Getting Our Heads in the Game
People often disregard headaches because they are common and usually temporary. However, about 300 million people suffer from chronic headaches or migraines worldwide, enduring frequent and severe pain.
Migraines, affecting around 100 million people, are a more intense neurological condition. Both conditions are more prevalent in women.
Among those with acute headaches, 3–5 percent have chronic symptoms. It’s evident that headaches and migraines greatly impact many lives, which makes finding ways to improve their quality of life essential.
Headache Risk Factors and Comorbidities
As complex creatures, it is not surprising when an individual experiences an overlap between multiple conditions. Discovering patterns of common comorbidities and possible risk factors is how functional medicine providers work effectively for their patients.
If you pay attention long enough, you will learn that headaches and migraines can be associated with a broad array of other health conditions. Additionally, there can be many causes of chronic headaches. It is valuable to learn about these common causes, risk factors, and comorbidities.
Misinformation and confusion continue to stand in the way of effective and lasting relief for those who suffer from headaches and migraines.
Of course, correlation is not causation. However, where these patterns have been noted, we can learn about additional factors to look for and develop best practices for treatment protocols.
Additionally, headaches and migraines are so prevalent that misinformation and confusion continue to stand in the way of effective and lasting relief for those who suffer from them. This frustration may contribute to the overuse of over-the-counter pain relief medications or loss of hope.
Prolonged and chronic migraines or headaches have a deleterious impact on an individual’s overall health and sense of well-being, while functioning from a place of suboptimal health has consequences for the family and friends of the sufferer as well.
Head Trauma and Chronic Headaches
Possibly one of the most easily recognized yet least-understood types of chronic headache is those related to physical trauma to the head. Often, the severity of the head trauma informs the severity of resultant headaches. But there are times when a seemingly small bump on the head can cause particularly painful or long-lasting chronic headaches.
Persistent post-concussive symptoms, also known as post-concussion syndrome, are symptoms of a mild brain injury.
Concussions have rightly gotten more news coverage in recent years following the alleged cover-ups of long-term damage suffered by repeatedly concussed NFL players. But one need not be a professional athlete to experience a hit on the head that causes life-altering headaches.
Persistent post-concussive symptoms, also known as post-concussion syndrome, are symptoms of a mild brain injury. The most consistent symptom is chronic headaches for over three months; some patients also experience dizziness, nausea, fatigue, blurry vision, sleep disturbance, and more.
The idea that a hard hit to the head may cause lasting and frequent headaches is not a medical mystery. However, sometimes the pain seems out of proportion to the initial trauma. The only way to prevent chronic headaches resulting from trauma is to avoid the trauma in the first place, which might not always be possible.
Cervicogenic Headaches and Cervical Myofascial Pain
Functional medicine focuses on understanding the interconnectedness of the body, and cervicogenic headaches are one of the examples that exemplify this concept.
Cervicogenic headaches result from misalignments in the upper cervical spine and the related musculature. The spine is impressively flexible while protecting the spinal cord and allowing the brain to connect to the rest of the body through a vast network of nerves. However, like any fine-tuned system, the spinal column, as well as the muscles and fascia around the vertebrae, does not need to be far out of alignment to cause significant pain. Even mild misalignments can create considerable and compounding pain over time.
Cervicogenic headaches result from misalignments in the upper cervical spine and the related musculature.
Some patients may note frustrating muscular pain around the upper spine extending from the upper back through the neck, but this should not be confused with jaw pain common to temporomandibular joint (TMJ) dysfunction. Because some chronic headache sufferers have a misalignment in their spine along with stress and TMJ pain, cervicogenic headaches are often mistaken for or lumped in with tension headaches despite having a distinct physiological cause.
Certainly, the overlap between tension headaches and headaches resulting from cervical myofascial pain and dysfunction may intensify the discomfort and frequency of both.
Stress, TMJ, and Tension Headaches
Few adults around the world could honestly declare their lives to be completely free of stress. Yet not everyone experiences stress or tension headaches. Similarly, all of us have temporomandibular joints, but not all of us experience temporomandibular joint disorders.
Continual pressure exerted through the musculature of the face and jaw leads to several symptoms, along with headaches.
Temporomandibular disorders (TMDs) encompass around 30 distinct dysfunctions of the TMJ, and as a group of disorders, they are well-known for causing headaches. The jaw clenching common to feeling significant anxiety easily contributes to bringing on nasty headaches that are widely considered to be the most common headaches plaguing people.
Whether it is due to a TMJ disorder or jaw clenching, the continual pressure exerted through the musculature of the face and jaw leads to several symptoms—pain radiating through the face and down the neck, changes to bite alignment, clicking of the jaw, and restriction of movement in the jaw—along with headaches.
Among the most common types of headaches, tension and TMJ headache treatments still mainly consist of mouth guards and medication, to varying degrees of success.
Thyroid-Related Headaches
Often overlooked in discussions of headaches, thyroid-related headaches are a symptom of dysfunction or disease in the thyroid. Both hypothyroidism and hyperthyroidism can cause substantial discomfort by way of headaches, sometimes even moving beyond typical headache and into the set of symptoms we know as a migraine. It may begin with a dull pulsing or throbbing sensation that may seem like a typical tension headache, but when auras, nausea, and vomiting set in, thyroid-related headaches attain a new level of pain and frustration.
Fortunately, this type of headache is gaining some recognition, and more medical practitioners have learned to look for other signs of thyroid dysfunction.
Thyroid-related headaches are a symptom of dysfunction or disease in the thyroid.
For many people struggling with thyroid-related headaches, the successful treatment of the underlying thyroid disorder is the key to eliminating these types of headaches. When the thyroid is well-managed, the headaches abate.
Furthermore, thyroid-related headaches can function as a canary in a coal mine, effectively signaling when the patient’s thyroid levels have changed and need to be checked and treated.
Migraines and Vascular Injury
Migraines are uniquely dangerous, both in the direct impact they have on the immediate well-being of the one who suffers from them and the ongoing damage they cause.
The vascular system is susceptible to injury from many sources, and migraines are one of them. There are significant changes to vascular function during a migraine as blood vessels undergo atypical dilation and constriction. (Most migraine treatments impact this as well.)
The vascular system is susceptible to injury from many sources, and migraines are one of them.
Given this, it is not surprising that migraine sufferers have a higher risk of stroke, especially when the sufferer experiences auras or other visual disturbances. Additionally, those with chronic migraines have higher rates of hypertension, diabetes, and hyperlipidemia.
The link between migraines and the vascular system makes it clear that managing migraines may literally save the life of the migraine sufferer.
Migraines and Brain Injury
As often happens in medicine, there are times when it is nearly impossible to differentiate causation from correlation. When it comes to migraines and the considerable link to neurodegenerative disorders, experts continue to debate whether or not chronic migraines cause neurological disease.
The facts that remain undisputed are that over 75 symptoms and conditions are comorbidities with migraines, and chronic migraine sufferers have higher rates of Alzheimer’s, Parkinson’s, and dementia, with women being more affected than men.
Over 75 symptoms and conditions are comorbidities with migraines.
Some doctors argue that migraines cause ongoing brain injury that is a precursor to these neurodegenerative conditions. Others claim that chronic migraines should function as a red flag to indicate that the individual and their healthcare provider should be on the lookout for these issues.
Are migraines causing brain damage or simply signaling that the damage is there and the resultant conditions are lurking?
Deepening Your Understanding of Headaches and Migraines
The prevalence, variety, and potential impact of chronic headaches and migraines require that functional medicine providers take the time to gain an understanding of how best to treat patients suffering from these issues. We must learn to recognize different types of headaches and what they might mean for our patients’ current and long-term health.
Taking time to understand the full systemic impact of headaches and migraines is key to helping our patients manage—and even eliminate—this form of suffering from their lives.
If you want to deepen your understanding of chronic headaches, sign up for Dr. Datis Kharrazian’s course, Headaches, Clinical Strategies, and Treatment Applications. Dr. Kharrazian has been working with chronic patients suffering from debilitating conditions, including all forms of headaches, for over 25 years.
In this course, he will break down the complex pathophysiology of conditions like migraines and various forms of headaches into simple steps so you can understand their specific mechanisms. He will also teach you a step-by-step approach to how to ask the right questions, order the correct labs, and develop a personalized approach to managing patients suffering from chronic headaches.
