How to Stop Headaches Using Science-​​Based Approaches

Types of Headaches and Underlying Biology

• Different types of headaches arise from changes in different types of tissues in the head and neck area
• To find relief from a headache, it’s important to understand which tissue is mainly involved in creating that type of headache

Tension Headaches

• Most common type of headache
• Felt around the top part of the head, like where a headband would be placed
• Main underlying tissue system: muscular system 
  • Muscles on the skull and neck can undergo excessive constriction
  • Muscles in the jaw can also lead to headache and jaw ache
• Stress can cause tension headaches

Meninges

• Tissues that line the outside of the brain and reside between the brain and the skull
• Brain is encased in a very thick, durable sac called the dura 
  • Dura is wrapped tightly around the brain like Saran wrap
  • Requires a very sharp razor blade to cut through

Headache Treatments

• Prescription drug treatments and over-​​the-​​counter medications (e.g., ibuprofen, acetaminophen)
• Many natural treatments for headaches that can be as effective or more effective than drug treatments 
  • Natural treatments typically do not carry side effects
• Treatments are grounded in solid biological understanding of why they work

Examples of Natural Treatments

• Addressing muscular pain
• Addressing vasodilation (arteries and blood vessels getting bigger and wider, causing pressure and swelling within the cranium)

Understanding the Brain and Headaches

• Meninges provide a buffer between the brain, dura, and skull
• Vasculature (arteries, blood vessels, capillaries) are in close proximity to the brain

Cluster Headaches

• Arise from deep within the head, often behind one or both eyes
• Caused by the activation of the trigeminal nerve 
  • Trigeminal nerve has three branches: ophthalmic, mandibular, and nasal
• Symptoms can include tearing up, nasal discharge, and small, non-​​dilating pupils

Inflammation and Headaches

• Inflammation is a form of signaling in the body 
  • Can be caused by the introduction of a foreign object, local toxin, or systemic inflammation
• Inflammation in the head and neck area can lead to headaches 
  • Sinuses can become clogged, leading to sinus headaches
• The immune system tries to limit the extent of inflammation by creating scar tissues and restricting the affected area

Understanding the Structure of the Skull

• The skull is not one solid piece of bone, but has small holes and canals called fenestrations 
  • These allow the passage of fluids through the skull
  • Bone is an active, living tissue that needs nourishment from blood and cerebral spinal fluid

• Inflammation can affect any portion of the head or neck, leading to headaches
  Headaches and Inflammation

• Face and head heavily infused with blood vessels

• Constant perfusion of blood, cerebral spinal fluid, and other substances through metabolically active brain and eye tissues
• Inflammatory response can trigger pain mechanisms in various tissues

Types of Headache Origins

1. Muscular origins
2. Meningeal origins
3. Neural origins

4. Inflammation-​​based origins

5. Different sources of ache can exist alone or in combination

6. All pain experiences are neural in origin

Understanding Neurons

• Trillions of neurons in the brain with different shapes, sizes, and functions
• Three key types of neurons:
• Motor neurons: control muscle contractions
• Sensory neurons: respond to environmental events or internal body conditions
• Modulatory neurons: adjust the relationship between sensory and motor neurons

Tension Headaches

• Common symptoms: headband-​​like pain around the head, sleep deprivation, excessive caffeine intake, stress, low-​​level infections, jaw pain, neck tightness
• Can be treated by targeting motor neurons, sensory neurons, or modulatory neurons

Treatment Approaches

1. Target motor neurons: relax hyper-​​contracted muscles (e.g., muscle relaxants)
2. Target sensory neurons: shut off the sensory input (e.g., painkillers)

3. Target modulatory neurons: adjust the relationship between sensory and motor neurons (e.g., non-​​addictive treatments)

4. Each approach has advantages and disadvantages

5. Some painkillers can be sedative, habit-​​forming, or addictive
   Behavioral Approaches to Pain Relief

6. Some people prefer behavioral approaches to modulate pain

   • Deliberately turn off communication between sensory and motor neurons
7. No more biology lessons on pain sensing and headaches

Different Types of Headaches

• Important to understand major types of headaches for proper treatment

Tension Type Headaches

• Tend to start as a halo or headband around the forehead, above the eyes 
  • Can include jaw, neck muscles, and upper back
• Often caused by chronic psychological stress, lack of sleep, and lifestyle issues 
  • Excessive stress and lack of sleep are interconnected
• Can extend to other tissues, not often in the face 
  • May be localized to one area due to tension in neck muscles

Migraine Headaches

• Recurring attacks of headaches, more prevalent in females 
  • Not directly related to hormonal changes or menstrual cycle
• Debilitating and can be sensed before onset (aura)
  • Aura: experience that something is about to happen
• Dilation of blood vessels and photophobia (sensitivity to light) are common features 
  • Sleep deprivation can increase photophobia

• Treatment should focus on constricting blood vessels and adjusting sensitivity to light
  Dealing with Migraine Headaches

• Photophobia: sensitivity to light during migraines

  • Preventing photophobia can offset a lot of migraine pain
• Knowing the type of headache is essential for selecting the best treatment 
  • Aspirin: anti-​​inflammatory, affects vasodilation and vasoconstriction 
    • Can be the worst choice for migraines due to hyperdilation of blood vessels
  • Caffeine: can cause vasoconstriction or vasodilation, depending on when taken 
    • Can be a potent treatment for headaches if the type of headache is known

Cluster Headaches

• Arise from deep within the head, feel as if they’re coming from the inside out
• Tend to be unilateral (one-​​sided), originating behind the eye, nose, or mouth region
• Trigeminal nerve involved in cluster headaches 
  • Herpes 1 virus lives on the trigeminal nerve, causing inflammation and cold sores
• Symptoms of cluster headaches: 
  • Unilateral, deep pain
  • Last 30 minutes to 3 hours
  • More common in men, especially during sleep
  • Droopy eyelid, meiosis (inability to dilate pupil), lacrimation (tearing), nasal discharge
• Standard anti-​​inflammatory or vasodilation/​​constriction treatments may not relieve cluster headaches 
  • Must be treated as a neural issue

Hormonal Headaches

• Hormonal headaches are too general a term, as there are many different hormones
• Steroid hormones (e.g., estrogen, testosterone) can impact gene expression and bind to the surface of cells 
  • Estrogen can control aspects of headache through binding to the surface of cells
• Low estrogen and low progesterone can cause headaches due to their impact on vasodilation, vasoconstriction, and inflammation
• Hormonal headaches most likely to occur when estrogen and progesterone are lowest 
  • During the follicular stage of the ovulatory menstrual cycle (first half of the cycle)
  • Estrogen starts increasing, peaks, and then falls quickly around the time of ovulation

Understanding Headache Types and Treatments

• Identifying the type of headache is crucial for selecting the best treatment

  • Aspirin and caffeine can be helpful or harmful, depending on the type of headache
  • Cluster headaches require neural-​​focused treatments
  • Hormonal headaches may be related to low estrogen and progesterone levels
    Hormonal Headaches and Menstrual Cycle

• Hormonal headaches occur during the luteal phase of the menstrual cycle

  • Buildup of the lining of the uterus due to increased progesterone
  • Estrogen increases during the follicular phase, then decreases
  • Progesterone increases during the luteal phase
• Menstruation occurs when there’s no fertilization of the egg 
  • Estrogen and progesterone levels are low during the first week of the menstrual cycle
  • Hormonal headaches occur due to low estrogen and progesterone levels
  • Estrogen and progesterone impact vasodilation and vasoconstriction systems

Headaches Associated with Traumatic Brain Injury (TBI)

• Headaches can occur after head hits, even without a diagnosed TBI
• Sports-​​related concussions are a small fraction of TBIs 
  • Majority of TBIs occur from accidents (e.g., car, bicycle, workplace)
• Headaches after TBI can be infrequent and severe or chronic and low-level 
  • Can be caused by swelling of brain tissue or meninges surrounding the brain
  • Can also be caused by restricted flow of cerebral spinal fluid, blood, or mucus

Non-​​Obvious Treatments for Headache and TBI

• Regular, sufficient amounts of deep sleep each night 
  • Reduces frequency of headaches and time to repair after TBI
• Proper circadian cycles with sunlight exposure 
  • Improves gut-​​brain axis, inflammatory and anti-​​inflammatory pathways
• Proper nutrition, exercise, and healthy social connections 
  • Critical for maintaining and raising baselines of health

Importance of Sleep, Sun, Nutrition, Exercise, and Social Connection

• These five factors are essential for maintaining and improving mental health, physical health, and performance

• They provide a foundation for health and should be prioritized before considering specific treatments for issues like headaches or TBI
  No Replacement for Sleep, Sunlight, and Nutrition

• No pill, powder, or behavioral practice can replace sleep, sunlight, and proper nutrition

• Some strategies can partially offset lack of sleep or sunlight, but they are not complete replacements

Reducing Headache and Treating Traumatic Brain Injury

• Creatine can significantly reduce the intensity and frequency of headaches
• Useful for headaches caused by traumatic brain injury, tension, migraine, and possibly cluster headaches

Creatine: Beyond Muscle Performance

• Commonly known for improving muscle performance in weightlifting and endurance exercise
• 5–10 grams per day of creatine monohydrate typically used for sports performance
• More data supports creatine’s role in clinical settings, particularly for treating headaches

Creatine for Traumatic Brain Injury (TBI) Headaches

• Pilot study: “Prevention of Traumatic Headache, Dizziness, and Fatigue with Creatine Administration”
• Creatine can be stored in brain tissue, particularly in the forebrain, important for cognition and planning
• Neurons rely on calcium regulation for communication, which is impacted by creatine and ATP
• Creatine’s interaction with calcium and ATP systems was the motivation for the study

Creatine Supplementation in the Study

• Dosage: 0.4 grams of creatine monohydrate per kilogram of body weight
• Higher than typical sports performance dosage
• Taken daily for six months

Study Results

• Significant decrease in the frequency of headaches in creatine-​​supplemented group
• Reduction in dizziness and fatigue (both physical and mental) in creatine-​​supplemented group
• Results are preliminary but promising for TBI sufferers and those with chronic headaches

Considerations for Creatine Supplementation

• Relatively inexpensive and considered safe at the dosages used in the study
• Few other compounds have shown such significant long-​​term impact on headaches
• Consult with a physician before adding or removing any supplement or treatment Six Fatty Acids for Headache Reduction: A Systematic Review. In this study, they looked at a total of 13 randomized controlled trials, which included 1,568 participants. They found that increasing omega‑3 fatty acids and reducing omega‑6 fatty acids in the diet led to a significant reduction in headache frequency, intensity, and duration.

Some key points from this study include:

• The most effective ratio of omega‑3 to omega‑6 fatty acids for headache reduction was 1:3, meaning for every 1 gram of omega‑3 fatty acids, there should be 3 grams of omega‑6 fatty acids in the diet.
• The optimal dose of EPA (one of the omega‑3 fatty acids) for headache reduction was found to be 1,000 mg per day.
• The optimal dose of DHA (another omega‑3 fatty acid) for headache reduction was found to be 600 mg per day.
• The study also found that combining omega‑3 fatty acid supplementation with other headache treatments, such as magnesium or riboflavin, could further enhance the benefits.

The third study, published in 2021, is titled “Effect of Diet High in Omega‑3 Fatty Acids and Low in Omega‑6 Fatty Acids on Chronic Headache: A Randomized Clinical Trial.” This study included 182 participants with chronic headaches, and they were divided into three groups:

1. A high omega‑3 and low omega‑6 fatty acid diet group
2. A high omega‑3 and average omega‑6 fatty acid diet group
3. A control group with no dietary intervention

The results showed that the group with the high omega‑3 and low omega‑6 fatty acid diet experienced a significant reduction in headache frequency, intensity, and duration compared to the other two groups. This study further supports the idea that increasing omega‑3 fatty acids and reducing omega‑6 fatty acids in the diet can be beneficial for headache reduction.

In conclusion, these studies suggest that increasing omega‑3 fatty acid intake, particularly EPA and DHA, while reducing omega‑6 fatty acid intake, can lead to significant reductions in headache frequency, intensity, and duration. This can be achieved through dietary changes, such as consuming more fatty fish and fewer seed oils, or through supplementation with fish oil capsules or liquid fish oil. It is important to note that individual responses may vary, and it is always recommended to consult with a healthcare professional before making significant changes to one’s diet or supplement regimen.
Six Fatty Acids for Headache Reduction in Adults with Migraine

• Randomized control trial 
  • Participants serve as their own internal control
  • Controls for variables like sex, age, health background, etc.
• Study conditions:
  • Increased omega-​​3s (EPA and DHA)
  • Increased omega-​​3s and reduced linoleic acid (omega‑6)
  • Control diet with average intake of omega-​​3s and omega-6s
• General results: Reductions in headaches, especially for those who increased omega-​​3s and reduced linoleic acid
• Omega‑6 fatty acids (linoleic acid) may increase inflammation and exacerbate headaches 
  • Increases CGRP, a molecule involved in vasodilation and blood vessel expansion
  • Inflammatory cytokine pathways also involved

Omega‑3 Fatty Acids for Headache Reduction

• Effective in reducing frequency and intensity of tension headaches and migraines
• Effective in improving outcomes for premenstrual syndrome (PMS) related headaches 
  • Omega‑3 fatty acids can reduce severity of PMS symptoms, including pain related to headaches
• Dosage: 1 gram or more of EPA per day 
  • Can be obtained through food or supplements (liquid fish oil or capsules)
• Meta-​​analysis of omega‑3 fatty acids for headache treatment 
  • Significant impact on reducing headache frequency and intensity found at 1 gram or higher dosage per day
• Omega‑3 fatty acids also beneficial for mood improvement 
  • 1 to 3 grams per day of EPA can improve mood

Photophobia and Aura in Headaches

• Aura: Sense that something is about to happen or a visual/​​auditory sensation surrounding an object or environment 
  • Often described as a halo or emanating from one’s body or an object
• Photophobia: Sensitivity to light, common in headaches and migraines 
  • Can be debilitating and lead to negative consequences (e.g., missing work or school, staying indoors)
• Spreading depression: Possible origin of aura 
  • Not mood depression, but a wave of reduced neural activity in the brain
  • Can lead to changes in blood flow and increased sensitivity to light

• Treatment for photophobia: Wearing sunglasses or using tinted lenses

  • Can help alleviate symptoms and improve quality of life for those with photophobia
    Depression of Neuronal Activity and Aura

• Depression of neuronal activity: reduced excitability of neurons

• Aura: semi-​​abstract sensory phenomena experienced during a migraine 
  • Originates from a back-​​to-​​front spreading depression in the brain
  • Starts in the visual cortex, causing visual disturbances
  • Spreads forward, affecting other sensory modalities like touch and hearing

Photophobia and Intrinsically Photosensitive Retinal Ganglion Cells

• Photophobia: sensitivity to light during a migraine
• Intrinsically photosensitive retinal ganglion cells (IPRGCs): neurons in the eye that respond to bright blue and green light 
  • Connect to various areas of the brain, including the central circadian clock and the thalamus
• Thalamus: a sensory relay center in the brain 
  • Receives information from IPRGCs and sends it to other areas of the brain
  • Lateral posterior nucleus of the thalamus (LP) is specifically involved in photophobia

Photophobia and Pain Sensing

• Bright light activates IPRGCs, which in turn activate LP neurons
• LP neurons communicate with areas of the brain involved in pain sensing, particularly in the meninges and intracranial pressure
• Bright light can trigger pain sensations during a migraine

Dealing with Photophobia

• Common methods: dimming lights, wearing sunglasses, lying down
• Alternative method: using red or orange light 
  • Longer wavelengths do not activate IPRGCs as much
  • Can help reduce pain and pressure sensations during a migraine
  • Inexpensive red light bulbs can be used for this purpose

Preventing Migraine Onset

• Reducing early signs of photophobia and aura may help prevent migraines
• Using red lights may help reduce the probability of developing a migraine

Red Lights and Cortisol

• Red lights can help keep cortisol levels low in the evening and at night 
  • Cortisol is a stress hormone that should be high during the day and low at night
  • Low cortisol levels at night can improve sleep quality

Tension Headaches

• Tension headaches are muscular in origin

• Strategies for reducing tension headaches will be discussed in the next section
  Neural Control of Pain and Tension Headaches

• Tension headaches often associated with muscle tension in the skull, jaw, and neck

• Common treatment: non-​​steroidal anti-​​inflammatory drugs (NSAIDs) like acetaminophen, ibuprofen, and aspirin 
  • Can be helpful, but people develop tolerance and need higher doses
  • Can be hard on the liver and offset benefits of exercise
  • May not work for everyone or stop working after initial use
  • Lower body temperature, affecting sleep-​​wake cycles, metabolism, and immune system

Alternatives to NSAIDs for Headache Treatment

• Botox: effective for relieving tension headaches 
  • Injected into muscles, causing them to relax and relieve tension
  • Safe and long-​​lasting relief, sometimes for weeks or months
• Herbal and oil-​​based treatments 
  • Some herbs and oils outperform NSAIDs in reducing headache frequency and intensity
  • Example: Peppermint and eucalyptus oil study 
    • Recreated headache in human subjects using tightening cuffs and measured muscle response and pain perception
    • Four groups: peppermint and eucalyptus oil, just peppermint oil, tiny traces of peppermint oil and smaller doses of eucalyptus oil, and placebo
    • Applied oil to temples and forehead, then induced head pain and measured muscle activation and pain

Findings from the Peppermint and Eucalyptus Oil Study

• Peppermint and eucalyptus oil preparations reduced experimentally induced pain and muscle activation
• Oils outperformed NSAIDs in reducing headache frequency and intensity
• No apparent side effects like those associated with NSAIDs

• Supports the potential effectiveness of herbal and oil-​​based treatments for headaches
  Heat and Constriction Experiment for Headache Relief

• Experiment mimicked headache pain using heat and constriction

  • Heat applied to the skin at high levels, almost to the point of excessive pain
  • Constriction applied by cutting off blood circulation to pericranial muscles using an inflatable collar
• Aimed to give every participant the same headache experience to test different interventions

Essential Oils for Headache Relief

• Peppermint oil and menthol-​​containing oils found to significantly reduce headache pain intensity 
  • Subjects could tolerate pain better and experienced less pain subjectively
• Combination of peppermint oil and eucalyptus oil applied to the skin increased cognitive performance during pain 
  • Also had muscle-​​relaxing and mentally relaxing effects
• Mechanism: menthol, peppermint, and eucalyptus activate certain channels in sensory neurons that respond to touch and cooling sensations 
  • This leads to analgesic effects by shutting down heat and pain pathways, while activating parallel pathways for cooling and pain relief
• Essential oils can be as effective, or even more effective, than nonsteroidal anti-​​inflammatory drugs for tension headache relief

Acupuncture for Headache Relief

• Acupuncture has been used for thousands of years to treat headache and other forms of pain 
  • Many insurance companies now cover acupuncture as an insured practice
• Chufu Ma’s lab at Harvard Medical School has been studying the mechanisms of acupuncture 
  • Found that specific needle insertion sites can activate sensory neurons and their downstream pathways to reduce inflammation and muscle activity
  • Acupuncture can deactivate pain pathways and activate parallel pathways for pain relief and muscle relaxation
  • Can also impact the activity of organs that release pain-​​causing molecules, reducing inflammation and increasing anti-​​inflammatory pathways
• Acupuncture has been shown to be effective for treating tension headaches and, to some extent, migraines

Summary

• Omega‑3 fatty acids, essential oils, and acupuncture are not just alternative treatments for headaches

  • They have scientific backing and are starting to be understood mechanistically
  • These treatments can be effective for tension headaches and migraines, and in some cases, outperform traditional pain relief methods
    Mechanistic Approaches to Dealing with Headaches

• Not meant as replacements for NSAIDs or prescription drugs

• Goal is to control health outcomes and reduce headaches with minimal side effects
• Can be used in conjunction with other treatments

Herbal Treatments for Migraine

• Based on a systematic review of randomized controlled studies published in 2020
• Menthol and peppermint oil effective for tension-​​type headaches and migraines
• Other herbal treatments include coriander, citron, damask rose, chamomile, and lavender

Caffeine and Headaches

• Caffeine can both relieve and exacerbate headaches
• Blocks adenosine receptors, preventing sleepiness and causing vasoconstriction
• Can also increase vasodilation through the nitric oxide pathway
• Effects depend on time of day, adenosine levels, and individual response
• Important to determine personal response to caffeine for headache relief

Curcumin (Turmeric) for Headache Relief

• Potent anti-​​inflammatory properties
• Can prevent inflammation and adaptation response in exercise
• Explored in the context of migraine treatment
• Generally safe for most people at dosages up to 8000 mg/​​day (not recommended)
• Can impinge on hormonal pathways, such as dihydrotestosterone (DHT)
• Effective in treating migraines by inhibiting nitric oxide and reducing intracranial pressure

• Dosages range from 80 mg/​​day for eight weeks to higher amounts
  Curcumin and Omega‑3 Fatty Acids for Migraines and Headaches

• Studies show curcumin (80mg) taken with omega‑3 fatty acids (2.5g) significantly improves migraines and other headaches

  • Reduces frequency and intensity of headaches
• Curcumin dosage can be as low as 25–50mg for sensitive individuals
• Caution: Curcumin inhibits cytochrome P450, affecting blood coagulation 
  • Consult a doctor before adding or removing curcumin from your supplement regimen

Types of Headaches and Treatments

• Tension headaches, migraine headaches, hormone-​​based headaches, cluster headaches, and traumatic brain injury-​​related headaches
• Treatments include creatine, omega‑3 fatty acid supplementation, herbal remedies, essential oils, and acupuncture 
  • Results can be as effective as non-​​steroidal anti-​​inflammatory drugs (NSAIDs)
• Consult a physician for prescription drugs and personalized treatment plans

Spicy Peppers and Headaches

• Eating extremely spicy peppers, like the Carolina Reaper, can induce headaches and even brain damage 
  • Causes “thunderclap headache” due to hyper constriction of brain vasculature
  • Can lead to permanent neuronal tissue damage and stroke-​​like symptoms
• Caution advised when consuming extremely spicy foods, especially for those not accustomed to them

Omega‑3 Fatty Acids for Headaches

• Can be obtained through supplementation or nutrition 
  • Difficult to achieve high dosages (2–3g) through food alone
  • Supplementation likely necessary for maximum benefits