While headaches and migraines are an infrequent part of life for most people, they can become altogether too frequent for others. Up to 20% of people will be affected by migraines at some point in their lives, and up to 16 million people in the US alone have a migraine 15 days a month (1, 2). Treating chronic headaches and migraines can be tricky, and because there is no set treatment, many people go to the ER and are prescribed painkillers such as NSAIDs or opioids to simply deal with the pain (3). While there is no one cure, there are a number of therapies and treatments that functional medicine can provide to those suffering from chronic headaches.
What is the difference between a headache and a migraine? And when is it considered chronic?
Many people consider a migraine just a very bad headache, but it is more than that. A headache may be any type of pain or pressure in your head, usually occurs on both sides, and is often caused by other factors, such as muscle tension, stress, or sinus pressure (4). They can range from mild discomfort to severe pain and can last up to a week. While the type of pain and pressure can vary, headaches are usually characterized by a dull, throbbing ache (7).
A migraine, on the other hand, is always moderate to severe and is usually a sharp, pulsating pain. It is always accompanied by other symptoms, such as (1, 2, 4, 5):
Nausea or vomiting
Pain behind one ear or eye
Seeing floaters, flashing lights, or spots (usually before the migraine begins)
Temporary loss of sight or blind spots
General sensitivity to light, sound, or smell
Pain that worsens with physical movement or exertion
Numbness or tingling of hands, arms, face, lips, tongue, usually on one side of the body
Changes to bowel movements
Fatigue, abnormal energy, neck stiffness, or frequent urination (before migraine begins)
An increasing number of migraines over time
Migraines are most commonly known for affecting only one side of the head, but they can also be equally painful on both sides, or even at the front or back of the head (5). Women are twice as likely to have headaches and migraines as men, and they occur most commonly in those ages 18-44, according to the CDC (6).
While nearly a quarter of the population can report experiencing a headache or migraine within the past three months, both have to meet specific criteria to be considered chronic (1, 3, 7). Headaches must occur on at least 15 days per month for more than three months to be chronic, and 8 of those days must be migraines to be diagnosed with chronic migraines (1).
What causes migraines and headaches?
Headaches share the same risk factors as migraines (7). However, sinus pressure, muscle tension, inflammation or pressure in and around the brain, traumatic brain injury, and infections may also cause headaches (7).
The exact cause of migraines is not known, largely because there doesn’t seem to be one cause. The tendency to suffer from migraines has a genetic basis, but there are other internal and external factors that can trigger their onset (5). Commonly known risk factors for migraines include (1, 2, 7):
Depression, anxiety, and other mood disorders
Stressful or traumatic life events
Ongoing disrupted sleep patterns
Head or neck injury
Caffeine or alcohol
Eating certain foods, or irregular eating habits
Persistent, frequent nausea
One study found that the average person has 91 toxins in their blood and urine, since they come from so many sources (11, 12). Cigarettes, asbestos, burning wood or gas, unsafe drinking water, lead, and other chemicals are all sources of toxins that may cause headaches (11). Water damage in buildings is a common source of toxic mold formation, which can sometimes go without being noticed. These toxins are known to cause inflammation, disease, and death (13, 14).
Inflammation is another potential source of brain problems and headaches. Inflammation has many causes, including toxins and mold, gut dysfunction, autoimmune diseases, bacteria and infection, and more (15). When there is inflammation anywhere in the body, it can move to the brain, causing headaches (7). A common source of this is leaky gut, which can cause leaky brain. Due to permeability and/or inflammation in the gut, many types of gastrointestinal disorders (IBS, inflammatory bowel syndrome, celiac disease, etc.) lead to headaches and migraines as well (16).
Mitochondrial dysfunction is another important potential cause of headaches and migraines (17). When our cells begin to become unhealthy, a specific part of the cell that acts as the battery (called the mitochondria) becomes inefficient or impaired, meaning that none of the affected cells are functioning at the level they should. This leads to chemical imbalance, inflammation, and dilated blood vessels, leading to migraines (17).
What can I do to help a headache or migraine after it begins?
Treatment for headaches depends on the cause of the headache. For tension headaches (the most common type), rest can be helpful, as well as using heat or massaging and stretching the muscles can all help ease or eliminate the headache (4). Meditation, relaxation exercises, and other means of reducing stress may also be helpful (1, 4). Sinus headaches may be eased by these methods, as well as elevating the head and hydration. Of course, pain relief medication, such as acetaminophen and nonsteroidal anti-inflammatory medications, may be helpful (1). But as mentioned above, there is a limit to how much these may be used. And while some physicians may allow patients access to opioids to treat severe headaches, most agree (including our physicians at TCIM!) that opioids will do more harm than good in the long run (1, 3).
When it comes to migraines, many people find that taking a painkiller can prevent its development if they take it as soon as they first notice symptoms (1, 3). Preventative medications are often prescribed. Other than that, it seems that rest and treating any co-occurring symptoms (such as nausea) is the best way to get through it (1, 3, 4, 7).
How can I reduce the frequency of my chronic headaches and migraines?
The first step is to take stock of your symptoms and begin to keep a headache log to identify if you have any noticeable headache triggers. Meeting with a functional medicine doctor to discuss your health history is another important step, because they can help identify any potential events or patterns that may be contributing to your headaches.
Lifestyle changes may be able to reduce the frequency of your headaches. If you have one or more of the risk factors listed above, working toward greater health in those areas may bring relief, such as (1, 2, 4, 5, 7, 9, 10, 18):
Seeking treatment for underlying mood disorders, trauma, or high-stress levels
Establishing good sleep hygiene to get enough sleep regularly
Eating more healthy foods
Eliminating trigger foods (some of the most common triggers are cheese, chocolate, wine, and food additives)
Drinking enough water
Taking magnesium supplements
Establishing regular mealtimes or eating patterns
Reducing or eliminating caffeine and alcohol (if triggering)
Getting asthma, allergies, and/or snoring controlled
Seeking healing and/or physical therapy for head or neck injuries
Addressing underlying disorders that cause nausea or pain
If female, regulating hormones to reduce the severity of hormonal fluctuations
If you have found that you have reduced the risk factors above and still not found relief, considering your toxic load (from environmental toxins and mold) and getting tested may provide an answer. Discussing a potential mitochondrial dysfunction with one of our physicians is another option. Pulsed electromagnetic field (PEMF) therapy is a great therapy option to get cells working at a healthier and more energized level, reducing the risk of migraines. If you have noticed some gut problems, working together with one of our physicians to reduce inflammation, heal the gut lining, and introduce supplements such as magnesium is another potential option to reduce chronic headaches and migraines.
Partnering with our team can be a great way to assess which of the risk factors listed above you may need to focus on. At Temecula Center of Integrative Medicine, our doctors desire to listen and work with you to take stock of your health history, run any necessary tests, and address any underlying disorders that contribute to your headaches or migraines. Our chiropractors and massage therapists can help reduce muscle tension and physical strain, and our nutritionist will work with you to create a diet plan that supports your gut health and brain health to reduce headache triggers. We would love to talk with you to determine what other concerns (hormones, asthma, weight loss) you may have, and how we can help!
If you or a family member suffer from chronic headaches or migraines, please reach out to us. We would love to schedule a consultation and create a plan together to help you achieve greater health and freedom from headaches!
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
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