Recently I spoke with a neurosurgeon, and he specialized in caring for people who are concerned with ruptured brain aneurysms (blood vessel blisters) or have had them. Ruptured brain aneurysms typically present with severe headache. As a chiropractic neurologist I am often asked, “When is a headache more than just a headache? When should I go to the hospital?”
A headache is considered to be pain located anywhere in the region of the upper neck or head. It is one of the most common locations of pain in the human body and can have many different causes. There are three major categories of headaches which include primary headaches, secondary headaches, and cranial neuralgias which can be associated with facial pain.
- Primary headaches include tension, migraine, and cluster headaches.
- Secondary headaches are those due to something affecting the underlying structure of the head and neck. Causes include bleeding in the brain, tumors, meningitis, and encephalitis.
- The third type of headaches which involve neuralgias and facial pain are usually caused by inflammation of the nerves in the head and neck.
Tension headaches are the most common type of primary headache and are more common in women than men. Their cause is unknown but thought to be due to the contraction of the muscles covering the occipital bone aka the muscles at the base of the skull (suboccipital muscles). Tension headaches usually occur because of physical or emotional stress placed on the body. Symptoms of a tension headache include pain which is described as “tightness” that begins in the back of the head and upper neck. Most patients report that the discomfort begins back behind the ear and wraps around the ear, then the temple, then often radiates into the eye on that same side. They range from mild to moderate in intensity, can be on both sides (bilateral) and not associated with vomiting or sensitivity to light. Usually, these headaches do not impair function although they can, but most patients report they’re “just really annoying”.
**Second only to migraines, we see tension style headaches in our clinic daily and these are typically relieved within 1-2 visits, though some can take longer depending on the chronicity and severity and the trigger associated with them.
Migraine headaches are the second most common type of primary headache and are also more common in women than men. They are associated with unilateral headache, nausea, vomiting, and sensitivity to light. These can be debilitating, often resulting in missed work, missed scheduled events with friends or loved ones, and a change in lifestyle due to heavy dosing of medications to try to “limit” the number and severity of migraines. Injections like botox are a common form of therapy that only last 3 months at a time (if effective at all). Keep in mind Botox is a “de-clawed” neurotoxin you are injecting into your body. Migraines are very often, almost always dependent on triggers. Triggers are in the form of physical or mental stress, poor diet, food sensitivities, infections, autoimmunities and functional neurological imbalances.
*We often see patients with these types of headaches after attending specialty headache clinics in the valley or across the US when they haven’t found any relief yet.
Cluster headaches are rare primary headaches and occur more commonly in men than women. The cause of cluster headaches is unknown. They tend to run in families, which suggest genetics may play a role. They may be triggered by changes in sleep pattern and by certain medications. Symptoms of a cluster headache include unilateral pain in the face and head that is sharp in quality and very short in duration. The pain is usually excruciating and the eyes and nose may become watery.
** See our website under Success Stories for a man who recovered from trigeminal neuralgia
Secondary headaches include causes such as head and neck trauma, blood vessel problems in the head and neck (ruptured brain aneurysms fall into this category), non-blood vessel problems in the brain, medications, infection, and changes in the body’s normal environment, problems with the structures of the head, and psychiatric disorders.
**In the case of suspected trauma, rupture (stroke, aneurysm, bleed following head/neck trauma) patients are always referred out immediately or recommended to call 911 if outside the office if suspecting a serious issue.
Headaches are treated differently depending on the type, cause, and nature of the headache.
Treatment for Tension Headaches (typically caused by tight muscles at the base of the skull), a Medical Doctor is most likely going to prescribe medications such as aspirin, ibuprofen, acetaminophen and naproxen. As Chiropractic Neurologists, we utilize multiple natural approaches to resolving these types of headaches in our office:
- Adjustments, cold laser, myofascial/trigger point therapies, neuromuscular reeducation, neurological rehabilitation to relax muscles
- Supplements like turmeric, resveratrol, fish oils (omega 3’s), glutathione support, detox programs
Treatment for Migraine Headaches
Medically these are usually first treated with non-steroidal anti-inflammatory agents or NSAIDs. The drugs of choice for migraines are considered to be triptans such as Imitrex, Maxalt, Amerge, Zomig, Axert, Frova, Relpax, and Treximet. Some other medications used include ergots, anit-nausea medications, butalbital combinations, and opiates.
In our office, we utilize similar therapies as above and typically use additional therapies as well:
- Adjustments, cold laser, myofascial/trigger point therapies, neuromuscular reeducation
- Supplements like turmeric, resveratrol, fish oils (omega 3’s), glutathione support, detox
- Neurological rehab including exercises to increase oxygenation, realignment of eye/head reflexes and light and sound dampening so you can remove yourself from your dark room and get back to your life
- Food avoidance strategies, gut repair
- Extensive laboratory testing of blood, stool and saliva to get to the bottom of your issues that your medical doctor may have overlooked
Cluster headaches are usually treated with inhalation of high concentration of oxygen, injection of triptan medications, injection of lidocaine, ergotamines, and caffeine. Preventative medications include calcium channel blockers, prednisone, lithium, and valproic acid.
When should a headache be treated?
A patient should seek medical care for a headache when it is considered the “worst headache of his/her life,” different than a usual headache, starts suddenly or is aggravated by physical exertion. Medical care should also be sought if the headache is associated with nausea and vomiting, fever, stiff neck, seizures, trauma, changes in vision, changes in speech, changes in behavior, weakness, is getting worse, and/or is disabling.
Why should a headache be treated?
A headache should be treated because it may be caused by something serious or be associated with a worsening condition and if left untreated may even lead to death. Headaches should also be treated so that it does not become disabling and impair normal function. Overtreatment should be avoided due to the fact that some medications, once stopped, may cause rebound headaches. So, to answer my simple original question, “When is a headache more than just a headache?” with a simple answer; any headache that presents with neurological deficits and is different than a usual type of headache that you suffer, requires medical attention.
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