Headaches and Migraines
Some key facts about headaches and migraines:
- 85% of the population will have experienced headache within one year.
- 38% of the population will have had a headache within two weeks.
- 40% of children will have experienced more headaches by the age of seven.
- 75% of children will have experienced one or more headaches by the age of 15.
- Drug induced headaches are relatively common
-aspirin and codeine
-blood pressure medicines including beta-blockers and calcium channel blockers
Age-related causes of headache and migraine
Children: infection, stress, migraine, meningitis. Headache in children which is present first thing in the morning or which wakes a child at night.
Adults and people in middle age: migraine, cluster headache, tension headache, neck vertebrae related/cervical dysfunction, combination headache (typically a tension migraine with characteristics of both tension headache and migraine)
Elderly people: Neck/ cervical vertebrae dysfunction, cerebral tumour, temporal / giant cell arteritis, neuralgia, Paget’s disease, subdural haemorrhage.
By the time you are reading this page you will have been investigated by your GP and or consultant and, almost certainly, will already have had a trial of a headache treatment.
So you will be finding that the treatment is not working for you and, usually, you will have become aware that you need to dig deeper and look for possible causes of your particular headache / migraine
So what do I do when I meet a patient who has a life- wrecking headache?
First of all take a complete and thorough medical history.
I really emphasized to patients:
- Do not think in black and white terms about possible causes of headaches.
- Do not get fixated on just one possibility otherwise we will lose a lot of diagnostic time -
- Do look for multiple causes and try to join the dots as much as possible.
Think very broadly about possible trigger factors including, but not limited to, the possible combinations of causes listed below:
Think magnesium deficiency:
One of the common causes which I see for headaches in adults is magnesium deficiency. Then when I mention possible magnesium deficiency I may be told:
" I have already tried magnesium". But what this statement really tells me is that I need to be thinking about : how can it be that this person is taking a decent magnesium supplement but still has a lot of symptoms of magnesium deficiency? In other words: why is this patient not absorbing magnesium properly.
Think Hormonal scarcity or imbalance:
Let's carry this on a little bit: as well as having symptoms of magnesium deficiency, this imaginary patient is female aged 38, and always gets headaches coming up to a period - then maybe we need to assess and think about oestrogen and progesterone relationships.
Think possibly unrecognised perimenopause or menopause:
These conditions may go unrecognised sometimes over several years
Think subtle unrecognised sinus infection:
All just because an individual has a 'normal' CT or MRI of his or her sinuses I will not necessarily be convinced that the sinuses might not be playing a part.
Think chemical sensitivity:
Some headache patients may present with chemical sensitivity - very sensitive to perfumes, smells , chemicals, modest amount of alcohol. This suggests that perhaps the liver detoxification biochemistry may not be working well.
Think: Might the person's liver not be detoxifying efficiently?
Think: Might there be a significant food intolerance ?
Is there a fungal infection which is already overloading liver detoxification pathways? Interestingly individuals with fungal infection may remark, regarding alcohol. "Oh I really am rubbish with wine or beer but I am not too bad with spirits such as gin" Testing for fungal toxins is via the urine.
Could there be a chemical overload? Nowadays we can do quite reliable testing for chemicals just using a urine sample.
Could there be some kind of persistent infective or viral situation :
Maybe history of glandular fever in the teens, maybe a history of some mysterious type of flu that took a long time to go away but still seems to "come back " every now and again - maybe even more now than again. Another scenario for this might be someone with lyme disease who also now has high levels of fungal toxins secondary to long-term and repeated use of antibiotics.
Could there be a persistent, low-level gastrointestinal infection?:
This might be producing bacterial toxins and possibly overloading the liver?
Think: Methylation chemistry status : How efficient is this persons methylation chemistry?
If this individuals methylation capability /capacity is not up to par then detoxification will be sub-optimal and also their serotonin levels may be a lot lower than desirable ( this is sometimes the person who feels absolutely 'yuck' during the dark, dreary, days of winter).
So: to make a long, long story very, very short
My approach to headache is: use the medical history and investigations to construct a 'mind map' type of approach to investigation and treatment. In other words try, insofar as it is possible, to work out the exact chain of events which is occurring in this patients biochemistry and treat the specific problems rather than just hammering the patient with a huge load this or that prescription medicine or this or that supplement and hoping for the best.