July 2012 | A Better You | Headache Help

Don’t let migraines and more ruin your day

By Suzanne Martin, PT, DPT

If you suffer from frequent or severe headaches, here’s one more reason to be glad you weren’t around in the not-so-good old days: one treatment in centuries past was a technique called trephining, which involved cutting little holes into the skull to relieve pressure. But there are more civilized options. If you feel like someone’s drilling into your head on a regular basis, here are some tips to help you control your headaches and get relief.

Headaches come in various kinds, but migraines are the scariest. These typically involve intense pain in one area of the head, accompanied by nausea, vomiting, and extreme sensitivity to sound and light. Attacks can last as long as three days. Migraine sufferers may see flashes of light or experience blind spots or tingling in an arm or leg, either before or during an attack. Warning symptoms—neck pain, irritability, constipation, diarrhea, hyperactivity, and food cravings—may precede attacks by a day or so. As many as nine out of 10 migraine sufferers have a family history of the problem.

Women are three times more likely than men to have migraines, which can be set off by monthly female hormonal fluctuations. Many women suffer attacks immediately before and during their periods, when their estrogen level falls sharply. In some women, oral contraceptives can induce attacks. Migraines can also result from a trigger allergy, often to things in your daily diet such as red wine, chocolate, aged cheeses, and monosodium glutamate (MSG). If you suffer from migraines, chances are that you already know which foods can set them off. Intense exertion, mental stress, and loud sounds can also be triggers, so the risk factors you face in a studio are numerous.

Some dance teachers I know get migraines very intermittently, two or three times a year. Another has migraines so severe that she has to take medication that leaves her incapacitated for a day. For severe cases, triptans are the prescription drug of choice for relieving pain, nausea, and sensitivity to light and sound. They include sumatriptan (Imitrex), rizatriptan (Maxalt), almotriptan (Axert), naratriptan (Amerge), zolmitriptan (Zomig), frovatriptan (Frova), and eletriptan (Relpax). Bed rest and aspirin with caffeine may be enough for milder cases, while dimmed lights may be enough to ease others’ symptoms.

Many dance teachers prefer to go the natural route and avoid medication, but once your doctor has identified the source of the migraine as a hormonal or inflammatory response, it’s best to use the medication. These responses are biochemical cascades, meaning their cycles take time to resolve. It’s like blowing on a dandelion puff and watching the seeds disperse into the air. Each seed that starts pain, inflammation, and swelling will cycle until something stops it. Medications interfere with these cycles and stop them mid-stream. The sooner you can intervene, the sooner the headache will diminish.

Non-traditional therapies such as acupuncture, massage, and chiropractic treatments may be helpful in reducing the frequency or severity of migraines. According to the Mayo Clinic website, biofeedback “appears to be especially effective in relieving migraine pain.” In a biofeedback session, electrodes that are hooked up to specific muscles help patients identify tension-holding patterns in the face, neck, and head areas that contribute to migraine pain.

If you feel like someone’s drilling into your head on a regular basis, here are some tips to help you control your headaches and get relief.

Be aware, as you consider medication options, that if you take over-the-counter or prescription headache medications frequently or in high doses, you could induce what are called “rebound headaches,” in which the medications are causing your pain, not relieving it. Caffeine can make such headaches worse. Treatment may involve weaning you gradually off the medications, stopping them outright, and in some instances hospitalization.

If your migraines are unusually frequent or severe, you should discuss preventive medications with your doctor. These drugs usually don’t eliminate attacks completely, and some have serious side effects, but they can be helpful in some cases. They include beta blockers, certain antidepressants (useful even if you don’t suffer from depression), anti-seizure drugs, and Botox injections.

Other headaches
Other common types of headache are tension and cluster headaches. With tension headaches, you may feel pain on both sides of your head (as if a metal band were squeezing your skull); sometimes symptoms include neck pain and fatigue.

Cluster headaches involve severe pain on one side of the head, sometimes accompanied by nasal congestion and tearing from one eye, usually the one on the same side of the head as the pain. These can last from 15 minutes to three hours and can strike more than once daily during clustered attacks (hence their name).

Some headaches are physically induced. For part of my work in getting my doctorate, I focused on the spine’s influence on head pain. Physical therapists evaluate clients to determine if their pain is originating from the cervical spine or thoracic spine. By listening carefully to the client, as well as using our hands, we can investigate the pattern of a certain pain area. For instance, if head pain is experienced upon awakening in the morning, the pain may be caused by an incorrect or prolonged sleep position. Sleeping on one’s back with a rolled-up hand towel placed under the arch of the neck can be helpful. (This is a good sleep technique in general.)

Also, you can buy bed pillows equipped with a little roll that fits under the neck and eases the pressure of the head’s weight. The same roll is good for side sleeping. Try to keep the head level with the spine and avoid using high, stiff pillows that push the head forward when you’re on your back. An arc-shaped neck roll is useful for plane flights and for reading in bed.

The typical physical stresses of teaching, plus being “on” and speaking for hours, can produce tight muscles. Even a stiff rib cage area can produce neck and head pain. Since musculoskeletal symptoms can overlap with the inflammatory type of headache caused by periods and allergies, reaching an accurate diagnosis can greatly aid in easing your pain. If you suspect you are getting head pain from stiffness in your rib cage or upper trapezius area, wear a liniment patch such as Tiger Balm, Tylenol, or Salonpas (made with red pepper). Sometimes all you need is a little direct menthol action or plain pain relief.

Play detective
Use your dancer’s ability to analyze what’s going on in your body to tease apart the various elements—hormonal, musculoskeletal, sleep position—that cause pain in your head, neck, and shoulders. They all go together. Figure out which element needs what for relief. You’ll be happy you did.

I have faith in you.