Debilitating Headaches

By Phuc-Bao Tran, Candidate for Doctor of Osteopathic Medicine 2016 and Dr. Courtney Mizuhara-Cheng, D.O., M.S.H.S.

Headache is a common complaint among patients.  For many, it can be so severe that the pain results in loss of quality of life and the ability to function properly in daily activities.  If you are experiencing a debilitating headache, a health care professional can help to differentiate the cause of this problem and provide the appropriate management for resolution of the pain.  Understanding the common presentation of headaches can help guide common causes.  By understanding the cause, a holistic approach can be applied that addresses the cause.  The treatment options discussed below do not replace the role of a qualified medical professional. Although most headaches are not caused by life-threatening disorders, it is important to seek consultation with a health care professional if your headache worsens despite following recommendations below.

What are the most common causes of headaches?

Despite the common perception that most headaches are migraines, tension headache (a.k.a. primary headache) is the most common type of headache.  Below is a table that outlines the characteristics of common headache syndromes.

Type of Headache	Migraine	Tension	Cluster
Location	~65% one-sided; ~30% all over	Both sides of head	Always one sided; typically around eye
Characteristic	Starts gradually & builds in intensity; pulsating	Pressure or tightness that comes and goes	Sudden, deep, excruciating pain
Activity	Needs to retreat to quiet, dark room	May remain active or need rest	Able to remain active despite pain
Timing	4 hrs to 3 days	Varies; typically occurs later in the day	30 minutes to 3 hrs
Other symptoms	Nausea, vomiting, hypersensitivity (to sound or light), blurred vision; fatigue; dizziness	Sleep disturbances, irritability; difficulty concentrating; Chronic fatigue	Eye tearing or redness; runny nose or congestion

CONNECT WITH YOUR BODY

What causes headaches?

The exact cause of headaches is unclear.  However, by eliminating certain known triggers of headaches, one can often reduce the intensity and frequency of headaches.  Here is a table that outlines some of the common triggers of the common types of headaches listed above.

Type of Headache	Migraine	Tension	Cluster
Drinks	Caffeine (excessive consumption or withdrawal) Alcohol	Dehydration	Smokers who drink alcohol
Nutrition	Skipping meals; Mature cheeses, MSG	Hunger	Not related
Lifestyle	Emotional stress; Fatigue; Sleep disruption	Poor posture; fatigue; Overexertion; Inadequate rest; Stress/anxiety	None
Environment	Weather changes; Bright lights	New child; new job; exam preparation	Autumn/Spring
Physiology	Hormonal changes	Tight muscles in neck and head	Trigeminal Nerve Irritation

What are some lifestyle advice for preventing headaches? 

Irregardless of the type of headache you might be suffering from, the most important is maintaining proper sleep hygiene resulting in adequate restful sleep.  Avoid sleeping with the television or other electronic device on.  Maintain healthy coping strategies for handling emotional stress.  Maintain proper posture throughout your day whether at home, at work or at play.  Remember to listen to your body and avoid overexertion resulting in fatigue.

What are some nutritional advice for preventing headaches?

Minimize consumption of alcohol and caffeine.  Make sure to eat three well-balanced meals with appropriate healthy snacks.  Avoid skipping meals and getting to a point of hunger.

What are some exercise advice for preventing headaches?

Regular aerobic exercise helps provide healthy blood flow to the body and especially the head.  It is important to avoid running during the hottest time of the day.  If you are prone to headaches, exercising in the morning can be an invigorating way to start the day without overexerting the body. If you are prone to tension headaches, try placing your palm on your forehead, use your neck muscles and press your forehead lightly forward against your palm while keeping your head upright and arm still for resistance.  Cold and heat may also relieve pain and muscle tension.

INTEGRATE COMPLIMENTARY ALTERNATIVE MEDICINE

What can be expected during an osteopathic manipulative treatment?

During an osteopathic manipulative treatment, your physician will likely use various techniques to release strain patterns in the whole body.  Trials have shown that a combination of manual therapy such as OMT along with an exercise program led to long-term control of tension-type headaches.  In 2004, Bronfort showed that manual manipulation treatment was as effective, short term for chronic headaches, as prescribed drugs like Amitriptyline, but with fewer adverse effects.

What homeopathic options are available for headaches?

Homeopathic medicines can be used at home for mild to moderate headaches.  Since there are many different homeopathic medicines, it is difficult to choose the right one for a headache.  Many headaches are made better or worse by the same factors, and many homeopathic medicines cover these common modalities.  Often, the general symptoms will help guide in choosing the right medicine.  If there’s trouble picking the right medicine, it is recommended to use one of the following:  Belladonna, Nux, and Bryonia.  One of those three will help most people who suffer from acute headaches with few specific symptoms.

Other homeopathic medicines include:

Gelsemium:  Headache associated with blurred vision, tight band around skull.
Arnica:  Headache from head trauma. 

Nux vomica:  Irritable people with headaches.  Symptoms of headaches brought on by overeating, alcohol/coffee use, staying up late and missing sleep.  Hangovers and tension headaches.

Belladonna:  right-sided headaches and migraine. 

Bryonia:  Headaches aggravated by motion.  Pulsating throbbing centralized near or into left eye.

China:  Headaches from dehydration, weakness, or anemia

Cocculus indicus:  Headaches from worrisome behavior/insomnia. 

Natrium muriaticum:  Pounding head pain, anxiety.

Lachesis:  left sided migraine

Ignatia amera:  stress headaches.

Gallstones

Karim Jreije OMS III 

What are gallstones?

Sometimes, bile can become supersaturated within the gallbladder; this can ultimately lead to the formation of gallstones (cholelithiasis). These stones are very common within the general population; it is reported that 6% of men and 9% of women are reported to have them. Only 20% of patients with gallstones will become symptomatic over a 15-year period.

What are the risk factors?

There are several risk factors that can contribute to gallstone formation.  Females are at 3 times the risk of men for developing gallstones; in addition, pregnant women are more likely to develop stones in comparison to non-pregnant women. Some of the modifiable risks include: Obesity, diabetes, high cholesterol and decreased activity.

How do I know if I have gallstones?

As mentioned above, 80% of the population that have gallstones are completely asymptomatic. However, when gallstones do cause symptoms, there are a couple of signs to look out for. Many patients complain of belly pain that can be localized to the right side, just under the ribs. In addition, some patients also report having pain in their right shoulder. If the gallbladder ruptures as a result of inflammation, some of the symptoms will include jaundice, severe abdominal pain and fever.

What is the treatment?

There are three main treatment options for patients with gallstones.  The first option is to do nothing. If you are not having symptoms, then there’s no reason to have anything done. Another option is to surgically remove the gallbladder. This is one of the most common surgeries performed, and carries little risk. The main side effects associated with the surgery are bloating, gas and diarrhea. Lastly, there are treatments to remove the gallstones and keep the gallbladder. Medication can be taken, or a procedure known as, ERCP, can be performed. Treatment depends on the size of the gallstones, severity of symptoms, and your own personal input. 

Connect with your gallbladder.

What is a gallbladder?

The gallbladder is a small hollow organ located just under your liver. It is divided into three different parts: the fundus, body and neck. The main purpose of the gallbladder is to store and concentrate bile, which helps to emulsify fats as they pass through the small intestine. As stated before, sometimes the bile can become super saturated and turn into gallstones. These stones can get stuck in your gallbladder, or in the common bile duct. If stones get stuck in the common bile duct, it can lead to inflammation of the gallbladder (cholecystitis).

Somatic dysfunction

Osteopathic physicians believe in integration of the body, mind and spirit. Thus, when doing a physical exam, you might notice that we check areas other than your right upper quadrant. The gallbladder can send signals into the spinal cord, which manifest in the musculature of your back as increased tension and pain. The gallbladder specifically sends signals to the T5-T9 segment of your back. Often times, we will palpate this area in order to determine if there is some gallbladder dysfunction.

Harmonize with your body

Diet modifications- There are several preventative steps that can be taken to decrease your risk of developing gallstones. Diet modification plays a large role in decreasing your chances of forming gallstones. Studies have shown that Vitamin C deficiency was associated with an increased risk of gallstone formation. Women who consumed higher amounts of Vitamin C were at a 13% less chance of developing gallstones. Other studies have shown that moderate coffee consumption can also decrease the risk of gallbladder disease. Patients who drank 2-3 cups of coffee a day were 40% less likely to develop gallstones. In addition, consumption of vegetable protein and nuts had a decreased risk, as well as patients who consumed poly and monounsaturated fats.

Lifestyle modifications- Exercise is one of the most important steps in decreasing your risk for developing gallstones. In addition, drinking a lot of water helps to dilute the bile that is recycled throughout your body. It is vital that you drink 4-6 glasses of water every day.

Integrate complimentary alternative medicine

Tumeric is a flavorful spice that is used in Indian cuisine. Some studies have shown that curcumin, a chemical found in turmeric may play a role in helping to rid your body of gallstones. This spice is fairly easy to find in grocery stores and can even be used to make a simple, and delicious tea.

Tumeric Tea

                                                                                                                             

Ingredients: 1 cup almond milk, ½ tsp turmeric, 1 tsp cinnamon, 1 tsp honey and ¼ tsp ginger (optional).

Directions: Microwave the almond milk for 1 minute. Whisk in the spices, and add honey. Stir and enjoy. 

Asthma

By Phuc-Bao Tran, Candidate for Doctor of Osteopathic Medicine 2016

What is asthma? 

Asthma is a condition where there is narrowing and swelling of the airways we use to breathe.  Extra mucus is also produced.  This makes it difficult to breathe and triggers wheezing, coughing, as well as shortness of breath.  Asthma can range from being a mild to major problem, affecting our daily lives and even lead to a life-threatening asthma attack.  Asthma isn’t curable, but its symptoms are controllable.  Asthma is variable over time, hence it is important to work with your doctor to monitor the signs and symptoms and adjust treatment as needed. 

What causes asthma?

Asthma is likely caused by a combination of genetic and environmental factors.  However, it is still unclear as to why some get asthma, and others do not.  Asthma can be triggered by being exposed to different substances.   This trigger allergies and irritants triggering signs and symptoms of asthma.  Asthma triggers are different for everyone that they include: 

•  strong emotions and stress
• cold air
• air pollutants and irritants like smoke
• respiratory infections like the common cold
• airborne allergens like dust mites and pollen
• physical activity (exercise-induced asthma)
• certain medications
• certain preservatives in some foods and beverages 

There are also risk factors that may possibly increase your chances:  being a smoker, overweight, exposure to smoke, mother smoked during pregnancy, having an asthmatic relative, having another allergic condition, exposure to chemicals from work like farming or manufacturing.    

How do I know if I have asthma?

Asthma symptoms are different for everyone and can range from mild to severe.  Some people may have symptoms all the time while others may have it only at certain times like during exercising.  Some signs and symptoms include:

• chest tightness or pain
• difficulty sleeping from coughing, wheezing, or shortness of breath
•  whistling (wheezing) sound when exhaling (this is a common sign of asthma in children)
•  coughing or wheezing episodes worsened by a cold or the flu

It’s very likely that your asthma is worsening if you have the following: having to use a quick-relief inhaler more often, your asthma symptoms are more frequent, or more trouble breathing.

What can I expect when I see a doctor?

Your healthcare provider will ask about your health history and perform a physical examination to rule out other conditions like chronic obstructive pulmonary disease or respiratory infection.  Tests may also be given to see how your lung is functioning.  These tests include a peak flow and a spirometry.  A peak flow measures how hard you can breathe out.  A spirometry checks how much air you can exhale after breathing deeply and how fast you can breathe out.  The spirometry helps to estimate the degree of narrowing of your airways.  Other tests that can be used to diagnose asthma include: 

• Imaging tests such as a chest x-ray or a CT scan of lungs and nose cavities
• Methacholine challenge (triggers asthma)
• Allergy testing
• Nitric oxide test (abnormally high levels nitric oxide indicates that the airways are inflamed – an asthma sign)
• Sputum eosinophils (certain white blood cells in saliva and mucus that is discharged during coughing, these are present when symptoms develop)

How is asthma treated?

Stopping asthma attacks before they start involves long-term control.  It is important to know your triggers and avoid them.  It is also important to track your breathing to make sure the medications are controlling your asthma.  There are many different medications depending on factors like age, symptoms, and asthma triggers specific to the individual. 

·         Long-term control medications for prevention work by reducing the inflammation in your airways that leads to symptoms.  These include:  theophylline (daily pill); leukotriene modifiers (oral); long-acting beta agonists (inhaled); inhaled corticosteroids; combination inhalers (long-acting beta agonist with a corticosteroid).

·         Quick-relief medications to relieve asthma attacks or before exercise if recommended by your healthcare provider.  These include:  short-acting beta gonists (inhaled); ipratropium; oral and IV corticosteroids.

·         Allergy medications if your asthma is related to allergies:  allergy shots; omalizumab (injection); oral and nasal spray antihistamines and decongestants.

Create an asthma action plan with your doctor in regards to when to take medications or when to adjust the dosage of the medications based on the symptoms.  Identify the triggers and how to avoid them. 

CONECT WITH YOUR RESPIRATORY SYSTEM

What is the respiratory system?

The respiratory system (ventilator system) is a biological system consisting of specific organs and structures used for the respiration process.  Anatomical features of the respiratory system include trachea, bronchi, bronchioles, lungs, and diaphragm.  Respiration takes place specifically in the lungs.  The passage of air into the lungs to supply the body with oxygen is inhalation, and exhalation is the passage of air out of the lungs to expel carbon dioxide; collectively, this is breathing or ventilation. 

How can I prevent asthma?

There isn’t a specific way to prevent asthma, but it is possible to prevent asthma attacks.  These include:  identifying and treat attacks early, monitor your breathing, identify and avoid asthma triggers, follow the plan for taking medications and managing an asthma attack, stay current with vaccinations to prevent flu and pneumonia from triggering asthma flare-ups, take medication as prescribed.

HARMONIZE WITH YOUR BODY

What are some lifestyle advice?

Even though most asthmatic people use medications to help, there are other steps you can take to stay healthy and decrease the likelihood of asthma attacks.  Staying healthy includes:  getting regular exercise, eating fruits and vegetables, maintain a healthy weight, control heartburn and gastroesophageal reflux disease.  It is important to reduce exposure to asthma triggers.  The following steps can be taken to help avoid the triggers:  wearing a face mask to avoid cold/dry air; avoid pets with fur or feathers; clean regularly; use a dehumidifier; minimize dust that may worsen nighttime symptoms; use air conditioner; do not smoke.

What are some nutritional advice?

Eating a lot of fruits and vegetables may help boost lung function and reduce asthma symptoms.  Fruits and vegetables are rich in protective nutrients called antioxidants.  Antioxidants helps in boosting the immune system.  For some, it may help to avoid dairy products as dairy products may cause inflammation and narrowing of the airways.  Omega-3 fatty acids found in fish and other foods may reduce the inflammation that leads to asthma symptoms as well.

What are some exercise advice?

Breathing techniques involves exercises that may reduce the medications needed to control asthma symptoms.  Regular exercise can strengthen your heart lungs and therefore aid in relieving asthma symptoms.  Having asthma doesn’t mean you can’t be active.  Treatment can prevent asthma attacks and keep the symptoms controlled during exercise.  Exercising also helps in maintaining a healthy weight.  Maintaining a healthy weight puts you at less risk of other health problems.

INTEGRATE COMPLIMENTARY ALTERNATIVE MEDICINE

What can be expected during an osteopathic manipulative treatment?

Osteopathic manipulative treatment is therapeutically hands-on by releasing body restrictions.  Osteopathic manipulative treatment focuses on stimulating the rib cage muscles by applying pressure to the thoracic region and mobilizing the ribs and therefore enhancing respiration.  Patients with worsening asthma symptoms often experience emotional distress and often experience a relaxing effect simply by being touch.

What can be expected from homeopathic medicine?

Asthma is a potentially serious and even life-threatening condition.  Homeopathic medicines can be used to reduce the distress that an acute attack can create. It is often observed by homeopaths that when a right medicine is given, the asthma disappears but the old skin rash, if it was there originally, reappears for some time, before finally disappearing.  This reappearance of old symptoms is a considered a good prognostic sign.  There are a lot of medicines in homeopathy for asthma symptoms.  Some of the common medicines are ars-arlb, ipecac, lachesis, pulsatilla, spongia, sulphur, ignatia, antim-tart, hepar-sulph, nat-sulph, tuberculinum etc.  The selection of medicine varies from patient to patient.