Headaches are ubiquitous. I have never met someone who has never had a headache in their life. As a neurologist, I see a lot of patients specifically for this disorder. The World Health Organization estimates that about 50-75% of adults in the world aged between 18-65 years have had headaches in the past year, and 30% of those individuals have had migraines specifically. That is a significant number of people. According to a recent study, headaches rank third in causing years lost to disability. It definitely keeps my neurology clinic busy. But unfortunately, many people also do not get the help they need – either because they decide to push through it or are not referred to headache specialists.
The first step in feeling better is coming to a diagnosis. There are several different types of headaches that need to be differentiated. Some of the more common types that people can have are migraine headaches, tension headaches, rebound headaches, etc. Some people even have a combination of the above.
Rebound and Drug-Induced Headaches
Rebound headaches or drug-induced headaches are unfortunately extremely common. Any pain medication taken more than twice a week for longer periods of time can potentially cause this type of headache. I see this very commonly in my neurology clinic in patients with other headache syndromes. They may develop a migraine or a tension headache and start treating that particular headache with ibuprofen, Excedrin, or some other form of pain medication. As they continue taking the pain medication, the original type of headache can resolve but then their continuing headache is being driven by the original pain treatment itself. Caffeine is actually one of the most common causes of this type of headache. Your body starts to get used to the medication and, in a sense, need the medication. So, you develop a headache, feel better right after taking a pain medication, then the headache returns as the level of the pain medication starts to lower in your body, so you need more pain medication, and so on. The mainstay of treatment for this type of headache syndrome is to stop the offending medication, let your body reset itself, and maintain an internal equilibrium. I always warn my patients that this type of headache will worsen before it improves.
Tension headaches are commonly a result of stress or musculoskeletal issues like neck muscle spasms etc. It is probably the most common primary headache syndrome and typically described as a band around the head, pressure around the temples, or posterior head/neck pain. People frequently develop the aforementioned drug-induced headache syndrome while they are trying to treat this type of headache syndrome with pain medications. I frequently stress the importance of sleep, regular exercise, stress relief, physical therapy, internal balance, etc.
Migraine headaches are also extremely common, unfortunately. They occur in a wide range of people, from children to adults and the elderly. This type of headache is usually one-sided, throbbing, and severe. Commonly lasting for hours. I have some patients that have migraine headaches that last for days. Neurologically, there is a spreading neuronal depression that leads to a release of inflammatory substances in the brain and body.
We have quite a lot of options for treatment, which is both a blessing and a curse. Treatment frequently becomes trial and error with traditional migraine headache pain medications. I tend to use amitriptyline, propranolol, and topamax depending on certain factors such as age, comorbidities, etc, but there are a plethora of medications to choose from. For my chronic migraine patients with 15+ headache days monthly, I use botulinum toxin injections. This form of treatment can be very effective in the right patient. I have one patient who used to go the emergency room almost on a weekly basis for her migraine headaches; however, since starting botox injections, she has not had to go to the ER for her migraines at all. And more recently, the new class of CGRP antagonists are opening up new hope in the fight to treat migraine headaches. I have a handful of patients on this new class of migraine treatment who are doing really well, and a few who are considered super responders where they no longer have headaches.
However, not all treatments are as effective in everyone. And unfortunately, most medications have some form of side effects. Everyone’s body chemistry is unique. In my opinion, less medications is always better though. So, if improving sleep, reducing stress, increasing exercise, addressing depression and anxiety, and changing diet helps treat your headache syndrome, then all the better. If you do not have internal balance, the above will be difficult to attain. And frequently, with vitamin and nutrient imbalances, the medications we give will not work as effectively. For example, most migraine sufferers also develop a leaky gut syndrome where they do not absorb nutrients, vitamins, and medications well through the stomach. Therefore, the most effective way to treat the headache is by treating the whole body. Diet changes may be needed to decrease pro-inflammatory foods. A probiotic can set the stage for a healthy gut to improve absorption. And intravenous hydration and vitamins are necessary to balance the internal system to give your brain and body the tools to combat the different headache syndromes.
The philosophy at RevIVe Wellness is whole body and brain health and wellness. You cannot effectively and efficiently treat headaches by throwing medications at people. Some may work in the short term but they then may contribute to developing other headache syndromes like the rebound headache. Others seem to not work at all because of the leaky gut syndrome where people are not absorbing the headache medications well anyway. At RevIVe Wellness, the headache IV infusion was created to resupply the body with fluids, nutrients, and vitamins to help your body treat itself and improve your headaches.
In addition, mental health needs assessment as well. If your mind is not aligned, then your body cannot be aligned either. Any component of stress, depression, or anxiety, can cause headaches or, more commonly, worsen and prolong headaches. RevIVe Wellness can refer you to a psychologist if you need, or they can discuss IV ketamine for severe refractory depression when other medications and treatments fail.
Headaches are treatable. Do not suffer in silence. Seek the help you need.