The likelihood of a headache increases during the summer months. According to a recent study which surveyed ER visits for headaches, every 9°F rise in temperature increased a person’s short-term risk of a headache by about 7.5% before their emergency room visit. Heat, dehydration, weather changes and barometric pressure changes are the primary drivers of headaches during the summer months, but some lifestyle factors, such as the foods we eat during the summer, can also increase the risk of headaches.
Heat, Headaches, and the Weather
During the summer months, heat can be a contributor to both headaches and migraines. In certain areas of the country where barometric pressures can change suddenly during a storm, people frequently report headaches. This is a common and classic migraine trigger. Sometimes a headache may be caused by heat exhaustion, which has the following associated symptoms:
Dizziness
Muscle cramps or tightness
Numbness in the face and neck
Fainting
Nausea or vomiting
Cold, clammy, pale skin
Fast and weak pulse
Weakness or tiredness
Drenching sweat
Extreme thirst
For a summer headache that is not related to heat exhaustion, your symptoms may only include a throbbing or dull achy sensation in your head, fatigue, sensitivity to light, and dehydration. If you do have heat exhaustion, it is best to seek medical help because heat exhaustion can lead to heat stroke.
Relief for Heat and Weather-Related Headaches
For people prone to headaches and migraines triggered by heat, there are some ways to mitigate them. It might be wise to limit outdoor times on hotter days. Sunglasses, a hat, and sunscreen can also help. If you need to exercise, try to stay indoors in an air-conditioned environment. Sports drinks that contain electrolytes and plenty of water will also help you stay hydrated. If you already are suffering from a heat-related headache, certain essential oils, cold compresses, iced herbal teas (without caffeine), and NSAIDs can help reduce the intensity of the headache.
Exercise and Summer Headaches
Heat and exercise are often a combination of conditions for a headache, but if you choose to exercise, there are certain things that you can do to avoid getting a headache. Generally speaking, it is understood that when a person exercises, the blood vessels within their skull dilate. If you participate in strenuous activities, like rowing, running, weight lifting, or team sports (like baseball, softball, or volleyball), these can contribute to a headache.
Avoiding activities like these in high heat is advisable. However, another way to avoid headaches related to exercise is to develop a set of warm up exercises, which can help prevent headaches. Some good warmup exercises include stretches, followed by some light jogging and walking.
The Importance of Staying hydrated To Prevent Headaches
As a rule of thumb, people have generally learned that you should drink at least eight 8-ounce glasses of water each day. That is about two liters. However, during hot summer days when you are active, you might need to increase that to about 2-½ liters. When you are dehydrated, the brain can shrink and this causes the brain to pull away from the skull, causing a headache. When you relieve your dehydration, the brain returns to a normal state, relieving the headache.
Pollution, Allergens, and Summer Headaches
During the summer months, there are also other factors, like pollution and allergens, that can lead to headaches. Various air pollutants tend to increase during the summer months due to more people traveling and there being vehicles on the road. Lead, carbon monoxide, nitrogen dioxide, sulfur dioxide, and particulate matters all increase during the summer months and can cause headaches. Headaches that are related to pollution are often intense, sometimes leading to the point of being disabling, because they are often migraine. Pollution irritates the lungs, eyes, and triggers what is sometimes a very intense headache.
Allergy headaches have unique symptoms. Sometimes a person may experience pain localized over the sinus area and some other facial pain. More intense headaches can be throbbing and one-sided and sometimes are accompanied by nausea, and these are more likely to represent migraine.
Foods and Headaches During the Summer
More people typically barbecue and picnic during the summer months. Certain “summer foods” can trigger headaches. For example, hot dogs can potentially trigger headaches because of nitrites. Nitrites are generally present in some foods in very small quantities, but sensitivity will vary depending upon the person to this chemical. Processed meats like salami and bacon also can contain varying levels of nitrites. In this situation, it is best to substitute processed meats for something like a salad. Even the condiments that you put on your food can trigger headaches. Instead of pickles, you might want to consider swapping them for fresh vegetables on your burger. Avoid aged cheeses and try fresh herbs instead of soy-based condiments. More detailed discussion of migraine triggers can be found here.
Sunburn and Headaches
Generally, when we get sunburn, we think nothing of it and it goes away within a few days. However, sunburn can be more severe in certain types of situations. When swimming, sunburn is often more intense if you don’t use sunscreen. Sunburn can happen relatively quickly, within just 10 to 15 minutes of sun exposure. Some of the symptoms that you can get with severe sunburn include:
Tenderness and blistering of the skin
Pain and tingling sensations in the burned area
Headaches, fevers and chills
Nausea, dizziness, and dehydration.
The type of headache that accompanies a severe sunburn can sometimes feel like exhaustion and will often cover the entire head. To relieve a sunburn headache, cool/cold treatments can often help alleviate the intensity, including cold compresses, a cold shower, and drinking water.
Taking Care of Headaches During the Summer
Headaches are more frequent during the late spring and summer months. By drinking plenty of water, staying hydrated, regulating our exposure to sunshine, paying attention to food triggers, and not overexerting ourselves, we can reduce the potential for frequent and intense headaches. However, even with taking these precautions, headaches and migraines will still periodically happen. Thus, it is important to have a good abortive headache treatment such as the gepants (Ubrelvy, Nurtec ODT), Ditans (Reyvow), triptans, or regular over the counter (OTC) pain medicines such as acetaminophen, aspirin, ibuprofen, or naproxen if they work for you and if you can use them safely. If the headache frequency is high enough (generally more than 4 per month), a preventive headache or migraine treatment should be considered until your high frequency headache cycle subsides.
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.
If you experience headaches every day, you likely have a condition known as chronic daily headache. Generally speaking, the difference between episodic and chronic headaches is the frequency. Episodic headaches happen “sometimes,” while chronic headaches happen “all of the time.” To be exact, chronic daily headaches occur for 15 days or more per month for longer than than three months. Episodic headaches happen less than 15 days per month. Acute headaches refer to a flare up, or exacerbation, of the headache regardless of if the headache disorder is in an episodic or chronic daily headache frequency. Depending on the specific type of headache disorder, the acute headache attacks can last a number of minutes, up to days or weeks.
The true causes of many types of headaches are not known and involve many variables. Most chronic daily headaches are from primary headache disorders, meaning there is not something specific or bad causing the headache (such as a head injury or brain tumor). The 4 most common types of primary headache disorders causing chronic daily headache are chronic tension type headache, chronic migraine, new daily persistent headache (NDPH), and hemicrania continua, in that order. Chronic migraine and chronic tension type headaches are often being fueled by medication overuse headache (rebound headache). Some chronic daily headaches are the result of an underlying condition, such as head injury, brain tumor, etc. These are called secondary headaches, because they are being caused by something else. This is why any type of headache requires a visit with your doctor for a more detailed history and examination.
Sometimes, there are certain symptoms that accompany frequent daily headaches, and these associated symptoms help determine the specific headache type. These can include: head pain that evolves from one or both sides of the head or radiates from one point; nausea or vomiting; sweating; sensitivity to light or sounds; stuffy or runny noses if the headache is sinusoidal in nature; redness or tearing of the eyes.
What Is Causing Me To Have Headaches Every Day?
There are a wide variety of potential causes for chronic daily headaches, which is why any headaches, especially daily headaches, require an evaluation with your doctor. The general cause of chronic daily headaches often tend to be a mixture of factors such as: tightness of muscles in the neck, shoulders, and head; trigeminal nerve issues; hormonal changes; environmental factors, medication overuse headache, also known as rebound headache (such as excess over the counter pain medications), excess caffeine (or caffeine withdrawal headache) and genetics. However, many other conditions and diseases may also be causing your chronic daily headaches, a few of which are mentioned below. There are a wide array of medical conditions that can also contribute to headaches, and this is why it is important to see your doctor about any type of headache problems.
Anemia
Some other medical conditions, like anemia, can also cause frequent daily headaches. Anemia is a condition where your blood cells have difficulty transporting oxygen throughout your body. This can be the result of an iron deficiency, lack of Vitamin B, and folic acids. There is also a condition called sickle cell anemia where your red blood cells are not formed correctly and cannot carry adequate levels of oxygen. Typically speaking, more severe cases of anemia will result in chronic daily headaches.
Chronic Disease
Chronic daily headaches are also associated with certain types of chronic disease like fibromyalgia, lupus, and diabetes. Typically, these diseases are accompanied by other symptoms. Lupus, for example, comes with joint pain and skin lesions. Diabetics tend to get headaches when their blood sugar levels are low. Fibromyalgia patients typically have a lot of musculoskeletal pain throughout the neck and shoulders, and this can also influence headaches.
Lack of Sleep
Sometimes, exhaustion over a long period of time can cause headaches to persist. Insomnia is a common trigger for daily headaches. People who suffer from sleep apnea often will experience frequent daily headaches in the morning. Sleep apnea sufferers receive less oxygen to their brain than regular sleepers. Untreated and undiagnosed sleep apnea can result in frequent morning headaches and lead to other issues like heart conditions,higher blood pressure, excessive daytime fatigue, memory and cognitive complaints. Heavy snoring is often a clue, and when a bed partner notices the patient seems to stop breathing at times or gasps for air during sleep, this is almost certain sleep apnea. The medical term is obstructive sleep apnea because during certain stages of sleep, the muscles in the neck and throat relax and collapse, causing obstruction to the airways.
Stress and Frequent Daily Headaches
Stress is another issue that can cause frequent daily headaches. According to Excedrin’s website, if your stress increases by 10 percent, you are likely to experience 6.3% more days per month where you have a headache. If you suffer from migraines, you will have them 4.3% more often. Eliminating stress will potentially help reduce your chronic headache frequency and could potentially eliminate them altogether. Stress is one of the biggest migraine triggers.
Chronic Sinusitis
If you have chronic sinusitis, you may have headaches that accompany it. This is caused by infection, nasal polyps, and swelling of the lining in your sinuses. The most common way to deal with chronic sinusitis is nasal corticosteroids, saline irrigation, or oral/injected nasal corticosteroids. In some cases, aspirin sensitivity can cause sinusitis, but these instances are pretty rare. Occasionally, surgery may be necessary to clear out sinuses. However, it is important to remember that many times sinus symptoms in the setting of headache are actually migraine. The reason is because migraine originates in the trigeminal nerves. The trigeminal nerves also innervate all of the sinuses and teeth. So, when the migraine is triggered by the trigeminal nerves, many times the sinuses are also activated. The result is headache with sinus symptoms, which is most often misdiagnosed and mistreated as “sinus headache”.
Allergies
An unknown allergy may be an uncommoncause of your headaches too. This can be related to excess histamine release along with significant sinus inflammation, fluid buildup, and blockage. If you have an allergic reaction that leads to a chronic headache condition, you will likely have a headache that is located very close to your sinuses.
COVID-19 Long-Haul Headaches
In some people who have been diagnosed with COVID-19, the COVID-19 headache that accompanies it in some individuals can last for several months or longer. Along with the headache, some patients also develop many other associated persistent symptoms called long COVID syndrome. This headache is usually a whole-head, severe-pressure, persisting type of headache, although the pain and locations can vary widely. They can also have migraine features and many times presents as New Daily Persistent Headache (NDPH). There are a wide variety of treatment options as discussed here.
Trigeminal Nerve Issues
The trigeminal nerve is The reason for this is because the trigeminal nerve innervates many structures including the face, sinuses, teeth, TMJ areas, and everything inside the skull including the arteries in the brain. Some people have chronic daily facial pains which they refer to as chronic daily headache, so let’s touch on that too. More severe trigeminal nerve problems can cause severe facial pains, such as trigeminal neuralgia. Trigeminal neuralgia tends to occur in older patients (over 50) and more often in women. However, it can certainly occur across all age groups and not uncommonly in men as well. This condition can impact men, too. Simple tasks such as brushing your teeth, putting on makeup, or any other interaction with your face can produce a short bout of excruciating pain, and in some instances, longer cases of pain, and even daily continuous levels of varying facial pain. This condition often occurs because of aging, could be related to multiple sclerosis (particularly in younger patients), or other issues, like a tumor or aneurysm compressing on the trigeminal nerve. To deal with this type of headache, your doctor might prescribe an antiseizure or antidepressant medication (certain ones work well on pain pathways such as irritated nerves), and in some cases surgery depending upon your condition.
Treating Headaches That Happen Every Day
If you get a headache every day, you will likely need to be treated for the condition that is causing your headache, such as diabetes, elevated blood pressure, or other medical conditions that may become uncovered as the headache is evaluated. However, there are certain things that you can do to help reduce chronic daily headaches, like drink plenty of water, avoid caffeine, stay away from alcohol, certain types of foods, and other common headache triggers. Reducing stress is also going to help reduce chronic daily headaches. Eliminating medication overuse headache (rebound headache) is a key factor necessary for headache improvement to occur, if present.
Certain headache preventive treatments and medications may include beta blockers, tryglycric antidepressants, anti-seizure medications, and NSAIDs can help deal with chronic daily headaches. In some instances, Botox can help deal with chronic daily headaches if they are chronic migraine.
Seek Help For Your Chronic Daily Headaches
In the United States, while there are not many of them, there are health professionals dedicated to the pursuit of headache medicine. There are around 720 doctors who are UCNS-certified headache specialists, and have taken an interest in treating headache disorders. There may be one of these health professionals in your state who can help you deal with your headache.
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.
The temporomandibular joint (TMJ) is the joint that connects the jawbone and the skull. This is one of the most powerful joints in the human body, as it can apply 162 pounds per square inch when a person bites. It is important to realize that the TMJ is a synovial joint. In other words, it is a joint composed of a capsule filled with synovial fluid. Similar to a knee joint (but on a much smaller scale), the synovial fluid keeps the joint lubricated and healthy. However, this can also be the source of various types of dysfunction. There is a condition called TMJ disorder that can contribute to facial pain and headaches. TMJ disorder is fairly common, impacting about 12% of Americans at any given time. Women get TMJ disorder more often than men; in fact, for every male TMJ sufferer, there are 9 female TMJ sufferers.
TMJ disorder tends to be higher among younger people, while women using estrogen or contraceptives tend to experience TMJ disorder more frequently.
What Is TMJ Disorder and What Causes It?
Loosely put, TMJ disorder is any type of pain and restricted movement that impacts the jaw joint and surrounding muscles. There are several different causes of TMJ, including
Injury to the tooth or jaw
Grinding or clenching of the teeth
Poor posture
Stress
Other issues
In some instances, even chewing gum can aggravate an outbreak of TMJ. TMJ disorder can lead to headaches and facial pain.
TMJ Disorder and Headaches
When TMJ sufferers have a headache, they often report a headache that is like a tension headache in nature. TMJ associated headaches often recur in one or more regions of the head and face and are accompanied by several different symptoms:
Tight face and jaw muscles
Face or jaw pain
Clicking noises in the jaw when chewing
Overall restricted movement of the jaw
Changes in how the teeth fit together when biting down
It is important to keep in mind that TMJ discomfort can also be a manifestation of migraine headache attacks. Migraines can also cause referred pain to the TMJ areas, neck, shoulders, sinus areas, and face. So if the TMJ discomfort happens primarily when someone has a migraine type headache or symptoms, it could also just be a referred pain syndrome rather than a true TMJ disorder.
Is There a Positive Outlook for TMJ Headaches?
TMJ headaches are incredibly uncomfortable, but there is generally a very good outlook for TMJ headaches. Your doctor may suggest a wide variety of treatments to alleviate the pain and often lifestyle changes and other treatments may be required to eliminate and address TMJ disorder. Treatments aimed at alleviating TMJ disorder itself are generally very successful in reducing the frequency of these types of headaches. Let’s take a look at some of the treatments that are available for TMJ headaches.
Very rarely are TMJ disorders serious and long lasting. In these rare situations, diagnosis and treatment must be sought quickly to manage and resolve the condition. Chronic, severe TMJ disorder is very rare, however, tendons, muscles, and cartilage over time can become damaged leading to arthritis. The good news is that most cases of TMJ disorder go away within about two weeks if the jaw is given the necessary time to rest and the root cause, such as stress, is removed.
Occasionally, TMJ disorder will go away on its own. Self-limiting cases are common and being aware of grinding and clenching can help alleviate TMJ over time if it’s not a severe case.
Lifestyle Changes to Address TMJ Associated Headaches and Facial Pain
Some behaviors may cause and trigger flare ups of TMJ disorder, as well as associated headaches and facial pain. Some people may experience this disorder from the type of food that they eat, the stress in their life, and certain jaw movements that they have learned as habits over the years. Some small lifestyle changes can help with TMJ disorder and associated headaches and pain, including:
Avoiding foods that are hard or require a great deal of chewing
Reducing the stress factors in one’s life to prevent jaw clenching and teeth grinding, which are coping behaviors aimed at dealing with stress.
Learning jaw exercises to strengthen the jaw muscles themselves and avoiding things like gum chewing and wide yawning, which can irritate the jaw joint.
Over-The-Counter Solutions for TMJ Associated Headaches and Facial Pain
For the short-term, certain medications may help alleviate the headaches and facial pain caused by TMJ disorders. These include NSAIDS, such as aspirin, ibuprofen, and naproxen. These can help eliminate a headache as an abortive treatment. Additionally, icing your jaw can also help relieve the pain associated with a TMJ headache. Jaw exercises can help with muscle relaxation and pain symptoms. Muscle relaxers are often prescribed in conjunction with NSAIDs in an attempt to lessen the muscle spasm and clenching of the muscles surrounding the TMJ.
Long-Term Treatments for TMJ Associated Headaches and Facial Pain
There are a wide variety of different treatments for TMJ disorder, which can help relieve headaches and facial pain. These include physical therapy, Botox, surgery, and other types of treatments.
Sometimes, there are certain exercises that may help address TMJ associated headaches and facial pain. Patients can learn various exercises, like chin tucks, upward tongue, forward jaw, and resisted closing movements. These help with TMJ pain relief. Generally speaking, these exercises provide a very good therapeutic outlook for patients.
Some patients may also benefit from alternative treatments like acupuncture and massage. Consulting with a medical professional is advised to make sure that any exercises are learned correctly.
Splints and Mouthguards For TMJ Disorder
Splints and mouthguards are a treatment that may help alleviate TMJ associated pain and headaches. These do not directly treat the pain itself, but can help prevent clenching and grinding of the teeth. Some dentists may fit these for patients after a consultation with a health professional. Seeing a TMJ specialist for these types of treatments is recommended to ensure precision of the device, because if it is off even slightly, the pain can intensify. The idea behind splints and mouthguards are that they prevent the grinding and biting that typically occurs during sleep, allowing the jaw to rest. Sometimes, a dentist will work on a long-term bite placement solution, which is often a frequently successful treatment for TMJ disorder.
Other Treatments for TMJ Disorder and Associated Headaches and Facial Pain
There are other techniques to help with TMJ disorder that are surgical and alternative in nature. A TMJ arthroscopy is a minimally invasive surgery that allows the surgeon to remove inflamed tissue and align the jaw correctly.
Another treatment that may also work is Transcutaneous Electrical Nerve Stimulation. This provides an electrical pulse that creates muscle contractions so that your jaw muscles will massage themselves. This helps relieve pain and stiffness, simultaneously improving your overall jaw mobility.
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.
I see the worst of the worst headache, migraine, chronic migraine, facial pain, fibromyalgia, and chronic pain from many states and countries. I see patients who have been debilitated by pain, patients whose pain has destroyed their family, marriage, work life, social life, and the ability to function normally. They are void of hope and have lost all self-esteem and confidence, replaced by depression and seclusion. They hide in the shadows of life. They come into the office with dark sunglasses, hoods up, appear detached, soft-spoken with little to say, and have fully committed themselves to the mindset that they will never get better. And they won’t because they don’t allow their brain to develop the plasticity to escape out of that mindset and behavior. We’ll talk about this concept and brain plasticity more later. I have seen patients who slide into this mindset commit suicide because they see no way out. These patients are rampant and come from all walks of life; professionals such as attorneys to blue collar workers to the jobless. It is an equal opportunity nightmare of chronic pain syndromes. These patients evolve from a once normal life and function to one of minimal to no ability to function normally in life, career, or relationships. I have seen plenty of people pull out of this described rut of a chronic pain lifestyle. It’s possible, but it takes work. Most importantly, it takes the step of convincing yourself that it is possible and will be done, and then readjusting your behaviors, mindset, and thought process accordingly. Give yourself no other option than improvement and realize that there is always hope for improvement. The placebo response in clinical trials involving pain patients (and similar in other subgroups) averages around 30%! That means on average, 30% of pain patients will develop significant improvement despite taking a placebo (fake) treatment. This happens because they convince themselves that they are using the new treatment, and thus they convince their mind that they are improving, and they do! Your mind is the most powerful weapon in your battle against your chronic pain, so learn to use it to your advantage.
Let me be clear that chronic pain is real, it is valid, it can be debilitating, it shouldn’t be ignored or overlooked, it can validly negatively impact all aspects of life which can be out of the control of the patient. I profoundly empathize with these patients. However, there is a lot that is in control of the patient which they often do not realize, and that is my purpose for this blog article. Specifically, they do not realize that they are creating a self-fulfilling prophecy of never improving in pain or function, directly related to their behavior and mindset. No, this discussion doesn’t apply to everyone and all cases, but I would say it does apply to the majority of patients.
Many of these patients create websites, blogs, and social media accounts dedicated and centered around their chronic pain experiences. Their chronic pain becomes their persona, and who they are. It redefines them. This can certainly be helpful to others to learn about similar pain experiences and to feel that they are not alone, and I think it is fantastic that other patients can have these outlets and sources to share their experiences. However, it can also become a dominating way of life which dissolves away any thought, hope or attempt at improving their pain and overall function. These patients get to a point where living any other way besides centered around their chronic pain would seem abnormal to them. They focus their life, their daily activities, their restrictions, their abilities, and their relationships around their chronic pain. It defines them and dictates their life. They are chained and restrained from this focus. This behavior begins to feed into itself and they continue down a path where there becomes no chance at improvement because they don’t allow their mindset or focus to see that as a valid option, and thus do not initiate behavioral changes to try to influence positive changes.
This phenomenon is also reflected in patients who have chronic daily headache, chronic pain, chronic neck pain and whiplash syndrome related to a motor vehicle accident, work related injury, or some other event where they were injured. If there is litigation (lawsuit) involved, it is well known as a clinical predictor that they will rarely improve, because of potential secondary gain (financial, disability, etc.) from their pain, which their subconscious maintains focus on. There have been studies supporting this correlation as well. This phenomenon is not seen in other countries which are not as litigious and ready to sue over anything. We used to have a large unique chronic pain rehabilitation program which was very effective and helpful to many patients. A large focus of this program was on behavioral changes to influence improvements in overall pain and functional abilities. However, patients were excluded from entry if they were involved in any ongoing lawsuit related to their pain, because these patients invariably never got better until the lawsuit was settled and done, and it would be much more beneficial and cost effective to them after legal issues were resolved. We would then admit them following the conclusion of their legal battles if they continued to have chronic pain issues. I have seen many patients reverse their course from that dark reclusive patient scenario described above with the right mindset and approach.
How does pain behavior influence brain plasticity and your chances of improvement?
Anatomically and physiologically, this reclusive and socially isolated behavior and mindset of telling yourself that it is impossible for pain to improve or that one cannot function and live a normal life with chronic pain becomes a self-fulfilling prophecy. DON’T LET THAT HAPPEN!! This is solidly based in scientific and biological evidence. Behavior influences cellular, molecular, and physiological changes in the body and brain. Studies have shown that behavior (such as pain limiting behavior, social avoidance, etc.) causes structural and circuitry changes in the brain, which can be lifelong. Social behavior can also cause changes in the brain, although this can be more reversible. These structural changes in the brain and the circuitry of the brain, influenced by behavioral changes (behavioral neuroscience) and mindset, are called brain plasticity. Essentially, plasticity refers to the nervous system’s ability to constantly modify its organization, structure, function, and circuitry connections in response to experiences, behavior, and an endless list of other influencing factors such as pain, stress, diet, emotion, medications, and many other things. Brain circuits related to chronic pain overlap with circuits involving anxiety, depression and some mood disorders. Mood disorders such as depression can affect the plasticity of chronic pain, and likewise chronic pain can influence plasticity of depression and other mood disorder circuitry.
Treatment and conclusions of chronic pain
Treatment is difficult, requires patience, and involves treatment trial and errors (if one treatment doesn’t work, another is tried). The single most important treatment involves you, your behavior in how you respond to your pain, your mindset, and attitude which all in turn influence your brain plasticity positively, and chances of improvement. Do not let your pain define who you are and what you are able to do. Expectations are important in that you should realize that (typically) there is no quick fix or “cure” (but if you stumble across one, which can happen, great!). Learning to live, deal, and function with the chronic pain is vital. If you realize this and make it a primary goal, it can in turn lead to improvements over time by modulating your brain plasticity and electrical circuitry. Most preventive treatments can take 2-3 months to see effects, and there is no way to expedite that. Hang in there and be patient.
Chronic migraine, fibromyalgia, and some other chronic pain syndromes often cluster together. The way to look at these types of chronic pain syndromes is that the neurological system is “hyperactive”, “overactive” or “hypersensitive”. So, the goal is to try to “turn down the volume” of this “hypersensitive” neurological system with medications or other types of treatments. Never conclude that there is no possibility of improving. Remain active physically, socially, emotionally, and maintain active relationships. Treating depression or mood disorders is very important, and a good psychiatrist can make a big difference with this. Chronic migraine and chronic daily headache should have appropriate treatments which may include preventive treatments, CGRP mAb once monthly treatments, supplements and natural therapies, neuromodulation devices, eliminating rebound (medication overuse headache), and using appropriate abortive (as needed) therapy such as triptans, gepants and ditans. Most importantly, remain hopeful. There is always hope and there are constantly new types of treatments becoming available. You can do this!!!
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.
I see patients in our headache center from all over the United States and from many other countries. Many patients travel hundreds of miles by car or airplane for these visits, due to the shortage of available headache specialists (about 570 in the US). Many patients are lucky enough to be relatively close to a headache specialist. Whichever scenario you fall into, you want to get the most out of your appointment with a headache specialist in order to get on a better path to less headache or facial pain burden.
When to see a headache specialist
So first of all, when should you see a headache specialist? First off, any type of headache, head pain, or facial pain, is reason enough to see a headache specialist. Basically, headache specialists specialize in any type of pain or discomfort involving anywhere in the head or face. They also commonly see patients that may have other neurological symptoms which may not necessarily be associated with headaches, but their doctor wants to rule out a migraine “equivalent” disorder. Some patients can have neurologic symptoms without headache (visual, sensory, speech, vertigo, weakness, nausea/vomiting, abdominal pain), which may actually reflect a painless migraine disorder, such as migraine aura without headache. I have compiled a list below of a few of my thoughts of when your headache or facial pain treatment journey signals that it is time to see a headache specialist.
Reasons to see a headache specialist:
-You have a headache, head pain, or facial pain.
-Your doctor tells you, “your headache is all in your head”.
-Your doctor tells you, “there’s nothing else I can do for you”.
-Your doctor says, “I don’t treat much headache, but…”.
-You continue to have frequent headaches despite trying several preventive medications.
-You just don’t feel like you are making any progress despite a couple office visits with your doctor or their NP or PA (or you never even get to see the doctor).
-You don’t feel like your doctor is listening to you or taking your symptoms seriously.
-The doctor spends only a few minutes in the visit, so you feel rushed and unable to discuss all of your concerns.
-Your doctor is googling your symptoms in the office.
-Your doctor recommends that you take opiates/opioids for migraine treatment.
-Your doctor says it is ok to use NSAIDs, OTCs or triptans more than 10 days per month or butalbital/fioricet/fiorinal more than 5 days per month on average for migraine treatment.
-Your doctor says your headache is “because you are depressed”.
-Your doctor does not give you a more specific classification or name for your diagnosis.
What information should you gather before the visit?
Unfortunately, we all know how strapped for time most physicians are during office visits due to a variety of factors such as low insurance reimbursement and the need to increase patient volume to compensate for this and break even. So to get the most out of your office visit, making it efficient and helpful, it is important to compile certain information in preparation. Typing out this information and bringing it to your office visit is a great idea. It is also a great idea to keep this as a running file that you can continue adding to in your personal files. This helps to eliminate time wasted in the office that could easily be organized and thought through prior to the visit, allowing more time for the important parts of the office visit; optimizing the diagnosis and treatment plans. Some of this information you may not have available, and that is certainly ok. You may be able to retrieve some of it from records, memory, and your local pharmacist.
Never assume that your local doctor’s office has faxed all of your records ahead of the visit. If that happens, great. However, many times patients are told that the records will be sent, but when we see the patient, we have no records that were sent. So, it is always best to bring all of your records yourself. Furthermore, it is good to have copies of all of your medical records, testing, etc. for your personal files anyway.
The following list are items that I have found to be the most useful for patients to have gathered and thought of prior to the visit, allowing the most efficient and useful office visit:
A) Acute/abortive headache or pain treatments (used “as needed”). This information is also needed in order to pursue insurance approvals for various types of treatments such as the newer gepants (Ubrelvy, Nurtec) or ditans (Reyvow).
-All that have been tried (which triptans, NSAIDs, neuromodulation devices, etc.)
-Doses used
-Responses (effectiveness, side effects) of each treatment
B) Preventive headache or pain treatments (used daily to lessen headache frequency/severity). This information is also needed in order to pursue insurance approvals for various treatments such as Botox or the CGRP mAb antagonists (Aimovig, Ajovy, Emgality, Vyepti).
-All that have been tried
-Maximum doses used
-Duration that each treatment was used
-Responses (effectiveness, side effects) of each treatment
C) Testing
-All CD and radiology reports for all brain MRIs, CTs, and other relevant testing for your headache or pain. Most CDs do not include the radiology report, and you need to request that separately. It is a good idea to have copies of all of these things for your personal files regardless. Bring them all to the office visit for the doctor to review.
-All bloodwork done in the past 5 years. Labs particularly important for headache evaluations include TSH, CBC, CMP, Vitamin D, Vitamin B12, ESR, CRP, ANA, to name a few, but this may vary and include more or less, depending on the specific clinical scenario.
D) Think about the clinical features of your headache or facial pain as listed below. These will be important questions that your headache specialist will ask. So, it is good to answer these questions in your head prior to the visit, so you can provide more accurate and thought out answers. This helps to prevent being put on the spot by questions you never really thought about which may result in forgetting some important details. For a free headache and facial pain self-diagnosis tool which incorporates all of these important questions that a headache specialist asks, look here.
-Location of the headache or facial pain
-Frequency of the headache or facial pain attacks
-Duration of the headache or facial pain attacks
-Description and characterization of the headache or facial pain attacks
-Neurological symptoms associated with the headache or facial pain (visual disturbances, numbness, tingling, weakness, speech disturbances, vertigo, etc.)
-Other associated symptoms with the headache or facial pain (nausea, sensitivity to light or sound, one sided autonomic features (runny eye, red eye, runny or congested nose, droopy or puffiness around eye))
Conclusions:
If you are able to gather all or much of the above listed information prior to your headache specialist appointment, you’ll be well on your way to a much more efficient and beneficial office visit. As a result, you and your doctor will be able spend more time in the office discussing the most important things rather than spending it trying to look up records or digging through your memory for various details. As a result, your doctor will have more time to better formulate a list of the most likely diagnoses, and best treatment approaches for minimizing the disruption of your headache or facial pain on your life. Good luck!!
IF YOU HAVE HEADACHE, MIGRAINE, OR FACIAL PAIN AND ARE LOOKING FOR ANSWERS ON ANYTHING RELATED TO IT, A HEADACHE SPECIALIST IS HERE TO HELP, FOR FREE!
FIRST, LET’S DECIDE WHERE TO START:
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR THE LATEST INFORMATION, HOT TOPICS, AND TREATMENT TIPS, VISIT OUR FREE BLOG OF HOT TOPICS AND HEADACHE TIPS HERE. THIS IS WHERE I WRITE AND CONDENSE A BROAD VARIETY OF COMMON AND COMPLEX MIGRAINE AND HEADACHE RELATED TOPICS INTO THE IMPORTANT FACTS AND HIGHLIGHTS YOU NEED TO KNOW, ALONG WITH PROVIDING FIRST HAND CLINICAL EXPERIENCE FROM THE PERSPECTIVE OF A HEADACHE SPECIALIST.
IF YOU HAVE AN EXISTING HEADACHE, MIGRAINE, OR FACIAL PAIN DIAGNOSIS AND ARE LOOKING FOR FURTHER EDUCATION AND SELF-RESEARCH ON YOUR DIAGNOSIS, VISIT OUR FREE EDUCATION CENTER HERE.
Virtual Headache Specialist™ is NEVER a replacement for an office visit with a medical doctor. Diagnoses and treatment suggestions of any type cannot be made without a face-to-face office visit with a medical doctor, and a detailed medical history and examination first.
