Features a foreword by renowned talk show host Montel Williams.
Features a foreword by renowned talk show host Montel Williams.
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Overview
Features a foreword by renowned talk show host Montel Williams.
Product Details
| ISBN-13: | 9781945188107 |
|---|---|
| Publisher: | Bull Publishing Company |
| Publication date: | 09/05/2017 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 400 |
| File size: | 829 KB |
About the Author
Read an Excerpt
CHAPTER 1
Headache Pain
When Priya first walked into my office, she had come to the end of her rope. A young mother of two who had once led an extremely active life, she had been battling debilitating migraines since becoming pregnant with her first child. The pain would appear without warning, beginning in her eyes and the back of her neck. It moved up through the base of her skull, blurring her vision and causing her eyes to water. Finally, her entire head would be so crushed with pressure and pain that over-thecounter medications, such as aspirin or acetaminophen (Tylenol), did nothing.
Headaches are not unusual. It's estimated that 46% of adults across the world have an active headache disorder. But the pain Priya experienced went far beyond the typical tension headache. It caused nausea and vomiting, condemning her to lie in bed in a dark room for days at a time. Her husband would beg the children to stay quiet so Mommy could rest. In addition to interfering with their daily routine, the family found themselves canceling vacations and social engagements when Priya's migraines mercilessly incapacitated her for days.
Priya's doctors prescribed increasingly strong prescription pain pills, suppositories, and patches to try to manage these episodes. And while the medications enabled her to "sleep off" the migraine if she caught it early enough, they did little to nothing if she didn't catch it in time. Her days were haunted by the anxiety that a headache could appear at any time. Finally, her doctors resorted to injectable opioid painkillers and, in time, sent her to me.
The key to Priya's long-term relief came from an unlikely ally: Botox injections. Known primarily for its cosmetic abilities to minimize wrinkles, botulinum toxin (Botox) is actually a neurotoxin produced by the same bacteria that causes serious food poisoning. In small doses, Botox blocks the signals sent from nerves to muscles, preventing the muscles from contracting. New research now suggests that Botox may also reduce pain and inflammation by inhibiting neurotransmitters, which are the chemical messengers that transmit pain signals and sensitize the spinal cord to pain. Its utility for treating migraines was discovered when a number of the patients who were getting cosmetic treatments reported experiencing migraine relief as well.
I treated Priya by inserting a tiny needle into the muscles of her forehead, scalp, and along the back and sides of her head. I also gave her injections in the back of her neck and even above her shoulder blades. Research supports the efficacy of precise needle insertion sites, which target the muscles and trigger zones that are the sources of pain. Unlike muscle relaxants or injectable pain relievers, which focus on relieving pain after a headache has begun, Botox injections are used to prevent headaches. After regular treatment, Priya's headaches became less frequent and less intense. Although not yet medication free, Priya has regained a significant level of control over her migraines and, as a result, is living a richer, fuller life.
Understanding Headache Pain
Headaches can range from garden-variety tension type headaches to full-blown migraines. As I noted in Priya's story, an estimated 46% of adults across the world have an active headache disorder, and 99% of women and 93% of men experience headache pain in their lives.
Causes of Tension Type Headache (TTH) Pain
Everyday headaches known as tension type headaches (TTH) can be triggered by any number of common causes including, allergies, stress, fatigue, injury, illness, sun exposure, dehydration, or caffeine withdrawal, to name just a few. The pain from TTH is typically mild-to-moderate in intensity, on both sides of the head, and doesn't throb. Patients of mine who are experiencing TTH will say that they feel like a tight cap is on their heads or a tight band constricts their heads. Some even have nausea. Diagnostic testing (magnetic resonance imaging (MRI) or computed tomography (CT scan) is usually not needed for TTH.
Physicians currently believe that sensitization of pain receptors in the muscle or fascia around the head lead to these types of headaches. Pain receptors around blood vessels and tendons may also be sources of pain. If these pain receptors continue to send signals to the central nervous system, then chronic TTH develops. Similar to brain imaging studies in patients with chronic low back pain, one study in patients with chronic TTH showed a decrease in a certain type of brain tissue called gray matter in those areas of the brain involved with pain processing. This highlights the importance of treating TTH so that it doesn't become chronic.
Tension type headaches are often the normal reactions of the body to problems that the pain should prompt us to correct. A dehydration headache reminds you to drink more water. A person suffering from a cold or the flu will hopefully be driven by a mild headache to get much needed rest. Often, mild headaches can be remedied or prevented by getting adequate rest, drinking more liquids, and taking steps to reduce stress, tension, and anxiety in your life.
Causes of Migraine Headache Pain
Unlike everyday tension headaches, migraine and cluster headaches arise from spontaneous pain signals that serve no health-related purpose. People who suffer from these types of headaches on a regular basis are often born with sensitivity to certain stimuli. When present, those stimuli, such as light, sound, certain foods or food additives, can spark unbearable, throbbing, and usually one-sided pain.
Twelve percent of the U.S. population suffers from migraine headaches. An attack usually unfolds gradually over the course of hours to days, and most migraine sufferers (including myself) don't experience an aura, a strange sensation such as dizziness, ear-ringing, or flashes of light experienced before the headache. If left untreated, an attack will continue for several hours or even days. I suffer from episodic migraine headaches, which happen occasionally, whereas others experience chronic migraines, attacks occurring 15 days or more monthly for at least three months with headaches lasting four hours or more.
Migraines appear to be connected to hormones, since three times as many women experience them as men, most often during their childbearing years. Fortunately, women suffer less frequently after menopause, and migraines are relatively uncommon in children. We also believe that there is a genetic basis to migraines, but gene studies have not yet clarified which ones are actually linked to the disorder.
Migraine headaches begin at the "headache center" of the brain, a small area in the brainstem. This bundle of nerves is like a busy central traffic intersection between the brain and the body; nearly every neural signal from the brain to the body or from the body to the brain passes through it. When this part of the brainstem becomes overstimulated, it amplifies the effect of normal environmental stimuli. Sufferers suddenly feel as if someone turned up their hearing aids too high or forced them to wear night vision goggles in broad daylight, resulting in tremendous pain and nausea. Along with nausea and light sensitivity, many patients experience sound sensitivity.
Physicians used to believe that dilatation of blood vessels caused migraine headaches, but current research supports a process known as cortical spreading depression, a wave of electrical activity spreading across the brain, and specifically the cerebral cortex. This is thought to cause the aura of migraine, trigger a nerve of the face called the trigeminal nerve, and disrupt the natural barrier between brain tissue and blood. It's a complex process that leads to inflammation of the membranes enclosing the brain that are known as the meninges. This inflammation ultimately generates the headache. Nerve inflammation may intensify and prolong the migraine and may also sensitize nerves in a way that they "turn on" more easily, with greater force, and spontaneously. It's this sensitization in the brain that may explain why migraines worsen with coughing, bending, or quick head movements and may account for the throbbing quality of the pain.
Although not necessarily a source of migraine headaches, a condition known as occipital neuralgia can lead patients to feel one-sided head pain that's burning, deep, throbbing, and shooting, along with scalp tenderness to light touch. Patients can have symptoms that begin in the back of the head and travel to the top of the head (greater occipital nerve), or travel to the side of the head near the ear (lesser occipital nerve). There can be tenderness over the nerves, but not always. We believe that irritation or entrapment of the nerves may be the reason for occipital neuralgia, and many cases are related to whiplash injuries and head trauma. Certain patients report radiating pain up to the forehead or discomfort behind the eyes along with features of migraines. There certainly can be an overlap between this headache type and migraines. Occipital nerve blocks are shown to help patients with migraines as well as patients with the other primary headache disorders discussed in this chapter, TTH and cluster. I've had several referrals from neurologists to evaluate patients for nerve blocks with migraine-like headaches associated with occipital neuralgia. When nerve blocks are used for pain treatment and management, a local anesthetic medication is injected around a specific nerve in the body.
It is important to note that sinus headaches are often misdiagnosed. Many patients actually meet the diagnostic criteria for migraine. Sinus pain headache usually presents as a pressure-like sensation located on both sides of the head and behind the eyes. In addition, patients often have nasal congestion or obstruction with sinus headaches.
Causes of Cluster Headache Pain
Cluster headaches — so-called because of the group of headaches that attack closely together that most sufferers experience — involve similar areas of the brainstem as migraines, but cluster headaches also affect the nose, sinuses, and eyes. It's not clear what happens during the cluster attack, but it's thought that the hypothalamus, trigeminal nerve area, and nerve inflammation of a sinus deep inside the head may all contribute. Cluster headaches cause substantial disability and impair quality of life.
This headache type is classified among a group of headaches called the trigeminal autonomic cephalgias. The one-sided attacks can be vicious, making patients rock back and forth or pace relentlessly. The pain is on one side of the face — around or above the eye, or in the temporal region. The attacks can strike up to eight times per day, and usually last between 15 minutes to three hours. Compared to migraine headaches, this is short, but the excruciating nature of the cluster headache attack makes it seem like an eternity. Many times, cluster attacks continue every day for weeks before a period of remission. Patients may awaken in the middle of the night with severe pain, red and watery eyes and inflamed sinuses. This is due to the changes in the autonomic nervous system and specifically, the activation of the parasympathetic system and the blunting of the sympathetic system. Patients experience a droopy eyelid, small pupil size, tearing, and nasal congestion during the attacks. Cluster headache pain is not connected to any other medical problem: It's as if that burglar alarm has been triggered for no reason.
Thankfully, cluster headaches occur rarely, in less than 1% of the population. They affect men more than four times as often as women. There is some evidence that these headaches are inherited, and that cigarette smoking may be a risk factor for development.
No special testing is needed for diagnosis of cluster headaches (which is true for migraines as well). However, most doctors will order an MRI or CT scan of the brain when the diagnosis of cluster headache is first made. This excludes brain abnormalities that might be the source of the headache pain (tumors or aneurisms, for example). This is based on reports of patients thought to have cluster headaches, but who ended up having brain abnormalities instead. In contrast, an MRI is usually not needed for patients with classic migraine headaches or TTH.
Headache Pain and Triggers
Although it is unclear why some people experience migraines and cluster headaches and others do not, some factors have been shown to trigger symptoms in multiple patients. Stress, skipping meals, weather, sleep disturbances, perfumes, smoke, exercise, and even sexual activity can trigger headaches in some individuals. Alcohol consumption has been shown to increase the frequency and severity of migraine and cluster headaches: the darker the alcohol, the greater the chance of a problem. For instance, dark rum can trigger my own migraines (as will sleep loss, red wine, and sometimes stress). Caffeine, another common trigger, is a double-edged sword. A cup of coffee or large glass of soda can actually help get rid of a headache, but if you regularly drink more than one or two cups of coffee, tea or soda per day, you are at a higher risk of migraine, tension, or even chronic daily tension type headaches.
Stress is one of the most frequent triggers of both migraine and tension headaches, so managing stress is an important part of controlling headaches. If you suffer from headache pain, it makes sense to invest time in getting to know your triggers. Keeping track of other possible headache triggers in a journal and avoiding them can be a huge step toward conquering your headache pain.
When to Call Your Doctor about Headache Pain
Most headaches are very common and usually no cause for alarm. For example, I've had some patients worry that their headache may be caused by a brain tumor. Even though brain tumors can cause headaches, only a very small number of patients with headaches actually have brain tumors. However, there are some headaches that may require medical attention and serve as warning signs of possible serious disease:
* A "thunderclap" headache in which the pain comes suddenly and intensifies rapidly. This may reflect a bleed inside the brain called a subarachnoid hemorrhage.
* A "first headache," or a particular kind of headache experienced for the first time, particularly if you're over 40 years old. New headaches can suggest metastasis in a patient with cancer, encephalitis in a patient with Lyme disease, or an infection in a patient with HIV, for example.
* A headache that is unusually intense in comparison to the kind you usually get.
* A change in headache patterns (for example, awakening with a headache in the morning when you normally only get them at night).
These red flag symptoms do not necessarily indicate a severe health threat, but they should be checked out by your doctor and usually require a brain MRI or CT.
Treating and Preventing Headache Pain
If you suffer from headache pain, it is important to determine what kind of headaches you are experiencing and identify your triggers. Being able to discuss this with your physician will help your medical team find the right treatment for your headache pain. Depending on the type or severity of your headache, there are a variety of simple, effective treatments available.
Treating Tension Type Headache Pain
The typical tension type headache (TTH), can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, acetaminophen (Tylenol), ibuprofen (Motrin), or even a cup of coffee. Ibuprofen (Motrin) leads to fewer side effects than other NSAIDs according to several studies. Some patients of mine have benefited from naproxen (Aleve) or diclofenac (Voltaren) as well. If these medicines don't help enough, then combining caffeine with acetaminophen or aspirin may be even more effective than taking a single drug alone. Adding caffeine can cause more side effects, though. These mainly consist of gastrointestinal upset.
A specific tricyclic antidepressant medication, amitriptyline (Elavil) can reduce the number and intensity of tension type headaches, and it even decreases tenderness of the muscles surrounding the head. Reducing this tenderness is important because it can prevent pain amplification from occurring in the spinal cord and brain. Other drugs in that family, nortriptyline (Pamelor) or protriptyline (Vivactil) are alternatives, but amitriptyline has the best evidence of efficacy. There are also many over-thecounter medications, such as decongestants or antihistamines that target sinus or allergy-related headaches.
Trigger point injections, injections of small amounts of local anesthetic into specific "tight" muscles in the scalp, jaw, and neck, can decrease tension type headache frequency as well as the need for medications.
(Continues…)
Excerpted from "Aches and Gains"
by .
Copyright © 2017 Bull Publishing Company.
Excerpted by permission of Bull Publishing Company.
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Table of Contents
Featured Celebrity Stories (listed in order of appearance in the book),
Foreword by Montel Williams,
Preface,
Introduction,
Part I Understanding and Treating Your Pain,
1 Headache Pain,
2 Joint and Soft Tissue Pain,
3 Arthritis Pain,
4 Neuropathic Pain,
5 Pelvic and Sexual Pain,
6 Infant Pain,
7 Sports Injury and Pain,
8 Skeletal Pain,
9 Workplace Injury and Pain,
10 Postsurgical Pain,
11 Disease-Related Pain,
12 Cancer Pain and Caregiving,
13 Autoimmune Pain: A Hidden Epidemic,
Part II Medical Therapies for Pain: Traditional and Innovative,
14 Pharmacological Therapies,
15 Pain-Relieving Devices,
16 Regenerative Biomedicine,
Part III Integrative Therapies for Pain,
17 Weight Control, Exercise, and Diet,
18 Sleep, Stress, and Emotional Health,
19 Mind-Body Techniques for Pain Relief,
20 Alternative Medicine and Pain Relief,
21 Aromas, Music, and Pain Relief,
22 Harnessing the Human Biofield,
23 Pain Relief through Movement,
24 Conclusion,
Bibliography,
Index,
About the Author,