When I came across these clinical practice guidelines, I was a little giddy - you may have noticed the excitement in my instagram post. When the Veteran’s Affairs/Department of Defence Clinical Practice Guideline For The Primary Care Management of Headache dropped a few weeks back, I poured myself a glass of wine and settled into my favourite patio chair for a quiet evening of evidence-based practice. Here are some facts I pulled out of the 150 page document:
66% of people will experience a headache disorder in their lives. Sixty-six. SIXTY-SIX. That number blew my mind. I knew it was a common thing to experience, but I never would have guessed THAT common.
Women are more likely to experience migraines (15-18%) than men (6-10%). These migraines are often triggered by hormone fluctuations and are most prevalent in women of childbearing age.
The three most common types of headaches are:
Tension-type headaches - these can last anywhere between 30 minutes to 7 days and are characterized by pain on both sides of your head and a pressing or tightening feeling. Tension headaches do NOT pulse and are typically not aggravated by life - they just happen.
Migraines - lasting typically from 4-72 hours, migraines usually take over one side of your head with moderate to severe pulsing or throbbing pain, sometimes with a whole host of other symptoms (nausea, vomiting, light and noise sensitivity, visual or auditory auras and more!). Migraines are often triggered by physical activity, such as climbing the stairs, or other triggers in foods or the environment.
Medication-overuse headaches - I’ll be honest, this one surprised me as making the “Top Three” list. These are a result of overmedicating with anything from over-the-counter meds like Tylenol or Advil, or the heavy hitters like opioids and triptans. (If you think this may be you, please speak with your doctor before changing your medication use)
So what kind of headache do you have?
Headache Diary
First things first - you need a headache diary. By tracking the time, medication used, triggers and patterns of your headaches, we can figure out what kind of headaches you’re experiencing and the best method of attack for your headaches. To make an accurate diagnosis, you should track your symptoms for at least a month - this gives us enough data to identify patterns and come to a more accurate diagnosis.
Now, for the big question - what can you do about your headaches? Let’s go through migraines and tension-type headaches separately.
Migraines
The best treatment option for migraines we have right now is the right medication. There are a whole host of them out there with various levels of evidence behind them - in fact, most of them are listed in this clinical practice guideline! If you have a migraine diagnosis or think you should, I urge you to speak with your physician - they can help you decipher your symptoms and figure out the right meds for you.
The other big treatment approach for migraines is trigger modification. Has your headache diary helped you figure out something in your diet is causing your headaches? Or maybe you’ve realized reading in the car can bring one on? Identifying and removing or dealing with these triggers is huge!
Tension-Type Headaches
With tension headaches, medications are also great. We have other non-pharmaceutical options with research behind them, including:
Physiotherapy for your neck - research is supporting more and more the use of manual therapy and exercise for the neck to help reduce headaches. This could mean traction, release of muscles in your neck, strengthening of the deep postural muscles or stretching of the tight muscles in and around your neck - it depends on you!
Aerobic exercise and progressive strength training - it turns out that getting your heart rate up and your body strong is one of the best things you can do for you head. For starters, any exercise that gets your heart rate up also gets your body making new blood vessels including in your brain. Add general body strengthening to that and your head becomes easier to hold up all day, reducing the tension in your neck.
Mindfulness and meditation - we are finally at a place in the medical community where mindfulness is mainstream! We know thought patterns can influence our bodies and the pain we perceive. We also know we can harness this for our own benefit through mindfulness practice. Not sure where to start? Apps like Calm and Headspace are a great place to get your feet wet - I like anything with a body scan!
Wondering about acupuncture and IMS? Right now, the research hasn’t come down on one side or the other, instead saying “more research is needed”. I interpret that as follows: if you’re someone who typically benefits from needling, it’s worth a try. If it doesn’t work for you, we have other options!
If you suffer with undiagnosed headaches, print out the headache diary, fill it out for a month and discuss the results with your family practitioner. If tension-type headaches are the problem, give us a shout - we would love to help you get your headaches under control!
As always, if you’d like to book an appointment you can do so online, via email or by phone at (778) 630-8800.