Headaches Archives - Michigan Spine & Pain

Chronic Headaches and Migraines

There are millions who suffer with migraines or chronic headaches. Headaches are a very specific type of pain, no two headache sufferers are alike. At Michigan Spine and Pain we approach each headache and each person as an individual and with a fresh multidisciplinary approach to diagnosis and treatment. Every patient is evaluated fully to determine the root cause of the pain and to determine the best course of curative and restorative action.

It is very common for headaches and migraines to be incorrectly diagnosed. There are many variable and different causes of headaches. In our e-book (click HERE) we discuss several different types of headaches and their symptoms and possible treatments.

We urge you to take your headache seriously and to know that we will do the same. Please call 800.586.7992 or contact us HERE anytime with questions or to schedule a consultation. We look forward to helping your relieve your pain.

What Do Chiropractors Do?

We feel very strongly that chiropractic treatment offers opportunities for pain reduction for many of our patients. That is why we consider chiropractic care to be an important part of the multi-dimensional care options we provide.

Many of our patients are curious about chiropractic treatment and want to know what it is and what chiropractic treatment can offer.

The goal of chiropractic treatment is to provide relief and comfort, as well as to educate patients on better ways to care for their bodies, preventing further injury and pain. Furthermore, chiropractic treatment is safe and non-invasive.

The most important part of our care at Michigan Spine and Pain is our initial set of visits with you, when we as a health care team determine a diagnosis and develop a treatment plan. Based upon that plan, we may determine that you would benefit from chiropractic treatment. Certain conditions are not appropriate for chiropractic treatment. Patients with cancer and those who take blood thinning medications may not be be candidates for chiropractic therapy.

Chiropractic adjustment, manipulation and therapy have been found to be highly effective complementary treatments for:

back pain
neck pain
headache
fibromyalgia

Our chiropractor uses these primary tools to aid in your rehabilitation and recover, as well as pain reduction:

Chiropractic Adjustment and Manipulation consists of manual therapy, performed by hand to the spinal joints or other articulations of the body, including the back,neck, ribs and extremities. Adjustments may also be rendered using the advanced Impulse Adjusting instrument. Chiropractic adjustment is designed to relieve pain, diminish muscle spasms, restore joint function, increase mobility and increase range of motion.

Disc Compression/Flexion Distraction/Cox Therapy/Traction are related manipulation treatments that are utilized to decompress spinal joints and discs. We use specialized equipment to coordinate hands on treatment with decompression traction to the spine. These techniques are used for treatment of disc problems, facet joint syndrome, lumbar stenosis, scoliosis and spondylolisthesis.

Massage Therapy/Trigger Point Therapy/Myofascial Release, Active Release Technique: These hands-on techniques are applied to areas of muscular pain and tension. They are used to help mobilize the soft tissues and adhesions, and include deep pressure and stretching procedures applied to sensitive points that are commonly found in the muscles.

Joint Mobilization Therapy: This therapy involves a deep stretching movement applied to the joints, ligaments, muscles, tendons and discs. These treatments work to restore mobility, range of motion, relax tight muscles, and help limit disability and pain.

McKenzie Technique: This patient education regimen includes teaching patients back care basics, correct posture principles and specialized stretching and exercises to help prevent and care for neck and back-related pain. Through individualized instruction patients learn ways to apply self-care treatments at home to help facilitate their rehabilitation and recovery.

Spinal Core Stabilization: These are exercises and stretches, prescribed to help strengthen the muscles that support the spine for improved control of body movements. Stabilization exercise works to help relieve pain, improve flexibility and limit the chance for re-injury and further bouts of pain.

The Placebo Effect in Pain Management

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Have you ever heard of the placebo effect?

A placebo is a pill that has no medicinal value. It is essentially an “empty” medicine. A placebo is a substance that has no therapeutic effect, used as a control in testing new drugs. The placebo effect is that improvement in symptoms of medical research participants, despite their receiving only the placebo.

An interesting phenomenon is occurring in United States painkiller drug trials: the placebo effect is increasing. In fact, the placebo effect has gotten so high that many new drugs are not progressing to the next level of research, because their effectiveness at reducing pain does not significantly exceed the effectiveness of study participants who received the placebo.

Jeffrey Mogil, who directs the pain-genetics lab at McGill University in Montreal conducted analyses of 84 American clinical drugs that were used to treat neuropathy. These drug trials’ results were published between 1990 and 2013.

Mogil’s team discovered these amazing facts:

Beginning in 1996, American study participants indicated that the drug being studied relieved their pain 27% more than a placebo.
By 2013, American study participants indicated that the drug being studied relieved their pain just 9% more than a placebo.

Researchers are wondering why so many Americans receive nearly the same benefit from a placebo. It must be noted that the placebo effect in the US is significantly higher than other countries. Some possibilities include:

American consumers are bombarded with drug advertisements promising beneficial results. This may encourage Americans to feel that pills will bring them relief.
American drugs in the trial stage are often administered by a nurse as opposed to other nations’ less personal lab settings. The development of the relationship between the study participant and the nurse may increase the placebo effect.
Just the act of taking a pill, even a placebo, may be triggering biological functions, specifically the release of endorphins, which dull pain.

A recent article in The New York Times discusses the usage of the placebo effect to help pain patients.

So many drugs are addictive or have potentially harmful side effects. Could placebo usage be the answer?

A drug trial of the painkiller Maxalt gave some interesting glimpses into the possible future of pain relief. Migraine sufferers were actually informed that they were receiving a placebo, and yet they experienced far more pain relief than those who received no placebos. This same study also showed that those who were told they were receiving a placebo but who actually received Maxalt reported less effective pain relief. And those who were told they were receiving Maxalt, but who were actually receiving a placebo, experienced greater pain relief. Fascinating!

Perhaps the act of receiving a placebo in a caring setting with a sympathetic health care professional delivering the placebo would be a good alternative for pain relief, one that causes no side effects and no dangers of addiction.

For those who wonder why anyone would consider taking a placebo, consider all of those women who utilize 28 day packs of birth control pills. The last seven days of the packet are placebo pills and the women are told that. But the makers and the women agree to take these sham pills, because the most important component of oral birth control methods is taking the pill daily without fail. For women who wish to prevent pregnancy, a daily fake pill that keeps her routine the same every day is worth the ruse.

For further reading:

“A Placebo Treatment for Pain”, published in The New York Times, January 10, 2016

Gratitude for Pain?

Photo by Julie Jordan Scott; https://www.flickr.com/photos/juliejordanscott/5982073991

It seems crazy to be thankful for the pain we suffer. Who would want to be thankful for chronic or acute pain?

We have patients who have told us some of the actual ways that pain has changed their lives for the better. Here are some of their anecdotes with their names changed to protect their privacy:

“Susie” has suffered cluster headaches on and off. She told us how her headaches forced her to simplify her life, creating working hours that were more nine to five and giving her the ability to say “no” to commitments that before, she felt obligated to say “yes” to.

“Jack” is a recent back pain sufferer. In the past, he used to have a frenetic schedule, filled with things that he loved, like time with friends and family and things that made him less than thrilled like constant errands, work-related socialization and a house he was renovating for resale. When his back problems began, he hired contractors to do the house renovation. He realized that he really could find others to do some of the physical work that he couldn’t rely on himself to do anymore, pain-free. The monetary cost was worth his heath, he decided. Now, Jack is more willing to delegate certain tasks to a select group of people whose standards match his.

“Evelyn” retired years ago, but her fibromyalgia has become more complex. She related to us that lots of things used to bug her in the past: slights from relatives and friends, minor spats with her husband over chores and bills and waiting in lines or on hold. Now that she has to treat herself with kid gloves, slowing down, not overdoing it and being really planful of her time, these things seem much less important than her overall health and well being.

We don’t wish pain on anyone. But we have seen that patients who are able to be positive even as they experience pain are typically motivated to live full, meaningful lives. Furthermore, they are excellent partners with their health care team as we work together towards their recovery and healing.

Not Tonight, I Have a Headache

Your headache is truly a pain. Perhaps your head is throbbing, or maybe there is a sharp pain. Maybe your headache improves when you lie down

Knowing what kind of headache you have matters.

Different headaches respond to different treatments.

The first question about your headache is, “Do I have a primary or a secondary headache?”

Secondary headaches are headaches that are caused by other disease processes, some relatively minor (dehydration, sinus infection, ear infection, flu); some quite serious (encephalitis, aneurysm, stroke). Your health care provider would need to evaluate your symptoms and examine you in person to rule out more serious ailments.

Primary headaches are headaches where the major illness is the headache. For some reason, there is overstimulation of the pain-sensitive structures in your head.

The most common primary headaches are:

Cluster Headaches (can involve any part of the head, usually consists of sharp, stabbing pain, can be debilitating)
Migraine Headaches (typically starts as a dull pain, but then worsens, can involve any part of the head, often includes light sensitivity and nausea)
Tension Headaches (typically a dull ache or pain, most often in the front of the head)

Primary headaches can be caused or exacerbated by the following:

Poor or insufficient sleep
Insufficient hydration
Hunger
Eating certain trigger foods
Alcohol use or abuse
Extended periods of discomfort, including poor positioning, strain, excessive work or exercise
Stress

Primary headaches can be treated with over the counter medications, a variety of prescription medications, biofeedback, physical therapy, complementary medicine, and relaxation techniques.

In order to get relief from your headache, it is critical to narrow down the type of headache you are experiencing.

Don’t Sweat It: Heat, Humidity and Pain

Heat and humidity, while a welcome change from the freezing Michigan winters, often bring with them challenges for our pain patients.

Arthritis sufferers often say they prefer heat as they find it easier on their joints. However, headache patients vary: some prefer heat; others experience more pain during the summer.

The effects of humidity are not clear. Migraine sufferers report less pain in both low humidity and high humidity, while many report increased migraine headaches during changes in both humidity and pressure.

Sweating and Humidity: Sweat is a natural phenomenon. It helps the body to cool down. However, perspiration only works if the sweat evaporates off your body. In highly humid days, if the sweat just lingers on your body, it is not working well. Be aware that if you are feeling constantly dewy or moist, that your body’s perspiration functions aren’t working optimally. You can actually become dehydrated in this situation, increasing your chances for headaches and spine pain. Increase your hydration accordingly, drinking as much as 1-2 cups per hour of water while actively sweating.

Take a Dip: The warm weather makes swimming an ideal pastime and exercise, all in one. Take advantage of the sunny skies and swim, either leisurely or with some gusto. Enroll in a water aerobics or hydrotherapy class. All of these are beneficial for all pain sufferers. Check out these articles about swimming for pain relief:

Water Workouts Swimming Away From Back Pain

Other summer issues that may bother pain sufferers:

Different summer schedules which could mean school age children underfoot who need attention and activities. Often, vacations can be stressful, as adults’ and children’s activities outside (waterparks, theme parks, sports events) are not always easy on pain patients.
Long days and short nights. If you are very sensitive to the amount of light outside, then it may be hard for you to settle down until much later in the evening than usual. In addition, the morning light may wake you up earlier than you had hoped. Pain sufferers need consistent, restorative sleep. Buy the plushest pair of eyeshades possible (think 1940’s films!) and try to avoid the light.
Traveling while exciting can be tough on pain sufferers. You might want to check out these tips for traveling and pain management:

Travel Tips to Stay Pain Free Driving Trips for Pain Sufferers

OTC Pain Relief: They’re Not All The Same

Lots of people find temporary relief for all sorts of aches and pains with so-called over the counter medication (OTC). These are the varieties of pain relievers we keep at home and in our offices, in our purses, and in our vehicles. These are the tried and true medications that can be purchased at all sorts of stores without a prescription, without the authority of a doctor.

But not all OTC pain relievers are alike. They are designed for different uses, they operate differently in our bodies they and have different precautions. Here’s a quick review of the major classes of OTC pain relief:

Medicine	Brand Names	Used to treat:	Precautions:
Aspirin	Bayer, St. Joseph	Mild aches and pains; can also be used as prevention for heart disease, reduces fever	Never to be given to children (can cause Reye Syndrome), should not be taken if you have bleeding ulcers or take a blood thinner
Acetaminophen	Tylenol	Headaches, arthritis, sore throats, backaches, toothaches, earaches, commonly prescribed for children	Overuse can cause liver damage, can interfere with high blood pressure medication. Should not be taken if you suffer from kidney disease.
Ibuprofen	Advil, Motrin, Midol	Menstrual cramps, any pain that is a result of swelling (like a muscle sprain), reduces fever	May cause upset stomach and stomach bleeding, can interfere with kidney and heart disease
Naproxen sodium)	Aleve	Headaches, menstrual cramps, pain from swelling (like a muscle sprain), reduces fever	May cause upset stomach and stomach bleeding, can interfere with kidney and heart disease
Pain relief with caffeine	Excedrin	Headaches, including migraines	May interfere with sleep

We recommend that you consult with your health care provider if you already take prescription drugs before adding OTC pain relievers to the mix. We also urge you to take only the necessary amount and never to take more than is recommended. If you have chronic health conditions, you absolutely should consult with your physicians regarding which OTC pain relief medications are appropriate for your care. If pain persists beyond ten days while taking OTC pain relief, please contact your health care team.

Sinus Headache or Migraine?

Two of the most prevalent types of headaches are sinus headaches and migraine headaches. Yet the treatment for each of these are quite different. How can you tell the difference between these two types of pain?

Migraine headache symptoms:

Moderate or severe pain in the head
The pain can be sudden or can come on gradually.
The pain is often accompanied by dizziness, nausea or vomiting.
The pain can be in a variety of locations, including just one side of the face or head, or even traveling down the back of the head and neck.
Light appears to exacerbate migraine headaches.

Unfortunately, many patients struggle with occasional or even chronic migraines. These patients tend to know the migraine triggers, that is the things that can turn into migraines like stress, certain food combinations, menstruation, weather patterns and other illnesses (including sinus headaches). For regular migraine sufferers, a migraine headache begins to follow a recognized pattern in terms of the development of the pain, where the pain travels in the head and even the duration of the pain.

Sinus headache (sinusitis) symptoms:

Moderate or severe pain in the head, above or behind the eyes, in the cheeks, and around the bridge of the nose.
Sinusitis can be on one or both sides of the head or the face.
Sinusitis typically does not involve the back of the head or the neck.
Sinus headaches often get worse when the patient moves their head, so coughing and lying down can be painful. Sometimes even touching the face can hurt.
Often, sinus headaches are accompanied by a runny nose, which can be clear or can be yellow or green in color.

Sinus infections, when untreated, can create even more problems. Unfortunately for migraine sufferers, sinusitis can also bring about a migraine.

Migraine headache treatment:

There are a host of medications that are prescribed for relief of migraine headaches. Some of these are meant to stop the migraine in process and other drugs are taken in the hopes that they will prevent migraine “attacks”. Drugs used for occasional migraine relief include over the counter aspirin, ibuprofen and acetaminophen, as well as over the counter drugs specifically combined with caffeine. These over the counter drugs have been known to cause ulcers and and other gastrointestinal bleeding. A large variety of prescription medications are also being used to combat migraine pain, including triptans which constrict blood vessels, Ergots, which include caffeine, anti-nausea medication, opioid medications (which have an inherent danger of being highly addictive), and steroid-based medication.

There are also some drugs that are perceived to prevent migraines. These include beta blockers, calcium channel blockers, antidepressants and anti-seizure medications.

Migraine sufferers may also benefit from certain lifestyle changes like quitting smoking, getting enough rest and beginning a moderate exercise program. In addition, in the midst of a migraine headache, sufferers can often find short-term relief by lying down in a cool, quiet, completely dark environment.

Sinus headache treatment protocols:

Sinus headaches are the result of either an allergic reaction an infection in the the sinus cavity. This infection can be viral , bacterial or fungal. Sinus headaches that are allergic in nature typically occur at the same time each year to correspond with the increased presence of the allergen, typically a pollen.

A variety of medications will be prescribed for sinusitis, including antibiotics for a bacterial infection, as well as decongestants. Allergic sinusitis will also be treated with antihistamines and steroid nasal sprays. Recurrent sinusitis may require surgery, if it appears that there is a malformation in the nose.

Please refer to your health care team for a definitive diagnosis and appropriate treatment for all headaches.

Let’s Get Clear on Water

We know that our body is composed of water. But not enough water that we can’t use more!

We need to remain hydrated, so that blood moves to our organs. When we are properly hydrated, we avoid kidney stones, our digestive system moves along appropriately, our skin is in its optimal condition and we can also keep hunger at bay if we are watching our weight. In addition, headache sufferers need to remain fully hydrated, as dehydration can be a trigger for migraines and other headache disorders.

It is very easy to become dehydrated. Water leaves our system through sweat, through just exhaling and when we urinate or have a bowel movement. We lose more water during the summer or during times when our breathing rate or sweating are increased such as during exercise, if we are in a hot sauna or shower, during hot or humid weather or when overlayered in clothing, or if our job or leisure activities are physically demanding.

Do we have to drink water?

No, you can also be hydrated through juices and foods that contain water (typically fruits and vegetables), but water is available for free, has no sugar added and often has fluoride, aiding oral health. In addition, water does not contain caffeine. Caffeine is not necessarily bad in smaller amounts. Contrary to popular opinion, caffeine has not been implicated in contributing to dehydration issues, especially if its use is limited (2-4 cups of coffee per day or two servings of pop).

How much water does a typical person need?

The old information is that you need to divide your weight in half (so if you weigh 150 pounds, divide that in half to get to 75). The halved number is the number of ounces that you should drink. So, under the old formula, a 200 pound person needs to drink 100 ounces of water and a 150 pound person needs to drink 75 ounces of water.

It now appears that the above formula overstates the need for water by a bit. Essentially, if you drink when you are thirsty and monitor your urinary output, you are drinking the right amount.

Signs that you are properly hydrated:

You are not overly thirsty.
Your mouth does not feel dry (and you don’t suffer from bad breath, a sign of dry mouth).
Your urine is clear or light colored (bright yellow urine or darker is a classic sign of dehydration).
Your bowel movements are relatively soft.

Depression and Pain

photo by Sander van der Well

Those of us who suffer chronic pain (pain that does not ease after 3 months’ duration) are at increased risk for developing depression.

Depression is misunderstood by many. Depression is not a character flaw or weakness. Depression is real and it can be as debilitating as the chronic pain that preceded it. We have seen with the death of Robin Williams, that depression, when treated improperly, can be life-threatening.

According to the Diagnostic and Statistical Manual of Mental Illness (DSM-V), depression is considered major or often termed clinical when it lasts for at least two weeks and when its symptoms are present daily. The symptoms include the following, five of which should be present in the case of a diagnosis of depression.

An overall feeling of sadness and hopelessness, irritability and recurrent crying spells
Significant changes in appetite resulting in either weight loss or weight gain
Major changes in sleep patterns, typically a desire to sleep all the time or an inability to either fall asleep or stay asleep
Restlessness or agitation, or complete lack of energy
Little or no energy or attention for the activities that used to entertain us or bring us joy
Decreased sex drive
Feelings or worthlessness, overwhelming guilt feelings
Inability to concentrate or remember big or little things
Thoughts of death, suicide, or wishing to be dead, fantasizing about funeral and the aftermath of our death

Dealing with chronic pain requires a team approach. There must be attention paid to the physical nature of your complaints, appropriate therapy must be administered, any medication must be prescribed and adjusted when necessary and constantly monitored for effectiveness as well as side effects. In addition, the mental aspect of pain must be addressed. Patients must avoid saying to themselves, “If I could just get rid of this pain, I’m sure my mental status would improve.” Instead, patients need to be honest with their care providers about the nature of their depression: their moods, the duration of their depression, what their thought processes are, and particularly if they are considering hurting themselves.

Depression, in and of itself, is not always easy to treat. But patients who are already receiving medical care for pain relief are at least part of the medical community and are often open to the treatments that work for depression, combined with chronic pain. These include:

Medication to alleviate severe depression.
Avoidance of triggers of chronic pain, which can in turn, increase depression.
Cognizance of lifestyle choices that contribute to depression, including alcohol and substance abuse, high stress activities, close proximity to difficult or even abusive people
Increased physical activity when possible, including endorphin-producing cardiovascular activity, stretching, and light walking.
Meditation and breathing exercises.

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