Osteopathic Perspective on Headache: for the Patient

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An Osteopathic Perspective on Headache: For the Patient
Rebecca J. Bowers, D.O., NMM/OMM Resident
One of the most common complaints that patients present to their
physician’s office with is headache. In fact, over 50 million Americans
suffer from chronic headaches. The medical term for headache is
cephalgia. Cephalgia literally means “head pain”.
There are many reasons why a person may be experiencing head
pain. These can be divided into two different categories. The two types of
cephalgias are primary and secondary.
Primary cephalgias are caused by problems with or over-activity of
the pain-sensing structures in the head. The most common types of
primary cephalgias are migraine headache, tension headache, and
trigeminal autonomic cephalgias. These headaches are called primary
because they are disorders in and of themselves- they are not just a
symptom of another disorder.
Secondary headaches are caused by some other underlying disease.
The headache in this case is a symptom. There are many conditions that
can cause head pain. It could be a medication side effect, an illness like
the common cold, or something more life-threatening that may require
prompt medical intervention. Some warning signs that suggest that a
headache may be a sign that a person is in immediate danger and should
seek medical attention right away are if they are experiencing the worse
headache of their life, the headache started suddenly (one moment they
were feeling fine- the next, their head aches badly), they recently fell or had
hit their head, they are having difficulty speaking or understanding or
moving, or they have a rash on their skin. There are other signs and
symptoms that could point to the underlying cause of a headache, and
having a person with a headache examined by a physician is the best way
to investigate the seriousness of the situation. Luckily, most of the time a
headache is not a medical emergency.
For people who suffer from chronic headaches (i.e. have headaches
on a regular, long-term basis) and for whom there is no one easily-treatable
underlying cause, the primary concern is managing the headaches. The
management of chronic headaches is divided into preventative (trying to
prevent getting another headache) and acute (trying to alleviate the current
headache). Many people place a lot of emphasis on the acute
management and not enough on prevention. It’s easy to understand why:
when people hurt, they don’t want to, and when they don’t hurt, they’d
rather forget about the times when they do hurt. Unfortunately, this may
result in more time spent experiencing pain.
Most people with chronic headaches have what are commonly
referred to as “triggers”. These are stimuli (chemicals, sounds, sights,
tastes, smells, and other feelings) that make them more likely to experience
a headache. A trigger can be just about anything, and not all triggers bother
a person with chronic headaches the same amount as they might another
person who suffers from chronic headaches. In many ways, the word
“trigger” is misleading. It implies that when a chronic headache sufferer is
exposed to a certain stimulus, this will trigger them to get a headache. This
is only the case for a few “triggers”. Most triggers act in an additive way,
and the stimulus that a headache sufferer experiences just before they
develop a headache is not usually the most offensive trigger- it was just the
straw that broke the proverbial camel’s back.
I will use myself as an example. I have suffered from migraines for
at least a decade. Over the years, I have been able to identify various
stimuli that make me more likely to get a headache. Some of them being
changes in the amount of sleep I get, the smell of citrus, alcohol, emotional
stress, and caffeine. It took me 8 years to figure out that caffeine was a
major trigger for me. The reason being that I do not usually develop a
migraine shortly after drinking a caffeinated beverage (In fact, sometimes it
actually made me feel better if I drank something caffeinated when I felt like
I might be getting a headache), nor do I get a migraine after a certain
amount of time of not having had caffeine (this would suggest caffeinewithdrawal as a trigger). Yet I noticed when I did not drink coffee for a
month, the frequency of my migraines went from 3-4 per week to 3-4 per
month. Just to be sure that it had really been the coffee that so
dramatically affected the frequency of my migraines, I started drinking
coffee daily again. Sure enough, I started getting 3-4 migraines per week
again, and when I stopped the coffee, the migraines went back down to 3-4
per month. For some reason having caffeine on a regular basis stresses
my body and makes it less able to handle other triggers well.
When it comes to triggers, the important thing is not the trigger itself,
but how much stress that trigger causes. Stress is anything that makes it
more difficult for the body to properly function. Some examples of stress
are not getting enough sleep; not drinking enough water; or being exposed
to allergens, illness, or emotionally stressful situations. When a body is
under stress, not only can the person become emotionally irritable, their
muscles and other body systems can become irritable and overreact as
well. This hyperirritability causes more stress, and for a person who tends
to get headaches, if there are too many stressors on the body at one time,
this results in a headache and possibly other unwanted manifestations like
fatigue, stomach upset, anxiety, depression, insomnia, and more.
While it is impossible for a person to eliminate all stress from their life,
it is possible to reduce stress and develop healthy habits that help the body
better deal with stress. Optimal water and nutrient intake and sleep are
essential for increasing the likelihood that the body can properly deal with
the many stressors people encounter on a daily basis. Emotionally
rewarding relationships and activities are important, and paying attention to
health and minimizing risk factors for disease helps improve the body’s
ability to cope with stress as well.
Good overall health starts with healthy cells and tissues. In order for
the cells and tissues of the body to be healthy and function well there must
be good flow of blood and lymph to help with the delivery of nutrients and
hormones and the removal of toxic substances. Tight muscles and stiff
joints get in the way of blood and lymph fluids moving well through the body
and hence get in the way of the tissues being healthy. Unhealthy tissues
release substances that signal to the nervous system that the body is in
trouble. The nervous system then sends out its own signals trying to
correct the problem. A lot of this happens without the person being
consciously aware of it, but if there is enough of a problem, the nervous
system send out signals to warn the person to whom the body belongs.
Pain is one of those warning signals that tend to get a person’s
attention. One of the problems with pain, whether it’s a headache or pain
elsewhere in the body, is that it causes increased stress to the body. This
can cause an unhealthy cycle of pain and stress and more pain. Taking
medications that decrease pain only addresses one aspect of the painstress cycle. It is important to also work on decreasing the stress on the
body, so that health can be restored to the tissues and the nervous system
no longer feels that it needs to maintain the pain signal.
An Osteopathic physician who practices manual medicine uses
hands-on techniques to improve a person’s state of health by improving the
motion in the person’s body and hence reducing the total amount of stress
on the body. This can be a great help to a patient who suffers from pain,
such as headaches. Because of an Osteopathic physician’s medical and
manual therapy education and training, they can provide not only a
diagnosis for the headache, but a treatment plan that includes medication,
lifestyle coaching, and using manual techniques to address
musculoskeletal factors that can be causing mechanical stress to the body
and contributing to head pain. Many patients with chronic headaches find
this holistic approach helps them to feel better, experience less pain, and
be able to lead more active and healthy lives.
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