Headaches

Headache Facts

Introduction

Headache pain is a common problem which many individuals seek relief through health care assistance. While the pain is common, headache treatment and management can be an ongoing source of frustration for many individuals. There are many types of headaches with differing causes, presentations, durations and intensities. These may range from the common migraine, classic migraine, tension, cluster, temporal aritis, and sinus headache. While a headache’s presentation and symptoms may be similar or different from one patient to another, effective treatment strategies usually take an individualized approach to identify the cause for appropriate management.

The most common forms of headaches are tension and migraine headaches. Tension headaches are a non-specific headache which usually stem from overactive muscle tension in the head, shoulder and facial areas. Dull, achy, non-pulsating pain is often felt in the temples, TMJ, forehead and base of the skull. There is usually a correlation to daily stress and these headaches do not commonly associate with bouts of nausea, eye pain, facial numbness.

More than 28 million Americans suffer from migraine headaches which are generally more severe than tension headaches. Women are three times more likely to suffer migraine headaches than men. These headaches may be influenced by external factors such as alteration of sleep-wake cycle; missing or delaying a meal; medications that cause a swelling of the blood vessels; daily or near-daily use of medications designed for relieving headache attacks; bright lights, sunlight, and fluorescent lights; TV and movie viewing; certain foods; and excessive noise. Migraines often occur with nausea, visual pain or disturbances, facial and hand numbness, and sensitivity to light and sound. Migraine headaches usually last in bouts, lasting from a few hours to several days. Classic migraines differ from common migraines due to the aura (flashing lights, blind spots, or jagged lines in vision, smelling strange odors and difficulty speaking) that will precede the manifestation of the migraine by 10 to 30 minutes.

When should I see a doctor?

Understand that while headaches are quite common, they can greatly impact the quality of your life and limit your daily activities. Seek care from your healthcare provider when you are unable to manage or cope with your headache. Your healthcare provider will take a history to try and identify the cause of your headache and rule out sinister causes. Once “red flags” have been eliminated, treatment solutions are offered to control the pain and reduce future reoccurrence so you can get back to your daily activities. While serious pathology is a rare cause for most headaches, it is normal to worry about the cause of your headache pain. Often fears of more serious disease may be of worry to you. Talking with your healthcare provider about these worries and concerns can be helpful. You will usually find there is no serious cause of the headache pain and that there are ways to relieve the symptoms and get you back to your normal activities.

What can I do for myself?

Since headache occurrence can be frequent, often there are ways to cope with an episode and limit its effects. Some individuals keep a headache diary to track headache triggers such as specific types of food or stressful situations that can be avoided in the future. In the event of a headache, avoiding certain types of light, finding a quiet place to rest, reducing light exposure with sunglasses or sitting in a dark room may help ease the pain. Some people find sipping strong coffee helps with the headache pain. Others find alternating a hot compress for several minutes on the forehead followed by a cold compress helps reduce the pain and repeating this cycle several times. Try different coping strategies and see what works best for you. Some over-the-counter medications may help you control the pain. Prescription medications may also benefit some individuals. Speak with your healthcare provider about such remedies to determine if they are appropriate for you.

Rehabilitation

If your healthcare provider determines that your headache is from a musculoskeletal origin a rehabilitation program may be ordered. This may consist of short term trial of spinal mobilization/manipulation, soft-tissue treatment, neck stability exercise training and/or sensory motor training all used to reduce headache intensity and prevent reoccurrence. Workplace and lifestyle advice is often incorporated to improve management skills.  The Brugger relief position is excellent stress “micro-break” which relaxes over-tense muscles.
Neck retraction is another exercise that helps to increase neck stability and stretch overactive muscles at the base of the skull.
Keep in mind that while headaches can be unpleasant and greatly affect the quality of our lives, there are emerging treatment strategies that can empower the patient to effectively control a headache’s intensity and frequency. Speak with your healthcare provider about any fears and concerns regarding your headache pain and discuss a management plan that works for you.
(www.clinicalrehabilitationspecialist.com)

Core exercises to replace your sit-ups

Hey everyone!
Due to the move I am a little behind on posting things on my blog. Today is supposed to be an exercise day, so I found a video of Stu McGill explaning and demonstrating some great core exercises. These exercises should be done in place of sit-ups/crunches. These exercises are much better for your back and will not put as much stress on it. There are a few different exercises demonstrated. The one with the exercise ball will be a pretty tough one, but the others are not bad. Click on the link below and give them a shot!

Conditioning Research: McGill Exercises

Exercise of the Week: Burpees

Hello Everyone! I am going to be posting an exercise each week that either I suggest often or that you may have never tried before. I will also suggest a difficulty level. I will grade it on a 1-5 scale (1=easy, 2-3=challenging, 4=advanced, and 5=athlete level).  Add them to your workouts and see if you feel that muscle you haven't felt before!

Burpees

Difficulty Level: 4

Major Muscles Worked: All of them!

Burpees

Purpose:

_ Functionally train multiple muscle groups at one time as well as a cardiovascular endurance

_ Train multiple movements at one time

Procedure: (see picture below)

_ Start in a standing position.

_ Perform a low squat and place hands on floor.

_ With hands on floor, jump legs straight back and land into a pushup position.

_ Perform a pushup.

_ With hands still on floor, jump legs back into the low squat position.

_ From the low squat, jump straight up.

Common errors:

_ Bending at the waist instead of performing a proper squat form (refer to last week’s blog).

_ Allowing low back to sag while in the pushup position. Back should be kept in a neutral position and core held tight.

ARTICLE IN fitness training: The functional reach

What you should feel:

_ Tired. No joke. This is a high intensity exercise. Your heart rate should be up and your muscles should begin to feel fatigue. This is as much of (if not more of) a cardiovascular exercise as it is a strength training exercise.

Are Disc Herniations So Scary?



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A close friend and colleague recently wrote this article on disc herniations. It is a great article and if you have ever been diagnosed or suspect you have/had a disc herniation this article will be very interesting to you! 

So what exactly is a disc and what is its function?
Discs are located between each of the vertebra of the spine, with the exception of the top two.  The disc is made up of three parts: nucleus pulposis, annulus fibrosis and end plate (Picture 1 @ left).  The nucleus is a liquid material in the middle of the disc with the consistency of tooth paste or jelly.  The annulus is a fibrous ring that contains the nucleus, and finally the end plate is cartilage that sits on top and below the nucleus to further contain it.  Located directly behind the disc lies the spinal cord and the nerve roots that supply the arms and legs.  The main function of the disc is to allow for mobility of the spine and transmit forces during these movements.  They are not shock absorbers, but are better to think of as a fulcrum for spinal movement.

What is a disc herniation? 
A disc herniation is when the nucleus inside the disc tears its way through the annulus and either applies pressure directly on the nerve roots and/or creates an inflammatory reaction that can irritate the nerves (Picture 2). These herniations can create low back pain, buttock, leg and foot pain, numbness, tingling or burning sensations.  However, presence of a disc herniation does not guarantee symptoms.  Research has shown that as much as 50% of 40 year old patient will have signs of disc herniation on MRI's without any symptoms!

How do you get them?
Clinical research has shown that the number one cause of disc herniations is repetitive forward bending with rotation of the spine.  Countless studies by famed low back researcher Stu McGill PhD have taught us that it takes about 10,000 bends of the spine to create a disc herniation.  This is why patients will commonly come in to our office embarrassed because they hurt their back simply bending over to lift a pencil or other small item.  Well in all actuality it had nothing to do with what they were lifting, but rather the number of times they lifted with poor form.  Sitting and sit-ups also play a tremendous toll on the low back.  Prolonged sitting, particularly with a slouched posture, is the worst posture for the low back (picture 4).  The only thing worse for the spine then sitting is sit-ups!  Commonly patients will tell us that they have been doing sit-ups at home to try and strengthen the muscles around the spine, however they have no idea that every time they do a sit-up it puts 730 LBS OF PRESSURE ON THE DISC AND ACTUALLY CREATED THEIR DISC HERNIATION WITH THEIR EXERCISE! 

How does a doctor know if I have a disc herniation?
Our physicians will begin our exam with a thorough history, physical exam and later imaging if necessary.  The classic disc herniation history will show pain in the low back and leg that is worse in the morning and painful with sitting and bending.  Physical examination will vary depending upon specifics of the case but will typically include watching the patient walk, checking spinal reflexes, and performing various orthopedic test to see if we can reproduce the chief complaint.  As a rule of thumb, if we can change your pain, we can help your pain.  Finally, after the physical exam IF we determine that imaging is required the patient will be sent for an MRI (Picture 3). 

How are disc herniations treated?
We manage disc herniation cases by treating with biomechanically superior adjusting techniques.  In addition these patients will receive a full workup with the McKenzie Technique to determine the required route of rehabilitation exercises that the patient warrants.  With the combination of spinal adjusting and rehabilitation we can successfully treat the vast majority of patients with disc injuries.  Although they may be painful, disc injuries are really not as scary as they sound and the research supports conservative management as the first approach to treatment.  Clinical research has shown that less than 3% of disc herniations will require any surgical action.  We are trained to recognize the patients that do require more aggressive action and will readily refer to our Medical colleagues when it is indicated.

~Originally posted by Dr. Clinton Daniels

Thanks for reading this blog on disc injuries.  If you have had a disc injury in the past please share your experience or if you have any questions about this blog or suggestions for future blogs, please feel free to leave a comment or contact our office to speak with one of our physicians directly.



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Perfect Squats

Perfect Squats

Squatting exercises are one of the best exercises for increasing strength in your legs, glutes, and core. If performed correctly it can be very beneficial in injury prevention during everyday life. On the other hand, if performed incorrectly, squats can become a source of injury. So, it is very important for squats to be done with good form. To insure this, watch yourself in a mirror while performing a squat and make sure your mechanics follow specific guidelines. I will give some guidelines for you to follow as well as examples of easy/beginner squats. If you are still uncomfortable with jumping into squats on your own, get the help of a fitness professional to assist you.

·        If you are squatting with added weights (barbell, dumbbell, etc.), it is best to do them in the afternoon or evening. Early morning squatting can cause extra stress to the back.

·        To prevent knee pain, keep your knees behind your toes throughout the entire squat and keep your stance slightly wider than shoulder width. Also, point your feet at 45 degree angles.

·        Keep your eyes forward (good time to have a mirror in front of you) and back neutral.

·        Take a deep breath (allow your belly to expand with your breath) as you squat down and hold that breath and belly tension until you are on your way back up.

·        When doing the squat, stay on your heals and sit back like you are going to sit in a chair.

When starting a squatting exercise for the first time, I would suggest starting simple. Here are a couple examples of simpler squatting exercises.

Leibensonn, C., JOURNAL OF BODYWORK AND MOVEMENT THERAPIES OCTOBER 2003

Oh and just for fun, babies around 9-10 months old will begin to demonstrate the perfect squat without even realizing it!

Omega-3 Compare to Ibuprofen

Omega-3 vs. Ibuprofen

I recently ran across this article and found it very interesting. It was a study that was done to compare the results of the use of omega-3 fatty acids (fish oil) to NSAIDS (ibuprofen) in non-surgical pain patients. The results were pretty conclusive at the effectiveness of the Omega-3’s. Many of the patients quit using their prescription NSAIDS due to the results of the omega-3. A very large majority stated they were happy with the results of the omega-3 and would continue to take omega-3 in place of their NSAIDS. The conclusion states that omega-3 is a safer alternative to pain relief when compared to

NSAIDS. It also mentions a previous article showing the benefits of omega-3 in arthritis pain relief.

*Below is the abstract of the article.

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Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain.

Background: The use of NSAID medications is a well-established effective therapy for both acute and chronic nonspecific neck and back pain. Extreme complications, including gastric ulcers, bleeding, myocardial infarction, and even deaths, are associated with their use. An alternative treatment with fewer side effects that also reduces the inflammatory response and thereby reduces pain is believed to be omega-3 EFAs found in fish oil. We report our experience in a neurosurgical practice using fish oil supplements for pain relief.

Methods: From March to June 2004, 250 patients who had been seen by a neurosurgeon and were found to have nonsurgical neck or back pain were asked to take a total of 1200 mg per day of omega-3 EFAs (eicosapentaenoic acid and decosahexaenoic acid) found in fish oil supplements. A questionnaire was sent approximately 1 month after starting the supplement.

Results: Of the 250 patients, 125 returned the questionnaire at an average of 75 days on fish oil. Seventy-eight percent were taking 1200 mg and 22% were taking 2400 mg of EFAs. Fifty-nine percent discontinued to take their prescription NSAID medications for pain. Sixty percent stated that their overall pain was improved, and 60% stated that their joint pain had improved. Eighty percent stated they were satisfied with their improvement, and 88% stated they would continue to take the fish oil. There were no significant side effects reported.

Conclusions: Our results mirror other controlled studies that compared ibuprofen and omega-3 EFAs demonstrating equivalent effect in reducing arthritic pain. Omega-3 EFA fish oil supplements appear to be a safer alternative to NSAIDs for treatment of nonsurgical neck or back pain in this selective group.

Maroon, J. C. and J. W. Bost (2006). "Omega-3 fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain." Surg Neurol 65(4): 326-31.

Exercise of the Week (10/13/10) - Supported Functional Reach

Hello Everyone! I am going to be posting an exercise each week that either I suggest often or that you may have never tried before. I will also suggest a difficulty level. I will grade it on a 1-5 scale (1=easy, 2-3=challenging, 4=advanced, and 5=athlete level).  Add them to your workouts and see if you feel that muscle you haven't felt before!

Supported Functional Reach

Difficulty Level: 3

Major Muscles Worked: Thighs, Glutes, Core

Supported Functional Reach

Purpose:

_ Train buttock and thigh muscles.

_ Dynamically stretch the back of your hip.

Procedure:

_ Stand in front of a bar or handle.

_ Reach one leg straight back as far as possible.

_ The other leg that you are standing on should

flex at the knee while the thigh approaches

horizontal (see Fig. a).

Common errors:

_ Bending at the waist without flexing the support

leg’s knee.

_ Gripping too hard.

ARTICLE IN fitness training: The functional reach

What you should feel:

_ Buttock and thigh effort along with buttock

stretching.

Liebenson, C. Journal of Bodywork and Movement Therapies (2006) 10, 159–162