Everyone is familiar with pain. Most pain is caused by inflammation. Most of the inflammation comes from tissue damage that may occur from many different exposures. We have all felt the pain from sunburn, or putting our hand on a hot burner, or holding ice cubes.
We’re also very familiar with the pain caused by infection or abrasions, chemical irritations, or even radiation injury. Tissue damage from any source triggers the release of specific chemical substances that cause blood vessel dilation and leakage of blood vessel components into the surrounding tissue. These chemicals include histamines, kinins, prostoglandins, complement, and leukotrienes. The leakage of the blood contents into the tissue causes local swelling, pain, and sometimes redness, all of which make up the inflammatory reaction.
Anti-inflammatory medications are frequently prescribed for pain. Some common ones include Bextra, Celebrex, Motrin, Naprocin, and Vioxx. Other common pain medications that are NOT anti-inflammatories are Hydrocodone, Vicodin, Percocet, and Oxycodone.
Unfortunately, all medications have side effects. Vioxx may have contributed to up to 139,000 heart attacks and strokes, forcing the FDA to withdraw it from the market in September 2004. Long term use of Celebrex may increase the risk of cardiovascular events by 2.5 fold. Naproxen (Aleve, Naprocyn) was linked to a 50% increase in cardiovascular events (compared to placebo), necessitating the suspension of the $26 million Alzheimer’s trial by the National Institute of Health.
Because inflammation is at the core of much of the pain we all experience, let’s review some other ways to control inflammation, or at least reduce it.
1. Diet. Avoid inflammatory triggers, including caffeine, sugar, trans fatty acids, hydrogenated oils, and aspartame. Eat “real” food and avoid processed foods, as processed foods increase the amount of free radical production, leading to increased inflammation. Also decreasing red meat and dairy consumption may reduce inflammatory triggers.
As the majority of headaches are food related, assessment of food allergies, which are what is tested with skin tests or blood RAST tests, and subsequent avoidance of the offending foods or desensitization treatment is necessary. Most food allergies are mediated through the IgG system, and not through the IgE system.
2. Supplements. The most critical supplements would be the antioxidants C, E, and beta-carotene, which will modify the free radical damage in the body. The increase of Omega-3 fatty oils will encourage the production of anti-inflammatory prostaglandins.
3. DMSO, which is a precursor to MSM, acts as an anti-inflammatory and reduces damage to the tissue after a toxic exposure. DMSO is usually found in a cream or gel, and its aroma can be slightly offensive. MSM has no odor and is better tolerated. Neither MSM nor DMSO has any gastrointestinal side effects, which is a concern with all anti-inflammatory medications.
4. Frequency Specific Microcurrent (FSM) machines are extremely effective in reducing inflammation and pain. The amperage in these microcurrent machines falls in the millionths of amps range, so the current is very small. TENS units are typically in the thousandths of amps. Both the TENS units and the Microcurrent machines have been cleared by the FDA for use in pain. Studies done with FSM machines show reductions in four inflammatory markers: IL-1, IL-6, TNF-alpha, and substance P, to a greater extent than any anti-inflammatory medication available. [i] A corresponding reduction in pain, based on the VAS pain score, was also noted. ATP production (which is the energy currency of the body) was increased four times in the tissue receiving the current.
Because pain and inflammation are caused by many different sources, this is merely a starting point for other specific pain patterns. Fibromyalgia is a whole topic by itself, as is rheumatoid arthritis and all arthritis conditions. Stomach pain is a huge topic (sometimes that depends, though, upon the size of the stomach :)). I will address all of those topics individually in later articles.
Let’s take headaches as an application of what we have just discussed. Headaches have generally been classified into two categories: vascular and non vascular. The vascular headaches include migraines, cluster headaches, and a miscellaneous group caused by hypertension, hangovers, exertion, toxins, or drugs. The most common non-vascular headache is the tension headache, related to muscle tightness. There may also be headaches from brain tumors, or increased intracranial pressure. Regions outside of the brain, like the sinuses, dental areas and ears may also be inflamed, causing headaches. Eyestrain may also be a factor in headaches.
The two most common headaches are migraines and tension headaches. Although there are many kinds of migraine headaches, the simplified form presents as a throbbing or pounding sensation, usually unilateral, while a tension headache is steady and constant, usually starting at the neck or forehead and spreading to the entire head.
Why People Get Headaches
There are multiple theories as to why people get migraines. Because these theories relate to therapies, let’s review them. Vasomotor instability, which means that the size of the blood vessels changes from a constricted state to a dilated state by some known or unknown triggers. [ii] There is increased platelet aggregation, which means that platelets attach to each other, which blocks blood flow in tiny vessels. [iii] There appears to be a stress component in some patients that triggers a sympathetic discharge that may be part of the vasomotor instability. [iv] There also seems to be a serotonin deficiency that may be the cause or the result of the recurrent migraines. [v]
The treatment of headaches begins with avoiding any known triggers. As mentioned earlier in this article, a significant number of headaches are related to food intolerances. Although the list of foods is long, the top four include milk, wheat, chocolate and eggs. [vi] Most food sensitivities can be diagnosed with an IgG ELISA test. Avoidance of those “allergic” foods is very effective in reducing headaches.
There are also vasoactive compounds; that is, compounds that are known to affect blood vessel size, and these should be avoided. These include chocolate, cheese, beer and red wine. [vii]
Reducing Histamine Levels
Because histamine plays such an important role in pain, including headaches, there are two substances that reduce histamine levels. 1) If the levels of vitamin B6 are high, it decreases histamine levels; if levels of vitamin B6 are low, it increases histamine levels. [viii] Although blood levels of vitamin B6 are available, supplementation of 50-200mg/day of the vitamin may help, and certainly will not hurt. 2) Quercetin stabilizes the membrane of mast cells, thereby reducing its release of histamine in the local area. This herbal compound should be considered in any histamine or allergy-related condition, and is available in most health food stores. Because serotonin is deficient in many patients with migraine headaches, the serotonin precursor, 5 HTP (5 hydroxytryptophan) in doses of 100-600mg per day may be quite effective. [ix] 5 HTP should be used for just a few months trial, as long term use may imbalance the neurotransmitter system. If magnesium levels are low, magnesium is critical to reduce headaches. [x] This needs to be a free magnesium level, and not a total magnesium level. By that I mean, free magnesium is the only magnesium that is available for tissue use. The body carefully maintains a normal total magnesium level, even with a mild magnesium deficiency. Six hundred to 1000mg/day of magnesium is an acceptable range. Additionally, feverfew is one of the most remarkable herbal treatments for migraines. [xi]
Interestingly, many temporomandibular joint (TMJ) dysfunctions are at the core of headaches diagnosed as both migraines and tension headaches. The release of those tight muscles through massage and a specially designed mouthpiece for TMJ is critical if that is the source of the headache. [xii] TENS devices (transcutaneous electric nerve stimulators) have been used effectively for all pain conditions. [xiii] A recent addition for treatment is the microcurrent machine, which is described above. Acupuncture [xiv] and other energy modalities such as magnets have proven useful. Biofeedback and relaxation techniques have also been shown to reduce headaches to the same extent as medications in well designed studies. [xv]
A final, fascinating look at chronic headaches is called “analgesic rebound” headache or “ergotamine rebound” headaches. These are caused by the very medications used to treat headaches. The chronic use of these substances will occasionally cause dependence and headaches upon withdrawal of the substances. Many patients have found that if they become medication free, their headaches actually diminish (after the first few days of increased headaches). [xvi]
When headaches occur, first it is always best to look at and eliminate common causes, which may or may not be obvious. Dehydration is probably far more prevalent than we realize as a society, and many diseases, including headaches, are exacerbated by lack of water to lubricate the tissues and allow elements in the body to flow freely. Additionally infections in the ear, sinuses or teeth are located in areas close to the brain. Their proximity can affect the rest of the head and cause intense pain. Lastly, eye strain can create headaches, as those of you who have studied long and late into the wee hours of the morning, preparing for an exam, can attest.
1. Pain and inflammation always have a cause, and avoidance of triggers is the first step toward treatment.
2. You may have to be a detective in order to locate the source of the headaches.
3. There are many non-medication approaches that can be used with no dependency and fewer side effects.
[i] Submitted for publication in Journal of Body Work and Movement Therapy, April 2005.
[ii] Rose FC. The pathogenesis of a migraine attack. TINS 1983; 6:247.
[iii] Hanington E. The platelet and migraine. Headache 1986: 411-15.
[iv] Welch KMA. Migraine. A biobehavioral disorder. Arch Neurol 1987; 44:323-27.
[v] Fozard JR, Gray JA. 5-HTIC receptor activation. A key step in the initiation of migraine? Trends Pharmacol Sci 1989; 10: 307-9.
[vi] Egger J, Carter CM, Wilson J et al. Is migraine food allergy? Lancet 1983; ii: 865-9.
[vii] Peatfield RC. Relationship between food, wine and beer-precipitated headaches. Headache 1995; 35: 355-7.
[viii] Wantke F, Gotz M, Jarisch R. Histamine free diet. Treatment of choice for histamine induced food intolerance and supporting treatment for chronic headaches. Clin Exp Allergy 1993; 23: 982-5.
[ix] Bono G, Criscuoli M, Martignoni E. Serotonin precursors in migraine prophylaxis. Adv Neurol 1982; 33: 357-63.
[x] Ramadan NM, Halvorson H, Vande-Linde A et al. Low brain magnesium in migraine. Headache 1989; 29: 590-3.
[xi] Johnson ES, Kaddam NP, Hylands DM et al. Efficacy of feverfew as prophylactic treatment of migraine. Br Med J 1985; 291: 569-73.
[xii] Walts PG, Peet KMS, Juniper RP. Migraine and the temporomandibular joint The final answer? Br Dent J 1986; 161: 170-3.
[xiii] Solomon S, Guglielmo KM. Treatment of headache by transcutaneous electrical stimulation. Headache 1985; 25: 12-15.
[xiv] Laiten J. Acupuncture for migraine prophylaxis. A prospective clinical study with six months follow-up. Am J Chin Med 1975; 3: 271-4.
[xv] Holdroyd KA, Penzien DB. Pharmacological vs. non-pharmacological prophylaxis of recurrent migraine headache: a meta analytic review of clinical trials. Pain 1990; 42: 1-13.
[xvi] Isler H. Migraine treatment as a cause of chronic migraine. In: Rose FC, ed. Advances in migraine research and therapy. New York, NY: Raven Press 1982: p. 159-164.