Proving That Chronic Pain Isn’t Just In Your Head

People with chronic pain often have been told it is “all in your head.” Now we can actually image brains with a combination of techniques and see actual differences in structure and chemistry that is being linked to chronic pain. The use of radioactive tracers, with PET, MRI and functional MRI scans are showing changing patterns of activity between normal people’s brains and those with chronic pain. The studies have led to several new key concepts, including glial cells and the role certain proteins play in pain expression.

Traditionally, pain has been related to signals of various nerves cell. Sensory nerve cells in the periphery of the body receive signals, then they are transmitted to the brain via the spine and interpreted by the brain, which transmits signals back to periphery. The electrical sensory and motor neurons are the critical components for understanding pain.

Brain Scan

Now we are learning glial cells, which were thought of as structural components – the scaffolding of the nervous system – may be equally or more important in pain. Glial cells support and protect nerve cells. They also produce compounds that may control or contribute to chronic pain. As we identify the compounds, controlling their levels may be the next big discovery in managing chronic pain. One compound that is increased in chronic pain sufferers is the translocator protein. Studying the protein, one can see where glial cell activation has occurred. Using the special scans, the protein and glial cell activity can be measured, and hopefully in the near future, controlled.

Understanding the connection between pain, translocator proteins and glial cells is important to find effective treatments. Medications that may control chronic pain would decrease both translocator protein levels and glial activation. If a medication is working on these cells effectively, then the brain scans may change. As the science improves, hopefully we can use this knowledge to more fully identify the scope of problems with chronic pain and determine effective management strategies that actually work to reverse the changes and return the brain to healthier function.

Migraines and Daith Piercings

Daith piercings are a specific type of ear piercing. The ear cartilage midline toward the front of the ear is pierced. This type of ear piercing has been around for 3,000 years, but the name for this type of piercing was probably started in the 1990’s. The placement of the piercing is at the entrance to the ear canal and has symbolic meaning as the “Guardian to the Gate.” These piercing can be quite painful since they are through bony cartilage, and care must be given to keep them clean and to prevent infection.

Daith Peircing

Migraines are a vascular type of headache. They occur more commonly in women and sometimes have a very specific trigger, such as certain foods. Management of these headaches can be quite simple, from avoiding specific triggers to the use of Excedrin. However, sometimes those management techniques prove ineffective, making the headache hard to treat. One of the non-traditional treatments beyond medication has been acupuncture. One of the areas of needle placement has been in the ear, and commonly in the same general area where Daith piercings are placed.

Recently, some people who have received a Daith piercing have coincidentally found improvement with their migraine headaches. It is not universal, and it is has not been studied formally. The correlation is based on the success for some people with acupuncture in the same region of the Daith piercing.

If a person enjoys ear piercing and suffers from frequent headaches, it may be worthwhile to consider getting this spot pierced. Since body piercings are generally less than $100, this may be a very economical treatment alternative. If you suffer migraines and are very unsure whether you want a piercing, trying acupuncture first would be a good alternative to determine if this treatment may be successful. If this is not working, and the migraines are not being well managed, further discussions with your medical practitioner about treatment options is warranted.

Post Story Edit

This post has received an incredible amount of views in the last few months, and many people have spoken out about their experience with a Daith piercing. However, I am a little disappointed to how some people are quick to chastise this option, saying it isn’t rooted in any concrete evidence. Many of those people likely saw the headline or skimmed the article and assumed I was simply trying get people to shell out more money for an unproven option that, in their opinion, can at best provide some pseudo-placebo effect. Having read their comments and seen stories refuting Daith piercings, I just wanted to clarify some misconceptions.

First, anyone who read the above post can clearly see that we’re not saying this is a well-studied, documented and thoroughly researched alternative. Hopefully we can find more hard evidence, and scientists are learning more every day about the underlying reasons why regionalized stimulation may help with headaches. I wrote a recent post that sheds more light on the role the vagus nerve plays in the equation and how the medical community is continuing to search for concrete answers.

Secondly, unless you’ve walked a mile in the shoes of someone who suffers from chronic pain or headaches, please don’t be quick to chastise potential solutions. Like many of this site’s readers, I deal with chronic pain (in my back), and at times I find myself at my wit’s end trying to manage and control pain. People who are considering a Daith piercing for their headache pain aren’t considering it as their first option, odds are they’ve seen specialists, tried therapies and medications, avoided certain trigger activities, altered their diets and their sleep schedules or undertaken a myriad of other treatments that haven’t solved their problems. Pain is a very personal issue, and having someone belittle a potential treatment technique, which appears to have worked for some commenters, adds nothing positive to the goal of solving the pain problem. Hope and belief that pain can be resolved is a key aspect of findings pain relief, and while people are certainly entitled to be wary of options lacking concrete medical evidence, I only ask that you consider the person in pain’s perspective before you belittle or demean their curiosity to this relatively new treatment avenue. I’m not trying to quell dissent and I thoroughly enjoy reasoned arguments on both sides of the spectrum, and I completely understand why it’s important to be hesitant of unfounded medical treatments, but if we ignored all potential solutions in their early stages simply because they had yet to be fully researched, the medical world would never evolve. 

Thanks for reading,

Dr. Cohn

Headaches, Nutrition, Neuroglycopenia and Children 

NeuroglycopeniaNeuroglycopenia is categorized as low blood glucose levels in the brain. Recently I was asked if children can have headaches due to inadequate nutrition and a neuroglycopenia. Children have a different susceptibility to low blood sugar than adults. Most people do not get low blood sugars if they have sufficient calorie intake. Many substances can be converted to glucose for the brain to maintain normal function, and that is a protective mechanism of the neurologic system. Low blood sugar levels in the brain can be manifested in a number of ways, including behavioral changes, headaches, and even seizures or loss of consciousness.

In a Google search on this topic, only one article was found; The Journal of Pediatrics in 1994 wrote that children can have behavioral changes related to low blood sugars and the possible affect on the brain. Low and high blood sugars due to nutrition in children probably occur regularly, and they can affect behavior and may be linked to headaches. Neuroglycopenia occurs when there is a severely low blood sugar level in the brain, and is generally linked to low blood glucose. Furthermore, this condition is linked mostly to diabetes and high insulin levels, and not to general nutrition.

Children can have headaches due to a number of reasons. Nutrition and sugar intake can definitely cause difficulties with headaches in some children. Headaches can be caused from problems such as poor vision, lack of sleep, psychological problems and stress. If headaches are frequent, then the child needs to be seen by a pediatrician, and possibly by a neurologist. Sudden severe new headaches need to be seen immediately at a hospital as an emergency.

Poor nutrition in children can lead to behavior problems, hyperactivity and headaches. The meal programs for breakfast and lunches in our schools partially grew out of awareness of the necessity of good nutrition in the ability of children to adequately learn. Severe low blood glucose in the brain, i.e. neuroglycopenia, is not necessary to be the cause of headaches. If the child is a diabetic, neuroglycopenia may be occurring and can cause headaches. Children without diabetes are unlikely to have nutritional issues so severe to cause low brain glucose and headaches. If a child is having headaches, the first stop is the child’s pediatrician.

Dealing With Pain After A Car Accident

car accident injuriesTrauma from motor vehicle accidents can cause significant ongoing injuries. Typically, lingering injuries that require medical care resulting from a car accident include:

  • Lower back injuries
  • Spine injuries
  • Headaches and neck injuries
  • Broken bones and and large lacerations
  • Whiplash injuries to the head and neck

Treatments For Car Accident Injuries

Treating acute pain is done symptomatically. Ice and heat for muscle strains in both the neck and the low back region is recommended. Immobilizing the neck with a brace for several days to rest the muscles may also be helpful. That said, wearing a neck or back brace for more than a week or two is not a good idea as the muscles need to move in order to heal correctly. Restoring normal movements is one of the main objectives in early treatment. In most cases, the muscles are only strained and not torn and will heal within a short period of time. Restoring movement and strength may require assistance and physical therapy. Chiropractic or massage treatments may also be helpful in the short term, but continued passive treatments are usually not helpful for larger issues.

If pain is a significant issue, over-the-counter medications are often very helpful. Initially, acetaminophen and nonsteroidal anti-inflammatory medications like Advil or Aleve may provide significant pain relief. If the nonprescription medications aren’t providing sufficient relief, it is time to see a physician. The physician may opt for a short course of narcotics along with regular physical therapy. With aggressive early treatment, most people will resolve their injuries within a month or two.

Continued Pain

If your pain has not resolved in two months, at that time, asking your doctor to be referred to a pain specialist would be beneficial. A pain specialist can perform a comprehensive evaluation and determine further tests and treatment that would help resolve your ongoing medical problems. Sometimes injuries such as whiplash cause microscopic damage to the spine and joints, and the use of injections along with other medications and physical therapy will allow for almost complete resolution of symptoms. There are many options in managing pain related to a motor vehicle accident, and depending on the unique characteristics of each person, a program can be found that meets any individual’s needs. A pain specialist is an expert in the complex problems that cause ongoing symptoms and is extremely knowledgeable about all the possible treatment options that will allow you to return to a full life.

5 Rare Types of Headaches & How to Treat Each

cluster headachesHeadaches are a common and painful occurrence. Almost everyone has had a headache at some point in his or her life. We’ve already talked in depth about common headaches like tension and migraine headaches. But there are less common headaches including:

  • Cluster headaches
  • Cervicogenic headaches
  • Giant cell arteritis
  • Subarachnoid hemorrhage
  • Idiopathic intracranial hypertension

These headaches are much more rare and usually diagnosed only by specialists. In this article we will explore the causes of each headache and discuss possible treatment options.

Cervicogenic Headaches

Cervicogenic headaches are a type of tension headache generated from muscle spasms in the neck.  These occur most often after neck injury, commonly a whiplash in a motor vehicle accident or similar type of trauma.  Cervicogenic headaches often improve greatly as trauma heals within one to two months.  Massage, heat, and ice, over the counter medications, chiropractic adjustments, and physical therapy may all be useful.  About 5% of these require more aggressive treatment by a pain specialist including cervical injections.  If the headaches are not resolving, a physical medicine pain specialist can be extremely helpful in coordinating more aggressive management to stabilize or cure symptoms.

Subarachnoid Hemorrhages (SAH)

Subarachnoid hemorrhages (SAH) are very distinct, severe headaches.  Known as thunderclap headaches, they are described as the worst pain you’ve ever experienced in the head.  They occur suddenly, lasting minutes to hours, and almost always send the person to the hospital for treatment due to the severe pain and symptoms.  A CT scan of the head usually shows the bleed, but sometimes lumbar punctures and MRI scans are also needed.  Depending on the severity and cause of the bleed, treatment may require neurosurgical intervention versus supportive care.

Cluster Headaches

Cluster headaches are a rare type of chronic headache.  They are most common in men.  Typically, they consist of one-sided pain, with tearing of the eyes and runny/stuffy nose.  They occur daily for a period of time and then stop, before starting again some time later.  At this time they are thought to be associated with serotonin release and the hypothalamus.  Treatments include avoiding triggers, breathing oxygen, pain and migraine medications.  A neurologist specializing in headaches usually coordinates management.

Giant Cell Arteritis

Giant cell arteritis is an inflammatory condition of the blood vessels in the head.  It affects mainly the elderly, those over 60 years of age.  It is characterized by pain over a blood vessel, often in the temporal region.  Blood tests show signs of inflammation, especially the ESR being very elevated.  Biopsy of the vessel is often done to help make the diagnosis.  Treatment is with steroids, and often it may be necessary to take them a long time.  Not treating the condition can lead to complications like strokes.

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension, previous known as pseudotumor cerebri, is where there is increased intracranial pressure.  The headache is a dull deep pressure with nausea, vomiting, and visual changes.  It is most commonly seen in young, obese woman.  MRI brain scans looking for other causes of symptoms and lumbar punctures are necessary in the evaluation.  By its name – idiopathic, the cause is unknown.  Treatment may include medications and sometimes requires neurosurgical management.

The above headaches are rare.  Most of them have unusual presentations and send one to see a physician immediately.  A neurologist is most commonly involved in both the diagnosis and management depending on the problem.  When symptoms do not improve despite optimum management, occasionally secondary specialty headache clinics become involved.  Generally, once one of these rare headaches is diagnosed, the treatment is effective.

Have you ever experienced any of these rare headaches? We’d love to hear your story in the comments!