Headaches: A Western Medical and Integrative
by Carolyn Coker Ross, MD
Tension headache, the most common kind of headache, is known
as a 'pressure' or 'muscle contraction' headache since it is thought
to be related to increased tension in the scalp muscles. It feels
as though something is squeezing the head, and both neck and scalp
may feel sore. A tension headache is most often caused by stress
leading to nervousness or fatigue, then knotting of the muscles
of the scalp, neck and shoulders. Here are other symptoms of tension
- Begins without warning, usually following stress or emotion.
- May begin as mild but constant, then gradually worsens as
pressure on the head.
- Generally involves both sides of the head.
- May be long-lasting (days or weeks), and may cause nausea
or vomiting if the pain becomes severe.
Migraine headache is much different from a tension headache,
although the two can coexist (called mixed headaches). It is a
disease that may run in families, and it has its own specific
symptoms. The pain and other symptoms generally first appear between
ages 10 and 20 and recur until about age 50. Over two-thirds of
all migraine sufferers are female. Migraine headaches usually
begin with a dull ache on one side of the head, then the pain
worsens and becomes throbbing or pounding. Although the cause
of migraine is still unknown, research points to involvement of
the nerves and blood vessels in the brain.
Following are further symptoms of a migraine:
- Often occurs upon awakening or after heavy or hectic activity.
- May be triggered by certain foods, bright light, loud noises,
stressful situations, odors and fumes or perfumes, or extreme
temperature and weather changes.
- The pain would most likely occur on only one side of the head,
and about half of patients will have nausea and vomiting.
- The throbbing pain of a migraine usually evolves into a dull,
more steady pain.
- Menstrual cycles and fluctuations of estrogen levels can cause
Other types of headaches include those caused by sinusitis, neck
pain, eye disease, stroke, tumor and a variety of other conditions
including acute infections such as viral meningitis.
Your Physician or Nurse Practitioner
You will need a careful evaluation by your physician or nurse
practitioner if you are having ongoing pain or debilitating problems
due to headaches. This evaluation will include a complete physical
examination along with a complete description by you of your symptoms
- location and severity of the pain
- type of pain
- frequency and times of headaches
- quality of the headache--dull, sharp, throbbing, constant,
Depending upon your headache diagnosis, your physician or nurse
practitioner will make special recommendations which will include
some of the lifestyle and related information in this guide, as
well as the following possible medications:
- Migraine - Migraines generally require prescription medications.
These can be taken to prevent both general and pre-menstrual
migraines. In some cases, you may need to receive injectable,
nasal spray or suppository forms of medication since at times
during migraines if nausea is present oral medication is ineffective.
- Tension - Your provider can guide you in the use of over-the-counter
medications such as acetaminophen or ibuprofen. Prescription
medications may be used for severe headaches or to prevent frequent
- Sinusitis - The headaches caused by sinusitis can be treated
with decongestants, sometimes as nasal sprays. In some cases,
antibacterial medication may be required to clear up an infection.
While not every headache should send you to the doctor's office,
the following situations make medical investigation a good idea:
- A sudden change in the severity or type of headache, or a
new kind of headache (especially if you're over age 50).
- Headaches accompanied by mental or neurological symptoms such
as drooping eyelids, loss of balance or muscle weakness.
- Headaches associated with fever or intense neck pain.
- Headaches associated with lifting, straining or coughing.
Headaches can be a distress signal, your body telling you that
something is out of balance. A tension headache often starts with
misaligned vertebrae, which may irritate a spinal nerve, setting
in motion the muscular contraction and vise-like pain. A migraine
headache may begin with spinal misalignment either restricting
blood flow into your head or irritating a spinal nerve. This nerve
irritation upsets the part of your nervous system which controls
functions such as narrowing and expansion of your blood vessels.
Your health history, physical exam and sometimes x-rays help your
chiropractor diagnose your tension or migraine headache. If your
exam reveals other kinds of headaches such as cluster, mixed headaches
or those associated with infection, tumor or hemorrhage, your
chiropractor will recommend referral to the appropriate health
care professional. Your chiropractor can help you get to the root
of your problem, being specially trained to evaluate and treat
spinal problems, including those leading to headaches. Chiropractic
care can help relieve your pain with spinal adjustment and related
treatment including ice packs and soft tissue massage. You can
also learn what to do to prevent future headaches, such as postural
exercises, correct work-area ergonomics and correct sleeping posture.
Traditional Chinese Medicine (TCM)
TCM can be an important of your headache management program.
Preventive treatment can be very effective in managing tension
headaches. This would include acupuncture and herbs as well as
diet and exercise recommendations. Migraine headaches generally
require twice-weekly acupuncture treatments for two to four weeks.
These generally either eliminate or reduce the pain, and some
patients get immediate relief. For menstrual migraines, acupuncture
treatments will be given two to four times each month before the
menstrual period, and treatment will continue for two to three
monthly cycles. Sinus headaches caused by either allergy or infection
can be successfully treated with herbs and acupuncture treatments.
Your TCM practitioner can also help relieve the muscle spasm associated
with headaches using a special massage technique.
We all know that over-indulging in alcohol results in a classic
'hangover headache'. But there are also a variety of substances
that can trigger a headache in migraine sufferers. Following are
some foods that the National Headache Foundation has identified
as being possible migraine triggers:
- Fermented, marinated or pickled foods
- Foods containing MSG
- Sausage, bologna, salami, hot dogs, chicken livers, pate
(these contain nitrites)
- Snow peas
- Pickled or dried herring
- Aged or ripened cheeses
- Sour cream (more than 1/2 c. per day)
- Nuts and nut butters
- Sourdough bread
- More than 1/2 c. of the following: figs, Alcoholic beverages
raisins, papayas, avocados, red plums, Broad, lima or fava beans
bananas, citrus fruits and juices
- Caffeine (coffee, tea, colas)
Remember, reactions to certain foods are highly individual,
so you may want to keep a food diary to identify those particular
items that cause you problems. However, some food allergy reactions
can begin up to 3 days after eating the food, so only a blood
test for food allergies can provide definite answers.
This way, you won't have to eliminate enjoyable and nutritious
foods if they are not causing you a problem. Also, you may be
able to tolerate caffeine if you limit your consumption to not
more than two cups per day.
Two nutrients that have recently received attention in as being
helpful in preventing migraines are vitamin B6 and magnesium.
Foods containing these important nutrients include green and leafy
vegetables, meats, fish, poultry, shellfish, legumes, fruits and
A regular program of low-impact aerobic activity complemented
by balanced strength and flexibility training will have a preventive
and therapeutic effect on both tension and migraine headaches.
In fact, some migraine sufferers have been able to avert an attack
by participating in a moderate aerobic activity that is part of
their usual workout routine. Be careful, though, since intense
activity such as running and racquet sports as well as activities
to which you are not accustomed can actually trigger or make a
A regular program of stress reduction is vital in managing tension
and migraine headaches. Here are a few techniques:
- Deep abdominal breathing--induces a state of peace and relaxation
and counteracts the shallow breathing that can often be induced
- Progressive relaxation--helps you discover and relax tense,
- Meditation--calms the mind and relaxes the body.
- Mindful activity--such as tai chi or yoga.
- Massage-- Why not treat yourself?