Headaches, ST/CD, and YOU!
There is not a single problem more complex in medicine than that associated with headaches. Headaches are the single biggest statistical complaint that causes people to go into their doctor’s offices. More time and money have been spent on this single common condition than many more rare diseases such as cancer. Yet, today we still have no cure for the common migraine or headache (nor the common cold, the flu, etc). They are the single biggest statistic for emergency room visits as well as the most common complaint for calling off work. It is estimated that several billions dollars are lost each year due to productivity loss due to the complaint of headache. There are some reports that 80% of the population has some sort of recurring headache of one sort or another.
We cannot in the space of a few short words go into the massive amount of information that exists regarding headaches. Of course, what we discuss here is by no means a substitute for the discussion that you should have with your doctor, should you suffer from headaches.
There is a spectrum of headaches from mild ones to the knock-down drag out migraines that some people experience. There is a classification of headaches that is designed to help with research, but for many of the patients the various treatments crossover using a wide variety of medications, injections including our old friend Botox®, manipulations, massage therapy and some biofeedback.
There are questionnaires that are occasionally helpful and some potential foods that may prompt various headaches. Keeping a headache logbook of when you have your headaches and rating how severe they are is sometimes extremely helpful. For women, documenting on a calendar their menstrual cycle and their headaches can be very helpful. Even after menopause the headaches may still cycle just as they did before, however the cycles may be drawn out further and further in time. The worst headache of someone’s life is still more statistically likely to be a migraine than anything more serious like a tumor or an aneurysm. However, it still needs to be checked out!
Remarkably, the inner portion of the brain itself has no feeling. It cannot feel pain when something is happening to it. This part is not for the squeamish. In the 2001 movie “Hannibal”, Anthony Hopkins as Hannibal Lecter (also an M.D., ha, ha, ha!) prepares Ray Liotta’s character’s brain with a butter sauce. Ray Liotta even sits there and tries a little for himself!
However, there are many sources of headache itself. There is a fine meshwork of nerves specifically surrounding bone and blood vessels that help determine if, for example, there is an injury. There is also a network of nerves within muscles and tendons. If acutely or chronically something aggravates these nerves then the result is sent back to a processing location in or out of the brain and a headache may result.
There are lots of distinctions between the various types of headaches including but not limited to headaches versus migraines; acute versus more chronic daily headaches; headaches with or without auras; and headaches with or without triggers. There is new information that smokers are more prone to headaches and headaches may put one at risk for stroke! Longstanding sinus headache sufferers may be having migraines due to the sinus disease. This is all the more reason to get a handle on this headache situation.
So if for some reason there is some pulling or tugging on a:
- Cranial nerve
- Meninges (covering of the brain)
Then you may be likely to suffer from a headache.
There are actually a very small number of conditions where one may have the worst headache of their lives and it may be life-threatening or life-altering. Some of these include meningitis of various causes; or subarachnoid hemorrhage from head trauma or a rupture of an aneurysm. We are now aware that aneurysms do run in families and recommendations are if you have someone who was seriously affected by an aneurysm or even perhaps died, then all members of the family should have a screening test of a MRA (magnetic resonance angiography). This is a finely sliced MRI of the brain that is put back together by the computer looking for any type of an aneurysm, without the need for the more traditional angiogram and the dye load that is sometimes a problem. The test takes approximately one hour and has been known to save peoples lives.
Now how does all this headache business relate to you if you suffer from ST/CD? Let’s take a few examples to demonstrate how this might occur.
- A ST/CD patient suffers from a degree of lateral collis with their head significantly tilted to the one side. This puts their eyes on two different levels from one another. Glasses do not necessarily help. The chronic eye strain will give them some headaches.
- A ST/CD patient suffers from a degree of retrocollis with their head tilted backwards and have done so for a number of years. There may have been fibrosis and bone spurs that have developed over the years. Gradually as time progresses the little openings of bones where the nerves come out of the neck are reduced in size. As the nerves are gradually “pinched” off, there is often the development of pain which can predispose to headaches.
- A regular person (of course, this let’s out someone with the initials H.T.) whether they have torticollis or dystonia and they develop a severe degree of arthritis of the neck with the bone rubbing directly on bone. Recall that there is fine meshwork of nerves covering most bones of the body. When these bones rub together they will irritate their nerve coverings and in the neck we usually experience a headache.
- A ST/CD patient may have a complex for of torticollis or cervical dystonia with a group of very pronounced muscles many have which have gotten larger with time. This unusual form of exercise has made the muscle bigger in a location that was not meant for it to have reached that size. This may put pressure on the tendons of the muscle or stretched the nerves within the muscle to the point that they get cranky and let the patient know. Voila! Headache.
Therefore, the number of different causes of headaches can be quite varied. Most of the time the patient’s affected just wishes for some relief. However, for an acute whalapaloosa severe headache get to the emergency room to be evaluated ASAP. For the more chronic nagging perhaps daily headaches please discuss them with your doctor at the next available opportunity. There are a number of different tests that need to be run.
“Hannibal Lecter: A census taker once tried to test me. I ate his liver with some fava beans and a nice chianti.”
My mom and I wanted to thank you for hosting such a great symposium this year. This was our third year and we are looking forward to next years. E. Mathews