December 8, 2019
My Approach to Headaches & Migraines | DailyDocTalk 63

My Approach to Headaches & Migraines | DailyDocTalk 63


Hey everybody! So unfortunately a lot of
people suffer from headaches, migraines, tension headaches,
whatever it may be. And unfortunately I
don’t believe that the current way that the system is set up, which is basically just giving Ibuprofen
other medications and neurology workup, that kind of stuff is doing a lot of
justice for the patients who have chronic headaches. And so I see quite a lot of patients in
my clinic who are suffering from chronic, chronic headaches and the
medications aren’t doing anything. The ibuprofen doesn’t do anything.
They’ve been cleared by the neurologist. So there’s no weird tumors or masses
in their brain or anything like that causing those symptoms.
And so they’re kind of left with this, here’s some medications,
let’s try, some different types of
medications and just go from there. And so I’m going to walk you through
kind of the thought process that I take with my patients who
are coming to me with whether it’s chronic headaches
or chronic migraines, and hopefully that gives you some insight
into how you might think about your current situation. So the first thing that
I want to say is just like people walk around saying
that they have sciatica when they likely don’t, but they might,
but they likely don’t. a lot of patients will walk around saying
they have migraines when they don’t actually have migraines. And I’m not saying that if you’re
watching this and you have migraines, don’t take it personally because
you might actually have migraines. but what I typically find is that 50
to 60 percent of my patients who come into the clinic who say they have migraines, I do a physical exam
on them. The findings that we get are going
to show that it’s coming from an a musculoskeletal or orthopedic condition. And when we end up treating that with
prolotherapy or PRP or whatever we choose, those symptoms go away and the migraines
are gone and the headaches are gone. The classic symptoms
of a migraine are people are going to need to be in a
dark, dark room, can’t have any noise.
There’s usually some, nausea or there could be
nausea associated with it, but it’s really intense
and it puts people out. Some patients will have tension
headaches where they get pain from the back of their skull. That kind of comes up and sometimes
it comes over into their eyes and they’ll still be able to
function, but it’s uncomfortable. But they’ll say that they have migraines. And so I think it’s just
important to understand that there’s differences in what we call
things because that’s going to frame up your mind and how you’re going
to approach these things. So getting back to
how I approach these things. So the first thing that I look at
when a patient comes into my office is musculoskeletal causes.
Okay. What that entails, and we have my lovely little model here. What that entails is I want to
look at the facet joints. Now, the facet joints here are the joints
that are in between each level of the vertebra. So they start all the way up actually
at the the base of the skull. Here’s your C1 and C2.
That’s the first level. They come all the way down into L5S1.
So there’s a facet joint in every single level. Those facet joints allow movement
between each vertebra level, so allows you to do
flexion, extension, rotation. It creates a stable pillar,
but allows you to do movements. Those facet joints can commonly become
inflamed with some mild arthritis in them. You can get some
irritation of the joint capsule. When that happens, that can
radiate pain into the head, into the shoulder, commonly
the upper cervical, so basically C4, C3, C2, C2, C1
and then the OA joint, the Occipital-Atlanto joint. Those will refer up into the head and
then it’s more common for C5 downwards to refer into the shoulder. But sometimes patients will have
C5-C6 or C6-C7 facet arthritis that refers up into the head
like a migraine or like a headache. And so that’s the first thing
that we’re going to want to do. So if you’re at home, if you notice that your neck
hurts when you look upwards, which when you do that, that’s
gonna compress the facet joints. If you look up or done,
that creates some neck pain. That could mean your facet joints
if you look up and over to the side, and that makes it even
worse on either side. Then that could also indicate that you
have some facet joint issues that could be contributing to your headaches, and so the facet joints are are
one of the first thing that I look at. The other things that I look at
is the suboccipital ridge. So the sub occipital ridge is if you are
on your skull and you go down and then you feel where the bone ends and then
you get into the muscles, that’s your sub occipital ridge. There’s a lot of fascia and muscles
that attach on that area that with poor posture, with car accidents,
with falls and other traumas, we can get some irritation in
that area because of degeneration, but also some neurogenic inflammation. There’s a lot of nerves
that come from here, deeper from the spinal cord
that then come up at over top, mainly the greater occipital nerve
and the lesser occipital nerve. And those are going to actually
connect with the super orbital nerve. So the super orbital nerve comes out here, it comes up to about mid
point on the actual on the head and then
it’s going to actually, it can connect with the greater occipital
nerve from the posterior aspect. So if you have headaches that either
start in the back and wrap all the way around to the eyeball or start in the
eyeball and wrap all the way around to the back. The another place that I look is going
to be the greater occipital nerve as well as the super orbital nerve. When
we have those nerve related issues, we can use 5% dextrose, which is our perineural injection
therapy and we inject it along those areas and we can get a significant reduction. And we’ve actually eliminated
headaches in a lot of people. And so those are kind of
the big three areas. Again, as long as the patient’s been a space occupying lesion in the brain, those types of things have been
ruled out on the orthopedic side. Those are the big things I look at. I
look at the facet joints. Then I look at, and I look at all these together,
but the facet joints, the suboccipital ridge and the tendons
and ligaments that are attaching there. And then we look at the nerves that are
coming from the skull and wrapping over super orbital nerve, greater occipital
nerve, lesser occipital nerve, those types of things. If all
of those come back as negative, then I start to look at food triggers. So there are some foods that people
eat that can trigger headaches and migraines and some people may not realize it
because it might be a food that is not classically known to
be an issue, especially if you’re
talking in today’s society. So it’s not always like a dairy, gluten
or corn or soy or anything like that. Some patients will have a, we’ve had
some patients react to blueberries, and when we remove blueberries
from their diet, their headaches go away. Other patients are really sensitive
to the chemical dyes the red 40 in the blue 32, or whatever
it is. It sounds like football, but, but the dyes that are used in foods
can sometimes be triggers for patient’s headaches. And so, so those are
the kinds of the big camps. There’s other things hormones can
contribute, gut health can contribute, but the big, big, big things I look
at are the musculoskeletal causes. And then if all those are ruled out,
then we look at food triggers. All right. Everyone hope you enjoyed hearing how I think about headaches, migraines and all that kind of jazz. See you later!

1 thought on “My Approach to Headaches & Migraines | DailyDocTalk 63

  1. This is so true about the food induced headaches! I was happy to hear you pose that possibility because most doctors will never even touch on the subject. No one would ever suspect it. People thing food intolerances only cause stomach problems! Food intolerances can cause ANY symptom the human body is capable of experiencing. Sometimes a food intolerance causes no gastrointestinal issues whatsoever! Thats what makes them so elusive! No one, not even a doctor, would ever guess that a food intolerance could do so many things to the body. I discovered many food triggers that I would have never guessed! Eggs, deli meat, dried fruit, and potato chips are triggers for me. It took me YEARS of suffering before I figured it out. There's more that I have not yet identified. It takes a long time and a lot of experimentation because the symtoms, especially headaches, arent always instant, so by the time it starts, theres several things it could have been if you are eating a variety of foods. It took me being on a mono diet for a few years before I was able to isolate exactly which foods were the culprit, and even after 20 years of experimenting with my diet theres still some things that elude me. I would almost go as far as saying probably 95% of all of my symptoms (not just headaches but other aches and pains, stomach problems, etc) are caused by food! Identifying all these offending foods without starving to death in the process, is a tremendous challenge, but Im still alive and will never stop working on it so long as I remain able. But I want to spread the word to suffering people everywhere, please take a very close look at what you eat and drink, especially if youve seen a doctor and have eliminated any other possible cause, because if youve gotten that far and you are still suffering from headaches or other symptoms and no one can tell you why….my guess is its something you are eating. And Im no doctor! Just a person who has suffered tremendously for 20 years with no answers until I started doing my own experimentation and taking a VERY close look at what Im eating, doing a modified mono diet (eating only one food at a time, or even just one food per day) and keeping a very detailed food journal for the past 8 years.

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