Roby Institute - Advanced treatments for a healthy living
Austin Headache Treatments
All headaches have one thing in common. Pain. The pain must have a cause; there must be a reason why the brain tells the person there is pain. There are basically two ways the perception of pain can be triggered:
- Nerves in the brain are stimulated by excitation from within themselves.
- Tissue around the nerves causes the excitation.
Regardless of which of the two mechanisms is involved, the perception is of pain. The pain can be very sharp: “I feel like there is an ice pick stuck in my head.” The pain can be very clearly localized: “right here over my left eye.” The pain can be all over: “My whole head hurts.” Or it can move from place to place: “It starts here over my left eye and then it goes over the top of my head and settles into my neck.” Whichever pain you experience, it can cause or be related to an amazing number of secondary symptoms. The most common secondary symptoms are nausea, visual disturbances, and numbness or tingling. Other less common side effects include almost every imaginable body ailment. The list includes:
- Hearing loss or increased sensitivity
- Smell disorders
- Soft tissue swelling (throat closes, hands and feet swell)
- “Gut” problems
- Breathing problems
- Heart problems
- Cold hands and feet
- Constipation or diarrhea
Pathways to Headache Pain
There are two pathways to pain. For the sake of illustration I will refer to the two pathways as direct and indirect.
Direct pathways to pain involve excitation of the nerves that lead to the pain perception areas of the brain. Certain groups of nerves and nerve fibers convey signals from all areas of the body to the pain perception area in the brain. These nerves can be fired or excited anywhere along the way. If I burn my finger the pain is perceived in my brain and the entire nerve from finger to brain is excited. In normal people, the exact area of the pain can be perceived with no chance of error. In the case of fingers, lips and a few other sensitive areas, we can be quite precise as to the location of the pain when it is perceived by the brain. In some other less sensitive areas where there are fewer nerve endings it is much less clear where the exact location of the pain is.
For instance, in the case of early appendicitis, it is common to feel the pain in the left upper portion of the abdomen just below the heart when the inflamed appendix is really many inches away in the lower right quadrant. It is only in the last stages of the attack that the pain finally localizes and is perceived to be in the actual area of the appendix. Doctors call this “referred pain.” In the same manner, early in a heart attack, the pain is often perceived by the patient to be, “going down my left arm.”
These examples help us understand that the pain we feel or perceive in our conscious awareness is not always where it seems to be.
The area of the brain that perceives pain makes us clearly conscious of the pain, but is much less clear about where, and especially how much, pain there is.
It will help us understand why headache pain can be such a fearful and devastating force if we consider how much pain a person feels. Severe headaches can be so painful the patient will literally do almost anything to relieve the pain.
Sedating doses of narcotics in hospital emergency rooms are often needed to relieve the pain. Some cases of headache pain have been so severe and so persistent that the patients committed suicide to relieve their suffering.
In early centuries doctors treated severe headache pain by drilling holes in the patient’s skull. This method of treatment, called Trephine, was apparently moderately successful because we can tell from the skulls that some of them “recovered” from the surgery. We can also tell that either the early patient or the early doctor must have seriously believed that it helped because some of the skulls show several healed trephine holes. This illustrates the lengths that some are willing to go to in order to relieve severe headache pain.
Headache pain often seems limitless. I was in a head-on car wreck in England a few years ago. My left lung was collapsed, my nose was split in two, seven ribs and my breast bone were fractured, my leg was broken in three places, my kneecap was fractured, and my right thigh was driven right out the back of my pelvis, which was shattered into several small pieces. But did it hurt? Not that much. I have had headaches that hurt a lot worse.
Severe body pain seems more easily tolerated than severe headache pain. Bad headaches make people want to scream in agony. Serious injury, even the pain of childbirth, can be dealt with fairly calmly in most cases.
Why? What’s the difference in the pain? Why can massive physical injury be borne stoically, while a severe headache can make grown men and women cower in darkened rooms?
I think the reason has to do with limits. When I was in this car wreck I could see the damage, assess the pain, and, with a moderate amount of pain medication, get myself on a plane and travel two days home for surgery. A headache, on the other hand, has no limits. There is no injury we can view and assess. When a headache begins we never know where it will go, how severe it will be, or how long it will last.
My crushed body told me early on just where it hurt and precisely how much pain there was present. The pain never moved and it was as steady as a rock. I quickly learned all about it and I knew I could handle it. I knew this because I knew all about this pain. For instance, if I didn’t move in certain ways, I could stay very still and experience almost no pain. I could also look at the steel pins driving through the bones and wonder, “shouldn’t this hurt more?” I would ask my knee, “How much pain is there?” and my knee would reply, “two units.” My pain was controlled by moderate pain pills.
In contrast, a headache cannot be viewed and often has no limits. The patient knows the range of possibilities and their previous experience tells them their headache “range.” For example, if in the past the worst headache they had was a “10″ and the mildest headache they had was a “1,” they know that any headache will probably fall somewhere on this scale.
Unfortunately, many headaches patients find they reach a steady state where a large number of their headaches quickly escalate to the 10 level. In this case, it is just a question of how long the headache will last. Even in this respect they know from experience a little of what to expect.
Often, the severe headache is unwittingly escalated by the patient. Since this pain is “in the dark” and the “injury” cannot be viewed and assessed like a broken bone, the patient continues to “query” the pain. The patient first notes pain, say at level 1 on their scale of 10. Immediately the patient becomes alarmed and vaguely uneasy. There is no way to know where this headache will end. Perhaps the patient has plans with their family for the next day. “Will this be one of my three days in bed headaches?” they wonder. So the query goes out again to assess the pain. The first signal of 1, which initiated the awareness of the headache, is now joined by a second signal, also of level 1 intensity. However, now there are two signals, so the headache seems to be gaining in intensity and the patient feels like the headache is getting worse.
Increasing fear and anxiety cause adrenaline to be released. This heightens the strength of nerve transmission so that now the signals of 1 are each boosted to their maximum intensity, allowing the patient to fully appreciate and feel the two units of pain. Of course, the next step in the sequence is a further query, which is responded to by two additional units along collateral pathways repeating the original two. Now, the patient is experiencing a level 4 headache. The obvious conclusion is that the pain is getting worse. Clearly, the logical extension of such a process would be a fairly rapid escalation of headache pain from the initial level 1 to the maximum level 10 headache.
This scenario is exactly what I frequently see in my patients. Some of the best evidence to support this lies in the experience of many emergency room physicians, family doctors, and neurologists who know that at the 10 level of pain, about the only thing that can be done is to knock the patient out. So they do this …literally. The patient is given an injection of a large amount of narcotic (such as Demerol) with a rapid-acting tranquilizer (such as Valium) in varying combinations at a dose calculated to knock the patient out for a short period of time.
If less medication is used and the pain is merely diminished, the headache will be more likely to persist and return to full intensity as the medication wears off. If, on the other hand, enough medication is used to interrupt the “query- pain-query” cycle, the patient becomes completely pain-free and remains so because there is no longer any pain to query.
Anything that heightens sensory awareness also tends to increase our appreciation of this type of pain. This explains why patients do better when the fear and anxiety can be avoided, thereby causing less adrenaline to be produced. Patients who have a good relationship with their doctors and who are assured that at some point relief is ultimately available do better.
Patients intuitively learn to avoid sensory stimulation and seek out dark, quiet, restful settings. Frequently they try to knock themselves out, knowing that if they can get to sleep, they will awaken without the headache. Patients use tranquilizers, alcohol, pain medication, etc., in their efforts to interrupt the cycle of pain or even knock themselves out or numb themselves.
Usually, these types of headaches are a result of direct stimulation of nerves to the “pain appreciation center” in the brain. Later, we will explore some of the possible causes of this type of direct stimulation.
The second type of pathway to the brain is indirect. These pathways are the result of pressure.
Most of the headaches I see in my allergy practice are from swelling, which leads to increased pressure on some areas of the brain. In fact, almost all allergy symptoms are, to some extent, related to swelling.
When people have tonsillitis they notice a swelling in the throat and on the sides of their neck just under the jaw. This is the drainage area or collection center for the debris from the cells involved in the defense of the infected tonsils. When our bodies mount a defense against bacteria or viruses, our defender cells attach themselves to the invading organism. This forms a relatively heavy particle called an antigen-antibody complex (ex. “AgAb”). The relatively heavy molecular weight of the AgAB complex causes it to move out of the of the vascular space, or bloodstream, into the tissue space, or soft tissue. Nature does this marvelous trick to slow down the “invader.” Once it is locked up in the soft tissue space, “killer” cells (mast cells or phagocytes) slowly find their way to the invader now securely locked in the embrace of a “defender,” and the “invader” is destroyed. That is how our body is supposed to defend against bacteria, viruses, and some toxins.
The tissue may also release other chemicals (such as histamine) to help hold the invader in place by causing more swelling or inflammation. Since the body is astoundingly complex when one area is under what seems to be an attack, other areas also seem to get the signal and we start responding throughout our bodies.
So, when we are under attack by bacteria in the tonsils we see antigen-antibody complexes formed and swelling (or inflammation) taking place in that local area. However, we may also feel feverish or achy in many other areas not specifically involved in the defense of the tonsils. This is due to the complex communication which seems to warn all our defense systems throughout the body when one part or another is the specific target. This whole process is the function of one of our most basic and yet advanced systems: The immune system.
Over the years of human development, we have evolved a marvelous system of defense. When we are under attack from the outside (bacteria, viruses, toxins) or the inside (cancer, defective cells) we have defender cells and inflammation to localize the invader. But this very defense can cause swelling, which leads to other problems.
CAUSES OF HEADACHES
Causes of migraines, sinus headaches, and temporal headaches are similar. Since all of these headaches are a result of swelling, we look to the causes of the swelling elsewhere in the patient.
Every patient is different and they all swell more in some areas than others. Those who swell mainly in the nose area have congestion and sinus infections. This is probably the most common type of swelling I see. If the ear tubes swell we see repeated ear infections, especially in young children. Some people have swelling in the lips, tongue, hands, feet, and some the throat, making swallowing difficult. Patients may also experience stiffness and joint pain.
Many of my patients swell in the intestines and this causes bloating and constipation. Frequently there is swelling in the urinary tract as well. This seems to be a urinary tract infection, or bladder infection, but may well be the same symptoms simply caused by swelling of the mucous membrane that lines the urinary tract.
All of these people, and all of my patients, have one thing in common… they swell somewhere. When they get allergic to airborne things like pollen and mold they begin to swell in their noses and they drain mucus down their throats. The mucus causes an acid stomach, and the acid stomach causes unusual food reactions, and the patient swells.
While different patients swell in different places, they all have some swelling to the brain. In almost every patient this swelling causes what I call the symptoms of “brain allergy.” These are the most common and universal symptoms of all the patients:
- Loss of short term memory
- Mood swings
If the swelling in the brain is severe, we see painful headaches and other neurological symptoms. In its most severe form I see seizures, loss of consciousness, violent mood swings, depression, and MIGRAINE headaches.
What are the causes of brain swelling? Well, obviously anything that makes any other part of us swell can also cause the brain to swell. For the culprit, we look for things in the air and things we eat and drink, and in particular we look for allergic reactions to “boy” hormone in ladies — PROGESTERONE.
How can one tell if allergy causes swelling and headaches? The simplest experiment is geographical. See if the symptoms are the same when you are out of town or out of state. Most of my patients feel better when they go 50 miles, in any direction, away from Austin. So then you ask, “Am I better when we’re gone on vacation, or is it in my house?” To determine this we have the patient stay in a new, non-smoking section of a high-rise hotel. If they are better in the hotel we see the problem may be in the home itself. Next, we have the patient sleep in a different room in their house (close to ducts, hard floor, different bed and pillows). Often, a bathroom with a tile floor works, or a non-carpeted room where the air conditioning ducts can be blocked. If any of these measures help I make specific suggestions on how to deal with these problems. Some of the things that help include:
- Electrostatic air filters
- Ultraviolet- C mold light
- Hard floors
- New pillows
- Duct cleaning
- Designing and building an “allergy-free” home
- Room air cleaners
- Sealants for walls, floors, and ceilings
- Steam cleaning carpets and drapes
- Moving to Hawaii
For severe headaches, these environmental measures may not give complete relief. If this is the case, we begin to explore some of the contributing causes of swelling.
All females swell during hormone cycles. I frequently find an irregular or unusual menstrual pattern in my headache patients. They started early or late, are irregular, or had some other menstrual problem. PMS is quite common and, in fact, is itself simply a result of monthly swelling. Many of my patients found their headaches or other allergy symptoms got much better (or much worse) when their hormones were higher during pregnancy. Some of my patients stop having migraines after hysterectomies. In others this makes them worse. Many of my patients have increasing allergy symptoms when they first begin to become premenopausal. This happens to some in their mid-to-late thirties, and to many in their forties. These women often notice subtle signs of hormone changes in their hair, skin, and nails. When they ask their doctors about this, they are often told their hormone levels are normal. Unfortunately, the tests we use often do not reflect the real effect of a diminished hormone level in a woman who still has a “normal” level but who has dropped from a previous “high normal” to a current “low normal” and feels terrible. In almost every female patient I see, who is between the ages of twelve and sixty, hormones are a significant part of the problem.
In a recent textbook, Endometrium & Endometriosis, Diamond, Michael P. (1998), several possible causes of endometriosis are set out. One of the more interesting involves the possibility of an allergic reaction to hormones themselves. I have prepared a diagram of the possible symptoms and causes of many disorders related to the interaction of hormone allergy, hormone imbalance and hormone deficiency.
After things in the air, the next area I explore is diet.
Two thousand years ago Socrates wrote, “One man’s food is another man’s poison.” The medical doctors of that time made a patient fast for five days as part of most medical examinations. Frequently, the patient’s symptoms would stop. I find that anytime my patients are having allergy symptoms, food is often part of the problem. It is unusual for food to be the only cause of a problem like headaches, but it does happen.
Once in a while a patient will tell me, “Every time I eat dark chocolate I get a migraine.” Obviously, if chocolate gives them a headache, they have to decide if it is worth it. For some people it is. Alcoholics have had sick headaches and hangovers for years and still have been unable to stop drinking alcohol.
Headaches caused by food are similar in that patients become addicted to the very foods that cause their headaches. The difference is that most headache patients would gladly stop eating the foods or drinks that caused the headaches if only they knew which ones they were. Determining this can be especially difficult because it is often more than one food. The headache can be caused by a combination of foods, and this is further complicated by what is in the air and by hormones.
For example, if there is a high mold count one rainy Friday, and it’s the end of a woman’s cycle, and she goes out for pizza and red wine, she might get a killer migraine. Maybe it takes the combined swelling effects of all three at once to cause the problem, or it could be just one thing that affects the patient.
How can you find out if you are reacting to food? The first thing to do is keep a record. My patients are so frustrated in their failure to get help with their headaches that they have trained themselves to ignore them in the hope that they won’t get too severe. As a result, they really can’t tell me much about their headaches except that they get them. In order to find the underlying cause of their headaches, patients must first turn the telescope around and make it a microscope.
I find that the patients who get the best results keep the best records. We give patients a record sheet form that gets the most basic information we need. It includes on a daily basis, morning and evening weight.
Weight is the best laboratory test for allergies. When a patient eats something they are allergic to they swell. This swelling is entirely due to water retention. As a result, your best indication of an allergic reaction is a sudden weight gain of two to 10 pounds overnight! When my patients see this type of increase they know this is their earliest warning of swelling. If it is allowed to continue or isn’t dealt with, their allergy symptoms (asthma, headache, etc.) will probably begin in the next 24 to 48 hours.
Next, the patient is asked to record everything they eat and the precise time. Then they are asked to record how they feel when they wake up, before and after every meal, and at bedtime. They also list the medications and vitamins they are taking and exactly when they take them. The more details the patient can give, the easier it is for me to spot the clues that help solve the mystery of what causes the patient’s headaches.
Click here to open a printable full page version of a sample record.
Using this record each day, you can track how you feel (0= dead, 5-6= mild symptoms, 7 or better= symptom free with increasing levels of energy with 10 being the best you have ever felt). Record this number “grade” on the graph at the bottom upon arising, before and after every meal, and before you retire every evening. Also record what you eat, and when, on this chart. Finally, weigh yourself each morning and evening and record this data also.
From the beginning, I assume that part of the problem is what the patient is eating at the time of the headache. Since we are all creatures of habit, this is pretty upsetting to new patients. The most common foods that people react to are included below in what I call the “list of eight.”
- Dairy Products. Milk, cheese, yogurt, ice cream.
- Citrus Fruits and Juices. Orange juice and fruit, grapefruit, lemon and lime.
- Tomatoes and Tomato Products. Tomatoes and tomato juices, sauces on spaghetti, lasagna, pizza, hot sauces, and ketchup.
- Brown Colas. Coca Cola, Dr. Pepper, Pepsi Cola, Etc.
- Chocolate. Candy bars, chocolate milk and drinks, chocolate in any form.
- Grains. Wheat, barley, oats, and especially corn. So, no chips, bread, cereal, pasta. No grains of any kind.
- Sugar. This is a big one. Sugar includes candy, sweets, table sugar and soft drinks (diet soft drinks are okay). Sugar makes us swell and that aggravates allergy swelling. No fruit juices either, as they are very high in sugar.
When I suggest to a new patient that they should avoid these eight foods in the first five days of their treatment they frequently look to me in genuine amazement and ask, “But what will I eat?” I can understand this, as I too have settled into a routine in my diet and I pretty much eat the same things week by week. But, I no longer have serious allergy problems.
Even today, I drink a lot of skim milk. But in January when the cedar hits, one glass and my nose stops up. Two glasses and my chest gets tight, I feel flushed, and my pulse rises to about 130-140. I haven’t tried a third glass. In March however, I’m back to half a gallon a day.
At any rate, experimenting with food is simple and safe. I have all my new patients change their diet, avoid the eight foods, and avoid anything they crave.
I also have patients identify and avoid any foods that make them feel good or make them sleepy. Foods are not supposed to make us feel differently. If they do, this is because they are having a drug effect and certainly should be avoided.
One of my patients began looking concerned when I suggested to her the food restriction experiment. As she looked over the list of eight foods to avoid she began to smile and appeared greatly relieved. “This won’t be too bad,” she said, “it doesn’t say anything about peanuts.” “Do you like peanuts?” I asked. “Oh yes. I eat about a pound of Planters Peanuts every day.”
Well, we obviously needed to see if that was part of the problem. When there is a deep emotional attachment to a food it is often an allergic one we are addicted to. Sure enough, she went off the foods (including peanuts) for five days. I told her to eat whatever she missed the most on the sixth day. She naturally chose peanuts and her headache occurred within minutes and was one of the worst she had ever had. She no longer eats peanuts.
Most, but not all, of my patients agree with me when I say, “I feel best when I don’t eat.” If this is the case your headaches may be caused in part by swelling as a result of food reactions. This simple food restriction test can tell you, in five days, whether foods affect you or not.
There are of course, other contributing factors.
Stress and anxiety play a major role in allergy symptoms.
Physical problems cause many of us to move our bodies less and less, especially as we get older and busier with family and jobs. However, I find that about half of all swelling can be relieved by simple physical movement. Any kind of physical movement helps. Walking is probably the best. Thirty minutes every day is quite helpful in preventing or reversing swelling. One hour is really great and anyone who can exercise two hours a day will not have much swelling and allergy.
I consider treatment and recovery a five step program which includes:
- Appropriate medication (including vitamins & minerals)
- Clean-air environment
- Non-allergic diet
- Physical movement
- Positive spiritual attitude
Number five is the most important, followed by the exercise of number four. After you get these two in order, the rest is easy.
Click for a printable full page version of the Daily Record.
* This treatment is not approved by the FDA