HEADACHES, PART 1
Medical issues that confront the medic on or off the grid can be obviously life-threatening, such as a heavily bleeding wound, or seemingly benign, such as a headache. A headache might not appear to be of much consequence, especially if you’re being chased by a grizzly bear; it can, however, be a sign of a imminent event, such as a stroke.
Headaches are one of the most common medical symptoms that you may face as a medic, but you might be surprised to know that brain matter itself doesn’t have any pain receptors. There are several structures around the brain that do, however, such as muscles, blood vessels, and sinuses. When stimulated, nerves associated with these structures can transmit pain signals to the brain, resulting in a headache.
Headaches are common components of flu syndromes and many other illnesses. There are almost more causes for headaches than you can reasonably write down. They include:
• Sinus or ear infections
• Sleep deprivation
• Teeth Grinding
• Hormonal changes
• Caffeine or alcohol excess and withdrawal
• Exposure to environmental toxins
· Adverse reactions to medicines
More serious concerns would include an imminent stroke, brain tumors, nervous system infections like meningitis, glaucoma, and much more.
Evaluating a headache involves determining what the symptoms are, the risk factors (e.g., high blood pressure), what makes it better or worse, and a physical exam. The part of an examination which evaluates the nervous system is called the “neurological exam”. Check reflexes, strength, sensation, movement, balance, coordination, vision, and hearing on both sides. It’s especially important to note any differences on one side versus the other.
This video is an excellent example of a short but comprehensive neurological exam:
TYPES OF HEADACHES
Once you have determined that the neurological exam is normal, you will have to determine what type of headache with which you’re dealing. The various types include:
• Tension headaches
• Migraine headaches
• Sinus headaches
• Headaches related to medical conditions
By far, the most frequently-seen type of headache is the tension headache. Although the cause has not been established definitively, it may be caused by spasms of the muscles of the neck and head, anxiety, abnormal posture, or any of a number of other issues. Stress appears to be the initiating factor in many cases.
Tension headache is usually seen bilaterally (on both sides) and/or the back of the head and neck. Sufferers report a dull ache and the sensation of a tight band of pressure around the forehead. Neck and shoulder muscles may also be involved.
Tension headaches may last a half hour or they can last a week. Treating a tension headache involves relaxation techniques and NSAIDs like ibuprofen (Advil). Some feel relief simply by taking acetaminophen (Tylenol). Excessive use of medications, however, may lead to “rebound” headaches, where the headache pain returns when off the drug.
A number of prescription medications like naproxen or even stronger drugs are also used in severe cases. If muscle spasm is suspected, prescription medications like cyclobenzaprine (Flexeril) may be of use. Relaxation techniques include massage, regular exercise, yoga, meditation, and deep breathing. Cold packs to the affected area may help.
Biofeedback training is another way to reduce stress that can cause a tension headache. This method uses devices that monitor heart rate, blood pressure, and muscle tension. It attempts to give you “feedback” to help control some of the factors that lead to headache. Counseling, also called cognitive therapy, may help by allowing you to voice your stress and find ways to deal with it.
Other alternative therapies may also play a part in dealing with tension headaches. Some attest to the effectiveness of acupuncture as a therapy. Other use herbal teas: Herbs that have sedative and antispasmodic properties may help relieve the pain of tension headaches. Consider teas made from Valerian, skullcap, lemon balm, or passion flower. Herbal muscle relaxants may also help: Rosemary, chamomile, and mint teas are popular options. For external use, some alternative healers recommend lavender or rosemary oil. Massage each temple with 1-2 drops as needed.
I’ll bet you have your own home remedy for tension headaches. If so, let me know what works for you.
In part two of this series, we’ll discuss migraines and other types of headaches, plus more natural remedies.
Joe Alton MD