A Holistic Approach To The Common Headache
Almost nobody has escaped the experience of a headache. In fact, nearly half the world’s population has a headache so severe that they are disabled at least once a year.
Although most headaches are clearly exacerbated by anxiety and stress, they are not only the plight of city folks with high-pressure jobs and fast lifestyles.
Headache researchers are often confounded by the blurry distinction between tension headaches and migraines. It may be that migraineurs are individuals who have inherited a cursed talent to amplify the usual headache into an extraordinarily painful event by “turning up the pain,” and invoking vascular and other inappropriate responses.
Acute headaches are getting easier to treat with the advent of new medications including triptans that can relieve the pain of a migraine once it has started. Unfortunately, we have done much less for the prevention of recurrent headaches. I’d like to offer a new way to think about headaches that gives a practical approach to the different types of headache and how each type can be treated on a long-term basis. In this article, I am assuming that the reader has already been seen by a physician to diagnose the type of headache among the dozens of possible causes, including the kinds needing urgent attention such as tumors or vascular malformations. I am also assuming that the reader has experienced the results of standard initial headache management.
The most common chronic headaches can be thought of in terms of three forces: wind, fire and water. Headaches with a musculo-skeletal basis, involving scalp, neck and shoulder muscles with their tension and movement, are related to wind. Migraine, cluster headache and other syndromes with a blood vessel response to an underlying nervous system imbalance are related to fire. Headaches due to congestion and phlegm are related to water.
“Wind” headaches are associated with tension, and are often due to an inappropriate muscular response to stress. Think of a furrowed brow and its muscular contractions in the forehead as the white-knuckle syndrome involving the musculature of the scalp and face. Contracted muscles can also spasm, restricting blood flow, thereby creating pain and more spasm in a vicious cycle. These headaches are also aggravated by environmental factors mimicking exposure to wind such as stiffness and tightness. Deal with tension headaches as if counteracting chronic exposure to a cold wind:
- Perform frequent oil massage with warm sesame or coconut oil. At least do a good massage of the head, face, neck and shoulders a few times a week, spending extra time on the muscle groups that seem to carry stress, tension and tightness, such as the trapezius, the temples and the forehead. In your eagerness to get well, avoid massaging to the point of injury.
- Undertake a program of progressively strengthening, toning and lengthening the muscle groups that are in spasm. The essence of this type of exercise is high repetitions with low weight or resistance. Movements performed without anything in the hands (like weights or pulleys) accomplish this nicely.
- The best exercise for tension headache is swimming or aqua-exercise because the shoulder and neck muscles are toned, yet the arms can float and the resistance is instantaneously adjustable. Try standing in warm water to the armpits and make small circles with the arms to the side and in front. Standing in water to the shoulders, perform the arm movements of breaststroke, backstroke and crawl, opening or closing the fingers to reduce or increase pressure. Start with this exercise program slowly, increasing the repetitions and resistance. If it seems too easy, hold small foam weights in your hands or wear webbed gloves to create resistance by increasing the surface area pressed against the water. If you don’t have access to a pool, you can do these exercises in your home, exercising extra caution to avoid injury.
- Use hot water bottles, hot showers and heating pads to loosen muscles in spasm. You may also enjoy whirlpools, Jacuzzis and hot tubs.
- Neck exercises are helpful to reduce spasm in muscle groups that refer tension to the head. Turn the head slowly with your eyes closed and your attention on the part being stretched. Work all three planes: extension and flexion, rotation and side to side. Think of it as yoga for the neck.
- Nothing helps the tradition of tension headaches more than finding a healthier way of dealing with stressors. Yoga asanas and meditation are the most time-tested ways to correct the pathological response of clenching and tightening muscles of the head and neck.
Migraine and Cluster Headaches
“Fire” headaches are the ones we associate with common migraine, classic migraine and cluster headache. Sufferers of these headaches need to read the section about “wind” headaches above because often their migraines are tension headaches gone amok. In my experience, standard therapy plus natural means of prevention without drugs is feasible in all but a few migraine sufferers. This requires attention to factors that have a heating influence in the body. While each person with migraine reports different triggers, so many of the commonly recognized factors are related to heat, light and the digestive fires that every migraine sufferer should carefully consider these potential triggers and try any lifestyle changes that could be help.
- Missing meals.
- Getting overheated or dehydrated.
- Exposure to bright sunlight, noise and strong odors.
- Frustration, impatience and anger.
- Excessive spices, preservatives, MSG, peanuts, alcohol (especially red wine), strong cheeses, chocolate, coffee, bananas, sour foods such as vinegar and yogurt.
- Getting overly fatigued, missing sleep, not taking the time and proper measures to recover from jet lag.
- Overusing the eyes and its connections to the visual cortex of the brain such as in excessive driving, reading, TV and use of computers.
Once a migraine starts, there are several effective medications for dealing with it and a good talk with your physician can help you identify the best ones for you. Sometimes these can be avoided by taking something natural before the actual pain begins, when you only have a premonition of one. Try this remedy: dry roast 4 cloves in a small cast iron skillet until they darken slightly and swell. Powder them with a mortar and pestle and mix with a teaspoon of mild honey. Lick it slowly from your fingertip.
“Water” headaches are associated with congestion of the nose, nasopharynx and especially the sinuses. The nature of water is heavy; the hallmark of these headaches is a sensation of heaviness, coldness and pressure.
- Eat a light diet. This means reducing the heavy foods that encourage mucus formation such as cold milk, heavy cheeses and meats, yogurt, rice and pasta that is improperly cooked making it waterlogged and heavy, rich pastries and deep-fried foods.
- Favor foods that have a demulcent effect, i.e. those that reduce mucus. These include spices such as fresh ginger root, black pepper, turmeric and fenugreek seed powder, all of which improve the interest value of soups, beans, lentils, stir-fried veggies, savory sauces and casseroles. Ever notice how your nose runs after a pungent dish? Blood flow to the mucus membranes increases under the influence of pungent spices to make the mucus clear and runny, allowing congestion to drain.
- Astringent foods like honey and turmeric help reduce membrane secretion. Try a pomegranate or persimmon to see this effect in your mouth. The net result of a light, pungent and astringent diet is to mobilize thick secretions and prevent their accumulation.
- Dealing with chronic congestion headaches and sinusitis requires a regimen of nasal administration. Drops can be administered one to eight times daily to bring about the desired effect. Drops can be either aqueous- or oil-based depending on the desired effect. Oil drops are generally more soothing.
- Because proper drops are hard to find, I will mention three kinds that can be procured by anyone. a) Plain sesame oil is lubricating, demulcent, and soothing; b) Clarified butter(ghee) is good for inflammation and allergies; c) Shuntiguda: 1 tbsp. hot water, one-twentieth tsp ginger powder (make it very dilute at first!), a half tsp brown sugar. Mix the ingredients in a small saucer, crushing the ginger and making a suspension. Use it at body temperature. Add more ginger only if there is no intense heating sensation in your nose. Shuntiguda is a good installation for heavy congestion after you are used to sesame oil or ghee.
- Proper nasal administration requires some care to get the full effect with ease and comfort. Start with 1-2 drops in each nostril. Tilt the head back and put the drops into the nose with a dropper. Pinching the sides of your nose between your thumb and forefinger, draw the drops deeper into the nasopharynx. You may be able to taste them on the tongue when properly applied. Increase the number of drops and frequency as you gauge your comfort level.
- A few times a week install the drops after performing the following procedure. Start with a good head and neck massage; then take a hot shower with the door closed so you breathe in steam (or alternatively you can create a steam tent with a pot of hot water and a sheet, adding one or two drops of eucalyptus oil or Tiger Balm to the water); next apply a hot, wet towel to the face and neck for 5 minutes (not scalding!). This procedure prepares the sinuses for the drops, which are best applied lying on your back with the head tilted back on a pillow, allowing the drops to penetrate more deeply.
- Saline can be helpful in chronic rhinitis , especially if done gently using a spray bottle (and not using a neti pot, an apparatus best left to healthy yogis without sinus problems, who use it to flush the nasal passages as part of cleansing rituals).
- These techniques for congestive headaches have been helpful by themselves or as a complement to standard medical measures such as decongestants, antihistamines, nasal steroids and antibiotics.
If you are looking for a solution for a chronic headache, think of your diagnosis in terms of wind, fire and water. Using these guidelines and your experience with your own aggravating and relieving factors, design a program that you can implement over several months. Keep a diary of your progress, recording when you made specific changes in your diet and lifestyle, and including the severity and duration of your headaches. As you review your diary, you will recognize patterns that can help you prevent them for good.
Jay Glaser, MD is a board certified internist in Massachusetts.