“New beginnings are often disguised as painful endings.”
– Lao Tzu

Headaches

Chronic headaches are a common problem, affecting an estimated 28 million Americans. There are many types of headaches although migraine and tension headaches account for the vast majority. For those who suffer from chronic daily headaches, defined as more than 15 debilitating headaches per month, the distinction between migraine and tension headache can become blurred as these headaches begin to blend in character and behavior.

 

The treatment of migraine headaches, especially chronic headaches, has recently been markedly improved with new classes of safe and effective medications that have allowed many migraine sufferers to reduce the severity and the frequency of their headaches to less than 3 per month, often proceeding entirely into remission.

 

This page is under construction and remains incomplete.

 

See also:

Integrative, Complimentary and Alternative Medicine (CAM)

CAM – Headaches

Acetyl-L-Carnitine

Alpha Lipoic Acid

CoQ10

Magnesium (Mg)

Melatonin

NRF2 Activators

Rhodiola Rosea

SAMe

Vitamin B-12

Vitamin D and Pain

 

 

Key to Links:

Grey text – handout

Red text – another page on this website

Blue text – Journal publication

 

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Headaches

 

Types of Headaches

There are multiple types of headaches with multiple causes. The study of headaches is exhaustive with entire books being written on headaches, so this section is limited to reviewing the most common forms of headaches, migraine and tension headaches, along with the common prescription medications used for their treatment.

 

Migraine Headaches

Diagnosis of Migraine Headache

Although  any headaches that are severe are commonly considered to be migraines, the fact is that not all severe headaches are migraines and not all migraines are severe. Diagnosis of migraine headaches can sometimes be complex, but typically migraines have common basic features:

  1. Moderate to severe intensity, interfering and worsening with physical activity, necessitating rest or lying down
  2. Accompanied by nausea and possibly vomiting
  3. Sensitivity and intolerance of bright lights or loud sounds

A headache consistent with at least 2 of these 3 characteristics is likely to be a migraine headache more than 90% of the time. Migraine headaches are considered “classic” if they include warning symptoms prior to the onset of pain. These warning signs, or auras, can include flashes of light, blind spots, or tingling in the hands or face. Other visual effects can appear to be jagged or wavy lines lasting up to 20-30 minutes that transiently precede the headache. These effects, called scotoma, are not always followed by a headache. Migraine without aura are considered “common migraines” and account for 70% of patients with migraine headaches.

 

Treatment of Migraine Headache

The treatment of migraine headaches can be divided into: (1) aborting or stopping a migraine headache once it starts and; (2) preventing the headaches before they start.

 

 

 

Management of Chronic Headaches

The management of chronic headaches is an extensive subject and includes emergency management, abortive management of acute headaches and preventative management of chronic headaches. It should be stressed, however, that behavioral approaches to headache prevention are extremely important and effective means of reducing the frequency and severity of debilitating headaches. Behavioral approaches include exercise, cognitive behavior therapy, deep relaxation techniques, yoga, tai chi, and mindful exercises such as meditation.

See: CBT, Yoga and Tai Chi).

 

References

 

Headaches – Overview

  1. Headaches – Diet & CAM Summary
  2. Dietary Supplements for Pain and Headache _Supplemental Article

 

Headaches – Rebound or Medication Overuse Headaches (MOH)

  1. Medication-overuse headache – epidemiology, diagnosis and treatment – 2014

 

Headaches – Medications

  1. Topiramate inhibits trigeminovascular activation an intravital microscopy study 2005
  2. The Use of Antioxidants in the Treatment of Migraine – 2020
  3. The eole of satellite glial cells in orofacial pain – PubMed – 2018
  4. The role of calcitonin gene–related peptide in peripheral and central pain mechanisms including migraine – 2017
  5. Targeted CGRP Small Molecule Antagonists for Acute Migraine Therapy – 2018
  6. Repression of stimulated calcitonin gene-related peptide secretion by topiramate – PubMed – 2006
  7. Proposed study collaboration regarding Rimegepant and Central Sensitivity.pdf 7:16:21
  8. Pharmacological treatment of migraine CGRP and 5-HT beyond the triptans – PubMed – 2020
  9. New Trends in Migraine Pharmacology – Targeting Calcitonin Gene–Related Peptide (CGRP) With Monoclonal Antibodies – 2019
  10. New Agents and Approaches for Migraine Treatment & Atypical Facial Pain and TMJ & Ketamine – The Good, The Bad and the Ugly SPS 10:2022
  11. Neuroprotective Effect of Antioxidants in the Brain – 2020
  12. Neuropeptides and Other Chemical Mediators, and the Role of Anti-inflammatory Drugs in Primary Headaches – 2010
  13. Migraine and the trigeminovascular system—40 years and counting – 2019
  14. Ketorolac in the Treatment of Acute Migraine: A Sys… [Headache. 2013] – PubMed – NCBI
  15. Ketorolac in the Treatment of Acute Migraine: A Sys… [Headache. 2013] – PubMed – NCBI copy
  16. Dual Therapy With Anti-CGRP Monoclonal Antibodies and Botulinum Toxin for Migraine Prevention Is There a Rationale? – PubMed
  17. Chronic Orofacial Pain – Models, Mechanisms, and Genetic and Related Environmental Influences – 2021
  18. CGRP-Based Migraine Therapeutics – How Might They Work, Why So Safe, and What Next? – 2019
  19. CGRP Receptor Antagonists and 5-HT1F Receptor Agonist in the Treatment of Migraine – 2021
  20. CGRP inhibitors for migraine prophylaxis a safety review – 2020
  21. Calcitonin Gene-Related Peptide Antagonists as a Savior in Episodic and Chronic Migraine – A Review – 2020
  22. Understanding side-effects of anti-CGRP and anti-CGRP receptor antibodies – 2020
  23. AHS Releases Updated Guidance on New Migraine Treatments – 2021

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

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