By Dr. Michael Cassaro
Headaches! What a headache! While most people never get headaches, most people do get occasional headaches, though they usually are not severe. Treatment, if necessary, is successful with over-the-counter medications as needed.
Yet, there are a lot of people with frequent headaches, recurrent headaches, headaches that last for days at a time and even what are referred to as chronic daily headaches. Despite their name, chronic daily headaches don’t have to actually occur every day. But for people who deal with fear of a headache on those few days without actually experiencing one, they probably still have chronic daily headaches. Headaches are also characterized by other attributes, such as where the pain is located, what it feels like, what aggravates the headaches or what relieves the headaches.
All of this makes very little difference to the person who has the headache. That person just wants relief, which comes in stages.
Self-help usually comes first. Basic treatments like correcting dehydration and taking over-the-counter medications help almost everybody with occasional headaches, regardless of the cause or type of headache.
For people with frequent headaches, recurring headaches and chronic daily headaches, the basic treatments just don’t bring enough relief. Sometimes, even when there is pain relief, the fear of the headache coming back, or a new headache starting, can be almost as debilitating as the headache pain. Those types of headaches require an accurate diagnosis of the cause and require different treatments.
The causes of chronic daily headaches are usually a combination of things that all come together. A component that is almost always present is a toxic environment. The toxins can be coming from outside your body or from inside your body. If you have chronic daily headaches, look at your environment at home, at work, in your car and in your yard. Get rid of all the chemicals. This includes things like lawn treatments, bug sprays those plug-in air fresheners, as well as air fresheners in aerosol cans. (I’ve got news for you, there is not a real pine forest or a real meadow in those cans. The can is potentially full of headache starters.)
In addition to cleaning up your external environment, you have to take a close look at your internal environment. The toxic component of your headache trigger can be something you put in your body or something you aren’t properly eliminating from your body.
When I first learned to treat people with headaches, I was taught to have individuals keep a headache diary. I no longer make that recommendation to my patients. There is usually so much information that it is just confusing. The cause of this afternoon’s headache may not be what you ate for lunch. It may be that something you ate two days ago reacting with something you ate two days before that and turned into a headache today, tomorrow or next week.
And, it may not be the food you see that triggers the headache. It’s more likely that some chemical food additive, or combination of additives, is causing your headaches. You will never find out what most of these additives are. They are not required to be listed on any food labels.
There are several thousand manmade chemicals that can be added to our foods and listed collectively as spices, colors or flavors (both artificial and natural flavors are mostly manmade chemicals). The only way to get away from these hidden headache triggers is to prepare your meals at home from ingredients you buy in the produce department or the butcher department of the grocery store. Bring your lunch to work.
I’ve been a physician for thirty years. In that time, I can’t remember a single patient whom I treated for chronic daily headaches who didn’t have irritable bowel problems. If the colon isn’t working right, the rest of the body is toxic. Until the colon function returns to normal, the chronic daily headaches are likely to continue. It doesn’t matter if the predominant symptom is constipation, diarrhea or both alternating back and forth.
Irritable bowel problems are caused by what you eat. It’s that simple – and it’s not genetic. If it runs in your family, it’s because everybody in your family eats at the same table. Eat what you can buy in the produce department or the butcher department of the grocery store. Leave the rest of the store alone. The deli is not the butcher department! Also, cereal is not in the produce department or the butcher department. Don’t worry about fiber.
Everything in the produce department is loaded with high quality, natural fiber. Another likely trigger for headaches is arthritis. More specifically, arthritis in the neck is one of the most common causes of headaches. This arthritis can be the result of an old injury, decades in the past. The headaches also can start immediately after a neck injury. This is common with a whiplash injury. Sometimes the headaches start right after the injury, go away after a short time and return years later. Sometimes, the arthritis is there for years without causing any pain. Then, a sneezing fit, or stepping wrong off of a curb can jar your neck just enough to start relentless headaches.
When there is arthritis in the neck, a new injury can cause the joints between two of the neck bones to become unstable. This is a common cause of very severe headaches, including migraine headaches that can last for many days at a time. This type of instability is a very common cause of headaches that awaken you or headaches with which you awaken. This is also a frequent cause of headaches brought on by looking down for prolonged periods of time, like when reading (or looking at your phone), studying or working at a desk.
Successful treatment of chronic daily headaches begins with an accurate diagnosis of the cause. That starts with a physical examination. A hands-on physical examination is step one. It can pick up many things that will not show up on any test or X-ray. When getting neck X-rays, the most valuable views are the flexion and extension views. The doctor has to specifically order these views, they are not done as part of a routine neck X-ray. Even better is a video motion X-ray.
Unfortunately, most insurance does not pay for video motion X-rays. An MRI has only limited value in finding the cause of headaches, unless it is looking at the neck. An MRI of the head will show things like brain tumors or aneurisms, but for the other 99 percent of people who have headaches, it adds no useful information.
Treating chronic daily headaches can sometimes be accomplished with just medications. For some people, a combination of medications that decrease frequency and severity of the headaches is combined with medications to treat a headache that still happens. However, for most people with chronic daily headaches, additional treatment is required and it is usually minimally invasive.
They may include injections. There are many types of injections used successfully to treat chronic daily headaches. Some of the common injections are Botox and nerve blocks. The nerve blocks can also be used to help specifically identify which nerves are involved. Once those nerves have been identified, other, more permanent treatments, are possible.
There are two main treatments used for chronic daily headaches to provide long-term, frequently permanent, relief. Those treatments are radiofrequency neurolysis and occipital nerve stimulation.
Radiofrequency neurolysis is performed with special needles that are placed so the tips are adjacent to the nerves identified as the culprits in headache generation. The nerves are then burned using the same technology that is used by a microwave oven. Those nerves can no longer carry the headache pain signals. Headache gone!
Radiofrequency neurolysis cannot be used on all nerves that might carry headache pain signals. For people who cannot get relief of their chronic daily headaches using radiofrequency neurolysis, occipital nerve stimulation can be used. Occipital nerve stimulation is more invasive than a procedure using needles. It involves a permanently-implanted device. With the implanted occipital stimulator, a headache can be “turned off” as easily as “flipping a switch.”
There is almost always a way to stop chronic daily headaches. If you are still suffering with chronic daily headaches, look for information on more effective ways to treat your headaches. Medications are most commonly managed by neurologists specializing in headache treatment. Invasive therapies like injections, radiofrequency neurolysis or occipital nerve stimulation are usually provided by pain management doctors specializing in headache treatment.
An ounce of prevention is worth a pound of cure. Radiofrequency neurolysis and occipital stimulation prevent headaches. Most people who have opted for one of these treatments, love the results. They no longer have to take a combination of medications, and don’t have to deal with the medication side effects.
Get a good headache examination. Find out if more can be done to eliminate your headaches so you can lead a pain free life.
Michael Cassaro, M.D. is one of the top pain treatment experts in the country. You can learn more about his Jeffersonville-based practice at www.painlessliving.net.