Headache Help (37 page)

C
ALCIUM

Calcium has been reported in at least one study to decrease premenstrual symptoms and menstrual headaches. If you take calcium and magnesium, take them at different times of the day, as the calcium may inhibit the absorption of magnesium. Food sources of calcium include dark green leafy vegetables, dairy products, seafood, and certain fish. Supplements are usually necessary, 750 mg to 1,500 mg per day.

V
ITAMIN
B
₆
(P
YRIDOXINE) AND
B
₁₂
(C
YANOCOBALAMIN)

Vitamin B
₆
is used to prevent migraines, particularly menstrual migraines. Typical and safe doses are 50 mg or 100 mg per day. Many people have found that taking a B complex (B-100) helps their headaches. It is known that the B vitamins, particularly folate and B
₁₂
, can help prevent heart disease and possibly stroke. Recent studies indicate that B
₁₂
(which is poorly absorbed orally) may be helpful in preventing headaches.

L
ONG
-C
HAIN
F
ATTY
A
CIDS
(P
RIMARILY
O
MEGA
-3
AND
O
MEGA
-6 F
ATTY
A
CIDS)

Certain types of fatty acids that are present in fish oil concentrate and flaxseed oil may help headache. These have also been demonstrated to be useful in certain types of anxiety or mood disorders. Because of the problems with fish oil, doctors usually recommend flaxseed oil, 1,000-mg capsules, one or two per day. This is a fairly low dose; much higher doses have been used. These fatty acids may be beneficial for prevention of heart disease as well.

AROMATHERAPY

Aromatherapy may work when small molecules of essential oils become absorbed into the skin or respiratory tract and directly stimulate the smell sense nerve (olfactory nerve). This nerve is widely distributed with connections throughout the brain. Aromatherapy may be useful for milder headaches, such as the usual tension headaches. Some people can take less medication when they use aromatherapy. A recent study revealed peppermint oil to be as useful as aspirin for pure tension headaches.

The oils should be stored in dark glass bottles; buy the ones with the words “distilled” and “pure” on them. Keep them out of sunlight and intense heat. These essential oils should not be used orally but rather inhaled or applied to the temples, neck, or shoulder muscles. Since the essential oils are very potent, use only very small amounts. For instance, one drop of the oil is usually diluted in a teaspoon of almond oil (or another carrier oil) and then rubbed into the skin. Alternatively, four to seven drops of the oil may be put into warm water for a bath.

The most commonly utilized oils for headache are peppermint, lavender, and chamomile. The Roman chamomile (English chamomile) has been used in aromatherapy more than the German chamomile. Lavender and peppermint may be the most useful in this group. In addition to these, tiger balm is a powerful herb that has been used extensively in China. Eucalyptus has been a popular aromatherapy for sinus-type headaches.

If aromatherapy is used for migraine, beware that intense smells may increase nausea.

HOMEOPATHY

In homeopathy, substances are extensively diluted so that virtually no active substance is still present. The idea is that these substances are supposed to stimulate the body’s own curative powers. There has been great controversy over the effectiveness of homeopathy. In reviewing various studies, some showed positive effects, while others revealed that homeopathy was no more effective for headaches than placebos. These treatments are very individualized, and one homeopathic remedy cannot be applied to all people. The drops are supposed to be taken every hour or two, and only for a limited period of time during the pain. Typical homeopathic remedies for headache include iris, belladonna, aconite, bryonia, gelsemium, and natrum muriaticum. Other remedies include sepia, sanguinaria, and
nux vomica.
These remedies are very safe. However, at this time the benefits of homeopathy for headaches remain unclear and unconvincing.

TRIGGER-POINT INJECTIONS

“Trigger points” are tender areas or areas of muscle tension just under the skin. When headaches are caused by muscle knots in the neck or head and are not easily relieved, trigger-point injections of Marcaine or lidocaine into the painful areas can be very effective, perhaps offering relief for weeks or even months. In some instances, doctors add cortisone, particularly for cluster headache or severe, long-lasting migraines. Certain pain centers give deeper injections, under fluoroscopy, in the hospital. This therapy might be beneficial, though it’s not certain. Some people, however, will find the injections of no benefit. Recently, Botox (botulinum) injections have been used for prevention of headache; this remains in the experimental phase, but is promising.

Many patients with chronic daily headaches have fibromyalgia, and this can lead to all-too-familiar chronic neck pain and stiff ness, with some tenderness. Injections of an anesthetic into these tender areas might help for a while.

However, injections are not a miracle cure, but then nothing is. Like other therapies to help pain, such as medications or physical therapy, injections can help ease the suffering for a period of time.

NERVE BLOCKS

Occipital nerve blocks, given in the back of the head, sound terrible but are actually safe and easy to do. These nerve blocks of anesthetic are sometimes used to relieve pain in the back of the head (occipital neuralgias). Many neurologists will do superficial blocks just under the skin, but some pain centers do “deep” blocks at the “root” of the occipital nerve. Each person has two occipital nerves, one on each side, and these contribute to headache pain. In fact, people with migraine have a 20 percent chance of having “occipital” neuralgia, or sharp pains around those nerves. Besides the usual medications for this problem (antidepressants, antiseizure medications), an injection near the occipital nerve can be helpful.

HYPNOSIS AND SELF-HYPNOSIS

Unfortunately, hypnosis has not been very helpful in treating headache. Biofeedback, a form of self-hypnosis, however, has been found to be quite beneficial. (See Chapter 2 for more details on biofeedback and other forms of self-hypnosis, such as imagery and relaxation techniques.)

ACUPUNCTURE

Acupuncture has been used to treat headaches for more than four thousand years. While not entirely conforming to modern scientific principles, acupuncture is helpful in some circumstances and is being used increasingly in the West. It is based on the principle of reestablishing a balance between the body’s yin and yang. Easterners believe that these two opposing forces, representing feminine and masculine qualities, are at work in the human body and the cosmos.

Although we don’t know exactly how or why acupuncture works, acupuncturists have identified about five hundred points that are related to nerve receptors. When stimulated, pain is somehow muted. Hair-thin stainless steel needles provide stimuli to the nervous system and work most effectively when applied to an area where nerve and muscle meet. Some American scientists suggest that acupuncture temporarily stimulates nerve cells to produce the body’s natural painkillers, the enkephalins and endorphins. At least one study, using rats, conducted at the University of Texas Health Sciences Center, supports this theory.

The acupuncturist may insert the needles into selected points on the body’s meridians—energy points considered essential to health. He or she may twirl the needles, stimulate them with mild electricity, or heat them to enhance the effectiveness of treatment. Electric stimulation seems to be the most effective mode.

Studies evaluating the efficacy of acupuncture for headaches are difficult to do, considering the high placebo response. The several studies that have been conducted produced conflicting findings for headaches, and the results of long-term studies have yet to come.

Although traditional Western physicians do not wholeheartedly endorse acupuncture, many doctors believe there is little harm in trying the services of a reputable (and in some states, licensed) acupuncturist. The procedure is generally very safe; occasionally side effects may occur, such as bleeding, faintness, or infection. The American Academy of Medical Acupuncture reports that some two thousand American physicians use acupuncture in their practices.

For more information and referrals, ask your doctor or medical center. (See Appendix A for specific addresses and phone numbers.) While acupuncture may produce short-term results, the ef feet tends to quickly wear off, and most people stop seeing the acupuncturist within weeks or months.

ACUPRESSURE

Acupressure involves applying circular finger pressure to some of the points that acupuncturists have identified. One acupressure point for headaches is the center of the web between your thumb and index finger. Apply pressure with the index finger from your other hand and, without lifting the finger, press in a circular motion. Other pressure points are the sides of the spine at the base of the neck.

For direct acupressure to the head, try rubbing your index fingers on the bony parts of your temples as close to the painful areas as possible, in small circles, pressing against the bone. Maintain the pressure for two minutes.

Other pressure points include the top of the ear; either side of the back of the neck at the base of the skull, where you can feel bony protrusions; and above your ears, where you can feel movement when you bite down. The effect is short-lived, and usually the pain returns when the acupuncture point is no longer stimulated.

TENS: TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION

A TENS unit is a battery-operated device that produces a small electrical current. Its pads are usually applied to the neck and lower skull to create a tingly, or vibrating, sensation. It may relieve some pain by blocking pain transmission signals or by stimulating the production of the body’s own painkillers, endorphins. While TENS has some limited usefulness for chronic pain, such as low back pain, its ability to cure headaches has been very disappointing. The relief, if any, is very temporary. Some thought has been given to developing a TENS unit that is applied to the head and affects serotonin. Such a device was tested in the 1980s, and with more research it could be helpful in alleviating chronic headaches in the future.

CHIROPRACTIC MEASURES AND PHYSICAL THERAPY

Although not useful for many people, chiropractic treatment can be very helpful for some. It may include manipulation of the spine, ultrasound, diathermy (heat on the skin), deep heat, electrical stimulation, and massage. These therapies will help some headache patients, but overall, chiropractic measures appear to benefit the neck and back to a greater degree.

Physical therapists treat head and neck pain with the same techniques (with the exception of spine manipulation). As with chiropractic measures, physical therapy usually benefits the associated neck pain more than the head pain. It is particularly useful, however, after whiplash injuries, to improve posture, to relieve neck strain, and may help headaches caused by workstation strain.

MASSAGE AND STRETCHES

Massage to the neck and lower skull area benefits many headache sufferers by easing painful knots, but the benefits are usually short-lived. Full-body or face massages may help by relaxing you, whereas massaging the forehead, temple, back of the neck, and shoulders may be particularly useful for tension headaches. Craniosacral massage is particularly effective.

You can also relax these areas with some stretching exercises that involve the neck (rolling your head, gently pressing it forward with your hands at the base of your skull, rolling and shrugging your shoulders).

SEX

Believe it or not, sexual intercourse was found to help relieve migraines in about half the women studied in a research project at the Southern Illinois University School of Medicine. Men were not evaluated in the study, but for some the release of tension from intercourse just may help. However, sex or other exertion may also trigger headaches (see Chapter 13).

ICE OR HEAT

Applying cold (ice) to the head or heat to the neck have been mainstays of headache and neck-pain therapy for many years. Simply apply the cold to the area of head pain. Migraine Iceâ„¢ conveniently provides instant cold for headache or neck pain.

IMPROVING POSTURE

Positions that strain the neck, such as sitting at a computer for long periods, may contribute to headache pain. Adjust the seat and table so your neck is not bent or extended. Take breaks every fifteen minutes or so; do two minutes of stretching every two or three hours. Regular stretching of the neck and lower back can decrease headaches. Physical therapists can be very helpful for improving posture and teaching stretching.

MAGNETS (MAGNET THERAPY)

Magnets have been used for pain for decades, even centuries. They are a primary therapy for pain relief in Japan and are gaining popularity in the United States. Good studies on their use are beginning to trickle in, and they indicate that magnets are more beneficial for pain than a placebo. One study, published in the
American Journal of Psychiatry
, indicated a possible role for magnets in treating depression. We will not know definitively for years if magnets truly work better than placebos, though early results are encouraging. The lack of side effects and relative low cost, though, are very appealing. However, they should not be used if you or your partner has a cardiac pacemaker or other internal device. They should also not be used if pregnancy is a possibility.