Integrative Medicine Treatment for Headaches

Virtually everyone experiences a headache at some point in their life, probably many times, as this is one of the most common forms of pain. This generally benign condition can cause significant impacts on quality of life and productivity. As opposed to many chronic conditions, headaches tend to occur more in younger people, decreasing with age. They also are more common in women than men (20% vs. 10% reporting having had a severe headache or migraine in the past three months).

Many people become intuitively aware of triggers for their headaches. Depending on the person and the specific type of headache, triggers can encompass a broad spectrum, including environmental, food, medication, hormonal, and psychological factors. This article will delve into headaches and discuss a functional medicine approach to testing, discovering potential contributing factors to headaches, and holistic methods that may support well-being.

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What is a Headache?

In pursuing a deeper understanding of headaches, it is important to recognize that a headache is technically a symptom, not a disease itself. As a symptom, a headache encompasses pain in the face, head, or neck. This pain is often described as throbbing, constant, sharp, or dull. Sometimes it feels like a pressure. It may occur in different locations or patterns depending on the cause, for example, on only one side or feeling like a band around the head. This location or pattern and the qualities that describe it (i.e., throbbing, sharp, dull) can be useful in understanding the type of headache and thus exploring potential contributing factors.

Most headaches are not harmful, but some types indicate urgent situations and should not be ignored. Thus, it is crucial to recognize the rare cases when a headache should be treated as an emergency. This distinction will be made later in this article.

What is The Difference Between a Headache and Migraine?

A migraine is a neurological condition with (often severe) headaches as one of many symptoms. A headache is a much less specific term that simply describes experiencing pain in the head. However, in migraines, the changes in brain activity may influence blood flow and chemical messaging in the brain and nearby areas.

Some of the symptoms of migraines that are not present with all headaches include:

• Nausea and vomiting
• Intense sensitivity to light, sound, or smells
• Dizziness
• Fatigue

In addition, a migraine occurs in 4 phases, which means it is sometimes possible to identify the onset before the head pain has even begun. These stages are not always all experienced, but the following may be noticed:

Prodrome Phase:

Occurring a few hours to days before the headache and can include the following symptoms:

• Fatigue or unusually high energy
• Mood changes
• Trouble concentrating
• Trouble sleeping
• Increased need to urinate and drink
• Food cravings

Aura Phase

Present in 25-30% of migraines) - occurring 30-60 min before the onset of head pain and may include the following symptoms:

• Visual disturbances (most common) include seeing zig-zags, colorful spots, or flashing lights. It may also appear as fogginess or blind spots.
• Sensory or motor disturbances such as tingling, numbness, or weakness
• Disturbances in verbal and language function (rare), such as mumbling or slurring speech or having a difficult time expressing thoughts or concentrating‍

Attack Phase ‍

Occurs for a few hours to several days. It is often difficult to maintain normal activities. The pain often begins above the eyes and affects only one side of the head at once, though not always. The quality of pain is usually throbbing and tends to be worse with movement or physical exercise. In addition to the head pain, these symptoms may also be experienced:

• Increased sensitivity to light, sound, and sometimes smell
• Nausea and vomiting
• Lightheadedness

Postdromal Phase

May occur after the most severe part of the headache stops. This can happen for a day or so after the migraine and potentially with the following symptoms:

• Extreme tiredness and sluggishness
• Confusion
• Return of head pain with certain activities, like bending down or moving quickly

What are the Different Types of Headaches?

Headaches are generally classified as either primary or secondary headaches. The difference is that primary headaches are caused directly by the interaction of some trigger with the pain system in the head. Secondary headaches occur as a result of another medical condition.

Some of the most common types of primary headaches include:

Tension headaches

This is the most common type of headache among adults and teens. It may feel like a band is constricting the head.

Migraine Headaches

Often a one-sided, throbbing pain lasting from 4 hours to 3 days and usually occurring 1-4 times monthly. Stages before and after the head pain may be present, as well as other symptoms such as:

• Sensitivity to light, noise, or smells
• Nausea or vomiting
• Loss of appetite
• Upset stomach

Cluster headaches  

These are known to be very intense, so much so that one can't sit still and paces around. The pain is often burning or piercing and feels like it comes from behind or around one eye. It can be throbbing or constant. In addition to the pain, the eye on the affected side may show a drooping eyelid, redness of the sclera, a constricted pupil, and wateriness. Sometimes the nostril on the affected side also becomes stuffy. These are known as cluster headaches because they tend to occur in groups, for example, once a day for two weeks to three months. Attacks typically last a shorter time than migraines, at 15 min to 3 hours. The pain is intense enough to wake one from sleep. In between clusters, they may disappear for months or even years. These are more common in men than women.

Some common types of secondary headaches include:

• Dehydration headaches
• Sinus headaches
• Medication-induced headaches
• Post-traumatic headaches

A third type of headache is cranial neuropathies, of which trigeminal neuralgia is an example. These are much rarer than the other kinds, but the pain can be very severe.

What are The Common Causes of Headaches?

Some common triggers of primary headaches include:

• Lack of sleep
• Poor posture
• Muscle tension in the neck and shoulders
• Alcohol
• Nicotine
• Caffeine withdrawal
• Certain foods
• Exposure to chemicals or strong odors
• Physical activity
• Missing meals

Common causes of secondary headaches include:

• Dehydration
• Heat illness
• Acute Mountain Sickness (AMS)
• Sinus infection
• Increased intestinal permeability from GI illnesses, including Celiac disease
• Mast cell activation syndrome
• Magnesium deficiency
• Exposure to mold
• Food or environmental allergies

Some secondary headaches can be a sign of life-threatening conditions and thus need to be treated with urgency. Generally, if a headache is the worst that one has ever experienced, especially with a sudden onset, occurs after a head injury or accident, or is accompanied by fever or signs and symptoms new to someone, it is advised to seek emergency medical care. Some of the severe causes of secondary headaches include:

• Traumatic brain injury
• Dangerously high blood pressure
• Bleeding in the brain
• Stroke
• Meningitis
• Carbon monoxide poisoning
• Toxin exposure

Functional Medicine Labs to Test for Potential Contributors to Headaches

Individuals with gastrointestinal (GI) disorders are more likely than those without to experience headaches, especially migraines. This may be due to the increased intestinal permeability (Leaky Gut) and, thus, inflammation. For this reason, functional testing of GI health via the GI-MAP test could be considered. Testing includes an evaluation of intestinal permeability, microbiota, and dysbiosis.

Related to GI health, food allergies can also be a common contributing factor to chronic headaches, and testing might be considered in an evaluation. Celiac disease and Non-celiac gluten sensitivity (NCGS) are also associated with an increased risk of migraine and chronic headaches. A Celiac and Gluten Sensitivity test by Doctor's Data can help assess and distinguish both possibilities.  

Chemical sensitivity is another possible cause of recurrent headaches and may be related to certain genetic patterns in the detoxification pathways. Some insight can be gained through testing.  

Mold exposure can be assessed environmentally, but urine mycotoxin tests may also give insight into current or past mold exposure levels and body stores of the mold toxins. Certain environmental exposures, such as mold, can trigger mast cell activation syndrome or histamine intolerance. However, testing specifically for this condition is challenging at this time.

Magnesium deficiency can be associated with increased rates of headache and is readily tested.

Conventional Approaches for Managing Headaches

Conventionally, headaches, including mild migraines, may be managed with over-the-counter pain medications like Tylenol, ibuprofen, aspirin, or Excedrin migraine. Prescription medications may be used for moderate to severe migraine. Some of these are:

• Beta-blockers (blood pressure medication)
• Antidepressants
• Anti-seizure medications
• Botox injections

In addition, a key part of conventional management is trying to identify and avoid environmental or food triggers.

For headaches that are a sign of underlying illness, such as sinus infection or dehydration, that underlying illness is identified and addressed.

Integrative Approaches for Supporting Headache Management

Lifestyle factors that may reduce common triggers for headaches:

• Get adequate and good quality sleep regularly
• Drink sufficient fluids to remain well hydrated, adjusting for environmental conditions and activity level
• Maintain regular exercise and stretching habits
• Use ergonomic work set-ups to improve posture
• Consider regular massages for excess muscle tension
• Identify and avoid trigger foods
• Identify and avoid chemical triggers such as gasoline or bleach
• Identify and avoid allergen triggers such as mold
• Use alcohol, caffeine, and tobacco in moderation if at all
• Eat regularly if missing meals has been a trigger
• Manage heat exposure to reduce the risk of heat illness

If gut dysbiosis has been identified through testing, it may be addressed with antimicrobials as indicated and pre and probiotics.

If increased intestinal permeability (Leaky Gut) has been identified, it may be addressed with anti-inflammatory foods as well as pre and probiotics.

If Celiac disease has been identified, it may be managed with a gluten-free diet and gut-supportive protocols.

If magnesium deficiency has been identified, it may be addressed with supplementation, magnesium-rich foods, and, optionally, Epsom salt baths.

Nutrition

The most commonly advised dietary action with headaches of many types is to keep a headache and food journal and write foods that were consumed in the day leading up to headaches to identify trigger foods and then avoid them. This is a beneficial baseline action. Common triggers include caffeine, MSG, cocoa, aspartame, cheese, citrus, and nitrates.  

As far as identifying trigger foods, any foods identified as problematic on a food allergy test should also be avoided.

The basis of a diet for headaches is likely similar to a long-term health-promoting diet in terms of nutrition that minimizes inflammation and stress on the insulin system and supplies an abundance of phytonutrients and micronutrients from abundant plant foods. Several studies have shown the benefit of similar diets for headaches. The specific diets being studied are the DASH diet and the MIND diet. In the study of the MIND diet, participants were 36% less likely to experience severe headaches.  

For individuals for whom this basic advice seems to not quite get to the problem, some other considerations might be:

• The ketogenic diet for migraine management, possibly including intermittent or prolonged fasting
• Low histamine diet
• A gluten-free diet (based on celiac or gluten sensitivity testing)
• Folate-rich diet for methylation

Complementary and Alternative Medicine

Melatonin may help support the management of migraines and cluster headaches. Other nutrients, including riboflavin, coenzyme Q10, feverfew (Tanacetum parthenium), magnesium, vitamin D, and folate, may also help support migraine management.

To help manage the acute discomfort of a headache, some simple home therapies may be of use as well, including:

• Relaxation methods (yoga, meditation)
• Hot/Cold packs
• Stretching
• Self-massage
• Caffeine
• Aromatherapy (especially peppermint and lavender essential oils)

Summary

Headaches can be a sign of many different conditions, including simple disruption in the pain processing near the brain. It is essential always to seek emergency care if uncertain. One significant contributing factor to headaches is gut health and eating a health-promoting diet that avoids any foods identified as triggers. Testing can help to identify targets for functional medicine approaches as well as to follow up on progress.