January 20, 2025 • 43 mins
Post-traumatic headaches represent a multifaceted challenge for those recovering from concussions, often requiring careful diagnosis and tailored treatment plans. The episode delves into various headache types, the dangers of medication overuse headaches otherwise known as rebound headaches, and the interrelation between neck injuries and headache presentations, urging patients to communicate effectively with their healthcare providers.
• Discussion on cervicogenic versus tension-type headaches
• Importance of glymphatic system in headache management
• The role of hydration in nurturing brain health
• Misconnections between migraines and post-traumatic headaches
• Practical tools for improved communication with healthcare providers
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I mean, I had a patient who was essentially to
make it short taking ibuprofenevery single day, and once I
explained to her that takingibuprofen for more than 15 days
a month can actually causerebound headaches, she finally
went off of it and her dailyheadaches went away just by not
taking a painkiller.
(00:21):
Every day, yeah, and so I thinka lot of people don't recognize
, even if they're only takingtwo to 400 milligrams of
ibuprofen a day.
If you're doing that more than15 days a month, it can actually
be causing rebound headaches.
Speaker 2 (00:36):
Welcome to the life after impact podcast, where we
do a deep dive into all thingsconcussion and brain injury
related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods conventional and
functional different types ofspecialists out there and
different therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
(01:00):
your guide to living your bestlife after impact.
Hi Sophia, how are you doing?
I'm doing well.
How are you today?
Speaker 1 (01:08):
I am good.
I'm excited to be hererecording our second podcast in
our series.
Speaker 2 (01:13):
Oh, Ayla, I'm so excited for this episode.
I know that we're going to haveso much to dive into.
Speaker 1 (01:18):
There's going to be a series of them, yeah headaches
are the most common symptom thatpeople report following a
concussion.
And yet what I have seenclinically and I'm sure you have
too, and many providers is thatthe headaches people experience
after a concussion are oftenmuch more difficult to treat
than other types of headaches.
Speaker 2 (01:46):
They are.
It's really confusing as aprovider and as a sufferer of
brain injury.
The headache complexity isreally tricky.
I really appreciated yourchapter that outlines so much in
your book about the differenttypes of headaches and how their
distinctions can be reallyimportant for getting correct
diagnosis.
So I think I would love tostart just by diving into the
different types of headachesthat people can have after a
(02:08):
head injury.
What do you say?
Speaker 1 (02:11):
That sounds good, and in my book, concussion
Breakthrough, my goal in writing.
It was really to develop atroubleshooting guide for people
to help them figure out.
Okay, I tried this thing andI'm still not any better.
What's next?
And so again beingpractitioners of acupuncture and
(02:32):
Chinese medicine.
Typically, what that means isthat by the time people come to
me, they've already had symptomsfor a long time, because most
people don't seek outacupuncture as a first line of
therapy right Although theyshould.
Yes, they should, because, man,when people do, they seem to get
better really quickly.
So when people do it right away, I do think it can make a big
(02:56):
difference.
However, a lot of the peoplethat come to see me have already
tried many, many things andthey're still symptomatic, and
so we have to do a lot of deeptroubleshooting to try to figure
that out.
Speaker 2 (03:08):
And they've already seen probably one or two or more
other providers and they've hadkind of hit or miss
effectiveness with theirtreatments.
Why do you think that is?
Do you think that the diagnosisis difficult, or do you think
that it's just a stubborncondition to treat, or do you
have thoughts on that component?
Speaker 1 (03:26):
Yeah, there are a number of things that I think go
wrong.
So the way that I've kind ofdesigned it in the book is I
classified headaches into acouple of different categories,
and one of the categories iscervicogenic headaches, meaning
a headache that arises from somekind of pathology in the neck.
And so oftentimes, when a lotof the people that I see have
(03:51):
concussions and whiplash andfrom, like, say, motor vehicle
accidents or slips and falls onthe ice where they slipped and
hit their head and also injuredtheir neck, some people can have
headaches as a direct result oftheir neck injury and the
nerves that get irritated in theback of the neck can then cause
these headaches that just kindof radiate even all the way up
(04:12):
into the front of the head andbehind the eyes.
Damage to the neck alone cancause a lot of the same symptoms
that a concussion can cause, sothings like nausea and
dizziness and even changes inbalance, even changes in depth
perception, and so that's whereit can get confusing is that a
lot of the same symptoms of atraumatic neck injury can kind
(04:35):
of look like concussion symptoms.
Usually people, I think, oftencan have a combination of both.
Right, they've got theirconcussion symptoms and then
they have these neck injurysymptoms and sometimes people
are diagnosed with the neckinjury and the concussion gets
missed.
And there's all this focus onthe neck and then in other cases
the concussion gets diagnosedand the neck injury kind of gets
(04:58):
diminished or not paidattention to, and so then that
gets missed.
And it's so important that bothof them are recognized and
tested and diagnosed correctlyand treated correctly.
Speaker 2 (05:09):
I'm excited to dive into that conversation more.
I have some patients I have toshare about some experiences
with that in particular, and Iwant to get your expertise with
that as well.
So cervicogenic, and thenthere's also a different type
tension type headache.
Speaker 1 (05:25):
Yeah, some people can have just a bad tension
headache after a concussion thatfeels a lot like a squeezing
pressure sensation and that canalso be caused from a number of
different things.
When people get a concussion,there can be congestion within
the glymphatic system, which isthe lymphatic system in the
brain, and so if you think abouta lymphatic congestion that
(05:49):
creates a sense of pressure, andso that lymphatic congestion
alone within the brain cancreate these types of chronic
pressure headaches, andoftentimes those feel
intractable, I always ask peopledo your headaches ever fully go
away?
And that's a really importantquestion, because when people's
(06:10):
headaches do fully go away, tome that is like a thumbs up Yay,
this is going to be easier totreat Something.
Yeah.
Then the people who say no, Ihave a headache 100% of the time
, it just varies in its level ofintensity.
And so the people that oftensay that their headache is there
all the time, it just varies inits level of intensity.
And so the people that oftensay that their headache is there
all the time and that there isalways a sense of pressure and
(06:31):
the sense that there's just toomuch inside the head kind of
wanting to come out is how somepeople describe it, and so
that's where I often think thatthere's usually an underlying
component of either dysautonomiathat's interfering with normal
blood flow to different parts ofthe brain and normal blood
vessel motility, as well as,potentially, this congestion
(06:53):
within the glymphatic system.
That needs to be addressed aswell.
Speaker 2 (06:56):
And the glymphatic system, or the lymph system, is
really our detoxificationcomponent, right, and so we have
the tension type, which we'lldive into more.
But the other types we havewe're going to do total episodes
on are this migraine and thismigraine-like headache
presentation.
Speaker 1 (07:13):
Yes, that's another area where I think a lot of
people are struggling is thatthey get a concussion and then
they get diagnosed as havingmigraines because their
post-traumatic headache veryclosely resembles a migraine.
And then they get diagnosed ashaving migraines because their
post-traumatic headache veryclosely resembles a migraine.
And then they're being placedon migraine medications and a
recent study came out that saidthat 87% of people with
(07:37):
post-traumatic headaches weredissatisfied with their current
therapies.
Speaker 2 (07:41):
It's a 13% success rate.
Yeah, that's not good.
No, and that?
Speaker 1 (07:46):
means that?
Basically means that we allneed to do a better job,
absolutely.
Speaker 2 (07:50):
So let's dive into kind of what these different
types are, because knowing thedistinctions between them can
lead to the correct diagnosisand the correct therapies,
because I'm assuming you don'tdo the same thing for all types.
Speaker 1 (08:02):
No, I think that's where you know, having the
Chinese medicine perspective, itcomes in handy because we talk
about this difference between aconstant sense of pressure in
the head, and in Chinesemedicine we talk about that.
We call it dampness, right.
This idea that there's too muchfluid or something wrong with
(08:23):
the fluid metabolism in the body, that murky water, that filter
is not working well, exactly.
So it's almost like again goingback to the fish tank analogy if
your filter is not working andyou haven't cleaned the water,
all of a sudden the fish poop isjust you know these fish are
swimming in their own poop rightand our glymphatic system in
the brain is literally meant totake out all of the metabolic
(08:46):
waste in the brain.
And then we forget, though, thatonce that is removed from the
brain, it has to also be removedfrom the body, which means we
do need our liver to filtereverything out, and we need our
kidneys to filter everything outand flush it out.
Part of the problem in medicineis that we rely so heavily on
blood work, and, when it comesto organ function, disease
(09:10):
within organs show up last inblood work.
And so by the time your labsstart to say, hey, you know,
you've got an indicator lightflashing, it's kind of like the
damage is already there, it'salready been done, and that's
where having more of a natural,holistic approach to health and
longevity isn't about.
(09:31):
Let's wait for something to getso bad that it's now red flag on
a lab right, and the truth isis we live in such a toxic
environment that everybody hasan excessive amount of burden
now on their liver and theirkidneys.
Yeah, so it doesn't matter ifyou live on a you know, desert
island, like we're all breathingthe same air on the planet and
(09:54):
it's toxic air, sadly.
Speaker 2 (09:55):
And I've had the privilege of being able to
travel the world in the pastyear, going to Egypt and going
to Nicaragua and living in theUnited States and seeing
everywhere has this haze?
Speaker 1 (10:05):
Yeah, and even the discussion about microplastics
and forever chemicals and all ofthe things that we're exposed
to that you know, even just allthese conversations around
Parkinson's being, in a sense, aman-made disease based on
chemical exposure to thesedifferent chemicals in our
environment, disruptors to ournervous system to these
different chemicals in ourenvironment, disruptors to our
(10:27):
nervous system, yeah, yeah.
So that's why, you know, wehave to really promote liver and
kidney health, because thoseare our filters, those are our
big, important filters.
Speaker 2 (10:37):
They help so much.
But let's start withcervicogenic headaches.
So if if you're seeing apatient in your clinic and they
come in with what symptoms, doyou start thinking more
cervicogenic versus the othertypes?
Do you want to talk about thedistinction of cervicogenic
headache?
Speaker 1 (10:52):
Well, there's often a lot that you can gleam from
somebody's you know, from doinga basic intake right and saying
you know what was the mechanismof your injury?
Did you have immediate neckpain afterwards of your injury?
Did you have immediate neckpain afterwards?
We do a lot of functional rangeof motion testing as well, and
there was a great study thatalso came out I think in 2024,
(11:13):
that said that after aconcussion, people that did not
complain about neck pain, whenyou evaluated them and did
certain orthopedic tests andpalpation, they were finding
that these people in fact didhave pain when they were being
you know palpated and evaluatedappropriately and then also they
had a loss of joint positionsense of that cervical spine and
(11:38):
so we do a lot of functionaltests.
where we've got the glasses thatpeople wear, it's got a laser
right in the middle and then youhave them close their eyes and
you turn their head and they'resupposed to bring the laser back
to the center with their eyesclosed.
And so all they're using is thekind of receptors in their neck
to tell them how far and howfast they're moving.
(11:59):
And so we can do thesefunctional tests to say how is
someone's joint position senseand are they having errors in
that joint position sense?
Meaning that their receptors intheir neck are not accurately
telling their brain how far orhow fast or in what direction
their head is moving.
Tension and a lot of problemswith the neck and how people
(12:27):
move.
And I also, just in looking atsomebody's gait, how they walk
down the hall, some people don'trealize how much tension they
have, but when you look at themthey're walking almost like
they're trying to balance apineapple on top of their head.
Yeah, and that can sometimes bebecause they have dizziness or
vertigo and they're actuallyafraid to move their head
because they're afraid totrigger that.
Speaker 2 (12:47):
And one thing I learned from you that really
blew my world apart was that ourneck alone can make us dizzy.
If those little receptors inthose joints don't feed forward
into the central nervous system,we can get a lot of
miscommunication and where ourhead and where our body is in
(13:08):
space.
So these proprioceptors, orthese joint receptors in the
joints of the neck alone candrive a lot of dizziness and
that dizziness can make oursystem really stressed out
because our brain and ournervous system doesn't like to
not know where we are in spaceor not trust it.
So we have a lot of feedinginto that system from the neck
(13:29):
that can drive concussion-likesymptoms.
Is that right?
Speaker 1 (13:33):
Yeah, I mean everything is connected and we
have to look at everythingholistically, as opposed to even
trying to separate head fromneck, because they all
communicate with each otherconstantly.
Speaker 2 (13:46):
I have a patient I've been working with for a while.
He's doing much better than hewas when I first saw him.
But we were treating hisconcussion mainly in the
beginning and really afterworking with him, realizing that
his neck was a lot moreinvolved in his symptoms.
Right, it was causing a lot ofdizziness.
I had him do a vestibularevaluation with another partner
(14:07):
and they confirmed for me thatit was more the neck that was
feeding bad information into thenervous system, making him more
dizzy.
So we've started working onthat joint perception more and
his tension has come down a tonand his headaches have gotten
better.
He was having these like kind ofticks come up from his tension
in the neck that was driving alot more symptoms.
(14:29):
That he thought was just hisconcussion.
His inability to concentrate orfocus or hyper fixate on
different things made itdifficult for him to see the
bigger picture and cut back alittle bit.
Once he started working theneck not just the cognitive
components he had a really bigturnaround.
What might you do differentlyfor a patient with a
(14:50):
cervicogenic headache from maybethe other types?
Speaker 1 (14:54):
Well, a lot of it has to do again as an acupuncturist
.
We have this incredible toolwhich can help to improve the
joint position sense of the neckby doing acupuncture points
along the spine the cervicaljaji points is what we call them
.
And not only do those help toimprove the joint position sense
(15:14):
in the cervical spine, but theyalso help to increase blood
flow to the brain as well.
And by doing that you canimprove a lot of even cognitive
symptoms and autonomic nervoussystem functions by getting more
blood flow into the brainstem.
And I think that that's whereyou know being able to
understand the importance of theneck in all of the different
(15:37):
pathology and in improving bloodflow to the brain.
Acupuncture just is such agreat tool for that.
Speaker 2 (15:44):
It really is.
How might a cervicogenicheadache mimic or be different
from a tension type?
Speaker 1 (15:49):
headache, a lot of times the cervicogenic headaches
, because you've got irritatednerves coming from the back of
the head.
The headache will often start inthe back of the head and it
might refer into the front ofthe head.
So a lot of people can literallytrace a line from the back
right to kind of their eyebrowor their eyeball, and so
(16:11):
sometimes the cervicogenicheadaches can be a unilateral
throbbing headache, depending onkind of which nerves are
irritated, or they can just bean intense pressure in the back
of the head or at least, like Isaid, a headache that starts in
the back of the head, whereaswhen people experience tension
headaches, a lot of times theydescribe it as their head being
(16:32):
in a vice or this bilateralsqueezing that can either be the
entire head or it can be thetemples, the forehead, a lot of
people with post-traumaticheadaches.
In that one paper where theywere actually trying to classify
the different types ofheadaches that people had, they
said that 65% of people hadbilateral headaches and of those
(16:55):
, 70% of those headaches were inthe front, and so a huge
percentage of people withpost-traumatic headaches, based
on the research, seem to reallycomplain about a lot of frontal
and temporal headaches, and alot of people do kind of point
right to their eyes and theirforehead and their temples when
they're describing thoseheadaches.
(17:16):
Again, because I see so manydifferent people with
concussions, I also have seenthat different eye movement
pathology can trigger headaches,and when people have problems
with convergence or convergenceinsufficiencies or convergence
spasms, those things can oftenalso cause occipital headaches
too, and so we have to be ableto look at it from you know, a
(17:40):
comprehensive neurological examto also point us in the right
direction, to say either oh look, there's a lot of findings
involving the neck, or maybethere's a lot of findings
involving the autonomic nervoussystem, and perhaps this
dysautonomia is what's drivingthe headaches.
Perhaps there is a lot of thiscongestion within the glymphatic
system that's creating thisbacklog of waste that's causing
(18:03):
increased pressure, that causesheadaches and that'll be more
the tension like headache thatyou see Glymphatic system.
Speaker 2 (18:09):
Talk a little bit about that.
Speaker 1 (18:11):
Within our brain, we've got what we call the
glymphatic system, which wasoriginally found in rats, and
then eventually they realizedthat we have this as well, and
this was really first discoveredback in, I think, 2015, when
this one researcher came outwith a very famous paper called
the Garbage Truck of the Brain.
(18:32):
And so we have to realize thatthe work on the glymphatic
system is very new, is very new,and that when it comes to what
is inside our heads, we oftenthink about neurons, but the
reality is that there are evenmore glial cells than there are
neurons.
Speaker 2 (18:51):
More cells for detoxification and clearing out
waste.
Speaker 1 (18:54):
Yeah, and specifically, there are these
interesting cells calledastrocytes, and the astrocytes
have what are called end feetthat clamp on to the blood
vessels and blood vessels.
When we often think about bloodpumping through our body as, oh,
it's our heart's job to pumpblood, but that's only half the
(19:15):
story.
The heart only pumps bloodthrough a portion of our blood
vessels and then the rest of theblood gets pumped through as
the smaller and smaller vesselsthrough a process called
vasomotion.
And what can happen with atraumatic event like a
concussion is that people canlose healthy vasomotion of their
blood vessels and all of asudden there's congestion and
(19:37):
stagnation.
And then, on top of that,you've got the astrocytes who
they have, end feet, and the endfeet clamp around the blood
vessels and within those endfeet there are these like
tunnels that actually funnelthrough all of the waste.
Sounds like little aliens, yeah, in your brain.
(19:58):
Some interesting research thatfound that military personnel
that had blast injuries andexperienced traumatic brain
injuries from sound wavesbasically causing the concussion
.
Those sound waves couldliterally blow the astrocytes
off of the blood vessels oh mygoodness and cause what's called
astrocyte scarring.
Wow, yeah, so there's, there'sa lot going on there within our
(20:22):
brains that we don't know right.
But, that come.
That basically can create ascenario where we have a loss of
vasomotion, we've got issueswith blood flow, we've got
problems with the glymphaticsystem being able to get
metabolic waste out of the brain.
All of that, like I said, cancause a lot of pressure buildup,
(20:42):
a lot of tension headaches, alot of tension headaches,
throbbing headaches and evendizziness and nausea and brain
fog.
Speaker 2 (20:48):
And what might you do for a patient with those kinds
of glymphatic-like symptoms, orwhat might you guide them to
look at or think?
Speaker 1 (20:56):
about.
Well, that's where being aChinese medicine practitioner
comes in handy, because goingback to this idea of pattern
differentiation and seeing thatthere is this accumulation of
metabolic waste and that thereis an inability to clear it out,
that means that we need toupregulate the glymphatic system
(21:18):
, we need to upregulate thewater metabolism, the waterways
in the body, and we can do thatthrough different herbs.
So do you have you ever usedone of those loofahs in the
shower?
Yes, yeah.
So those loofahs are actuallypart of the Chinese medicine
repertoire, and si guo lo is thename of the herb, and it
(21:39):
actually acts as almost adetergent that takes these large
solutes that are in the brainand breaks them down and clears
them out.
Speaker 2 (21:47):
That's amazing.
I love Chinese medicine becausethere's all these weird hacks
Like we use this loofah to cleanour body, but it's actually
like an herb that we can use toclean the inside too.
Speaker 1 (21:58):
Yeah, formulas that help to basically break down
these larger solutes that needto get cleared out of the body
and then kind of upregulatethese clearance pathways and
upregulate glymphatic functionand lymphatic function and
kidney function to startflushing all of that out.
Speaker 2 (22:15):
I can't talk about this detoxification flushing out
without stressing theimportance of hydration In my
own recovery and with mypatients.
I'm a big water pusher becauseI have found that ample
hydration really helps with thisprocess of keeping things clear
, helping with energy productionand usage, and also this
(22:36):
detoxification.
When I was doing a deeper diveinto the amount of water we need
, just wondering, like okay,we're 70% water, Our brain uses
a ton of it.
How much water do I need to betaking in?
There's a lot of differentnumbers out there, but finding
in general what surprised me wasthe amount of water everyone
(22:58):
should be drinking.
The average person should drink100 ounces of water a day as
kind of a minimum.
That number seemed reallydaunting to me because sometimes
I would lose my need for waterLike I wouldn't get thirsty, and
I actually found out that's asymptom of chronic dehydration.
So if you're in this chronicdehydration state, you don't
(23:19):
really get thirsty.
You can have all this toxicbuildup in your system.
Speaker 1 (23:24):
That leads to symptoms brain fog, headaches, a
number of other ones and, ofcourse, a lot of the other
things that people love to drink.
Like coffee can promotedehydration because, it's
diuretic.
Or we go to sodas which are fullof sugar, which need more water
to detox and clear our systemand not to point fingers, but I
(23:47):
will say that, in general, mypopulation of elderly people are
the worst, and they all give methe same reason for not
drinking enough water, which isthat they don't want to have to
get up and go to the bathroom.
Yes, and so that's why theychoose to actually not drink
water, but then they'redehydrated and everything gets
worse.
Speaker 2 (24:07):
Well, and I found so with this water schedule 100
ounces of water.
I put people on it, I have themtake a 20 ounce water bottle
and drink five a day, because100 ounces, and I break it down
into a schedule Every threehours you drink 20 ounces.
You drink first by 9 am, secondby noon, third by 3, fourth by
6, and the fifth by 9.
(24:28):
The first week or so I findthat we will pee all the time
because what's happening is yourbody is finally dumping all the
buildup and detox, all thethings that it wasn't able to
process before, because now itfinally has a place to put it,
to get rid of it.
So you do pee a lot more,especially if you're dehydrated,
because the body's working tofilter all this toxic waste.
(24:50):
But after about 7 to 10 daysyou go back to peeing as much as
you would normally when youweren't drinking 100 ounces of
water.
Your body adapts to having thatwater in it and uses it for
energy and uses it for functionof cells, to get better
concentration, better sleep.
I've had patients lose weightjust by doing this, having blood
(25:11):
sugars come in to balance moreLike.
There's a lot of symptoms thatget better when you just drink a
lot of water.
So a lot of elderly patients orI have a lot of patients who
will say like I just don't wantto go to the bathroom that much.
Or I started, but I had to peeso much.
I'm like actually it's a reallygood thing.
Keep with it and you'll bebetter off in the long term.
Speaker 1 (25:31):
Your body will regulate, you won't need to go
to the bathroom quite as muchbecause it is inconvenient to
have to go frequently andfrequent urination can also be a
sign of autonomic dysregulationand a sign of stress on the
kidneys and I have found, likewith some of the herbal formulas
that we have that supportkidney function, that once I put
(25:52):
people on those formulas thenall of a sudden their frequent
urination improves as well getsbetter too, because they're not
tight and dry like ropes anymore.
Speaker 2 (26:02):
They're moistened and they're able to be flexible.
I just think that the water andthe hydration and the
detoxification conversation isreally, really needed for that.
Speaker 1 (26:13):
Absolutely.
Speaker 2 (26:14):
What about the other types?
You break it down into migraineand then migraine-like headache
.
Now there's a lot we can diveinto with that, but we want to
break it down kind of acutelyfor us.
Speaker 1 (26:26):
Yeah, so our whole next podcast is going to be on
this topic in particular.
But to put it kind of quicklyas an overview, what is often
happening is that people willget a concussion and they will
develop a post-traumaticheadache that is throbbing in
quality, and they also oftenhave photophobia and phonophobia
(26:50):
so light and sound sensitivityand nausea, and so all of these
symptoms look like a migraine,but in reality, a lot of these
people don't actually meet thecriteria for true migraines.
In reality, a lot of thesepeople don't actually meet the
criteria for true migraines.
So what can happen is that theyget misdiagnosed as having
(27:11):
migraines and put on migrainemedication that isn't helping
them and then potentially cancreate rebound headaches, and so
we're going to talk about thatin our next episode and really
break that down and help peoplefigure out if maybe what they're
having is indeed a truemigraine or if it's more of
these migraine-likepost-traumatic headaches that
need to be treated differently.
Speaker 2 (27:30):
Okay, so let's do a quick review between
cervicogenic tension andmigraine headache symptoms again
.
What would you break down andyou do this really nicely in
your book and you have a greattool in there too to really
tease it out but for ourlisteners who aren't going to
necessarily right away dive intothat, what would be big
(27:50):
takeaways for communicating withyour providers accurately about
these types of symptoms To getthe correct diagnosis between a
cervicogenic tension and amigraine post-traumatic headache
?
Speaker 1 (28:16):
One of the most important things in order to get
the right diagnoses and and inthe podcast, is by giving people
the tools to be able toaccurately describe their
symptoms the communication tools.
Then we can hopefully avoidpeople getting misdiagn.
(28:36):
Weren't getting better, butbecause I had asked the right
questions, we could actually seethat certain types of their
headaches were improving even ifother ones weren't, which would
then allow me to kind of stickand move with what's changing
and change up my treatment planin order to continue to make
further, further progress.
(28:56):
So some of the descriptors thatwe need to have when talking
about headaches are these thingslike the difference between a
pressure and a squeezingsensation that is kind of
classic to attention headache,compared to a throbbing or
pulsing quality which could becoming from a cervicogenic
(29:18):
headache, and in that case it'susually starting in the back of
the head and potentiallyradiating upwards and into the
top of the head or the front ofthe head or even maybe the side
of the head.
So having that throbbing,pulsing quality could happen in
a cervicogenic headache, butit's likely coming from the back
of the head first or the backof the neck, or it could happen
(29:39):
in a migraine headache, becausea classic migraine is a
unilateral, one-sided, throbbing, pulsing headache.
At least at the start ofmigraines, that's how they
present, and then, withpost-traumatic headaches,
they're more often bilateral.
Many people say that they're onboth sides of the head when
they're having a migraine-likeheadache.
(30:02):
That is a combination of thispulsing, throbbing quality with
the light sensitivity, the soundsensitivity.
Like I said, it's more usuallyboth sides of the head, and so
that's where things can get.
Confusing is that a lot ofthese headaches do resemble each
other, but they have these kindof subtle differentiating
(30:22):
features that you then can alsodo further tests to really try
to get to the bottom of it.
If somebody has a true migraine,when they take migraine
abortives, they typically getsome level of relief, and many
people with post traumaticheadaches that are being
diagnosed with migraines willtake an abortive migraine
medication and they won't getthat much relief from it.
(30:44):
So there are little things thatwe can kind of look at that
give us these red flags to sayis this what's really going on?
And then there's this wholeother category of neuropathic
pain, which we'll do a wholenother podcast on, and people
that have concussions and braininjuries can often develop
neuropathic pain, where theyalso describe things like
(31:05):
electrical buzzing or electricalsensations in the scalp or the
head or these like lightningbolts of pain, or sometimes
they'll actually feel a sense ofwater kind of dripping down
their head Like this weirdtwinging sensation.
Yeah, and it can feel hot or itcan feel cold, and so the
neuropathic pain is also this,it's kind of own category of
(31:26):
pain that can include a lot ofdifferent sensations that are
maybe I don't want I don't knowif separate is the right word
separate from these otherheadaches.
But what I find is that peoplecan come in and they can have
kind of this constant low levelpressure tension type headache,
and then they can also havemoments where they have these
(31:47):
intense throbbing headaches andthen they can also have these
little zinger type sensationsthat are more of the neuropathic
pain.
And so people can actually comein with kind of a number of
these different headaches allhappening simultaneously, a
number of these differentheadaches all happening
simultaneously.
And that's where it's veryhelpful for people to be able to
have the tools and thecommunication, the language to
describe all of that, becausetypically when I start working
(32:09):
with somebody, some aspect getsbetter first, right, and some
people, even if they still havethese chronic tension headaches,
they might not even realize, oh, I'm no longer having those
sharp stabbing zingers anymore,because a lot of times when pain
goes away, you forget you hadit in the first place For sure,
and so a lot of people can feelvery dejected and depressed and
(32:32):
thinking that they're notgetting better.
But then you start goingthrough their chart and saying,
well, what about this pain, orwhat about that type of headache
?
And then all of a sudden theyrealize oh, that's actually
gotten better.
Speaker 2 (32:42):
I forgot I used to have that all the time.
If it's not knocking on thedoor, I don't hear it anymore.
Yeah, I find that a lot toowith patients.
Speaker 1 (32:56):
Yeah, and so for that reason I developed this
post-traumatic headachecommunication tool that we have
on the Life After Impact websitethat people can go to and all
they have to do is just sign inwith their email address and
then they'll get taken to alanding page where they can
download that PDF, and it servesas a way for them to very
quickly just check a bunch ofboxes and kind of fill in some
sections and then bring it withthem to their medical
(33:17):
appointments as a way of sayingyou know to their other
healthcare providers.
Here are the types of headachesI'm having, here's what I'm
doing about it, here's what hasworked, here's what's not
working, and it's just a veryconcise way to help people
communicate their experience.
Speaker 2 (33:33):
And that is a big takeaway I have after reading
your chapter is just being ableto communicate it correctly is
really important, because wedon't have that much time with
our providers and we're tryingto capture what's happened in
our life in like five or tenminutes with somebody right and
trying to hope that they get wesay it all correctly and that
they hear it the right way toknow what's in their arsenal to
(33:55):
give us for resources or tools,and so that tool is so valuable
for patients to kind of guidethat conversation and capture
that language correctly to knowwhat their providers might pay
attention to more, and that willhelp get the right diagnosis,
which will help get the righttreatment and more relief
(34:23):
practice, the more I realizedthat communication is everything
, and so often when people cometo see me and they're describing
their experience, I ask themthe same question, maybe in
three or four different ways,because when people have
concussions, they can also.
Speaker 1 (34:34):
The part of the part of what can be lost is their
ability to tune into their ownexperience, and I certainly feel
like that was my case with myconcussions is that I was so
focused on just trying to getthrough my day that I didn't
even have good self-awareness ofthe symptoms I was having, and
so to have somebody else be ableto really pull that out and
(34:54):
help you to recognize what it isthat you're dealing with and to
communicate it in a reallyclear, precise way is so
important in being able to getthe right diagnosis, get the
right treatments, be able tomonitor whether those treatments
are working or not.
I've never understood, you know,I have so many people that have
come to me and they've been ona medication for, like you know,
(35:16):
seven or eight years, and whenI asked them, well, the original
thing that they put you on thismedication for you still have.
So clearly it's not doinganything if eight years have
gone by and you still have thesame symptoms.
So why are we on this, right?
I mean?
And it's funny because, beingan herbalist, I think for a lot
of people herbs are so foreignand strange that they are like,
(35:39):
if I don't notice miraculousthings happening, in two weeks,
I'm quitting.
I'm quitting your therapy.
I'm over it, right?
And yet, when it comes topharmaceuticals, there's this
weird kind of buy in wherepeople are willing to be on them
for a very long time, even ifthey're still symptomatic and
they're not working.
Speaker 2 (35:56):
And yeah, because it's taxing your liver.
Speaker 1 (35:59):
I mean everything we put in our body taxes our liver.
And so if something's not doingthe job, let's not burden the
liver and the kidneys even moreby taking something that's not
working, which will cause maybemore headaches down the road.
Exactly.
We'll dive into that too inanother episode.
Speaker 2 (36:15):
Okay, this is really robust and really great
information.
This tool that you have isreally incredible and I hope it
will guide patients.
One example from my ownexperience is that I get a lot
of patients who refer to me fromproviders with diagnosis like
they already have, likemigraines right.
So I in my evaluation I take intheir chart review and then I
(36:37):
do my evaluation with them.
But it's more, it's a littlebit quicker at the Neuroscience
Center than it is in privatepractice because of the capacity
I have there.
So oftentimes I'm relying onthose referral diagnoses.
I had a patient come with mewith a referral diagnosis of
migraine and was treating hermigraine like headaches with
(36:57):
some success.
It would go away and it wouldget better.
But I was really just focused inon the migraine component and
after reading your chapter Ireally started thinking more
clearly about maybe this isn'tmigraine, maybe it's
cervicogenic, because I couldstart to see this patient and
that description and so Itreated more cervically and
headaches completely went awayand one type of them, because
(37:19):
they had two types.
Right, they had thiscervicogenic type and this
migraine-like one.
The migraine-like ones wouldrespond to migraine medications
but the cervicogenic ones didn't.
When I started treating theneck the cervicogenic ones went
away, still got a few migraines,but not nearly as many and
didn't need as much medication.
So that was helpful for mebecause I was able to read the
(37:41):
information to the provider toget them on board and some new
tools for that patient too justunderstanding where their
headaches are coming from andwhy they might be having them,
so that they can make decisionsin their daily life.
That might help alleviate thattoo.
So that's, it's really key andreally I really hope a lot of
our listeners glean from that.
Speaker 1 (38:01):
I love it.
So my book hasn't evenpublished yet, but it's already
helping.
It's really key and I reallyhope a lot of our listeners
glean from that.
Speaker 2 (38:06):
I love it.
So my book hasn't evenpublished yet, but it's already
helping people.
Is there anything else youthink that our audience should
kind of know or tune into beforewe wrap this up and dive into
more headache discussions in thenext episode?
Speaker 1 (38:16):
Yeah, I think that listening to the next couple
episodes should also help peoplewho still have questions
specifically on this question ofam I having a true migraine or
a quote migraine like headache?
that may not be responding wellto migraine medication and then
also exploring this idea of theneuropathic pain better, and so
(38:36):
I think that if people aresuffering from post
traumatictraumatic headachesdefinitely tune into our next
couple of episodes where we getinto even more detail about
these things as well as themedication overuse headache
factor.
I mean, I had a patient who wasessentially to make it short,
taking ibuprofen every singleday, and once I explained to her
(38:59):
that taking ibuprofen for morethan 15 days a month can
actually cause rebound headaches, she finally went off of it and
her daily headaches went awayjust by not taking a painkiller.
Every day, yeah, and so I thinka lot of people don't recognize,
even if they're only taking twoto 400 milligrams of ibuprofen
a day.
If you're doing that more than15 days a month, it can actually
(39:22):
be causing rebound headaches.
And you know, those kinds ofwarnings aren't very clearly
stated on the bottle.
People assume if this is overthe counter it must be safe, but
the reality is that thesemedications can be problematic,
even if there's something youcan just buy.
Speaker 2 (39:38):
You know over the counter and no one teaches us
all this in school, or there'sno academy really where you go
to learn all this.
And then you get a brain injuryand you're even more confused
and just in the midst ofeverything.
So, having the ability tounderstand it and communicate it
and really know what riskfactors are out there, as far as
if you're taking ibuprofenevery day or other things you
(40:01):
might be doing that could beadding insult to injury
unknowingly- yeah, so on thattopic, I did write a blog post
about medication overuseheadaches at the
lifeafterimpactcom website.
Speaker 1 (40:16):
So if people do want that information right away or
in writing, it's there in theblog and then also on the
homepage on the bottom.
That's where people can sign upfor the Post-Traumatic Headache
Journal.
It's on the bottom of thehomepage as well as on the
resource page at the moment.
So if people go tolifeafterimpactcom, all of that
(40:39):
information and resources arethere for them
posttraumaticheadacheactcom.
Speaker 2 (40:41):
All of that information and resources are
there for them, and our nextepisode is going to dive into
migraine, migraine-like headacheand medication overuse as well.
Then we'll dive intoneuropathic pain in another
episode and if you're notunderstanding that
post-traumatic headache isreally confusing, by the end of
that we even have an episodewhere we'll talk about our
research study on post-traumaticheadache and some of our
(41:02):
findings there.
Speaker 1 (41:03):
Excellent.
Well, thank you for tuning inand we hope you'll join us for
our next several episodes allstill kind of diving into this
topic on post-traumaticheadaches, and then we'll also
get into some of the therapiesthat are out there,
non-pharmaceutical therapiesthat people can try to help get
out of pain.
Yes, so stay tuned, Thank you.
(41:30):
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional healthcare services, including the giving of
medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
user's own risk.
The content of this video orpodcast is not intended to be a
(41:54):
substitute for medical advice,diagnosis or treatment.
Consumers of this informationshould seek the advice of a
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.
I mean, I had a patient who was essentially to
make it short taking ibuprofenevery single day, and once I
explained to her that takingibuprofen for more than 15 days
a month can actually causerebound headaches, she finally
went off of it and her dailyheadaches went away just by not
taking a painkiller.
(00:21):
Every day, yeah, and so I thinka lot of people don't recognize
, even if they're only takingtwo to 400 milligrams of
ibuprofen a day.
If you're doing that more than15 days a month, it can actually
be causing rebound headaches.
Speaker 2 (00:36):
Welcome to the life after impact podcast, where we
do a deep dive into all thingsconcussion and brain injury
related.
We talk about all the differentsymptoms that can follow a
brain injury, different testingmethods conventional and
functional different types ofspecialists out there and
different therapies available.
I'm Sophia Bowens, I'm herewith Dr Ayla Wolf and we will be
(01:00):
your guide to living your bestlife after impact.
Hi Sophia, how are you doing?
I'm doing well.
How are you today?
Speaker 1 (01:08):
I am good.
I'm excited to be hererecording our second podcast in
our series.
Speaker 2 (01:13):
Oh, Ayla, I'm so excited for this episode.
I know that we're going to haveso much to dive into.
Speaker 1 (01:18):
There's going to be a series of them, yeah headaches
are the most common symptom thatpeople report following a
concussion.
And yet what I have seenclinically and I'm sure you have
too, and many providers is thatthe headaches people experience
after a concussion are oftenmuch more difficult to treat
than other types of headaches.
Speaker 2 (01:46):
They are.
It's really confusing as aprovider and as a sufferer of
brain injury.
The headache complexity isreally tricky.
I really appreciated yourchapter that outlines so much in
your book about the differenttypes of headaches and how their
distinctions can be reallyimportant for getting correct
diagnosis.
So I think I would love tostart just by diving into the
different types of headachesthat people can have after a
(02:08):
head injury.
What do you say?
Speaker 1 (02:11):
That sounds good, and in my book, concussion
Breakthrough, my goal in writing.
It was really to develop atroubleshooting guide for people
to help them figure out.
Okay, I tried this thing andI'm still not any better.
What's next?
And so again beingpractitioners of acupuncture and
(02:32):
Chinese medicine.
Typically, what that means isthat by the time people come to
me, they've already had symptomsfor a long time, because most
people don't seek outacupuncture as a first line of
therapy right Although theyshould.
Yes, they should, because, man,when people do, they seem to get
better really quickly.
So when people do it right away, I do think it can make a big
(02:56):
difference.
However, a lot of the peoplethat come to see me have already
tried many, many things andthey're still symptomatic, and
so we have to do a lot of deeptroubleshooting to try to figure
that out.
Speaker 2 (03:08):
And they've already seen probably one or two or more
other providers and they've hadkind of hit or miss
effectiveness with theirtreatments.
Why do you think that is?
Do you think that the diagnosisis difficult, or do you think
that it's just a stubborncondition to treat, or do you
have thoughts on that component?
Speaker 1 (03:26):
Yeah, there are a number of things that I think go
wrong.
So the way that I've kind ofdesigned it in the book is I
classified headaches into acouple of different categories,
and one of the categories iscervicogenic headaches, meaning
a headache that arises from somekind of pathology in the neck.
And so oftentimes, when a lotof the people that I see have
(03:51):
concussions and whiplash andfrom, like, say, motor vehicle
accidents or slips and falls onthe ice where they slipped and
hit their head and also injuredtheir neck, some people can have
headaches as a direct result oftheir neck injury and the
nerves that get irritated in theback of the neck can then cause
these headaches that just kindof radiate even all the way up
(04:12):
into the front of the head andbehind the eyes.
Damage to the neck alone cancause a lot of the same symptoms
that a concussion can cause, sothings like nausea and
dizziness and even changes inbalance, even changes in depth
perception, and so that's whereit can get confusing is that a
lot of the same symptoms of atraumatic neck injury can kind
(04:35):
of look like concussion symptoms.
Usually people, I think, oftencan have a combination of both.
Right, they've got theirconcussion symptoms and then
they have these neck injurysymptoms and sometimes people
are diagnosed with the neckinjury and the concussion gets
missed.
And there's all this focus onthe neck and then in other cases
the concussion gets diagnosedand the neck injury kind of gets
(04:58):
diminished or not paidattention to, and so then that
gets missed.
And it's so important that bothof them are recognized and
tested and diagnosed correctlyand treated correctly.
Speaker 2 (05:09):
I'm excited to dive into that conversation more.
I have some patients I have toshare about some experiences
with that in particular, and Iwant to get your expertise with
that as well.
So cervicogenic, and thenthere's also a different type
tension type headache.
Speaker 1 (05:25):
Yeah, some people can have just a bad tension
headache after a concussion thatfeels a lot like a squeezing
pressure sensation and that canalso be caused from a number of
different things.
When people get a concussion,there can be congestion within
the glymphatic system, which isthe lymphatic system in the
brain, and so if you think abouta lymphatic congestion that
(05:49):
creates a sense of pressure, andso that lymphatic congestion
alone within the brain cancreate these types of chronic
pressure headaches, andoftentimes those feel
intractable, I always ask peopledo your headaches ever fully go
away?
And that's a really importantquestion, because when people's
(06:10):
headaches do fully go away, tome that is like a thumbs up Yay,
this is going to be easier totreat Something.
Yeah.
Then the people who say no, Ihave a headache 100% of the time
, it just varies in its level ofintensity.
And so the people that oftensay that their headache is there
all the time, it just varies inits level of intensity.
And so the people that oftensay that their headache is there
all the time and that there isalways a sense of pressure and
(06:31):
the sense that there's just toomuch inside the head kind of
wanting to come out is how somepeople describe it, and so
that's where I often think thatthere's usually an underlying
component of either dysautonomiathat's interfering with normal
blood flow to different parts ofthe brain and normal blood
vessel motility, as well as,potentially, this congestion
(06:53):
within the glymphatic system.
That needs to be addressed aswell.
Speaker 2 (06:56):
And the glymphatic system, or the lymph system, is
really our detoxificationcomponent, right, and so we have
the tension type, which we'lldive into more.
But the other types we havewe're going to do total episodes
on are this migraine and thismigraine-like headache
presentation.
Speaker 1 (07:13):
Yes, that's another area where I think a lot of
people are struggling is thatthey get a concussion and then
they get diagnosed as havingmigraines because their
post-traumatic headache veryclosely resembles a migraine.
And then they get diagnosed ashaving migraines because their
post-traumatic headache veryclosely resembles a migraine.
And then they're being placedon migraine medications and a
recent study came out that saidthat 87% of people with
(07:37):
post-traumatic headaches weredissatisfied with their current
therapies.
Speaker 2 (07:41):
It's a 13% success rate.
Yeah, that's not good.
No, and that?
Speaker 1 (07:46):
means that?
Basically means that we allneed to do a better job,
absolutely.
Speaker 2 (07:50):
So let's dive into kind of what these different
types are, because knowing thedistinctions between them can
lead to the correct diagnosisand the correct therapies,
because I'm assuming you don'tdo the same thing for all types.
Speaker 1 (08:02):
No, I think that's where you know, having the
Chinese medicine perspective, itcomes in handy because we talk
about this difference between aconstant sense of pressure in
the head, and in Chinesemedicine we talk about that.
We call it dampness, right.
This idea that there's too muchfluid or something wrong with
(08:23):
the fluid metabolism in the body, that murky water, that filter
is not working well, exactly.
So it's almost like again goingback to the fish tank analogy if
your filter is not working andyou haven't cleaned the water,
all of a sudden the fish poop isjust you know these fish are
swimming in their own poop rightand our glymphatic system in
the brain is literally meant totake out all of the metabolic
(08:46):
waste in the brain.
And then we forget, though, thatonce that is removed from the
brain, it has to also be removedfrom the body, which means we
do need our liver to filtereverything out, and we need our
kidneys to filter everything outand flush it out.
Part of the problem in medicineis that we rely so heavily on
blood work, and, when it comesto organ function, disease
(09:10):
within organs show up last inblood work.
And so by the time your labsstart to say, hey, you know,
you've got an indicator lightflashing, it's kind of like the
damage is already there, it'salready been done, and that's
where having more of a natural,holistic approach to health and
longevity isn't about.
(09:31):
Let's wait for something to getso bad that it's now red flag on
a lab right, and the truth isis we live in such a toxic
environment that everybody hasan excessive amount of burden
now on their liver and theirkidneys.
Yeah, so it doesn't matter ifyou live on a you know, desert
island, like we're all breathingthe same air on the planet and
(09:54):
it's toxic air, sadly.
Speaker 2 (09:55):
And I've had the privilege of being able to
travel the world in the pastyear, going to Egypt and going
to Nicaragua and living in theUnited States and seeing
everywhere has this haze?
Speaker 1 (10:05):
Yeah, and even the discussion about microplastics
and forever chemicals and all ofthe things that we're exposed
to that you know, even just allthese conversations around
Parkinson's being, in a sense, aman-made disease based on
chemical exposure to thesedifferent chemicals in our
environment, disruptors to ournervous system to these
different chemicals in ourenvironment, disruptors to our
(10:27):
nervous system, yeah, yeah.
So that's why, you know, wehave to really promote liver and
kidney health, because thoseare our filters, those are our
big, important filters.
Speaker 2 (10:37):
They help so much.
But let's start withcervicogenic headaches.
So if if you're seeing apatient in your clinic and they
come in with what symptoms, doyou start thinking more
cervicogenic versus the othertypes?
Do you want to talk about thedistinction of cervicogenic
headache?
Speaker 1 (10:52):
Well, there's often a lot that you can gleam from
somebody's you know, from doinga basic intake right and saying
you know what was the mechanismof your injury?
Did you have immediate neckpain afterwards of your injury?
Did you have immediate neckpain afterwards?
We do a lot of functional rangeof motion testing as well, and
there was a great study thatalso came out I think in 2024,
(11:13):
that said that after aconcussion, people that did not
complain about neck pain, whenyou evaluated them and did
certain orthopedic tests andpalpation, they were finding
that these people in fact didhave pain when they were being
you know palpated and evaluatedappropriately and then also they
had a loss of joint positionsense of that cervical spine and
(11:38):
so we do a lot of functionaltests.
where we've got the glasses thatpeople wear, it's got a laser
right in the middle and then youhave them close their eyes and
you turn their head and they'resupposed to bring the laser back
to the center with their eyesclosed.
And so all they're using is thekind of receptors in their neck
to tell them how far and howfast they're moving.
(11:59):
And so we can do thesefunctional tests to say how is
someone's joint position senseand are they having errors in
that joint position sense?
Meaning that their receptors intheir neck are not accurately
telling their brain how far orhow fast or in what direction
their head is moving.
Tension and a lot of problemswith the neck and how people
(12:27):
move.
And I also, just in looking atsomebody's gait, how they walk
down the hall, some people don'trealize how much tension they
have, but when you look at themthey're walking almost like
they're trying to balance apineapple on top of their head.
Yeah, and that can sometimes bebecause they have dizziness or
vertigo and they're actuallyafraid to move their head
because they're afraid totrigger that.
Speaker 2 (12:47):
And one thing I learned from you that really
blew my world apart was that ourneck alone can make us dizzy.
If those little receptors inthose joints don't feed forward
into the central nervous system,we can get a lot of
miscommunication and where ourhead and where our body is in
(13:08):
space.
So these proprioceptors, orthese joint receptors in the
joints of the neck alone candrive a lot of dizziness and
that dizziness can make oursystem really stressed out
because our brain and ournervous system doesn't like to
not know where we are in spaceor not trust it.
So we have a lot of feedinginto that system from the neck
(13:29):
that can drive concussion-likesymptoms.
Is that right?
Speaker 1 (13:33):
Yeah, I mean everything is connected and we
have to look at everythingholistically, as opposed to even
trying to separate head fromneck, because they all
communicate with each otherconstantly.
Speaker 2 (13:46):
I have a patient I've been working with for a while.
He's doing much better than hewas when I first saw him.
But we were treating hisconcussion mainly in the
beginning and really afterworking with him, realizing that
his neck was a lot moreinvolved in his symptoms.
Right, it was causing a lot ofdizziness.
I had him do a vestibularevaluation with another partner
(14:07):
and they confirmed for me thatit was more the neck that was
feeding bad information into thenervous system, making him more
dizzy.
So we've started working onthat joint perception more and
his tension has come down a tonand his headaches have gotten
better.
He was having these like kind ofticks come up from his tension
in the neck that was driving alot more symptoms.
(14:29):
That he thought was just hisconcussion.
His inability to concentrate orfocus or hyper fixate on
different things made itdifficult for him to see the
bigger picture and cut back alittle bit.
Once he started working theneck not just the cognitive
components he had a really bigturnaround.
What might you do differentlyfor a patient with a
(14:50):
cervicogenic headache from maybethe other types?
Speaker 1 (14:54):
Well, a lot of it has to do again as an acupuncturist
.
We have this incredible toolwhich can help to improve the
joint position sense of the neckby doing acupuncture points
along the spine the cervicaljaji points is what we call them
.
And not only do those help toimprove the joint position sense
(15:14):
in the cervical spine, but theyalso help to increase blood
flow to the brain as well.
And by doing that you canimprove a lot of even cognitive
symptoms and autonomic nervoussystem functions by getting more
blood flow into the brainstem.
And I think that that's whereyou know being able to
understand the importance of theneck in all of the different
(15:37):
pathology and in improving bloodflow to the brain.
Acupuncture just is such agreat tool for that.
Speaker 2 (15:44):
It really is.
How might a cervicogenicheadache mimic or be different
from a tension type?
Speaker 1 (15:49):
headache, a lot of times the cervicogenic headaches
, because you've got irritatednerves coming from the back of
the head.
The headache will often start inthe back of the head and it
might refer into the front ofthe head.
So a lot of people can literallytrace a line from the back
right to kind of their eyebrowor their eyeball, and so
(16:11):
sometimes the cervicogenicheadaches can be a unilateral
throbbing headache, depending onkind of which nerves are
irritated, or they can just bean intense pressure in the back
of the head or at least, like Isaid, a headache that starts in
the back of the head, whereaswhen people experience tension
headaches, a lot of times theydescribe it as their head being
(16:32):
in a vice or this bilateralsqueezing that can either be the
entire head or it can be thetemples, the forehead, a lot of
people with post-traumaticheadaches.
In that one paper where theywere actually trying to classify
the different types ofheadaches that people had, they
said that 65% of people hadbilateral headaches and of those
(16:55):
, 70% of those headaches were inthe front, and so a huge
percentage of people withpost-traumatic headaches, based
on the research, seem to reallycomplain about a lot of frontal
and temporal headaches, and alot of people do kind of point
right to their eyes and theirforehead and their temples when
they're describing thoseheadaches.
(17:16):
Again, because I see so manydifferent people with
concussions, I also have seenthat different eye movement
pathology can trigger headaches,and when people have problems
with convergence or convergenceinsufficiencies or convergence
spasms, those things can oftenalso cause occipital headaches
too, and so we have to be ableto look at it from you know, a
(17:40):
comprehensive neurological examto also point us in the right
direction, to say either oh look, there's a lot of findings
involving the neck, or maybethere's a lot of findings
involving the autonomic nervoussystem, and perhaps this
dysautonomia is what's drivingthe headaches.
Perhaps there is a lot of thiscongestion within the glymphatic
system that's creating thisbacklog of waste that's causing
(18:03):
increased pressure, that causesheadaches and that'll be more
the tension like headache thatyou see Glymphatic system.
Speaker 2 (18:09):
Talk a little bit about that.
Speaker 1 (18:11):
Within our brain, we've got what we call the
glymphatic system, which wasoriginally found in rats, and
then eventually they realizedthat we have this as well, and
this was really first discoveredback in, I think, 2015, when
this one researcher came outwith a very famous paper called
the Garbage Truck of the Brain.
(18:32):
And so we have to realize thatthe work on the glymphatic
system is very new, is very new,and that when it comes to what
is inside our heads, we oftenthink about neurons, but the
reality is that there are evenmore glial cells than there are
neurons.
Speaker 2 (18:51):
More cells for detoxification and clearing out
waste.
Speaker 1 (18:54):
Yeah, and specifically, there are these
interesting cells calledastrocytes, and the astrocytes
have what are called end feetthat clamp on to the blood
vessels and blood vessels.
When we often think about bloodpumping through our body as, oh,
it's our heart's job to pumpblood, but that's only half the
(19:15):
story.
The heart only pumps bloodthrough a portion of our blood
vessels and then the rest of theblood gets pumped through as
the smaller and smaller vesselsthrough a process called
vasomotion.
And what can happen with atraumatic event like a
concussion is that people canlose healthy vasomotion of their
blood vessels and all of asudden there's congestion and
(19:37):
stagnation.
And then, on top of that,you've got the astrocytes who
they have, end feet, and the endfeet clamp around the blood
vessels and within those endfeet there are these like
tunnels that actually funnelthrough all of the waste.
Sounds like little aliens, yeah, in your brain.
(19:58):
Some interesting research thatfound that military personnel
that had blast injuries andexperienced traumatic brain
injuries from sound wavesbasically causing the concussion
.
Those sound waves couldliterally blow the astrocytes
off of the blood vessels oh mygoodness and cause what's called
astrocyte scarring.
Wow, yeah, so there's, there'sa lot going on there within our
(20:22):
brains that we don't know right.
But, that come.
That basically can create ascenario where we have a loss of
vasomotion, we've got issueswith blood flow, we've got
problems with the glymphaticsystem being able to get
metabolic waste out of the brain.
All of that, like I said, cancause a lot of pressure buildup,
(20:42):
a lot of tension headaches, alot of tension headaches,
throbbing headaches and evendizziness and nausea and brain
fog.
Speaker 2 (20:48):
And what might you do for a patient with those kinds
of glymphatic-like symptoms, orwhat might you guide them to
look at or think?
Speaker 1 (20:56):
about.
Well, that's where being aChinese medicine practitioner
comes in handy, because goingback to this idea of pattern
differentiation and seeing thatthere is this accumulation of
metabolic waste and that thereis an inability to clear it out,
that means that we need toupregulate the glymphatic system
(21:18):
, we need to upregulate thewater metabolism, the waterways
in the body, and we can do thatthrough different herbs.
So do you have you ever usedone of those loofahs in the
shower?
Yes, yeah.
So those loofahs are actuallypart of the Chinese medicine
repertoire, and si guo lo is thename of the herb, and it
(21:39):
actually acts as almost adetergent that takes these large
solutes that are in the brainand breaks them down and clears
them out.
Speaker 2 (21:47):
That's amazing.
I love Chinese medicine becausethere's all these weird hacks
Like we use this loofah to cleanour body, but it's actually
like an herb that we can use toclean the inside too.
Speaker 1 (21:58):
Yeah, formulas that help to basically break down
these larger solutes that needto get cleared out of the body
and then kind of upregulatethese clearance pathways and
upregulate glymphatic functionand lymphatic function and
kidney function to startflushing all of that out.
Speaker 2 (22:15):
I can't talk about this detoxification flushing out
without stressing theimportance of hydration In my
own recovery and with mypatients.
I'm a big water pusher becauseI have found that ample
hydration really helps with thisprocess of keeping things clear
, helping with energy productionand usage, and also this
(22:36):
detoxification.
When I was doing a deeper diveinto the amount of water we need
, just wondering, like okay,we're 70% water, Our brain uses
a ton of it.
How much water do I need to betaking in?
There's a lot of differentnumbers out there, but finding
in general what surprised me wasthe amount of water everyone
(22:58):
should be drinking.
The average person should drink100 ounces of water a day as
kind of a minimum.
That number seemed reallydaunting to me because sometimes
I would lose my need for waterLike I wouldn't get thirsty, and
I actually found out that's asymptom of chronic dehydration.
So if you're in this chronicdehydration state, you don't
(23:19):
really get thirsty.
You can have all this toxicbuildup in your system.
Speaker 1 (23:24):
That leads to symptoms brain fog, headaches, a
number of other ones and, ofcourse, a lot of the other
things that people love to drink.
Like coffee can promotedehydration because, it's
diuretic.
Or we go to sodas which are fullof sugar, which need more water
to detox and clear our systemand not to point fingers, but I
(23:47):
will say that, in general, mypopulation of elderly people are
the worst, and they all give methe same reason for not
drinking enough water, which isthat they don't want to have to
get up and go to the bathroom.
Yes, and so that's why theychoose to actually not drink
water, but then they'redehydrated and everything gets
worse.
Speaker 2 (24:07):
Well, and I found so with this water schedule 100
ounces of water.
I put people on it, I have themtake a 20 ounce water bottle
and drink five a day, because100 ounces, and I break it down
into a schedule Every threehours you drink 20 ounces.
You drink first by 9 am, secondby noon, third by 3, fourth by
6, and the fifth by 9.
(24:28):
The first week or so I findthat we will pee all the time
because what's happening is yourbody is finally dumping all the
buildup and detox, all thethings that it wasn't able to
process before, because now itfinally has a place to put it,
to get rid of it.
So you do pee a lot more,especially if you're dehydrated,
because the body's working tofilter all this toxic waste.
(24:50):
But after about 7 to 10 daysyou go back to peeing as much as
you would normally when youweren't drinking 100 ounces of
water.
Your body adapts to having thatwater in it and uses it for
energy and uses it for functionof cells, to get better
concentration, better sleep.
I've had patients lose weightjust by doing this, having blood
(25:11):
sugars come in to balance moreLike.
There's a lot of symptoms thatget better when you just drink a
lot of water.
So a lot of elderly patients orI have a lot of patients who
will say like I just don't wantto go to the bathroom that much.
Or I started, but I had to peeso much.
I'm like actually it's a reallygood thing.
Keep with it and you'll bebetter off in the long term.
Speaker 1 (25:31):
Your body will regulate, you won't need to go
to the bathroom quite as muchbecause it is inconvenient to
have to go frequently andfrequent urination can also be a
sign of autonomic dysregulationand a sign of stress on the
kidneys and I have found, likewith some of the herbal formulas
that we have that supportkidney function, that once I put
(25:52):
people on those formulas thenall of a sudden their frequent
urination improves as well getsbetter too, because they're not
tight and dry like ropes anymore.
Speaker 2 (26:02):
They're moistened and they're able to be flexible.
I just think that the water andthe hydration and the
detoxification conversation isreally, really needed for that.
Speaker 1 (26:13):
Absolutely.
Speaker 2 (26:14):
What about the other types?
You break it down into migraineand then migraine-like headache
.
Now there's a lot we can diveinto with that, but we want to
break it down kind of acutelyfor us.
Speaker 1 (26:26):
Yeah, so our whole next podcast is going to be on
this topic in particular.
But to put it kind of quicklyas an overview, what is often
happening is that people willget a concussion and they will
develop a post-traumaticheadache that is throbbing in
quality, and they also oftenhave photophobia and phonophobia
(26:50):
so light and sound sensitivityand nausea, and so all of these
symptoms look like a migraine,but in reality, a lot of these
people don't actually meet thecriteria for true migraines.
In reality, a lot of thesepeople don't actually meet the
criteria for true migraines.
So what can happen is that theyget misdiagnosed as having
(27:11):
migraines and put on migrainemedication that isn't helping
them and then potentially cancreate rebound headaches, and so
we're going to talk about thatin our next episode and really
break that down and help peoplefigure out if maybe what they're
having is indeed a truemigraine or if it's more of
these migraine-likepost-traumatic headaches that
need to be treated differently.
Speaker 2 (27:30):
Okay, so let's do a quick review between
cervicogenic tension andmigraine headache symptoms again
.
What would you break down andyou do this really nicely in
your book and you have a greattool in there too to really
tease it out but for ourlisteners who aren't going to
necessarily right away dive intothat, what would be big
(27:50):
takeaways for communicating withyour providers accurately about
these types of symptoms To getthe correct diagnosis between a
cervicogenic tension and amigraine post-traumatic headache
?
Speaker 1 (28:16):
One of the most important things in order to get
the right diagnoses and and inthe podcast, is by giving people
the tools to be able toaccurately describe their
symptoms the communication tools.
Then we can hopefully avoidpeople getting misdiagn.
(28:36):
Weren't getting better, butbecause I had asked the right
questions, we could actually seethat certain types of their
headaches were improving even ifother ones weren't, which would
then allow me to kind of stickand move with what's changing
and change up my treatment planin order to continue to make
further, further progress.
(28:56):
So some of the descriptors thatwe need to have when talking
about headaches are these thingslike the difference between a
pressure and a squeezingsensation that is kind of
classic to attention headache,compared to a throbbing or
pulsing quality which could becoming from a cervicogenic
(29:18):
headache, and in that case it'susually starting in the back of
the head and potentiallyradiating upwards and into the
top of the head or the front ofthe head or even maybe the side
of the head.
So having that throbbing,pulsing quality could happen in
a cervicogenic headache, butit's likely coming from the back
of the head first or the backof the neck, or it could happen
(29:39):
in a migraine headache, becausea classic migraine is a
unilateral, one-sided, throbbing, pulsing headache.
At least at the start ofmigraines, that's how they
present, and then, withpost-traumatic headaches,
they're more often bilateral.
Many people say that they're onboth sides of the head when
they're having a migraine-likeheadache.
(30:02):
That is a combination of thispulsing, throbbing quality with
the light sensitivity, the soundsensitivity.
Like I said, it's more usuallyboth sides of the head, and so
that's where things can get.
Confusing is that a lot ofthese headaches do resemble each
other, but they have these kindof subtle differentiating
(30:22):
features that you then can alsodo further tests to really try
to get to the bottom of it.
If somebody has a true migraine,when they take migraine
abortives, they typically getsome level of relief, and many
people with post traumaticheadaches that are being
diagnosed with migraines willtake an abortive migraine
medication and they won't getthat much relief from it.
(30:44):
So there are little things thatwe can kind of look at that
give us these red flags to sayis this what's really going on?
And then there's this wholeother category of neuropathic
pain, which we'll do a wholenother podcast on, and people
that have concussions and braininjuries can often develop
neuropathic pain, where theyalso describe things like
(31:05):
electrical buzzing or electricalsensations in the scalp or the
head or these like lightningbolts of pain, or sometimes
they'll actually feel a sense ofwater kind of dripping down
their head Like this weirdtwinging sensation.
Yeah, and it can feel hot or itcan feel cold, and so the
neuropathic pain is also this,it's kind of own category of
(31:26):
pain that can include a lot ofdifferent sensations that are
maybe I don't want I don't knowif separate is the right word
separate from these otherheadaches.
But what I find is that peoplecan come in and they can have
kind of this constant low levelpressure tension type headache,
and then they can also havemoments where they have these
(31:47):
intense throbbing headaches andthen they can also have these
little zinger type sensationsthat are more of the neuropathic
pain.
And so people can actually comein with kind of a number of
these different headaches allhappening simultaneously, a
number of these differentheadaches all happening
simultaneously.
And that's where it's veryhelpful for people to be able to
have the tools and thecommunication, the language to
describe all of that, becausetypically when I start working
(32:09):
with somebody, some aspect getsbetter first, right, and some
people, even if they still havethese chronic tension headaches,
they might not even realize, oh, I'm no longer having those
sharp stabbing zingers anymore,because a lot of times when pain
goes away, you forget you hadit in the first place For sure,
and so a lot of people can feelvery dejected and depressed and
(32:32):
thinking that they're notgetting better.
But then you start goingthrough their chart and saying,
well, what about this pain, orwhat about that type of headache
?
And then all of a sudden theyrealize oh, that's actually
gotten better.
Speaker 2 (32:42):
I forgot I used to have that all the time.
If it's not knocking on thedoor, I don't hear it anymore.
Yeah, I find that a lot toowith patients.
Speaker 1 (32:56):
Yeah, and so for that reason I developed this
post-traumatic headachecommunication tool that we have
on the Life After Impact websitethat people can go to and all
they have to do is just sign inwith their email address and
then they'll get taken to alanding page where they can
download that PDF, and it servesas a way for them to very
quickly just check a bunch ofboxes and kind of fill in some
sections and then bring it withthem to their medical
(33:17):
appointments as a way of sayingyou know to their other
healthcare providers.
Here are the types of headachesI'm having, here's what I'm
doing about it, here's what hasworked, here's what's not
working, and it's just a veryconcise way to help people
communicate their experience.
Speaker 2 (33:33):
And that is a big takeaway I have after reading
your chapter is just being ableto communicate it correctly is
really important, because wedon't have that much time with
our providers and we're tryingto capture what's happened in
our life in like five or tenminutes with somebody right and
trying to hope that they get wesay it all correctly and that
they hear it the right way toknow what's in their arsenal to
(33:55):
give us for resources or tools,and so that tool is so valuable
for patients to kind of guidethat conversation and capture
that language correctly to knowwhat their providers might pay
attention to more, and that willhelp get the right diagnosis,
which will help get the righttreatment and more relief
(34:23):
practice, the more I realizedthat communication is everything
, and so often when people cometo see me and they're describing
their experience, I ask themthe same question, maybe in
three or four different ways,because when people have
concussions, they can also.
Speaker 1 (34:34):
The part of the part of what can be lost is their
ability to tune into their ownexperience, and I certainly feel
like that was my case with myconcussions is that I was so
focused on just trying to getthrough my day that I didn't
even have good self-awareness ofthe symptoms I was having, and
so to have somebody else be ableto really pull that out and
(34:54):
help you to recognize what it isthat you're dealing with and to
communicate it in a reallyclear, precise way is so
important in being able to getthe right diagnosis, get the
right treatments, be able tomonitor whether those treatments
are working or not.
I've never understood, you know,I have so many people that have
come to me and they've been ona medication for, like you know,
(35:16):
seven or eight years, and whenI asked them, well, the original
thing that they put you on thismedication for you still have.
So clearly it's not doinganything if eight years have
gone by and you still have thesame symptoms.
So why are we on this, right?
I mean?
And it's funny because, beingan herbalist, I think for a lot
of people herbs are so foreignand strange that they are like,
(35:39):
if I don't notice miraculousthings happening, in two weeks,
I'm quitting.
I'm quitting your therapy.
I'm over it, right?
And yet, when it comes topharmaceuticals, there's this
weird kind of buy in wherepeople are willing to be on them
for a very long time, even ifthey're still symptomatic and
they're not working.
Speaker 2 (35:56):
And yeah, because it's taxing your liver.
Speaker 1 (35:59):
I mean everything we put in our body taxes our liver.
And so if something's not doingthe job, let's not burden the
liver and the kidneys even moreby taking something that's not
working, which will cause maybemore headaches down the road.
Exactly.
We'll dive into that too inanother episode.
Speaker 2 (36:15):
Okay, this is really robust and really great
information.
This tool that you have isreally incredible and I hope it
will guide patients.
One example from my ownexperience is that I get a lot
of patients who refer to me fromproviders with diagnosis like
they already have, likemigraines right.
So I in my evaluation I take intheir chart review and then I
(36:37):
do my evaluation with them.
But it's more, it's a littlebit quicker at the Neuroscience
Center than it is in privatepractice because of the capacity
I have there.
So oftentimes I'm relying onthose referral diagnoses.
I had a patient come with mewith a referral diagnosis of
migraine and was treating hermigraine like headaches with
(36:57):
some success.
It would go away and it wouldget better.
But I was really just focused inon the migraine component and
after reading your chapter Ireally started thinking more
clearly about maybe this isn'tmigraine, maybe it's
cervicogenic, because I couldstart to see this patient and
that description and so Itreated more cervically and
headaches completely went awayand one type of them, because
(37:19):
they had two types.
Right, they had thiscervicogenic type and this
migraine-like one.
The migraine-like ones wouldrespond to migraine medications
but the cervicogenic ones didn't.
When I started treating theneck the cervicogenic ones went
away, still got a few migraines,but not nearly as many and
didn't need as much medication.
So that was helpful for mebecause I was able to read the
(37:41):
information to the provider toget them on board and some new
tools for that patient too justunderstanding where their
headaches are coming from andwhy they might be having them,
so that they can make decisionsin their daily life.
That might help alleviate thattoo.
So that's, it's really key andreally I really hope a lot of
our listeners glean from that.
Speaker 1 (38:01):
I love it.
So my book hasn't evenpublished yet, but it's already
helping.
It's really key and I reallyhope a lot of our listeners
glean from that.
Speaker 2 (38:06):
I love it.
So my book hasn't evenpublished yet, but it's already
helping people.
Is there anything else youthink that our audience should
kind of know or tune into beforewe wrap this up and dive into
more headache discussions in thenext episode?
Speaker 1 (38:16):
Yeah, I think that listening to the next couple
episodes should also help peoplewho still have questions
specifically on this question ofam I having a true migraine or
a quote migraine like headache?
that may not be responding wellto migraine medication and then
also exploring this idea of theneuropathic pain better, and so
(38:36):
I think that if people aresuffering from post
traumatictraumatic headachesdefinitely tune into our next
couple of episodes where we getinto even more detail about
these things as well as themedication overuse headache
factor.
I mean, I had a patient who wasessentially to make it short,
taking ibuprofen every singleday, and once I explained to her
(38:59):
that taking ibuprofen for morethan 15 days a month can
actually cause rebound headaches, she finally went off of it and
her daily headaches went awayjust by not taking a painkiller.
Every day, yeah, and so I thinka lot of people don't recognize,
even if they're only taking twoto 400 milligrams of ibuprofen
a day.
If you're doing that more than15 days a month, it can actually
(39:22):
be causing rebound headaches.
And you know, those kinds ofwarnings aren't very clearly
stated on the bottle.
People assume if this is overthe counter it must be safe, but
the reality is that thesemedications can be problematic,
even if there's something youcan just buy.
Speaker 2 (39:38):
You know over the counter and no one teaches us
all this in school, or there'sno academy really where you go
to learn all this.
And then you get a brain injuryand you're even more confused
and just in the midst ofeverything.
So, having the ability tounderstand it and communicate it
and really know what riskfactors are out there, as far as
if you're taking ibuprofenevery day or other things you
(40:01):
might be doing that could beadding insult to injury
unknowingly- yeah, so on thattopic, I did write a blog post
about medication overuseheadaches at the
lifeafterimpactcom website.
Speaker 1 (40:16):
So if people do want that information right away or
in writing, it's there in theblog and then also on the
homepage on the bottom.
That's where people can sign upfor the Post-Traumatic Headache
Journal.
It's on the bottom of thehomepage as well as on the
resource page at the moment.
So if people go tolifeafterimpactcom, all of that
(40:39):
information and resources arethere for them
posttraumaticheadacheactcom.
Speaker 2 (40:41):
All of that information and resources are
there for them, and our nextepisode is going to dive into
migraine, migraine-like headacheand medication overuse as well.
Then we'll dive intoneuropathic pain in another
episode and if you're notunderstanding that
post-traumatic headache isreally confusing, by the end of
that we even have an episodewhere we'll talk about our
research study on post-traumaticheadache and some of our
(41:02):
findings there.
Speaker 1 (41:03):
Excellent.
Well, thank you for tuning inand we hope you'll join us for
our next several episodes allstill kind of diving into this
topic on post-traumaticheadaches, and then we'll also
get into some of the therapiesthat are out there,
non-pharmaceutical therapiesthat people can try to help get
out of pain.
Yes, so stay tuned, Thank you.
(41:30):
Medical disclaimer.
This video or podcast is forgeneral informational purposes
only and does not constitute thepractice of medicine or other
professional healthcare services, including the giving of
medical advice.
No doctor-patient relationshipis formed.
The use of this information andmaterials included is at the
user's own risk.
The content of this video orpodcast is not intended to be a
(41:54):
substitute for medical advice,diagnosis or treatment.
Consumers of this informationshould seek the advice of a
medical professional for any andall health related issues.
A link to our full medicaldisclaimer is available in the
notes.
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