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What are the different types of headache?
There are two different categories for headaches: primary and secondary.
Primary headache is an actual clinical condition and not a symptom caused by another disorder. Primary headaches include tension-type headaches, migraines, and cluster headaches. Secondary headaches are caused by other medical conditions such as sinus disease, allergies, dental disorders, head injury, or brain tumors. Here, we mainly discuss the most common primary headaches – tension-type and migraine headaches which can be treated with acupuncture.
Tension-Type Headache
Tension-type headaches used to be referred to as muscle-contraction headaches. This is the most common type of headache and almost everyone will have one once in a while. They are recognized as recurrent headaches lasting minutes to days. Typically, these headaches are experienced as a dull pressure type of pain which is mild or moderate in severity.
Migraines
Typical migraine headaches are one-sided, pulsating or throbbing, and moderate or severe in intensity. They are usually worsened with activity and may be associated with nausea and/or vomiting, as well as sensitivity to light or noise. Some patients experience auras prior to the onset of a migraine. An aura is a neurological symptom that typically develops gradually over a period of several (5-20) minutes. The headache sufferer sometimes sees little flashes of light, waves of lights, or changes in their vision. Other common features associated with auras include vertigo, imbalance, confusion, and numbness.
Chronic Daily Headache
Headaches occurring every day or almost every day are known as chronic daily headaches (rebound headaches). At times they may resemble tension-type headaches and other times they appear more like migraines. The overuse of headache or pain medications usually results in an overall worsening of headache patterns.
Headaches That Require CAUTION
Although headaches are a common symptom that most adults experience, on some occasions, headaches are a sign of serious medical misalignment. The following are some of the signs that your headache may require medical evaluation before you proceed for treatment:
- Headache following trauma
- Vomiting without nausea
- Severe dizziness
- Fever
- Extreme neck stiffness
- Sudden onset
- High blood pressure
- Older individuals
What is the relationship between the autonomic nervous system and headaches?
 The functioning of all our internal organs is regulated by an involuntary nervous system known as the autonomic nervous system (ANS). There are two main divisions of the ANS – the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is responsible for activating the “fight or flight” response that is characteristically engaged during periods of stress. The parasympathetic system opposes this response by activating the restful state, thus causing the relaxation response.
When our bodies are subjected to a prolonged period of stress, a chronic state of hypersympathetic activity and/or suppressed parasympathetic response results. This happens because the body gradually shifts to an increased sympathetic response to deal with the stress appropriately. This may eventually lead to the development of symptoms such as neck and upper back rigidity and stiffness, heaviness behind the eyes, and tension-type headaches. In addition, other symptoms may include anxiety, irritability, and digestive problems (bloating, constipation).
Did you know?
Only 5% of migraine sufferers are affected by food/chemical triggers such as caffeine, alcohol, aspartame, nitrates, MSG, and chocolate.
To explain the pain involved with headaches, it is important to understand that circulation is minimized to the internal organs by the constriction of the blood vessels (including those carrying blood to the head) during the development of this chronically sympathetic-dominant state.
The internal branch of the carotid artery passes through a hole in the skull and becomes a major source of blood for the brain. When local vasoconstriction becomes excessive, the body responds by releasing specific neurotransmitters, sometimes referred to as neurokinins, causing a rebound dilation in the segments of these overly constricted arteries (parasympathetic rebound state). This is a natural defensive mechanism of our body to compensate for deprivation of blood for long periods. The rebound dilation produces a state of overdilation in the affected segments of these arteries. Because these arteries are wrapped with pain receptors that are sensitive to being stretched and because the overdilation stretches the pain receptors, intense pain is experienced and is usually localized and throbbing (migraine headache). It is localized because of the limited areas of over-dilation and it is throbbing because each time the heart pumps blood into the artery there is an expansion of the artery which aggravates the pain. When the heart rests, the artery partially constricts which relieves the pain. This cycle produces throbbing pain.
Is a migraine part of a healing reaction?
As explained previously, chronic states of sympathetic dominance results in constriction of blood vessels (including those carrying blood to the head) and minimizes circulation to internal organs. If this situation is prolonged, the body enters into a sudden emergency state due to the deprivation of oxygen and nutrients to the internal organs (especially the brain). The body seeks to compensate for this by creating a rebound response. This is a natural innate recovery response and scientists have begun to view migraine as a part of the healing process.
The theory explains many unique characteristics of migraine attacks which often develop when one is relieved from a situation of prolonged stress (from increased sympathetic state to rebound parasympathetic elevation state). For example, many migraine sufferers often develop migraines on weekends, the first day of vacation, following a relaxing dinner at the end of a stressful day, or after sleeping-in on Sunday mornings. Many sufferers also experience some of their most intense migraine episodes following massage treatment. This is not surprising considering that massage and other natural therapies (such as acupuncture) trigger the healing reaction by eliciting a relaxation response and enhancing circulation.
Treatment approach for headaches
In his experience, Dr. Tanaka from the Pacific Wellness Institute in Toronto has found that tension-type headaches are always associated with chronic neck and upper back muscle tension. The research study of tension-type headache sufferers showed a strong correlation between headache intensity and the degree of upper trapezius muscle tension as measured by electromyography (Tanaka, Leisman, & Nishijo, 1997).
Acupuncture or massage is very helpful for this type of headache and patients often feel immediate relief. Regular treatment prevents future onset of headaches.
While treatment during tension-type headaches is very beneficial and is not difficult, treatment during migraine attacks needs extra attention. The relaxation response typically induced by the therapy may trigger or intensify the migraine for the reasons previously discussed. Many migraine medications target migraine headache pain by constricting blood flow. This approach provides symptomatic relief, but will not prevent the recurrence of migraine symptoms. Therefore, it is rather important to avoid accumulating stress and to minimize the consistent activation of the sympathetic system in order to prevent eliciting the parasympathetic rebound response. If the early stage of the migraine involving excessive vasosconstriction can be prevented, then the entire headache episode can be avoided.
The figures below are simplified theoretical illustrations that illustrate the theory of how prolonged stress accumulation leads to development of a dull headache (tension-type headache) and elicits intense rebound migraine headaches (Fig 1). With specific acupuncture approaches to minimizing abnormal prolonged vasoconstriction, in many cases, the frequency and intensity of headaches will decrease over time (Fig. 2).
Read An Acupuncturist's Perspective on Migraine by Dr. Tanaka of the Pacific Wellness Institute in Toronto. His acupuncture clinic has been treating patients with various forms of headaches and migraines for more than ten years.
References:
Abo, T. Iryou ga Yamai Wo Tsukuru (Diseases made by Modern Medical Interventions), Iwanami Co, Japan. 2001
Association for Applied Psychophysiology and biofeedback, Autonomic Nervous System Intervention, BCIA Certification Text
Headache Classification Committee, Classification and Diagnostic Criteria for Headache Disorders, Cranial Neuralgias and Facial Pain, Cephalalgia – An International Journal of Headache, Vol. 8, Suppl., 7, 1988
Tanaka, T.H., Leisman, G., Nishijo, K. The Physiological Responses Induced by Superficial Acupuncture: A Comparative Study on Acupuncture Stimulation During Exhalation Phase and Continuous Stimulation. International Journal of Neuroscience, Vol. 90, No. 1-2, 45-58, 1997
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