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...