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Headaches: What a Pain!

How Can Nutrition Assist?

Nia Rennix MSc., CN.Winter 2011

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Why is this topic of significant importance?

Answer Headaches are extremely common and responsible

for millions of doctor visits. Headaches can range in frequency and severity of

pain. Diet is considered to be a trigger Some individuals may experience headaches once or

twice a year, while others may experience headaches more than 15 days a month. Some headaches may recur or last for weeks at a time.

The level of pain caused by a headache can range from mild to disabling.

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DID YOU KNOW?? 76 % of women and 57 % of men report at least one

headache a month

In the U.S. an estimated 60 million to 80 million people experience recurring headaches

Headaches result in an estimated $30 billion in medical expenses

Only 30% of people with recurring headaches seek help, in many cases due to fear of being accused of "faking" the headache or being thought mentally ill

More than one million days of school and 160 million days of work are lost per year due to headaches

By age six, 31% of children have reported headaches; by age 15, this number soars to 70%.

The majority of headaches last for only a few hours, but some can persist for weeks

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Presentation OutlineI. Basic OverviewII. Migraine with Aura ClipIII. Nutrition TherapyIV. Vitamins & MineralsV. Herbal SupplementsVI. Presentation Wrap-Up

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What Is A Headache?Basic Definition

A pain in the head that is located above the eyes or the ears, behind the neck, thehead(occipital), or in the back of the upper

neck.

Basic Treatment

The suitable treatment will depend on many factors, including the type, severity and frequency of the headache and its cause. Treatment may include education, nutrition

therapy, herbal treatment, lifestyle/physical therapy, medication, and stress management

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Two Major Headache Disorder Categories

Primary Secondary

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I. Primary Headache Disorder Occurs independently and are not caused by

another medical condition.

Cause of primary headaches is vague, but there are series of events that change the flow of blood in the vessels inside/outside the head causing pain signals to be sent to the brain.

There are also changes in nerve cell activity and the levels of brain chemicals called neurotransmitters.

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Primary Headache Types

Migraine Headache Tension-type Headache Cluster Headache "Ordinary“ Headache

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Migraine Headache In the past migraines were considered vascular

Current research suggest that migraines and other primary headaches arise from disturbances within the central nervous system.

Migraine sufferers usually have their first attack before age 30- occur in children as young as age three.

Considered an inherited disorder, migraines affect women 3xs more often than men.

Female migraine sufferers-headaches may have started with first menstrual period or upon menopause. Some women find that their migraines go away during pregnancy or after menopause (NOT ALWAYS THE CASE)

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Key Migraine Headache Characteristics

The following familiar migraine symptom phases might occur alone or in combination with other phases:

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Prodrome

Consists of events that occur hours to days before the actual headache. Prodrome symptoms include:   

› Mood changes› Stiff neck› Chilled feeling› Sluggishness and fatigue› Increased frequency of urination› Constipation or diarrhea› Loss of appetite or food cravings› Increased sensitivity to light, sound and smells› Fluid retention

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Aura Neurologic symptoms typically occur five

to 20 minutes before the headache and last up to 60 minutes.

Most common aura symptoms: (visual) bright zigzag lines sparkling moving figures slurred speech blind spots distorted objects.

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Headache Phase 60% of migraine headaches (unilateral), while 40% occur

(bilateral).

› Throbbing and pulsating pain that may vary in intensity› Nausea or vomiting› Loss of appetite› Diarrhea› Blurred or restricted vision and sensitivity to light› Other sense changes, such as sensitivity to sound, smells, or touch› Fatigue, depression, irritability and anger› Mental dullness, confusion, hyperactivity› Lack of coordination, vertigo (spinning sensation), double vision› High or low blood pressure› Skipped heart beats› Nasal congestion

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Postrome After a severe migraine attack, people

often feel tired or "washed out," or irritable. Other symptoms may include:

Impaired concentration Muscle weakness and aching Food cravings or loss of appetite Feelings of euphoria or hyperactive behavior

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Migraine Triggers

In the Environment

Change in altitude Flashing lights Fluorescent lights Loud sounds Motion Strong odors Weather changes

Common Foods Aged cheese Alcoholic drinks Caffeine Chocolate Concentrated sugar Dairy products Food additives Fruits Meat with nitrates

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Migraine Triggers (cont’d) Lifestyle/Physical

FatigueHormonal changes Missed mealsOversleepingPsychological factors Strenuous exerciseTobacco smokingVacations, weekends, or other time off

Medications/Chemical

HistaminesHormoneSupplementsNitroglycerinReserpineTyramine

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Tension-Type Headaches Are merely a milder form of migraine

headaches with many of the same headache triggers and treatments.

Major Tension-Type Headache Characteristics: Tension-type headaches affect women more

frequently than men Pain is more intense as the day advances Pain is episodic or chronic and persistent Associated with sensations of tightness, pressure, or

band-like constriction around the head Associated with changes in muscle tension in the

neck or head

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Cluster Headaches Cluster headache is a significant headache disorder 16xs more common in males than females

“Cluster headache" was originally used to describe the clustering of painful attacks that occur many times throughout the day from weeks to months at a time and then subside for a few weeks or months.

The pain of cluster headache is extremely intense

Described as a hot burning poke by some, occurring in or around the eye.

The attacks do not switch sides of the head like in migraine but are always on the same side.

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Cluster Headaches (cont’d)

Described as a hot burning poke by some, occurring in or around the eye.

The attacks do not switch sides of the head like in migraine but are always on the same side

Migraine sufferers retreat to a dark quiet bed, cluster patients typically pace, rock back and forth and cannot lie down because the headache gets worse.

Reports indicate that patients frequently feel suicidal due to the intense pain

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Cluster Headaches (cont’d)

Key Cluster Headache Characteristics:

› Can resemble a migraine headache› While the attacks can begin at any age, they typically begin

between ages 20 and 40› Extremely painful headaches that last from 30 to 90 minutes

and commonly occur up to six times a day during the cluster headache "active" phase

› Frequently occur at night, and often at the same time each day› Can be associated with panic or fear› Generally localized (or restricted) to one side of the head,

affecting the eye, forehead, cheek, or temple› Associated with nasal congestion, eye drooping, contracting of

eye pupils, excessive tearing, and other facial changes› Accompanied by tenderness in the neck

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Ordinary Headache Type An extremely mild form of migraine Respond to simple remedies, such as diet,

physical activity practices, relaxation techniques, and mild non-prescriptive analgesics.

Key Common Headache Characteristics: Occurs once in a while Is not associated with an underlying medical

condition, such as head injury or allergies Responds to minimal treatment such as rest and

nonprescription pain relievers, or goes away without treatment

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Headache Pictorials

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HOW CAN NUTRITION ASSIST?

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Nutritional Therapy The traditional treatment of headaches has focused

on prescription medications for acute and preventive treatment. The role of nutritional issues in preventing headaches cannot be overemphasized.

Many medications have side effects or

contraindications, leaving migraine sufferers to alternative options.

In recent years there has been an increasing demand for dietary and natural therapies to prevent and/or control headaches.

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Nutrition Awareness Awareness and Education of nutritional issues is

helpful in decreasing the occurrence of headaches. People who suffer from migraines should know

which foods can potentially trigger headaches, and what types of eating patterns are best for avoiding headaches (how many meals).

Some people know exactly what foods consistently trigger their headaches, but others may not be able to accurately pinpoint their food triggers.

Food diary/ Elimination Diet

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Balanced Nutrition In preventing headaches it is important

to……› Eat regularly › DO NOT skip meals › Carbohydrate + Protein› Increase Fiber Intake› Stay well-hydrated!!

Skipped meals and fasting were reported migraine triggers in more than half of patients surveyed in several studies.

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Identifying Your Trigger Foods/Substance

Individuals who suffer from migraines appear to be sensitive to certain food. It is important to note that the identified foods and substances being mentioned are often recognized by patients as headache triggers.

Not all of the foods will trigger a migraine in any one person. Headaches are generally triggered by a combination of food/substances, during a time of particular weakness (i.e. preparing for a presentation)

Again food diaries are helpful in sorting out which ones

are problematic for each patient.

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Alcohol Red wine, is a common headache trigger

It can either trigger a headache shortly after drinking, or it can cause a headache the next morning. Headaches that occur within several hours after drinking alcohol are probably the result of blood vessel dilation and constriction.

Wine also contains substances such as tyramine, histamine and sulfites, all of which can trigger headaches.

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Caffeine Found in coffee, tea, soda and chocolate

Relationship between caffeine and headaches is a tricky

Small amounts of caffeine can be very helpful in treating headaches. (pain-killing properties)

Too much caffeine (2- 3 cups of coffee per day) on a regular basis can actually give you more headaches.

Even one cup of coffee on a daily basis can worsen headaches in some people overtime.

Withdrawal Headache

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Effects of Withdrawal Headache

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Food Additives Most Common

› Nitrate› MSG

Nitrates- preservatives that are used for food coloring, prevention of food poisoning and to add a cured or smoked flavor.

Examples of foods : sausages , hot dogs, bacon, ham, salami, pepperoni, corned beef, pastrami - Can Cause Headaches !

Nitrates probably trigger headaches by dilating blood vessels.

Food labels (sodium nitrite, sodium nitrate, potassium nitrite, or potassium nitrate)

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MSG MSG is a flavor or taste enhancer in food

Chinese Food Syndrome

It is also used in meat tenderizer, many canned, prepared and packaged foods.

You may also see it written as, hydrolyzed vegetable protein (HVP), autolyzed yeast, sodium caseinate, yeast extract, hydrolyzed oat flour, texturized protein, or calcium casinate.

In sensitive patients, MSG can trigger a headache within 30 minutes.

Other symptoms may include a hot flush in the chest, neck, and shoulders, dizziness, and abdominal discomfort.

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Artificial Sweeteners Aspartame (NutraSweet) is an artificial

sweetener that is 180 to 200 times sweeter than regular sugar.

Scientific evidence suggests that aspartame may be a headache trigger in people who ingest moderate to high doses (900 to 3000 mg per day).

Sucralose (possible headache trigger).

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Chocolate Role of chocolate as a headache trigger- controversial

issue.

Chocolate contains phenylethylamine- substance which may trigger headaches by altering the size of blood vessels.

Chocolate also contains some caffeine- may trigger headaches- some people have cravings for certain foods such as chocolate during prodrome stage. which may start up to 48 hours before headache pain begins.

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Tyramine-Containing Foods

Tyramine is a substance found in aged cheese, cured meats, smoked fish, beer, fermented food and yeast extract (including freshly baked bread or cake).

It is said to trigger headaches by constricting blood vessels or by activating some bio-chemicals in the body that can then set a migraine in motion.

http://www.headaches.org/headache-sufferers-diet/

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Migraine with Aura- Video

http://www.cbsnews.com/video/watch/?id=7357003n

http://www.youtube.com/watch?v=dwHpBwAxDIs

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Can you identify your headache triggers?

OR

Can you identify a family/friends headache triggers?

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Vitamins and Minerals Magnesium- daily dose is 400 mg -magnesium-rich foods (nuts,

legumes, dark green leafy vegetables, wholegrain breads, etc.)

Riboflavin- 400 mg daily (significant decrease in headache attacks)

Coenzyme Q10- 300 mg daily was show in one study to decrease headache frequency

Alpha Lipoic Acid- 600 mg daily

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Herbal Supplements Feverfew- was used to treat headache, inflammation, and fever

several centuries ago. Some studies and case reports have suggested that it may be helpful in preventing and treating migraine headaches.

Butterbur - it works by decreasing the inflammation associated with migraine- recommended dose is 150 mg daily.

Ginger- used in China for centuries, in the treatment of pain, inflammation, and musculoskeletal symptoms. It can have some effects on reducing inflammation and may be helpful in the treatment of migraine, especially for people that have nausea with their headaches

Valerian Root- can be useful as a sedative, especially in insomniacs. It may also be helpful for migraine patients with anxiety

suggested dose is 300 to 600 mg

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Wrap-Up We know we can’t cure headaches/migraines, but

there are many ways that we can decrease the frequency and severity of headaches without taking more and more prescription medications.

Eating well and avoiding possible headache triggers can have a major impact on your headache pattern.

Vitamins and herbal supplements are also potentially good options for decreasing headaches without many side effects.

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References http://www.nationalpainfoundation.org/

articles/881/resources http://www.medicinenet.com/script/mai

n/art.asp?articlekey=119252 http://www.nlm.nih.gov/medlineplus/he

adache.html