The truth about headaches

The medical profession is still ill-equipped to deal with the intricacies of headaches and how to manage them, according to a neuroscientist.

Durham University Professor  Professor Amanda Ellison tells Kathryn Ryan her new book Splitting was written in response to this gap in medical care and that headaches tell us a huge deal about what is going on in our physiology. 

From migraines and tension headaches to sinus pain and "ice cream" headaches, Splitting explains the science, and what headaches reveal about the brain and overall health.

There is growing awareness within GP circles, but progress is slow and that leaves sufferers often poorly served, she says. People may get lucky and find a doctor who is interested in the subject, but otherwise there have been glaring gaps in knowledge.

“The chances of you finding a medical practitioner who knows the intricacies of aspects of headaches and what’s actually happening in neuro-chemistry in your brain and how that’s causing the symptomatic experience that you’re going through – and what it is about your behaviour that they have caused this, or may help it – those are very slim, I would say.”

What triggers headaches varies greatly. 'Ice cream' headaches, for example, involve a painful rush of blood to the head causing vasodilation - dilation of blood vessels in the brain.

When eating something frozen or extremely cold there is pain signal from palate, causing rush of blood going to the head to avoid the brain cooling down, because it doesn’t function well when cold. Touching the roof of your mouth with your tongue warms the area and stops this signal, and hence the pain.

Other headaches are not too easy to address. Sinus headaches are prevalent among the population and often necessitate the use of an antibiotic.

Ellison says sinuses don't stop developing until the late teenage years, as the cavities widen and settle into their final form of the face. This accounts for the way many teens suffer from sinus infections, with blocked noises and mucus discharges down the back of the throat. Unfortunately for some people this may continue throughout their lives, continually being triggered.

“It generally happens because of an allergen, or something else that you are allergic too like dust mites and it’s really all about our immune defences and it can be because we’ve had a cold or something has blocked up your respiratory system and then you’re left with this hangover effect of a lot of mucus in the system.

"Remember it’s there to defend us from all these nasty bugs and it’s just trapped and not moving very well and that can cause secondary bacterial infection in your sinuses because the bugs just get stuck.”

Drugs will reduce inflammation, but unless the core issue is addressed it will reoccur, so that developing methods of avoiding sinus infection triggers is needed.

“Unless you know your triggers it will keep happening again and again.”

Tooth ache and nerve pain can be very intense. There is little space between the brain and trigeminal nerve, so that there are limited opportunities for pain 'gating', the bodies way of reducing pain signals and pain interpretation.

Stress headaches are brought on by emotional stress and postural stress. When the brain interprets bad posture and stress is signals to the body that something needs fixed, so it dilates blood vessels and nitrate oxide is released, causing an inflammatory response that can be extremely damaging, Ellison says.

"It create a vicious cycle, which your brain interprets as stress and then you get the fight or flight response and you get the adrenaline kicking in. In the adrenaline phase you have cortisol kicking in, which is a much longer-lasting hormone.

“We know that this has nasty effects on the body never mind the brain, in that you are actually mounting an immune response to the stress.

“So, you are increasing heart rate, you are causing facial dilation because as far as your brain is concerned you are being chased down the road by a bear and you need to ready all of your muscles to do something about it. This is where that physical tension comes on after emotional stress… but you aren’t expending the energy that’s being sent to your muscles.”

There are techniques to manage this tension,and also medical approaches including painkillers and muscle relaxants. Sleeping pills are often prescribed, but these not a good response, causing memory loss and the 'wrong' type of sleep.

Behavioural solutions on the other hand are longer lasting.

"Train yourself to do things to give yourself extra half step of mental space to enable you to decide whether or not to engage your fight to flight response," she says.

“A lot of this is very automatic. It is there is a very unconscious way to protect us. So, it’s about reasserting a conscious control over what it is we get stressed about and what it is that we can’t. This is all about reliance and control.”

Stress headaches can be reduced by meditation. Ellison says studies have shown that the patterns across the brain changes using meditative techniques.

“It’s almost as if the brain becomes a lot more joined up, that you can actually engage a lot more with your brain. So instead of running blindly into a brick wall in a panic it allows you to take a step back and be more analytical in what it is you need to do. In addition to that exercise helps, because you get happy hormones.”

Exercise and meditation create neuro-transmitters and hormones that bring balance and block pain.

“Endorphins are the body's natural painkillers and you also get shots of dopamine, the reward hormone, also the happy hormone serotonin – all of these things, they act to block the pain signals.”

An imbalance of these hormones can account for headaches, with lack of neuro-transmitters affecting mood, sleep and other healthy functions. Cognitive behavioural therapy can equipped people to engage in activities that replenish these and re-balance, she says.

[pull_quote] Unless you know your triggers it will keep happening again and again.

Cluster headaches bring pain to a frighteningly new level and drive many people to despair.

“People who suffer from cluster headaches describe it as the worst pain they have ever felt in their lives," Ellison says. "They tend it rock, they can be very agitated. One of their eyes can be very blood shot, their face tends to droop a little bit and the pain is excruciating and there’s nothing they can do to settle it down.”

No diagnosis of cluster headache can be given unless it reoccurs, multiple times per day, or over week. The headaches can reoccur years later. Professor Ellison says, after researching the illness for her book, it has become clear that central to the headache is the hippocampus region of the brain, which allows the body to operate without our consciousness being aware of these functions.

The hippocampus is a brain structure embedded deep in the temporal lobe of each cerebral cortex. It is an important part of the limbic system, a cortical region that regulates motivation, emotion, learning, and memory.

Ellison says it is the most important area of the brain. “It governs the entirety of all the functions that you are not conscious of… It’s also very sensitive to light, to the amount of light going into your eyes as it has a direct link to your retina. It’s very sensitive to lots of different things that you do as a human being that actually can knock your hippocampus back a little bit. So, if your diet’s not right, if you’re not taking in the right nutrients, if you’re eyes aren’t getting enough light it explains these disorders…”

She says there are many checks and balances of neuro-transmitters in the brain and if there is imbalance you get things like migraines and cluster headaches.

Pharmaceutically the most prevalent way to treat cluster headaches is with the drug Sumatriptan, which releases serotonin, causing the blood vessels around the brain to narrow. This reverses the dilating of blood vessels believed to be part of the headache process.

“It seems to reset what’s going on in the hippocampus, but it needs to be taken really early in the attack for it to work. Every sufferer has a window.”

Just as debilitating to people are migraines, bringing intense pain as the brain experiences vasodilation rebound.

“Migraine is neurological in how it starts. Whatever the trigger may be, it starts with a wave excitation across the brain… in all of the headaches they all have a vascular end.

"The pain always comes from vasodilation in the cerebral vascular system. The blood system of the brain. But where it all starts in different according to headache class and migraines happen in the nerve cells in the brain and it sets off this wave of excitation.”

‘What happens in the headache is you have a wave of depression and by depression I mean no activity at all…

“Your neuro-transmitters and the little ions that actually make neurons active, they’re in the wrong place. They’re caught in the extra cellular space – whereas they should be on the inside, they’re actually on the outside.

“The main culprit for this is potassium. That actually works directly on the pain receptors in the blood vessels, activates those and its causes vasoconstriction… and the pain receptors start going mad as well. Because of this vasoconstriction you get this rebound, massive vasodilation and then the pain signals start going well mad."

She says the majority of people don’t pick up signals that a migraine is on the way, but the signals are usually clear. Chocolate, contrary to popular misperception, is not a trigger.

“There can be changes in appetite. It may be fatigue, it may be yawning, you might get sugar cravings, a real craving for chocolate… Lots of people think chocolate is the trigger for their headaches, but it’s not. Because their brain is lacking a balance in neuro-chemicals and what is in chocolate is tryptophan and that is a precursor of serotonin, which is broken down in your body. That craving is your brain trying to self-medicate.

“Yawning is the same, that works on the dopamine system. By giving yourself a good yawn, it introduces a bolt of oxygen to your brain.”