problems, or degenerative bone disease in the neck or spine. Temporomandibular disorder (TMD) can also cause tension headaches (the temporomandibular joint, located just in front of your ear, is the hinge joint that allows your jaw to open). People with TMD are twice as likely to get headaches, with a greater frequency and severity. Usually this will be a tension-type headache, but sometimes it will be a combination of migraines and tension headaches.
Migraine Headaches
Approximately one in ten people get migraines, and about 75 percent are women. Some women experience symptoms just before or during their period (menses), indicating a hormonal role.
A migraine headache is characterized by throbbing, pounding, or pulsating pain that lasts from hours to several days. People with frequent migraines are more likely to have tension headaches between migraine attacks than those with infrequent migraines. Intensity of pain alone is not a symptom of a migraine, since tension headaches can be as painful or even more painful than migraines, and some migraines may not even have headache pain as a symptom. Pain may not be pulsating or it may vary in quality. Migraine pain is often only on one side, but it may occur on both sides or move from side to side. Pain can be intensified by movement, coughing, straining, or lowering your head.
Symptoms of migraines are usually incapacitating, and people often feel weak, tired, and sometimes nauseated after the migraine has subsided. Migraines are usually accompanied by one of more of the following: nausea, vomiting, depression, disturbed sleep, tenderness in the neck and scalp, cold and sweaty hands and feet, and/or sensitivity to light, sound, and smells. A migraine is sometimes accompanied by diarrhea, urinary frequency, fever, chills, facial swelling, irritability, and fatigue. Migraines may be accompanied by an aura, but more commonly this is not the case.
Though there are theories about the causes of migraines, the mechanism is still unknown. Most studies have attempted to explain migraines in terms of one particular causative factor and have failed to provide an explanation for the complexity of the symptoms and clinical observations. It’s likely that a combination of factors provide input in varying proportional degrees and result in a particular set of symptoms for any type of headache. These input factors are trigger points in muscles, emotional stimuli triggering the limbic system (part of the brain) to increase muscle contractions, and substances (including biochemicals such as serotonin and other neurotransmitters) that affect the blood vessels and other tissues in the brain (vascular system input), causing them to become inflamed and swollen, and result in a headache.
Known triggers of migraines include alcohol, smoking or exposure to smoke, weather changes, allergies, altitude changes, jet lag, hormonal changes, stress, sun glare, flashing lights, constipation, some medications, birth control pills, hormone replacement drugs, strong smells such as petroleum fumes and perfumes or colognes, and foods that contain caffeine, monosodium glutamate (MSG), and nitrates (processed meats, bacon, and hot dogs). Insufficient food, water, sleep, or exercise can also cause migraines. (For more information on migraines and other headaches, symptoms, and common triggers, click here)
Trigger points may play a far greater role in the perpetuation of migraines than previously thought. A study found that 93.9 percent of the migraine subjects had trigger points with referred pain patterns that reproduced their migraine pain and other symptoms. Pressing the trigger points of migraine subjects could reproduce the location of pain, the throbbing quality, light and sound sensitivity, and other symptoms that were common for that person. In 30.6 percent of migraine subjects, pressing muscles with trigger points actually caused a full-blown migraine that required immediate treatment. The researchers also discovered that the longer the history of migraines and the more frequent the attacks, the greater the number of trigger points the person had in their muscles.
Cluster Headaches
Cluster headaches primarily affect men between twenty and forty years old. They come on suddenly and are severe, and occur for a series of days, weeks, or months and then disappear. They may recur seasonally or randomly. Onset occurs most frequently within two to three hours of falling asleep, during a REM phase of sleep, when dreaming occurs. The pain is typically steady and feels like a sharp, burning, or boring pain on one side of the head or in and around one eye, but it can involve a whole side of the face from the neck to the temples. The pain quickly gets worse, peaking within five to ten minutes, with the peak pain lasting from thirty minutes to two hours. It may be accompanied by a red, flushed face. A runny nose, nasal congestion, swelling under or around the eye, or a red or teary eye with a small pupil may occur, usually on the same side as the headache.
The triggers and causes of cluster headaches are the same as some of the triggers and causes of migraines, and of trigger points, so trigger points may be partially involved.
Headaches from Trauma
Neck injuries are the most common cause of post-traumatic headaches. Even accidents that may seem minor at the time may cause significant damage; in fact, there is little correlation between the damage to the vehicles or the speeds involved in the accident and the amount of injuries to soft tissue and the cervical spine. Slip and fall injuries can cause damage similar to whiplash. Whiplash injuries can lead to TMJ dysfunction, affecting the muscles in the face and causing headaches due to referred pain.
Though symptoms from whiplash injuries generally improve over a period of weeks or months, up to 40 percent of people have symptoms that last for more than six months and a small percent become disabled. Often symptoms disappear after a short time, and then recur later. It is important to recognize that some loss of function is inevitable after a significant injury. However, it’s still likely that you can obtain significant relief from a combination of various therapies. Self-treatment of trigger points can play a big role in reducing pain and restoring function.
Secondary Headaches
A headache resulting from a known underlying condition is referred to as a secondary headache. It may be due to cerebrovascular disease, a tumor, a blow to the head, an infection, diabetes, thyroid disease, or tooth, eye, or ear problems—or some other primary condition. Medications can also cause secondary headaches. Treatment is usually aimed at minimizing or eliminating the cause.
Trigger Points and Headaches & Migraines
People who suffer from both migraines and tension-type headaches are far more likely to have a greater number of active trigger points. The greater the number of active trigger points, the more frequent and severe the headaches. With one-sided headaches, a greater number of active trigger points are located on the same side as the headache. You can probably relieve much or all of your headache pain with a combination of trigger point self-treatments and identifying and eliminating all the perpetuating factors to the extent possible. For more information on Headaches, Trigger Points, and perpetuating factors, click here.
You may also find it useful to keep a Headache Diary.
© Valerie DeLaune, LAc 2013
The Food and Drug Administration has not evaluated these statements. The products and information are not intended to diagnose, treat, cure, or prevent any diseases or, medical problems. Nutritional benefits may vary from one person to another.