My Head Hurts So Bad!

By Bernard Filner, MD

Bernard E. Filner, MD

. http://thepaincenter.us/

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My Head Hurts So Bad!

Headache is one of the most common symptoms that cause people to see a doctor. We're going to assume here that causes of headache that need immediate intervention, such as brain tumor, brain hemorrhage, stroke, seizures, etc. are excluded from this discussion. Many neurologists believe that most headaches are migraines, either classic or atypical. Based on my 25 years in the practice of pain medicine, essentially all headaches have some component of myofascial (musculoskeletal) involvement (from 30-100%). In other words, trigger points in the neck, upper back, and/or chewing muscles cause pain in the muscles and refer pain to various, predictable parts of the head. Unfortunately, most primary care physicians and neurologists (who see most headache patients first) are not trained to find and treat these trigger points, and therefore end up prescribing an ever-expanding group of medications that do not cure the problem, but inconsistently treat the symptoms headaches.

The classic theory of migraine headache generation had to do with various triggers (hormones, stress, foods, beverages, allergies, etc.) that set off a cascade of physiologic effects on brain circulation, having mostly to do with the constriction and dilation of blood vessels on the surface of the brain, in the pia mater. This jibed with most of the triggering mechanisms thought to set off migraine headaches. However, two things have created some doubt as to these theories.

First, there are a number of patients who appear to have migraines, but are resistant to essentially all the available medications and treatments. Second, a recent discovery (approved by the FDA) shows that Botulinum Toxin (attenuated) injection relieves migraines in some patients. Neither of these doubts have been adequately explained by any changes in the theory of migraine initiation. The problem with the doubts raised by the effectiveness of Botulinum Toxin is that as far as is presently known, Botulinum toxin is only effective where the nerve transmission is accomplished by acetylcholine released at a synapse. This is not the case in regards to small blood vessels, whose constriction or dilation is controlled by the balance of the sympathetic and parasympathetic systems (autonomic nervous systems), and circulating adrenalins in the blood.

The Autonomic Ganglia, which contain the cell bodies of the nerves involved, do involve acetylcholine for nerve transmission. The Sphenopalatine Ganglion, which lies at the very end of the nasal cavity, can be reached by the diffusion of Botulinum Toxin after it is injected, and can thus block the effect of the parasympathetic nerves emanating from this ganglion.

Over the past eight years, I have been using a Low Power Laser (Microlight) to inactivate myofascial trigger points. This painless, risk-free method has enabled me to treat patients with myofascial headaches quite easily and effectively. In the past year, I have begun using the laser to treat patients with migraines (minimally or non-responsive to “standard” treatments), atypical facial pains, TMD, and trigeminal neuralgia, by treating the Sphenopalatine Ganglion, as well as any trigger points that are found to be part of the clinical picture. Recently, I have treated a young woman with constant migraines, who now has only relatively mild headaches (once every 3-4 weeks), completely relieved by treating her myofascial trigger points. Hopefully, more physicians will start to recognize the value of Low Power Laser Therapy in treating these patients with chronic headaches, including migraines.