Headaches are one of the most difficult and common ailments that affect people world-wide. Although they are more common with females, headaches are a burden that almost every person is likely to experience not only in their lifetime, but every year. I understand the complexities of headaches and that many people are likely challenged by this condition, but until recently, it has become apparent that the confusion about headaches and their complexities are much worse than I originally thought. Because of this, I have decided to devote more time over the next few months providing more educational articles that address the problems caused by headaches and headache care, tips to help identify different types of headaches, and solutions for patients to help fight headaches. To start, I want to identify some of the problems surrounding headaches. Here are a few headache facts according to the World Health Organization:
- Headaches are one of the most common disorders of the nervous system.
- Almost half of the adult population have had a headache at least once within the last year.
- Headaches, which are characterized as recurrent, are associated with personal and societal burdens of pain, disability, damaged quality of life, and financial cost.
- Worldwide, a MINORITY of people with headache disorders are diagnosed appropriately by a health-care provider.
- Headache has been underestimated, under-recognized and under-treated throughout the world.
In summary, headaches suck, they are very common in today’s population, and most health care professionals mismanage, mistreat, or misdiagnose the cause of headaches. With all those factors, how can you trust you are getting the right treatment for your headache? Here are three problems that we all must avoid and address in order to improve headache outcomes.
Problem 1 – Finding a Good Health Care Professional
Obviously, the responsibility for determining the cause and treatment for your headaches does not have to be solely yours. In the United States and U.K. half of those with migraines sought professional help, and of those that did seek help only two-thirds (66%) were properly diagnosed. This means that the responsibility for better health outcomes is on both the individual and health care professional. For both individuals, education is the key for improving the outcomes of headache treatment. The more access to quality information a future patient has, the more likely they will be to seek further care. The second barrier, the practitioner is a similar story. Unfortunately, according to the above statements by the WHO, you are likely to go to a health care practitioner who is inept in diagnosing and treating your headaches. The WHO claims, worldwide, only 4 hours of undergraduate medical education are dedicated to instruction on headache disorders. A lack of understanding of headaches by your medical professional could lead to a misdiagnosis or an ineffective route of treatment.
Many times the cause of a headache actually originates in the muscles and joints of the neck, jaw, or skull which then refer headache-like pain. People with these types of headaches often feel “tightness,” “tension,” “ashiness,” or “sharp” pains in the front of the head, base of the skull, or in the neck. They often sit a lot at work, have stressful lifestyles, or have bad posture in the upper body. If this is the case, trying to mask pain with medication will not address the cause and will not result in a favorable outcome. In order to fix these types of headaches, the patient needs hands on evaluation and intervention in order to address the muscle or joint cause. In this scenario, a chiropractor is a great and cost effective option for fixing a headache over medications that, as we are about to discuss, only mask symptoms rather than addressing the cause.
The answer to this problem? Providing better education to our health care providers and patients to allow them to make better choices in the healthcare system for treating headaches. As most of the readers here are not health care providers, we should look to how you, the patient, family member, or friend can help improve healthcare for headaches. The best thing you can do to help others in the healthcare marketplace is by referrals. The health care market is no different than the car, cosmetics, or food markets. The best way to help reward a health care professional that has helped you is to send more people for them to help. And the best way that you can help a family member or friend in need is by getting them to someone who can help. We live in a free market healthcare system (for now) and as such, quality and supply of services will dictate demand for better doctors, so long as that demand is aware that these doctors exist.
We will discuss in another article why chiropractic can be so helpful for the more common causes of headaches, but let’s think critically about some of the facts we stated earlier as well as some facts about chiropractic: We have learned from the WHO that only a minority of headaches are properly diagnosed, that migraine headaches are only properly diagnosed 66% of the time, and that headaches are in general underestimated, under-diagnosed, and under-treated. The WHO also estimates that half to three quarters of adults age 18-65 have experienced a headache in the last year. To expand, doctors of chiropractic only see 15% of the United States population according to a 2016 Gallup Poll. If you have benefitted from chiropractic care for headaches, understand that you are part of a few percentage of people who know that chiropractic is effective for this condition. Please do your part in helping fix headaches by referring your friends and family to those that have helped you and your problems (whether they are chiropractors or not).
Problem 2 – Ineffective Methods of Diagnosis
Most people would agree that the most effective method for solving a problem is to find the cause of that problem. For example, if your car’s check engine light or oil pressure light pops on, when you take the car to a mechanic, you probably expect them to find out why these lights came on. You would probably get upset if your mechanic said “Well I solved your light problem. I just went into the computer and turned the light off. Here’s the bill. If it comes back on, just come back in and I will turn it off again.” Most people would agree that the mechanic didn’t really address the cause of problem, he just hindered the warning light’s ability to warn you that the underlying problem existed. You would expect the mechanic to investigate and inspect your car in order to find out why this light came on and to fix the problem to make it go off.
There are many different types of headaches. From tension headaches, to cluster headaches to headaches caused by tumors. So how can you possibly figure out which headache you have? Probability can lead the way. Although there are literally dozens of headache classifications, two of the most common are tension and cervicogenic headaches. Causes such as tumors and infections are rare. Although the latter are more serious and should always be considered, the reality is most people with headaches will not be caused by such life-threatening conditions. When it comes to diagnosing a condition, patients and health care professionals are often lured into “What If Land.” Unfortunately, instead of making a diagnosis based on history, presentation, and the evaluation a health care practitioner will end up spending time and money ruling out such rare conditions with expensive diagnostics “just to make sure.” Maybe the patient is a bit of a hypochondriac and maybe it makes them feel good to know they don’t have a spinal tumor, but in this process of diagnosing, that health care practitioner abandoned standard of care by likely ignoring findings in the evaluation or history that indicated the condition was one of the more common and less dangerous conditions. In medical humor, this practice of abandoning logic and instead selecting a very unlikely diagnosis is called “looking for zebras.” The point to this joke is that when you hear hoofbeats, think horses, not zebras.
So how do we help solve this problem as a patient? Don’t be afraid to get a second opinion. Chances are if you have an experience with the mechanic in the analogy used earlier, you may decide to go to the shop across the street for a second opinion. Just because a doctor wears nicer clothes and went to school longer than a mechanic doesn’t mean that you can’t question their methods of care for YOUR body. If your provider fails to inform you of the cause of your headaches, if you spend more time with the nurse than the doctor, or if your doctor wants to perform a multitude of diagnostic exams “just to make sure,” consider getting a second opinion.
Problem 3 – Ineffective Methods of Treatment
Arguably the biggest problem with headaches and healthcare is the inability of current treatment strategies to fix headaches and the lack of recommendations to those treatment methods that do work. If you were to go into your doctor’s office because your head hurts, the doctor spends 5 minutes with you and fails to evaluate the condition before prescribing pain medication, this is the exact same situation as our car mechanic analogy. Pain is a warning light that something is wrong, but it does not identify what the cause is. This happens all the time in the health care world when a physician fails to properly assess the cause of a problem and instead just treats the symptom with medication.
Most medicines are simply a chemical method of turning off or on some sort of physiological process or pathway in your body. In some cases, simply turning something off or on or blocking our body from accomplishing a process can help or fix a problem. Good examples of this are acute conditions like infections like strep throat, the flu, or to help numb an area for surgery. This is because the problem (like an infection) and usage of the medication are aligned in an acute presentation, the medicine takes care of the cause (kills the infectious bacteria), and the problem is fixed. When a condition is chronic, however, medicine often becomes less effective in fixing a problem as it is used to treat the symptom and not the cause. With many types of headaches, treating with medication is just attempting to turn the light off. Sometimes it works, and sometimes it doesn’t. Even if medication does work, because we are not addressing the problem, your headache (the light) is likely to come back.
Furthermore, because long term use of drugs develops tolerance in the body, the medication will eventually stop working altogether. When this happens, the answer from our astounding medical physician (mechanic), is to use more medication, a different medication or… why not both!? All the while, never identifying the cause.
As stated before, one of the most common causes for headaches involve dysfunction of the muscles and joints of the neck, jaw, and skull. This could be hypertonic and spasming muscles, a fixated joint that has lost range of motion and has become inflamed, or both. In these types of headaches, the best treatment option is to address the tissue itself through hands on therapy and then to identify stressors in an individual’s life which could be irritating or preceding this state of dysfunction. Turning off a pain receptor or trying to chemically shut down a muscle will not fix the problem or address a faulty movement pattern such as bad posture that is causing the muscle to tighten in the first place. Although the above statement is true, and generally known to the medical community, current guidelines for headache care almost exclusively surround pharmaceutical remedies. The inability or unwillingness to acknowledge the benefits from manual therapy, manipulation, and lifestyle changes from the medical community is a serious problem when dealing with headaches.
So how do we solve this problem? First and foremost, it is up to health care professionals who do provide alternative medicine treatment for headaches to educate not only the public, but also other health care professionals. Admittedly this part is outside the scope of the patient, but one thing I would encourage an individual who has benefitted from alternative care is to follow up with their previous doctors either at their office, over the phone, through mail or email, and tell them who they saw and what treatment they received that helped their headaches. To some degree, we need to understand that most health care professionals are completely overwhelmed with the current burden of our health care system and although most do care about following up with their previous patients, they very seldom get the chance. A follow up notification to a previous provider could help him make a decision to reach out to your current provider who is helping your problem or to refer a future patient to them down the road.
For more information on headaches, how chiropractic can help your headaches, or how to schedule a consultation to find out the cause of your headaches, visit our website below!