How to Stop Headaches Using Science-Based Approaches

00:00:00.000 | - Welcome to the Huberman Lab Podcast,

00:00:02.260 | where we discuss science and science-based tools

00:00:04.900 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.120 | and I'm a professor of neurobiology and ophthalmology

00:00:13.100 | at Stanford School of Medicine.

00:00:15.080 | Today, we are discussing headaches.

00:00:17.220 | Headaches are something that everybody will suffer

00:00:19.640 | at some point in their lifetime.

00:00:21.620 | Of course, some people suffer from headaches

00:00:23.140 | far more often than others.

00:00:24.740 | And for many people,

00:00:25.860 | headaches can be incredibly debilitating,

00:00:28.480 | limiting their ability to work, to socialize, to sleep,

00:00:31.740 | to exercise, essentially to live life

00:00:34.640 | in any kind of normal way.

00:00:36.540 | As we'll soon discuss,

00:00:38.140 | there are many different kinds of headache.

00:00:40.080 | We have migraine headaches, tension headaches,

00:00:41.920 | cluster headaches.

00:00:42.840 | Today, we'll review all the different types of headaches

00:00:45.800 | and what the underlying biology

00:00:47.880 | of each and every one of those types of headaches is,

00:00:50.480 | as well as, fortunately,

00:00:52.320 | the many excellent treatments that exist

00:00:54.440 | for the different types of headache.

00:00:56.000 | In fact, what we'll soon discuss

00:00:57.620 | is that by understanding which type of headache you have

00:01:00.960 | and a little bit about the underlying biology

00:01:03.200 | of each different type of headache,

00:01:05.080 | it becomes quite straightforward

00:01:06.440 | to select the best treatment options for you

00:01:09.260 | to, for instance, provide relief

00:01:11.160 | from frequent and recurring tension headaches,

00:01:13.820 | cluster headaches, even sinus headaches,

00:01:15.480 | the sorts of headaches that are associated

00:01:17.180 | with sinus infections and colds

00:01:19.200 | where the sinuses get clogged up

00:01:20.740 | and you experience headache.

00:01:22.000 | So while today's episode focuses on all aspects

00:01:24.360 | and types of headaches,

00:01:26.040 | it will have tremendous relevance for everybody.

00:01:28.440 | So for those of you that experience headache

00:01:30.240 | every once in a while,

00:01:31.640 | or only when you're sick or have a sinus headache,

00:01:33.980 | or for those of you that suffer from debilitating migraines,

00:01:37.160 | today's conversation actually has a bit of optimism

00:01:39.940 | woven into it, meaning there are excellent treatments

00:01:43.000 | for each and every one of the different types of headaches.

00:01:45.900 | And I was quite impressed and excited to learn

00:01:48.440 | when researching this episode

00:01:50.140 | that the treatments for headache range from, of course,

00:01:53.140 | prescription drug treatments

00:01:54.840 | and over-the-counter medications of the sort of type

00:01:57.720 | that most of us have heard about,

00:01:58.960 | ibuprofen, acetaminophen, and so forth,

00:02:01.040 | so-called anti-inflammatory drugs.

00:02:03.680 | But it turns out there are many natural treatments

00:02:06.740 | for headaches that when compared

00:02:09.520 | to those over-the-counter drugs

00:02:10.880 | and even some prescription drugs appear to be easily

00:02:14.560 | as effective and in many cases more effective

00:02:17.360 | than the typical drug treatments,

00:02:18.820 | many of which can carry side effects.

00:02:20.720 | That is the drug treatments carry side effects,

00:02:22.760 | whereas the natural treatments appear

00:02:24.720 | to not carry side effects.

00:02:26.480 | Now, of course, anytime we have a discussion

00:02:28.000 | about natural treatments,

00:02:29.500 | there are likely to be some eye rolls out there

00:02:31.400 | and people thinking, oh, you know,

00:02:32.440 | this is going to be a bunch of woo science.

00:02:35.260 | Well, far from it, as you'll soon learn today,

00:02:38.360 | each and every one of the treatments

00:02:39.600 | for each and every one of the different kinds of headaches

00:02:42.200 | is grounded in a solid biological understanding

00:02:45.140 | of why that particular treatment ought to work

00:02:47.280 | and does work.

00:02:48.120 | So for instance, you'll learn that some headache arises

00:02:50.740 | because of muscular pain, other headache arises

00:02:52.820 | because of excessive vasodilation,

00:02:55.420 | the arteries and blood vessels get bigger and wider.

00:02:58.160 | And so there's a pressure and a swelling within the cranium

00:03:01.420 | that people experience as a headache.

00:03:03.520 | And it turns out that many of the more natural treatments

00:03:06.040 | out there can address either the muscular pain issue

00:03:09.700 | or the vasodilation issue or other issues

00:03:12.800 | and underlying mechanisms for headache.

00:03:14.600 | So again, while headaches are very intrusive, irritating,

00:03:18.400 | and in some cases debilitating,

00:03:20.240 | there is certainly light at the end of this tunnel.

00:03:23.020 | Meaning by the end of today's episode,

00:03:24.960 | each and every one of you will have an array

00:03:26.880 | of excellent treatment options that you can choose from

00:03:30.500 | in order to address and provide relief

00:03:32.940 | from any of the different types of headache.

00:03:35.200 | Before we begin, I'd like to emphasize that this podcast

00:03:37.900 | is separate from my teaching and research roles at Stanford.

00:03:40.600 | It is however, part of my desire and effort

00:03:42.860 | to bring zero cost to consumer information about science

00:03:45.500 | and science related tools to the general public.

00:03:48.200 | In keeping with that theme,

00:03:49.300 | I'd like to thank the sponsors of today's podcast.

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00:07:47.380 | Let's talk about headaches.

00:07:48.980 | And as we are soon going to learn,

00:07:50.620 | there are different types of headaches

00:07:52.420 | and different types of headaches arise from changes

00:07:55.900 | in different types of tissues in the head area

00:07:58.820 | and indeed in the neck area as well.

00:08:02.120 | Now, one of the key things to understand

00:08:03.900 | is that if you want relief from a headache,

00:08:06.660 | you need to understand which tissue is mainly involved

00:08:10.220 | in creating that type of headache.

00:08:12.580 | So for instance, many people suffer

00:08:14.220 | from what are called tension headaches.

00:08:15.860 | Now, tension headaches are a little bit of a misnomer

00:08:18.220 | because many people might think,

00:08:19.580 | oh, tension, I'm under a lot of tension and stress

00:08:21.500 | and therefore I get tension headaches.

00:08:22.900 | And indeed, stress can cause tension headaches.

00:08:25.760 | But tension headaches are really the sort of headache

00:08:28.020 | that you feel around the top part of the head,

00:08:31.340 | not the very top,

00:08:32.420 | but sort of where you would put a headband,

00:08:33.980 | so above the eyes and around the head.

00:08:35.740 | It doesn't have to be experienced

00:08:37.260 | all the way around the head.

00:08:38.700 | But the main underlying reason,

00:08:40.260 | that is the tissue system

00:08:42.100 | that mainly underlies tension headaches

00:08:44.580 | is the muscular system.

00:08:45.880 | There are a lot of muscles on the skull, believe it or not,

00:08:49.180 | of course, on the neck

00:08:50.040 | and they allow you to move your neck and head.

00:08:52.540 | There are a lot of muscles that lie parallel to the skull

00:08:56.220 | and oftentimes those muscles

00:08:57.660 | will undergo excessive amounts of constriction.

00:09:01.380 | Now there are of course muscles in the jaw

00:09:03.120 | that can also lead to headache and jaw ache

00:09:05.040 | and things of that sort and neck aches and headaches.

00:09:07.780 | So what we're really pointing out here

00:09:09.300 | is that the muscles are a key player

00:09:12.260 | in the formation of different types of headache,

00:09:14.700 | tension headache in particular.

00:09:16.780 | But of course, muscles and muscle tension

00:09:19.720 | can be involved in the other types of headaches as well.

00:09:22.300 | Okay, so I just want to highlight muscular issues

00:09:25.160 | as one particular source of the ache in headaches.

00:09:28.700 | The other tissue that can be prominently involved

00:09:31.380 | in generating the ache of a headache

00:09:33.580 | are the so-called meninges.

00:09:35.200 | Now the meninges, in addition to being a fun word to say,

00:09:38.860 | are a bunch of tissues that line the outside of the brain

00:09:43.800 | and reside between the brain and the skull.

00:09:47.120 | So you might think, okay, between the brain and the skull,

00:09:48.880 | there's probably just a little bit of fluid

00:09:50.220 | and the brain is right up next to the skull,

00:09:51.600 | but it turns out that's not the case.

00:09:52.720 | The brain is actually encased in a very thick,

00:09:55.440 | very durable sac or casing

00:09:58.880 | that's wrapped around it tight like saran wrap.

00:10:01.440 | It actually has a name, which is dura, D-U-R-A.

00:10:04.740 | And so you can remember dura, durable.

00:10:06.800 | And having done some surgeries, many surgeries before

00:10:09.800 | on brains of different types, ranging from human,

00:10:13.220 | even though I'm not a neurosurgeon as a clinician,

00:10:15.900 | ranging from human to other types of species,

00:10:19.560 | what you find is that the dura is exceedingly durable.

00:10:22.760 | Getting through this thing really requires

00:10:24.280 | a very sharp razor blade.

00:10:26.540 | So the brain is actually sitting in a very fibrous-like sac

00:10:30.600 | that you simply could not open up with your fingertips

00:10:33.680 | under any conditions.

00:10:34.600 | It's really durable.

00:10:36.200 | The meninges are in that general area

00:10:39.240 | and also encasing the brain.

00:10:40.920 | And the meninges provide an additional buffer

00:10:44.080 | between the brain and the dura and the skull.

00:10:47.300 | So again, you don't want to think about the brain

00:10:48.820 | as just sitting right next to the skull.

00:10:50.400 | It's close by,

00:10:51.240 | but there are a bunch of other thin fibrous tissues,

00:10:53.700 | many of which are very thin and fragile,

00:10:56.400 | and others of which such as the dura

00:10:58.180 | that are very, very strong because they're very fibrous,

00:11:02.040 | almost like if you've ever felt, for instance,

00:11:04.880 | the sail of a sailboat, you might think,

00:11:07.640 | oh, it's just this big flapping sheet in the wind.

00:11:09.480 | It is anything but a sheet in the wind.

00:11:11.780 | It is a very, very strong and durable material.

00:11:14.780 | Now, the proximity of the dura and the meninges to the brain

00:11:17.360 | and the fact that everything is wrapped very tightly

00:11:19.780 | together and the fact that there's a lot of vasculature,

00:11:22.500 | so that would be arteries, blood vessels, and capillaries

00:11:24.640 | are all in that area on the top of the brain

00:11:26.560 | and throughout the brain.

00:11:27.720 | The fact that all of that is in very close proximity

00:11:29.920 | and wrapped really tight in this very durable sack

00:11:32.880 | is one of the reasons why when blood vessels

00:11:38.640 | or arteries or both become dilated, they open,

00:11:41.960 | there creates a pressure between the brain and those tissues.

00:11:46.160 | And because there isn't much distance between the tissues

00:11:49.240 | like the dura and the meninges and the skull,

00:11:51.640 | there's also pressure that allows for the brain

00:11:54.720 | to literally sneak up, or I should say,

00:11:58.240 | give the impression that your brain is expanding

00:12:00.240 | up against your skull.

00:12:01.640 | So the point here is that while muscular tension

00:12:03.780 | can give rise to headache,

00:12:05.040 | the other thing that can give rise to headache

00:12:06.680 | is so-called vasodilation, the expansion or the widening

00:12:10.420 | of the arteries, blood vessels, and capillaries.

00:12:13.120 | And one of the reasons why that gives rise to headache

00:12:15.320 | is because there's simply not a lot of space

00:12:17.240 | for that expansion to go.

00:12:20.200 | It doesn't allow anything except for the brain

00:12:22.360 | to push up against that very durable tissue

00:12:24.800 | and that very durable tissue to push up against the skull.

00:12:27.600 | And even though the brain itself doesn't have pain receptors,

00:12:32.020 | that's right, the brain itself doesn't have pain receptors,

00:12:34.080 | that is why a neurosurgeon can take off a piece of skull

00:12:37.120 | and can probe around in the brain with an electrode

00:12:39.200 | and the person is completely unaware.

00:12:41.080 | And in order to get through the skull,

00:12:42.960 | of course a little skin flap has to be removed

00:12:45.320 | from the skull, and that requires a little bit

00:12:47.600 | of topical anesthetic, but really you don't need

00:12:49.760 | any anesthetic to go into the brain itself

00:12:51.720 | because there aren't pain receptors on the brain itself.

00:12:53.980 | However, the tissue surrounding the brain

00:12:57.480 | such as the dura, the meninges, and the vasculature

00:13:00.880 | that then reaches up, believe it or not, into the skull,

00:13:03.620 | the vasculature doesn't actually stop right beneath the skull

00:13:06.160 | it actually blood vessels get into the skull

00:13:08.560 | and there are actually portals by which blood can move

00:13:11.240 | within the skull itself.

00:13:12.640 | Well, what that means is that since all of the tissues

00:13:15.000 | are very close by and very compact

00:13:17.520 | with respect to one another, any increase in the size

00:13:21.120 | of the portals that allow movement of blood there

00:13:24.460 | and the fact that there are what are called nociceptors,

00:13:27.580 | N-O-C-I, nociceptors, these are essentially pain receptors,

00:13:32.180 | because of the presence of pain receptors in the tissues

00:13:34.780 | around the brain, when there's an increase in the size

00:13:39.060 | of those vascular portals, the arteries, capillaries,

00:13:42.140 | and vessels, we experienced that as intense pain

00:13:46.140 | and pressure, and fortunately there are excellent treatments

00:13:49.260 | for dealing with that intense pain and pressure,

00:13:51.700 | but keep in mind that the intense pain and pressure

00:13:54.900 | that is the consequence of vasodilation,

00:13:57.020 | that is the widening of these different vascular portals

00:14:00.500 | is very different than the type of pain that arises

00:14:02.660 | from muscular tension as is the case with tension headache.

00:14:06.100 | Okay, so now we have two sources of pain

00:14:08.700 | that is the ache in headache, and there are two more

00:14:11.020 | that we need to think about in trying to better understand

00:14:13.580 | the different types of headaches that we'll discuss

00:14:15.820 | and in terms of trying to understand which are going

00:14:18.060 | to be the best treatments for the different types

00:14:19.740 | of headaches, and those are neural

00:14:22.380 | and inflammatory responses.

00:14:23.980 | So let's talk about the neural type first.

00:14:25.980 | There is a type of headache that many people unfortunately

00:14:28.440 | suffer from, we'll get into this in a bunch more detail

00:14:31.780 | in a moment, but those are called cluster headaches.

00:14:34.580 | Cluster headaches are headaches that arise

00:14:37.140 | not from the surface, people don't experience them

00:14:40.360 | as kind of a tightening of the forehead and the neck

00:14:42.340 | and the jaw, but rather it feels as if the headache

00:14:44.600 | is coming from deep within the head, and in particular

00:14:46.980 | from behind the orbit of one or the other eyes,

00:14:50.100 | and sometimes both eyes.

00:14:51.700 | For those of you that have ever experienced

00:14:53.460 | cluster headaches, they are extremely painful,

00:14:56.360 | even the more, or I should say the relatively

00:14:59.020 | more minor cluster headaches are extremely painful

00:15:01.340 | and the severe ones are exceedingly painful.

00:15:04.280 | Cluster headaches arise from deep, or we get the sensation

00:15:08.440 | that they are arising from deep within our head

00:15:10.260 | as opposed from the surface inward,

00:15:12.660 | because they are neural in origin.

00:15:14.440 | And there's a particular nerve pathway

00:15:17.140 | called the trigeminal nerve that often is the origin

00:15:21.520 | of these cluster headaches that people experience

00:15:23.480 | behind the eye.

00:15:24.460 | The trigeminal as the name suggests has three branches,

00:15:26.960 | tri, okay, so there's a branch that essentially extends

00:15:30.940 | to the eye, there's also a branch that extends

00:15:34.040 | to the mandible, right, to the lip, and there's a branch

00:15:38.000 | that extends more or less to the nasal area.

00:15:41.540 | And so this trigeminal nerve becomes inflamed

00:15:45.580 | or in other ways is hyperactivated in some cases,

00:15:49.480 | and that causes the deep pain below the eye

00:15:52.780 | because it is that first branch of the trigeminal nerve,

00:15:55.300 | which is the ophthalmic branch,

00:15:57.060 | which tends to be activated first.

00:15:58.880 | So people start feeling as if there's a pain

00:16:00.660 | behind their eye, in particular on one side,

00:16:02.540 | oftentimes there's lacrimation, which is tearing up,

00:16:05.620 | there can be some nasal discharge.

00:16:07.420 | Another common symptom of this type of headache,

00:16:10.020 | that is the cluster headache, is that the pupils

00:16:11.980 | sometimes will become very small, the pupils of the eyes,

00:16:14.920 | and they won't dilate even in darkness.

00:16:17.700 | So there are a bunch of things that are going on

00:16:19.940 | on one or both sides of the face that seem to arise

00:16:22.340 | from deep within the head, or it's almost as if it's coming

00:16:25.940 | from the brain outward, and that's because it's neural

00:16:28.100 | in origin, okay, so we've got muscular origins of headaches,

00:16:31.380 | we've got meningeal origins of headaches,

00:16:35.020 | that is the stuff around the brain and as it relates

00:16:37.620 | to the vasculature, and we have neural origins of headaches.

00:16:41.560 | And of course there's inflammation origins of headaches.

00:16:44.900 | Now inflammation is a term that gets thrown around a lot

00:16:47.220 | these days, people are talking about, you know,

00:16:48.660 | this reduces inflammation and inflammation is bad,

00:16:50.980 | and I suppose in some cases, and when inflammation

00:16:54.420 | is really widespread across the brain or body, it's bad,

00:16:57.220 | but I don't think any of us should think about inflammation

00:16:59.660 | per se as bad, what I mean is inflammation is just one form

00:17:04.100 | of signaling in the body, which of course includes

00:17:07.180 | the brain, inflammation of a tissue is one way in which

00:17:11.620 | a set of cells, so these could be, for instance,

00:17:14.900 | cells of the immune system, and we cover this

00:17:17.340 | in a detailed episode all about the immune system,

00:17:19.280 | if you'd like to check that out, you go to Hubermanlab.com,

00:17:21.440 | just put into our search function immune system

00:17:23.580 | and you can find that episode, by the way,

00:17:25.020 | all of our episodes are searchable by keyword

00:17:27.120 | at Hubermanlab.com and it'll take you to specific episodes

00:17:29.500 | and timestamps for the topics you're interested in,

00:17:32.640 | so for sake of this discussion about headache,

00:17:36.660 | inflammation is going to be the case

00:17:38.900 | when one particular tissue in and around the head area

00:17:42.580 | is releasing molecules, cytokines,

00:17:45.660 | which sometimes are called inflammatory cytokines,

00:17:47.600 | but there are also non-inflammatory

00:17:49.260 | or anti-inflammatory cytokines, but inflammatory molecules

00:17:53.120 | that are signaling to the rest of the body,

00:17:54.980 | hey, there's something going on here,

00:17:56.340 | there's either some intrusive object,

00:17:58.660 | and indeed, if you were to get a BB or a splinter

00:18:01.840 | into a particular skin area,

00:18:04.080 | there'd be a lot of inflammation,

00:18:05.140 | so it can be the introduction of a foreign physical object

00:18:07.400 | into an area that will cause inflammation,

00:18:09.380 | it can be the presence of some sort of local toxin

00:18:12.340 | in that area, it could be a more systemic inflammation,

00:18:16.380 | nonetheless, inflammation in the neck and head area

00:18:21.060 | or frankly anywhere within the sinus area,

00:18:23.780 | so this would include the mouth, the nose, around the eyes,

00:18:26.480 | because the sinuses, many of us think of sinuses

00:18:28.540 | as just our nose, but actually,

00:18:29.820 | if I were to show you a skull, a human skull

00:18:31.900 | or any other kind of skull, you'd be very hopefully

00:18:35.820 | intrigued to learn that the skull is just not one big piece

00:18:39.620 | of solid bone or a top with a jaw below it,

00:18:43.220 | it actually has all these small

00:18:44.620 | what are called fenestrations, little holes and canals

00:18:47.300 | that run through the skull and through the depth of the skull

00:18:50.300 | like little tubes, you've got them down here

00:18:52.420 | on your mandible, you've got them above your lips,

00:18:55.100 | you have them on either sides of your nose,

00:18:57.300 | those are the sinuses, the sinuses allow the passage

00:19:00.100 | of different fluids through the skull

00:19:01.660 | because the skull, even though it's bone,

00:19:03.980 | it's not a dead tissue, right?

00:19:05.820 | In a live person or animal,

00:19:07.540 | the skull is a very active living tissue,

00:19:11.260 | indeed all bone is active living tissue

00:19:13.580 | and it needs to be nourished with blood,

00:19:15.700 | it needs to be nourished with cerebral spinal fluid,

00:19:17.940 | in the case of the skull, it needs to be nourished

00:19:19.340 | with all sorts of important things,

00:19:20.940 | so those sinuses oftentimes can become clogged

00:19:23.780 | as is in the case with sinus headache,

00:19:25.500 | which we'll talk about in a little bit,

00:19:27.460 | but more generally, anytime there's inflammation

00:19:30.240 | of one given area of the body, so it could be a shoulder,

00:19:33.780 | it could be the neck, it could be the mouth,

00:19:35.060 | it could be the nose, or in the case of the headache,

00:19:37.640 | it could be any portion of the head or neck,

00:19:40.960 | what happens is inflammation,

00:19:43.700 | while it's a very efficient signal,

00:19:46.280 | it's much like the siren on an ambulance or a police car

00:19:49.580 | in that it sends out a very broad signal

00:19:51.240 | that's very clear something is wrong here

00:19:53.480 | and needs to be dealt with, it's not very specific,

00:19:57.200 | so it's very robust, but it's not very specific,

00:19:59.700 | so for instance, if there's a little bacterial infection

00:20:02.760 | or a little viral infection,

00:20:04.580 | the inflammation response to that site of infection

00:20:07.260 | tends to be far more widespread

00:20:09.660 | than the actual site of infection,

00:20:11.980 | it's a little bit different

00:20:12.820 | when you have a foreign object there,

00:20:14.040 | like a splinter or some other foreign object,

00:20:16.280 | that tends to be a bit more localized,

00:20:18.100 | and the immune system is always trying to limit

00:20:20.380 | the extent of inflammation

00:20:22.220 | by putting in different scar tissues,

00:20:23.920 | indeed, a lot of the things that we think of

00:20:25.500 | as kind of gross pussy, you know,

00:20:27.060 | pustules and boils and things like that,

00:20:28.620 | I know it's a gross topic,

00:20:29.780 | are ways in which our body tries to restrict

00:20:32.660 | the amount of inflammation,

00:20:34.120 | but the face area and the head itself

00:20:37.940 | are so heavily infused with blood vessels

00:20:40.420 | and there's a constant perfusion, as we say,

00:20:42.780 | of blood and cerebral spinal fluid and other things

00:20:44.980 | through this incredibly metabolically active tissue

00:20:47.300 | that we call our brain and our eyes,

00:20:49.480 | those are by far the most metabolically active tissues

00:20:51.900 | in our entire body,

00:20:53.020 | even if we're running hundreds of miles in ultra marathons,

00:20:56.340 | your brain is still far more metabolically demanding

00:20:58.960 | than all the muscles of your body combined,

00:21:01.120 | no matter what the conditions.

00:21:03.220 | Because of that, there tends to be a generalization

00:21:05.220 | or a spreading out of any inflammatory response,

00:21:07.860 | and that inflammatory response then can trigger

00:21:11.900 | the pain mechanisms or what we've experienced

00:21:14.220 | as pain mechanisms in the other three types of tissues

00:21:16.840 | that we talked about.

00:21:17.680 | So for instance, if you have a systemic infection

00:21:20.640 | or you're experiencing inflammation of any kind,

00:21:23.260 | and it has anything to do with or encroaches on the face

00:21:26.220 | or head area, that can easily and almost always

00:21:30.140 | spills over into activation of nerve cells,

00:21:33.140 | can give rise to neural-based headache or to the meninges

00:21:36.380 | and can give rise to meningeal headaches,

00:21:38.380 | and of course, to the muscles and to muscular-type headaches.

00:21:41.820 | So we've got muscular origins of the ache in headache,

00:21:44.680 | we have meningeal origins of the ache in headache,

00:21:47.700 | we have neural origins of the ache in headache,

00:21:50.220 | and we have inflammation-based origins

00:21:52.760 | of the ache in headache.

00:21:54.140 | And that pertains to all the different types of headaches

00:21:56.420 | that we're going to talk about.

00:21:57.460 | And it's important to keep in mind

00:21:59.020 | that there are these different sources

00:22:00.940 | of the ache in headache and that sometimes they exist alone

00:22:03.940 | and sometimes they exist in combination.

00:22:05.780 | However, and this is an important however,

00:22:09.140 | all pain, or I should say all experience of pain

00:22:13.300 | as a perception is going to be neural in origin.

00:22:17.000 | When we experience pain, whether or not it's a pinprick

00:22:19.460 | or a cut, stub our toe, we trip and fall, or a headache,

00:22:24.260 | it is neural in origin.

00:22:25.760 | It is the nervous system and nerve cells

00:22:28.140 | that are going to carry that signal

00:22:30.380 | that we perceive as pain.

00:22:31.980 | So as we talk about the different sources of pain

00:22:34.420 | and different types of headache,

00:22:35.800 | we will also talk about, of course,

00:22:37.940 | I think what most people are interested

00:22:39.100 | in today's discussion, the different treatments

00:22:41.180 | for the different types of headache

00:22:42.300 | and why each of those different treatments work.

00:22:44.560 | But by understanding a little bit

00:22:46.380 | about how pain arises in the nervous system

00:22:49.040 | and certainly by understanding the different types

00:22:51.220 | of headaches, you know, what is a tension headache?

00:22:53.340 | I gave you some impression that it's running around

00:22:55.620 | your head like a headband in many cases

00:22:57.940 | versus cluster headache, which starts deep below the eye.

00:23:01.260 | Often it feels as if it's emerging from deep in the brain

00:23:03.700 | versus migraine, which we'll get into in a moment.

00:23:06.560 | By understanding the different types of headaches,

00:23:08.200 | you should be able to quickly pinpoint

00:23:10.420 | what type of headache you have,

00:23:12.660 | what types of tissues are likely involved,

00:23:15.220 | and therefore what types of treatments

00:23:17.460 | are going to most quickly and most completely

00:23:20.320 | relieve that type of headache.

00:23:21.800 | Okay, so for the next three to five minutes,

00:23:23.600 | and I promise no more, I'm going to explain

00:23:25.880 | how pain arises at the level of nerve cells.

00:23:29.320 | And I suppose this is one of those times

00:23:31.520 | when if I had a highlighter pen that could go out

00:23:34.200 | across the microphones and speakers leading to your ears,

00:23:38.520 | I would use it here because what I'm about to tell you

00:23:41.840 | is perhaps one of the most important things to understand

00:23:44.180 | about your nervous system, that is your brain and you,

00:23:46.860 | which is that while you have trillions of neurons,

00:23:49.400 | and we hear that you have trillions

00:23:50.420 | in different types of neurons in your brain,

00:23:52.080 | and they come in different shapes and sizes

00:23:53.500 | and do different things, and some make dopamine,

00:23:55.280 | and some make serotonin, and some make glutamate,

00:23:57.920 | and on and on.

00:23:59.000 | The key distinction among different types of neurons,

00:24:03.020 | that is the three types of neurons that I believe everybody,

00:24:06.760 | scientists or no, everybody should understand exist,

00:24:10.340 | are some neurons, nerve cells,

00:24:12.820 | are what we call motor neurons in the sense

00:24:15.100 | that they control the contraction of muscles.

00:24:18.280 | Sometimes for walking, other neurons control

00:24:21.840 | the movements of your fingers,

00:24:23.460 | scientists call those digits, other ones your toes.

00:24:27.320 | They also control the beating of your heart,

00:24:30.120 | although that's a slightly different mechanism

00:24:32.720 | and slightly different type of tissue

00:24:34.380 | than is involved in generating motor movements of your limbs.

00:24:37.720 | These are neurons that we call motor neurons

00:24:41.120 | because their goal or their purpose, I should say,

00:24:44.660 | they don't really know what their goal or purpose is,

00:24:46.560 | but what they do is they make sure that muscles contract

00:24:50.140 | so that certain things happen in your body,

00:24:52.500 | like your heartbeats, or you move your limbs,

00:24:54.180 | you lift your eyelids or your eyebrows rather,

00:24:56.640 | and so on and so forth.

00:24:58.900 | Other types of neurons are what we call sensory neurons.

00:25:03.060 | They communicate the same way that motor neurons do,

00:25:06.500 | that is they fire what we call action potentials,

00:25:08.420 | which are just electrical signals,

00:25:09.780 | they release neurotransmitters like any other neuron,

00:25:12.380 | but they respond to certain events in the environment

00:25:16.060 | or the environment within the body,

00:25:19.380 | but they are not responsible

00:25:20.500 | for generating muscular contractions.

00:25:23.160 | So we call these sensory neurons.

00:25:24.460 | Some sensory neurons sense light touch,

00:25:27.320 | other sensory neurons sense firm touch,

00:25:30.060 | other sensory neurons sense pain,

00:25:32.100 | other sensory neurons sense light brushing on the skin.

00:25:35.680 | In fact, you have sensory neurons, believe it or not,

00:25:37.620 | that respond specifically to the light brushing of a hand

00:25:41.780 | across your skin, any region of your body,

00:25:44.380 | and if that particular region of your body

00:25:46.380 | happens to have hair on it,

00:25:48.540 | and you stroke the skin in the direction

00:25:50.760 | that the hairs lay down, we experience that as pleasurable,

00:25:54.140 | whereas if you stroke in the direction opposite

00:25:56.320 | to the way the hairs lay down,

00:25:58.180 | we experience that as not pleasurable.

00:26:00.340 | So these sensory neurons respond, in some cases,

00:26:03.500 | for instance, within the auditory system,

00:26:05.520 | they respond to sound waves,

00:26:06.620 | in your eye, they respond to photons of light,

00:26:08.620 | sometimes photons of light of particular wavelengths

00:26:10.820 | that we think of as red, green, blue, and so on.

00:26:13.300 | Sensory neurons don't move muscles,

00:26:15.320 | they respond to things in the environment,

00:26:17.040 | and they exist within us.

00:26:19.060 | So we have sensory neurons that sense, for instance,

00:26:21.060 | pressure within our head, or pressure within our gut,

00:26:24.780 | how full or empty our gut is, pain within our tissues,

00:26:29.160 | like our liver or any kind of other internal organ.

00:26:32.980 | So we've got motor neurons, sensory neurons,

00:26:35.260 | and then the last kind of neuron

00:26:36.980 | is what we call modulatory neurons.

00:26:39.460 | These are the ones that adjust the relationship

00:26:41.740 | between the sensory neurons and the motor neurons

00:26:44.140 | to determine whether or not we do anything

00:26:46.980 | in response to a sensory input.

00:26:49.760 | That is whether or not if a sensory neuron fires,

00:26:53.020 | sends an electrical potential,

00:26:54.280 | whether or not it will generate a motor change.

00:26:58.060 | Let me give you a very simple example of this.

00:26:59.800 | So for those of you listening,

00:27:01.540 | I'll just explain what I'm doing,

00:27:03.140 | and for those of you watching, you'll be able to see,

00:27:04.820 | I'm holding my hand out in front of me.

00:27:06.960 | If I were to touch the top of my hand with my fingertip,

00:27:10.120 | I can deliberately override,

00:27:12.800 | that is I can modulate that more typical reflex,

00:27:16.160 | which is that when something touches us,

00:27:17.600 | if we're not aware of where it's coming from,

00:27:19.320 | we typically move away from that thing that touches.

00:27:21.320 | This is a very natural response,

00:27:22.840 | but we can decide we're not going to move away.

00:27:24.380 | We can decide to stay still,

00:27:25.940 | or we can decide to move toward the thing that touches us.

00:27:28.440 | But typically, if you were to walk up to somebody

00:27:30.200 | and you were to touch them,

00:27:31.040 | they'd either turn toward you on the side

00:27:33.000 | that you touch them, or they'd step away.

00:27:34.900 | It's rare that they're going to step into you.

00:27:36.740 | But you could decide that you were not going to move away,

00:27:39.240 | or you could step into the direction of touch.

00:27:41.560 | And that's because you have modulatory neurons

00:27:43.500 | that can adjust the conversation

00:27:45.040 | in a very context-dependent way

00:27:47.080 | as to whether or not the sensory neuron

00:27:51.020 | will cause motor neurons to contract or not, okay?

00:27:55.000 | So we've got motor neurons, sensory neurons,

00:27:57.200 | and modulatory neurons.

00:27:58.300 | And you're probably thinking by now,

00:27:59.280 | why are we talking about this?

00:28:00.200 | I thought we were going to talk about headache.

00:28:01.380 | I thought we were gonna talk about treatments for headache,

00:28:02.720 | but this turns out to be very important

00:28:04.780 | because you could imagine,

00:28:06.160 | and in a moment I'll explain how,

00:28:08.100 | let's say you have tension headaches.

00:28:09.620 | You're somebody that has the classic symptoms

00:28:11.880 | of tension headache.

00:28:12.720 | Let me tell you what those are.

00:28:14.000 | These are headaches, again,

00:28:16.000 | that occur more or less in a kind of a headband-like fashion

00:28:19.540 | or they tend to start there and exist around the head.

00:28:22.460 | These are very common.

00:28:24.100 | They can arise from a number of different sources.

00:28:27.300 | They can arise from sleep deprivation.

00:28:28.600 | They can arise from excessive use of caffeine intake.

00:28:31.640 | We'll talk about why that is.

00:28:33.120 | They can arise from stress.

00:28:35.360 | They can arise from very low level viral infections

00:28:39.240 | or bacterial infections,

00:28:40.560 | but we experience these as just as headaches

00:28:42.240 | or you've been thinking too hard or working too hard

00:28:44.880 | or life has been stressful.

00:28:45.960 | They're often also associated with jaw pain

00:28:48.640 | and jaw tightness and neck tightness.

00:28:50.240 | So tension headaches,

00:28:51.060 | everything you'd imagine muscular tension could cause.

00:28:53.720 | Well, if you want to treat tension headache,

00:28:56.680 | you can imagine that because all headache is neural,

00:28:59.360 | that you'd want to go after some sort of neural mechanism

00:29:01.920 | to treat them.

00:29:02.960 | But of course, we now know that there are three types

00:29:06.400 | of neurons.

00:29:07.240 | There are motor neurons, sensory neurons,

00:29:09.020 | and modulatory neurons.

00:29:10.540 | So we have choices.

00:29:12.040 | We can say, okay, do we want to turn off the muscles

00:29:15.040 | in the head, jaw, and neck that are hyper contracted?

00:29:18.760 | For instance, you want to take a muscle relaxer or relaxant,

00:29:23.600 | or would you want to try and change the sensory input itself?

00:29:28.000 | Maybe don't change the way the muscles are behaving,

00:29:30.120 | but shut off the sensory part of it.

00:29:32.640 | Your ability to sense it.

00:29:34.840 | There are certainly ways you can do that.

00:29:37.160 | Or would you want to adjust the modulatory neurons?

00:29:40.320 | Would you want to make it such that you have the headache,

00:29:42.720 | but you don't perceive the headache?

00:29:44.300 | That is you cut off communication between the sensor

00:29:47.100 | and the motor so that the muscles relax.

00:29:49.400 | It turns out there are treatments and approaches

00:29:51.520 | for each and every one of those.

00:29:53.000 | Each and every one of those has different advantages

00:29:55.680 | and disadvantages.

00:29:56.880 | But as you can quickly see,

00:29:58.640 | we are going to have different types of headaches

00:30:00.680 | and different approaches to treating headache.

00:30:02.300 | But if you keep in the back of your mind

00:30:03.600 | that you have neurons that contract muscles

00:30:05.760 | to create movement or tension of muscles,

00:30:08.360 | remember you can turn off those neurons

00:30:10.520 | and allow those muscles to relax.

00:30:11.880 | You have sensory neurons that sense input

00:30:14.080 | and actually sense the pain.

00:30:15.680 | And you have modulatory neurons,

00:30:17.080 | which can allow you to adjust the relationship

00:30:19.600 | between the sensory neurons and the motor neurons.

00:30:21.720 | And of course, some of you are probably screaming at me

00:30:23.560 | by now saying, "Wait, why would you ever want to deal

00:30:26.080 | with the motor neurons or the modulatory neurons

00:30:28.840 | once you want to just go straight to the source

00:30:30.340 | and just cut off the pain?"

00:30:31.640 | Ah, well, the problem there is that many painkillers

00:30:36.200 | have other issues as well.

00:30:38.020 | In particular, they can be sedative.

00:30:39.980 | Many of them can be habit forming or even addictive.

00:30:42.800 | And for many people, not all, but many people,

00:30:45.220 | they don't want to take drugs,

00:30:46.520 | whether or not they're over-the-counter

00:30:47.580 | or prescription drugs

00:30:48.420 | or even more natural supplement-based type treatments.

00:30:52.620 | And they would rather use, for instance,

00:30:55.260 | a behavioral approach in which they can modulate,

00:30:58.320 | they can deliberately turn off the communication

00:31:00.640 | between sensory neurons and motor neurons.

00:31:02.240 | It turns out those approaches exist as well.

00:31:04.500 | Okay, so at this point, I promise you

00:31:06.940 | that I'm not going to give you any more of a biology lesson

00:31:09.560 | in terms of pain sensing and headaches

00:31:12.200 | as a more conceptual phenomenon.

00:31:15.040 | Instead, what I'd like to do next

00:31:16.280 | is talk about the different types of headaches.

00:31:18.600 | And I think this is something that's very important

00:31:20.600 | and not often discussed, except for those people out there

00:31:23.080 | that unfortunately suffer repeatedly

00:31:25.380 | from certain kinds of headaches like migraine

00:31:27.320 | or cluster or attention headache.

00:31:29.440 | But I think for most people out there

00:31:31.020 | who experience headache, and again,

00:31:32.160 | that is everybody at some point experiences headache,

00:31:35.740 | rather than just think of headache as one thing,

00:31:38.480 | understanding the major types of headache

00:31:41.000 | and how they differ from and are similar to one another

00:31:44.340 | will really help you identify

00:31:45.800 | what the best source of treatments for those are.

00:31:48.020 | So I'd like to talk about

00:31:49.220 | what the different types of headache are now.

00:31:51.360 | The first type of headache we're going to discuss

00:31:53.080 | is the tension type headache.

00:31:54.440 | Again, tension type headaches tend to start off,

00:31:57.760 | not always, but tend to start off

00:31:59.840 | as more or less a halo or a headband

00:32:02.460 | around the forehead in the area above the eyes,

00:32:05.180 | often also include the jaw, the neck muscles,

00:32:09.120 | and can extend even into the upper back.

00:32:11.840 | Again, this can be caused by some low level of infection,

00:32:15.040 | but more often than not,

00:32:16.480 | tension type headaches are going to come on

00:32:18.500 | because of some chronic psychological stress,

00:32:21.960 | usually combined with lack of sleep,

00:32:23.440 | usually combined with lifestyle issues.

00:32:26.480 | And of course, without getting into a long discussion

00:32:28.860 | about it, anytime you have lack of sleep,

00:32:30.800 | you're going to have excessive stress.

00:32:31.980 | Anytime you have excessive stress,

00:32:33.720 | you're going to have to make sure you're offsetting that

00:32:36.400 | by getting proper sleep.

00:32:37.280 | Most people don't when they're under excessive stress.

00:32:39.360 | By the way, we have excellent tools

00:32:41.440 | or grounded in excellent science

00:32:43.060 | available to you at zero cost.

00:32:44.400 | If you are experienced chronic stress

00:32:46.440 | or even short-term stress,

00:32:47.440 | we have a master stress episode

00:32:49.900 | of the Huberman Lab podcast.

00:32:50.820 | Again, just go to hubermanlab.com

00:32:52.280 | and all that's timestamped for you.

00:32:54.020 | Tension type headaches begin in a,

00:32:57.460 | more or less a headband pattern,

00:32:58.740 | but can really extend to other tissues as well.

00:33:00.940 | Not so often in the face,

00:33:03.060 | but really the head and often will start to climb up

00:33:06.100 | toward the top of the head.

00:33:07.460 | They are not always in this halo pattern.

00:33:09.780 | Sometimes they can be localized to one area,

00:33:12.140 | such as the back of the head or the front of the head

00:33:14.540 | or one side of the head more than others.

00:33:17.200 | And that's often the case because of tension

00:33:20.120 | within muscles of the neck

00:33:21.980 | that tend to bias the ache towards one side of the head.

00:33:24.980 | I'd like to take a quick break

00:33:26.380 | and acknowledge one of our sponsors, Athletic Greens.

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00:34:39.360 | The other type of headache

00:34:40.200 | that unfortunately is very common is migraine headaches.

00:34:43.660 | Migraine headaches are defined generally

00:34:46.400 | as disorders of recurring attacks of headaches.

00:34:49.160 | So people who get migraines often get them

00:34:51.520 | in a recurring fashion.

00:34:52.840 | Some people get them very often,

00:34:54.400 | other people get them less often,

00:34:56.280 | but migraines are very debilitating.

00:34:58.960 | The numbers, that is the prevalence of migraine,

00:35:02.200 | is still pretty debated.

00:35:04.640 | One thing that we know for sure is that females suffer

00:35:07.960 | from migraine headaches at a rate

00:35:10.240 | at least threefold higher than do males.

00:35:13.240 | And surprisingly, this does not seem

00:35:15.820 | to have any direct hormonal origin

00:35:18.280 | because we're also going to talk about hormonal headaches.

00:35:21.320 | That is, headaches that relate to a dip

00:35:23.760 | in estrogen and progesterone,

00:35:25.000 | a particular phase of the menstrual cycle,

00:35:26.680 | that is the ovulatory cycle.

00:35:28.120 | So there's a bit of a mystery here.

00:35:29.760 | And the mystery is why is it that migraine headaches occur

00:35:32.460 | at such greater frequency in females,

00:35:34.680 | even independently of the menstrual cycle?

00:35:37.320 | So when you control for changes in hormones,

00:35:39.520 | that still appears to be the case.

00:35:40.940 | And overall, migraines are very common.

00:35:42.640 | Now, the numbers on migraine and just how common migraine is

00:35:46.360 | are extremely wide.

00:35:47.920 | This was a little bit frustrating for me

00:35:49.500 | in researching this episode.

00:35:51.380 | You will find, for instance,

00:35:52.920 | that 17% of women suffer from migraines.

00:35:56.740 | You will also hear that 6% of males suffer from migraines.

00:35:59.400 | You will also hear that 43, 43% of females suffer

00:36:04.400 | from migraine, that is recurring headaches

00:36:07.480 | that qualify as migraine headaches.

00:36:09.440 | And that 17% of men suffer from migraine headaches

00:36:13.600 | on a recurring basis, which is, again,

00:36:15.160 | the definition of a migraine headache

00:36:16.400 | or one of the key definitions.

00:36:18.000 | So all we can say for sure is that many,

00:36:20.800 | many millions of people, maybe even billions of people,

00:36:24.680 | suffer from migraine headaches.

00:36:26.560 | It's kind of a staggering thing to contemplate,

00:36:29.600 | but we know it's extremely common.

00:36:32.120 | And we know that it's more prevalent in females.

00:36:34.640 | In any of the studies that you will find in terms of,

00:36:37.440 | that compare the overall prevalence of headache,

00:36:39.320 | it's going to be higher,

00:36:41.200 | substantially higher in females and males,

00:36:43.000 | does not seem to be related

00:36:44.160 | to the ovulatory menstrual cycle.

00:36:46.320 | There are some interesting facts related to that

00:36:48.640 | that I'll just touch on for a moment.

00:36:50.500 | Pregnancy, for whatever reason,

00:36:53.080 | seems to be protective against migraine headaches.

00:36:55.380 | That is, women who suffer from recurring migraines

00:36:57.720 | before they get pregnant, when they get pregnant,

00:37:01.600 | and often after they give birth,

00:37:03.740 | they experience fewer migraine headaches.

00:37:06.480 | So there may be something hormonal,

00:37:08.060 | it may be something else.

00:37:09.720 | What do we know for sure?

00:37:10.640 | We know that headache,

00:37:12.920 | that is the ache in headache, is neural.

00:37:15.160 | So whether or not the origins are hormonal

00:37:17.060 | or whether or not the origins are inflammation

00:37:19.640 | or gut microbiome or some other feature

00:37:21.560 | of the body-brain axis,

00:37:23.620 | at this point, all we know is that neural pain

00:37:29.180 | or the experience of pain at the neural level

00:37:31.060 | is the final common pathway,

00:37:32.460 | and it's more prevalent in females.

00:37:34.380 | So as I mentioned, migraines tend to be recurring.

00:37:36.640 | So some people get them once a week,

00:37:37.960 | some people get them once a month,

00:37:39.220 | some people get them far more frequently,

00:37:40.840 | that they can be extremely debilitating.

00:37:44.140 | Oftentimes, people who experience migraine

00:37:45.840 | because it is a recurring phenomenon

00:37:47.800 | will know when a migraine is coming on.

00:37:49.960 | They'll say, "My migraine is coming on,"

00:37:51.340 | they kind of sense it coming.

00:37:52.740 | There's this notion of aura,

00:37:55.480 | and we'll talk about aura in a little bit.

00:37:57.560 | Some people think of aura just as visual aura

00:38:00.220 | or the sense of kind of a haloing of light

00:38:02.580 | or the sense that there's something outside the body.

00:38:05.920 | The actual definition of aura is that it's the experience

00:38:10.060 | that something is about to happen.

00:38:12.080 | It's this kind of feeling of anticipation.

00:38:14.020 | It's not deja vu.

00:38:15.120 | Deja vu is different and very interesting in its own right,

00:38:17.600 | but different.

00:38:18.440 | It's this feeling that something's about to happen.

00:38:20.440 | And the fact that aura is such a prominent feature

00:38:22.240 | of migraine headaches,

00:38:23.360 | or at least that people feel that the headache is coming on

00:38:26.120 | long before they feel the actual ache of the headache

00:38:28.900 | and the other debilitating symptoms,

00:38:30.780 | suggests that migraine has something of deep neural origin,

00:38:35.240 | that it arises from deep within the nervous system,

00:38:37.320 | spinal cord and brain,

00:38:38.600 | and that it's not something like a tension headache

00:38:41.260 | that is going from outside in,

00:38:43.240 | the constriction of the muscles in the jaw and head.

00:38:45.100 | So migraine headaches are very different

00:38:46.720 | than tension headaches,

00:38:47.840 | even in terms of how they come on or their onset.

00:38:52.000 | The other feature of migraine headaches

00:38:53.560 | that I think is important to note

00:38:55.140 | is that dilation of the vessels.

00:38:57.440 | Remember the vasodilation,

00:38:59.480 | so the widening of those pipes that we call arteries,

00:39:03.520 | vessels, and capillaries,

00:39:05.060 | is a very prominent feature of migraine.

00:39:07.280 | And fortunately that allows

00:39:08.640 | for very particular types of treatment

00:39:11.100 | and ways of dealing with the pain

00:39:13.240 | specific to migraine headaches.

00:39:15.920 | The other feature that's common in migraine headaches

00:39:17.820 | is so-called photophobia.

00:39:19.360 | Many of you are probably familiar with photophobia

00:39:21.700 | if you've ever been sleep deprived.

00:39:23.980 | Simply if you're sleep deprived

00:39:26.680 | and you go outside in the morning,

00:39:27.880 | the light is going to seem very, very bright,

00:39:29.560 | much brighter than were you to have had

00:39:32.080 | a really good night's sleep.

00:39:32.980 | And that's because during sleep,

00:39:34.180 | there are all sorts of reset mechanisms in the brain.

00:39:36.120 | There's the washing out of metabolic debris

00:39:38.560 | and things in the brain,

00:39:39.400 | the so-called glymphotic washout that's essential.

00:39:41.800 | There's also an adjustment of the neural tissue of the eyes,

00:39:44.340 | which as many of you have heard me say before,

00:39:46.200 | are actually two pieces of brain

00:39:47.460 | that have been extruded from the cranial vault.

00:39:49.240 | So your eyes, yes, indeed are two pieces of brain,

00:39:51.320 | the only two pieces of brain outside the cranial vault.

00:39:53.280 | And within your eyes,

00:39:54.880 | you have neurons and mechanisms

00:39:56.560 | that adjust the sort of sensitivity of your eyes to light

00:40:01.560 | and of your brain to light.

00:40:03.760 | And when you are sleep deprived

00:40:05.120 | or when you have a low level viral infection

00:40:07.280 | or a cold or a flu of any kind,

00:40:10.160 | you tend to experience light as brighter than it actually is

00:40:13.360 | when you're rested or you're in the healthy state.

00:40:15.600 | So photophobia is something

00:40:17.000 | that's very, very common in migraine.

00:40:19.000 | And often the photophobia is a prominent feature

00:40:22.560 | of the experience that a migraine is coming on.

00:40:24.840 | People will start saying,

00:40:25.680 | "Oh, you know, it's just too bright in here."

00:40:27.920 | And normally they'd be able to tolerate

00:40:29.460 | that level of sunlight or indoor lighting with no problem.

00:40:33.680 | So there are two aspects of migraine

00:40:36.720 | that I think are particularly important to understand

00:40:38.560 | for sake of the treatment,

00:40:39.800 | and that's the dilation of vessels.

00:40:41.560 | So if we want to treat migraine,

00:40:43.160 | we're going to have to think about things

00:40:44.560 | that can constrict blood vessels in the brain area.

00:40:47.780 | But we also need to think about photophobia,

00:40:49.440 | not photophobia just as a symptom of migraine,

00:40:52.120 | but that maybe by adjusting our sensitivity to light,

00:40:55.560 | we can actually short circuit some of the onset

00:40:58.920 | and subsequent pathology of the migraine.

00:41:02.140 | That is, if we can prevent photophobia,

00:41:05.280 | partially or completely,

00:41:06.900 | can actually offset a lot of the ache of the migraine

00:41:10.220 | that would otherwise occur.

00:41:11.520 | So that's an exciting avenue

00:41:13.300 | for addressing migraine headaches.

00:41:15.380 | We'll get into photophobia and how to deal with that.

00:41:17.380 | We'll also talk about aura a little bit more

00:41:19.860 | in a few minutes.

00:41:20.880 | But for the time being, we've talked about tension headaches.

00:41:22.940 | We've now talked about migraine headaches.

00:41:24.580 | Again, keep in mind,

00:41:25.540 | knowing what kind of headache you have is essential.

00:41:28.420 | It's, I would say, indispensable

00:41:30.360 | for selecting the best treatment.

00:41:31.960 | Many people out there will simply get a headache

00:41:36.040 | and decide, oh, I'm going to pop a couple of aspirin.

00:41:38.400 | Okay, what does aspirin do?

00:41:39.640 | Aspirin's an anti-inflammatory.

00:41:41.000 | It also has pronounced effects on the vasodilation

00:41:44.460 | and vasoconstriction system.

00:41:45.720 | It actually allows more blood to flow

00:41:48.260 | through those arteries, vessels, and capillaries.

00:41:50.580 | A lot of people actually use baby aspirin

00:41:52.560 | or small amounts of aspirin

00:41:54.160 | as a way to offset cardiovascular disease.

00:41:56.120 | That's another discussion, but what do we know?

00:41:58.080 | We know that in migraine,

00:42:00.240 | there's a hyperdilation of the blood vessels,

00:42:02.300 | a hyperdilation of the very little portals

00:42:04.620 | that exist in the brain and around the brain

00:42:07.140 | and that are going to cause the pain.

00:42:09.220 | They're going to activate those sensory neurons,

00:42:10.880 | those nociceptors, that will then give us the experience

00:42:13.620 | of extreme headache and migraine.

00:42:15.280 | So taking an aspirin or something like it for migraine,

00:42:19.100 | in some cases, the worst possible choice.

00:42:21.380 | Again, so knowing what kind of headache you are experiencing

00:42:23.940 | is going to be essential here.

00:42:25.320 | The other thing that you'll sometimes hear

00:42:26.460 | is that drinking a cup of coffee

00:42:28.000 | or getting caffeine through tea

00:42:29.980 | is a great way to deal with headache.

00:42:32.360 | Why would that be?

00:42:33.240 | Well, it turns out that coffee

00:42:35.600 | can cause either vasoconstriction or vasodilation,

00:42:38.360 | depending on when you take it.

00:42:39.440 | And we'll get into the use of caffeine

00:42:42.020 | as a treatment for headache,

00:42:43.360 | because indeed it can be a very potent treatment

00:42:45.160 | for headache, but you absolutely need to know

00:42:48.200 | what kind of headache you are experiencing,

00:42:50.580 | because in some cases, drinking caffeine,

00:42:53.200 | whether it's in tea or coffee,

00:42:54.980 | can absolutely alleviate the pain of a headache,

00:42:58.120 | especially if you catch that onset of a migraine

00:43:00.680 | or a tension type headache early on.

00:43:02.640 | But in some cases, it can make it far, far worse.

00:43:04.900 | Again, knowing which type of headache you're experiencing

00:43:07.560 | and how the different treatments work is key.

00:43:09.600 | Okay, so we have tension type headaches,

00:43:11.220 | migraine type headaches.

00:43:12.400 | I think you're starting to get the picture.

00:43:13.440 | They have different underlying biologies.

00:43:16.240 | The next type of headache is cluster headaches.

00:43:20.560 | Cluster headaches are the ones I mentioned earlier

00:43:22.480 | that arise from deep within the head.

00:43:25.000 | They feel as if they're coming from the inside out,

00:43:27.000 | and they tend to be on one side or the other,

00:43:29.140 | what scientists and clinicians call unilateral.

00:43:31.520 | It tends to originate behind the eye

00:43:33.360 | and sometimes the nose region,

00:43:34.880 | sometimes in the mouth region as well.

00:43:36.760 | It feels kind of patchy,

00:43:38.120 | but as if it's coming from the inside out.

00:43:40.440 | And again, that's because of that trigeminal nerve.

00:43:42.320 | For those of you listening

00:43:43.760 | and not watching this on YouTube,

00:43:45.300 | I've got three fingers,

00:43:46.440 | as if I'm putting up three fingers in them.

00:43:48.120 | I've got one pointed toward my eye,

00:43:49.920 | one pointed towards my nose region,

00:43:51.880 | and one towards my upper lip.

00:43:54.360 | The trigeminal nerve is an easy one to remember,

00:43:56.920 | and it will completely explain cluster headaches

00:44:00.160 | and what to do about cluster headaches.

00:44:01.280 | In a moment, if you remember that the herpes 1 virus,

00:44:04.000 | and not herpes 2, not genital herpes,

00:44:06.200 | but herpes 1 virus is the one

00:44:07.980 | that gives cold sores on the mouth.

00:44:10.480 | Herpes 1 virus, by the way, is exceedingly common,

00:44:12.720 | up to 90% of people.

00:44:14.000 | Many children, in fact, have these.

00:44:15.320 | Again, this is not a sexually transmitted herpes,

00:44:17.760 | although it can be, of course,

00:44:19.120 | transmitted through kissing and sexual contact,

00:44:22.000 | but that's not the only origin of it.

00:44:24.600 | Okay, it can be passed by skin contact and mucosal contact.

00:44:28.420 | So mucosal, mucosal, so that would be kissing,

00:44:30.400 | mucosal lining, or even skin to mucosal lining,

00:44:33.520 | so that's why it's so common.

00:44:34.980 | And the reason why cold sores develop on the mouth

00:44:38.260 | for people that have herpes 1

00:44:39.920 | is because the virus actually lives on the trigeminal nerve.

00:44:44.580 | And yes, it is true that sometimes the virus

00:44:47.520 | will inflame the nerve and the inflammation will occur

00:44:49.960 | at the level of the eye,

00:44:50.800 | so people do, unfortunately, sometimes get herpes of the eye

00:44:52.920 | and actually can be quite dangerous

00:44:54.320 | if you have an infection of the eye,

00:44:55.880 | a herpes infection of the eye,

00:44:56.840 | you should see an ophthalmologist.

00:44:58.600 | Or the nose region, they can experience pain

00:45:00.480 | in the mucosal tissue of the nose.

00:45:02.640 | More often than not, most inflammation is occurring

00:45:05.480 | on the branch that innervates the lip

00:45:08.180 | or the region close to the lip,

00:45:09.460 | and that's why a cold sore develops there,

00:45:11.140 | an immune response there,

00:45:13.040 | signaling that there's inflammation due to the herpes virus,

00:45:16.700 | which lives on that neuron for a very long time.

00:45:19.160 | Neurons don't turn over in the lifespan,

00:45:21.440 | so it can live on there for the extent of the person's life.

00:45:24.640 | However, most people hopefully treat their HSV-1,

00:45:28.960 | but if they don't, the sort of frequency

00:45:32.480 | and the severity of infections

00:45:33.980 | tends to taper off with time.

00:45:36.020 | I'll have an entire discussion about viruses

00:45:37.840 | and herpes in particular in a future episode.

00:45:40.340 | But the thing to keep in mind here is that this very nerve

00:45:44.640 | is the one that gets inflamed

00:45:46.840 | in these cluster type headaches.

00:45:48.720 | Now, cluster type headaches are associated

00:45:50.680 | with a bunch of very uncomfortable symptoms.

00:45:53.600 | Again, they tend to be unilateral,

00:45:54.920 | they tend to begin very deep,

00:45:56.760 | and they tend to be excruciatingly painful,

00:45:59.700 | excruciatingly painful.

00:46:00.880 | They can last anywhere from 30 minutes to three hours.

00:46:03.680 | Some people experience these in sleep.

00:46:05.320 | In fact, this is one of the cases

00:46:06.940 | where men experience a headache more than females.

00:46:11.180 | Men experience cluster type headaches

00:46:12.900 | that have a sudden onset during sleep.

00:46:15.300 | At five times the frequency than do females.

00:46:17.400 | The origins of that aren't exactly clear.

00:46:19.400 | They do seem to have something to do

00:46:20.880 | with the biological clock mechanisms,

00:46:22.600 | the so-called circadian mechanisms.

00:46:24.800 | So if you are a man or a woman for that matter,

00:46:27.880 | and you're waking up in the middle of the night

00:46:29.240 | with a unilateral headache,

00:46:30.560 | and it seems like it's deep within your head,

00:46:33.760 | or it's starting there,

00:46:34.680 | and it's on one side and localized to the eye,

00:46:36.780 | and maybe these other regions the trigeminal is involved in,

00:46:39.360 | you may be suffering from cluster type headache,

00:46:41.340 | and you should talk to your physician.

00:46:42.680 | The other symptom that's quite common

00:46:44.160 | in cluster type headache is a droopy eyelid,

00:46:46.040 | which should make sense

00:46:46.880 | because the trigeminal innervates the eye region,

00:46:49.160 | and there are other nerves that control the eyelid,

00:46:51.400 | but they're in that general region and they can be impacted.

00:46:53.880 | The other thing is something called meiosis,

00:46:55.560 | which is that you can't dilate the pupil.

00:46:56.940 | I mentioned this before,

00:46:57.780 | so that your pupils might get really, really small

00:46:59.520 | and they won't dilate.

00:47:01.240 | And the other thing is lacrimation, tearing,

00:47:03.200 | and then nasal discharge,

00:47:04.520 | all because of a neural inflammation problem.

00:47:07.240 | Why do I tell you with such detail about cluster headaches?

00:47:10.280 | Well, if you are somebody that's experiencing

00:47:12.280 | the kind of pain that is consistent with cluster headache,

00:47:16.120 | taking a standard anti-inflammatory,

00:47:18.640 | or doing something that is going to adjust the, excuse me,

00:47:22.200 | the dilation or constriction of blood vessels

00:47:24.400 | may have an indirect impact on cluster headache,

00:47:27.500 | but is unlikely to relieve cluster headache,

00:47:30.460 | either acutely, meaning right away,

00:47:32.440 | or in preventing cluster headaches.

00:47:34.240 | You have to deal with this as a neural issue.

00:47:36.280 | And we'll talk about some of the main causes of inflammation

00:47:39.920 | and activation of these cluster type headaches

00:47:42.380 | at the level of the trigeminal nerve in a little bit,

00:47:44.680 | because fortunately there are some excellent treatments.

00:47:46.800 | The next type of headache that is quite common

00:47:49.280 | are hormonal headaches.

00:47:50.920 | Now, the phrase hormonal headache should already cue you

00:47:53.540 | to the fact that it's far too general a term,

00:47:56.160 | because there are so many different hormones,

00:47:58.240 | testosterone, estrogen, thyroid hormone, growth hormone,

00:48:00.160 | and on and on and on.

00:48:01.660 | And they all have many different functions

00:48:03.560 | in the brain and body.

00:48:04.840 | Every single hormone,

00:48:06.720 | and in particular the so-called steroid hormones,

00:48:09.100 | steroids, again, not just limited to things

00:48:12.320 | that people take for sports.

00:48:13.320 | In fact, the steroid hormones refers to estrogen,

00:48:16.000 | testosterone of the sort that we all make,

00:48:18.240 | that men and women make naturally.

00:48:21.580 | And those steroid hormones can impact gene expression.

00:48:24.920 | They can, or of course,

00:48:26.280 | what turns on the growth of the breast tissue,

00:48:28.980 | of the testicular tissue, of the hair growth,

00:48:32.040 | and on and on.

00:48:33.280 | And that's all because of gene expression.

00:48:35.040 | If you're really going to change the identity

00:48:36.720 | and function of a cell long-term, right,

00:48:39.060 | you're going to literally change the breast tissue

00:48:40.840 | or change the penile tissue or change the ovarian tissue

00:48:43.940 | in some sort of consistent way across the lifespan,

00:48:46.480 | you can bet that there are changes in gene expression.

00:48:48.540 | And those changes in gene expression occur

00:48:50.140 | because the steroid hormones have this incredible ability,

00:48:52.920 | sort of like the X-Men of hormones,

00:48:54.960 | to pass through the outer membrane of a cell,

00:48:57.580 | which we call the exocellular membrane,

00:48:58.860 | and into the so-called nuclear membrane.

00:49:00.520 | They can go into the area where genes are made

00:49:02.680 | and turn on and off different genes.

00:49:05.160 | However, they multitask in their life.

00:49:08.660 | That is, these steroid hormones,

00:49:10.360 | like estrogen in particular and testosterone in particular,

00:49:13.180 | can also bind to the surface of cells

00:49:15.360 | and impact all sorts of things at the level of the cells

00:49:18.240 | that have nothing to do with changes in gene expression.

00:49:20.500 | And that second mechanism of binding to the surface of cells

00:49:23.360 | is one of the ways in which estrogen

00:49:25.320 | can control different aspects of headache.

00:49:29.540 | Now, that doesn't necessarily mean

00:49:30.680 | that estrogen gives you headaches.

00:49:32.500 | In fact, it's just the opposite.

00:49:35.360 | It turns out that low estrogen and another hormone,

00:49:38.560 | low progesterone, combine to give rise to headache

00:49:42.560 | because of the ways that low estrogen and low progesterone

00:49:46.780 | impact vasodilation and vasoconstriction

00:49:50.680 | and the inflammatory response.

00:49:52.300 | We'll talk about how to deal with hormone-based headaches,

00:49:55.340 | in particular, hormone-based headaches

00:49:56.900 | that occur because of low estrogen

00:49:58.300 | and progesterone in a moment.

00:49:59.820 | But the key thing to know is something that we covered

00:50:02.860 | in the fertility episode.

00:50:04.380 | I did a very long, very detailed episode on fertility,

00:50:07.040 | so I'm not going to go into this in significant detail now.

00:50:10.520 | You can refer to that episode for probably more detail

00:50:13.900 | than you ever wanted, but also a lot of tools

00:50:15.680 | as it relates to fertility in both males and females.

00:50:18.200 | But right now, I'm just going to give you

00:50:19.360 | a course overview of that in about 60 to 120 seconds

00:50:23.560 | so that you'll understand when hormonal headaches

00:50:26.920 | are most likely to take place.

00:50:29.240 | Keep in mind that hormonal headaches

00:50:30.800 | are most likely to take place

00:50:31.980 | when estrogen and progesterone are lowest.

00:50:35.520 | So if you understand that during the follicular stage

00:50:38.880 | of the ovulatory/menstrual cycle, okay,

00:50:42.360 | so menstrual cycle is about 28 days on average,

00:50:44.800 | not in everyone, but it's about 28 days on average,

00:50:46.400 | and the first half of that,

00:50:47.880 | estrogen starts creeping up, up, up, up, up, up, up, up, up.

00:50:51.340 | And as we learn in endocrinology,

00:50:53.240 | estrogen primes progesterone.

00:50:54.900 | So estrogen will then peak and then start to fall,

00:50:57.760 | low, low, low, low, low, low, low, low, low, low, low,

00:50:59.020 | pretty quickly, right about the time

00:51:01.320 | that the egg ovulates.

00:51:03.580 | An egg is released and will essentially be ready

00:51:07.000 | for fertilization if the egg is fertilized,

00:51:09.880 | a whole bunch of other things happen

00:51:11.600 | as it relates to pregnancy.

00:51:12.840 | If not, what ends up happening is that

00:51:15.660 | during the luteal phase,

00:51:17.280 | which is the second half of the menstrual cycle,

00:51:19.240 | there's been a buildup of the lining of the uterus

00:51:22.520 | because of an increase in progesterone.

00:51:24.240 | So estrogen goes up during the follicular phase,

00:51:26.400 | then it goes down,

00:51:27.560 | and then progesterone goes up, up, up, up, up,

00:51:30.480 | which is important for generating that thick lining

00:51:33.800 | of the uterus to allow the fertilized egg,

00:51:36.820 | if it's fertilized to implant,

00:51:38.080 | and if it's not fertilized,

00:51:39.420 | all of that gets released from the body

00:51:40.920 | in this bleeding process that we call menstruation.

00:51:43.800 | If menstruation occurs and day one of the menstrual cycle

00:51:46.140 | is considered the first day in which bleeding occurs,

00:51:48.260 | well, then what that means is that estrogen is already low

00:51:50.960 | because remember, estrogen was low

00:51:53.120 | at the start of the follicular phase

00:51:54.280 | and went up, up, up, up, up, up,

00:51:55.700 | then it comes down right at the time of ovulation

00:51:57.760 | and progesterone goes up, up, up, up, up

00:52:01.400 | during the luteal phase.

00:52:02.880 | In fact, it's more than 1,000 fold increase in progesterone,

00:52:05.620 | but if there's no fertilization of the egg,

00:52:07.920 | progesterone starts coming down, down, down, down, down.

00:52:09.920 | What does that mean?

00:52:10.760 | That means that on the first

00:52:12.700 | to about the fourth or fifth day of the menstrual cycle,

00:52:15.180 | first being the first day of bleeding

00:52:17.360 | till about the fourth or fifth day of the menstrual cycle,

00:52:20.160 | both estrogen and progesterone are very, very low,

00:52:23.680 | and it is at that time,

00:52:25.440 | at the very beginning of the menstrual cycle,

00:52:27.420 | so about the first week of the menstrual cycle,

00:52:29.440 | that many women are very prone to hormonal headaches.

00:52:32.680 | Hormonal headaches, not because estrogen's high,

00:52:34.840 | that's a common misconception,

00:52:36.340 | rather because estrogen and progesterone are both low.

00:52:39.960 | And now that you understand the contour

00:52:42.660 | or the underlying reasons for hormonal headache,

00:52:45.560 | you can start to ask,

00:52:47.820 | well, what happens when estrogen is low?

00:52:49.540 | Well, estrogen has strong impact on the vasodilation,

00:52:53.000 | vasoconstriction system, as does progesterone.

00:52:55.520 | We'll talk about that a little bit later,

00:52:56.900 | but now that you know what hormonal headache is,

00:52:58.840 | at least this one particular type of hormonal headache,

00:53:01.000 | which is very, very common,

00:53:02.580 | given the number of women that are menstruating

00:53:05.360 | and the fact that low estrogen, low progesterone

00:53:07.620 | is the cause of the hormonal headache,

00:53:10.960 | and the fact that, of course,

00:53:12.360 | there are women who are no longer menstruating,

00:53:14.120 | so they're either in perimenopause

00:53:15.700 | and menstruation is becoming more infrequent

00:53:17.360 | or they're in menopause and it has ceased entirely,

00:53:20.240 | well, now you understand

00:53:21.800 | what the origin of the hormonal headache is,

00:53:24.160 | and so all we need to know is

00:53:25.400 | what do estrogen and progesterone normally do

00:53:27.600 | in order to prevent headache,

00:53:29.360 | and thereby you'll know exactly how to offset,

00:53:33.180 | that is prevent or treat hormonal headache

00:53:36.000 | in that first week of the menstrual period.

00:53:37.780 | The last type of headache that I'd like to discuss

00:53:39.700 | is headache associated with head hits,

00:53:42.140 | that is traumatic brain injury,

00:53:43.900 | although I definitely want to underscore the fact that

00:53:47.020 | even people who do not have traumatic brain injury

00:53:50.400 | can experience headaches

00:53:51.480 | as the consequence of hitting their head,

00:53:53.580 | so the line between traumatic brain injury

00:53:56.300 | and lower level brain injury

00:53:58.260 | is one that still seeks definition,

00:53:59.980 | and in fact, this is one of the major goals

00:54:02.640 | of the clinical field as it relates to concussion,

00:54:05.520 | you know, it's also what comes up a lot

00:54:06.920 | during the discussion about football,

00:54:08.840 | you know, these days you'll see players hit really hard

00:54:11.200 | and depending on whether or not they're laying there

00:54:13.980 | for five seconds, 30 seconds or three minutes,

00:54:16.940 | you know, the crowd and the people watching on television

00:54:20.180 | and everywhere else are all speculating

00:54:21.700 | as to whether or not the person should be allowed to play

00:54:23.660 | and to be quite direct,

00:54:25.220 | there really is no way to assess

00:54:27.200 | the extent of brain damage

00:54:28.680 | after the consequence of hitting one's head

00:54:30.700 | or having one's head hit

00:54:32.660 | because first of all,

00:54:34.820 | almost all of the best ways to detect traumatic brain injury

00:54:38.480 | except the most severe ones

00:54:40.680 | tend to require a lot of very large equipment

00:54:42.820 | like MRI and functional MRI and CT scans,

00:54:46.260 | none of which are available on the side of the field

00:54:48.860 | or in the locker room,

00:54:50.440 | but also because many, many,

00:54:53.460 | if not most of the effects of traumatic brain injury

00:54:56.300 | are going to occur not in the immediate minutes

00:54:58.480 | or even hours after the injury,

00:55:00.460 | but several hours, days, or even weeks after that injury.

00:55:04.040 | So this is a discussion that we should hold off

00:55:06.180 | for a longer full episode on traumatic brain injury.

00:55:09.600 | Keeping in mind, of course,

00:55:10.620 | that football is this very salient example

00:55:13.640 | of traumatic brain injury and concussion

00:55:15.620 | as is boxing, as is even soccer with heading of the ball,

00:55:18.360 | believe it or not repeated low level impact

00:55:21.340 | to the forehead and other parts of the head

00:55:23.900 | can give rise to over time,

00:55:25.740 | traumatic brain injury without the need

00:55:27.540 | for any kind of full-blown concussion

00:55:29.180 | or being "knocked out."

00:55:31.180 | But sports related concussion

00:55:33.160 | actually occupies just a tiny fraction

00:55:36.000 | of the majority of traumatic brain injury and concussion.

00:55:39.400 | Most traumatic brain injury and concussion

00:55:41.600 | and low level brain injury that can accumulate over time

00:55:44.360 | to become traumatic for sake of daily living,

00:55:47.300 | that is lowered cognition,

00:55:48.860 | disruption in mood, sleep, et cetera,

00:55:51.280 | is actually the consequence of things other than sports.

00:55:53.820 | So for instance, bicycle accidents,

00:55:55.820 | playground accidents, construction accidents,

00:55:58.780 | and this is often forgotten.

00:56:00.180 | And for some reason,

00:56:01.220 | all the sports and in particular football

00:56:03.320 | tend to grab all the attention as it relates to concussion.

00:56:06.280 | Keep in mind that while for certain people

00:56:09.300 | is a path to a living,

00:56:11.780 | for most people, traumatic brain injury

00:56:14.340 | is going to occur in a car accident,

00:56:15.780 | construction work or other types of work

00:56:17.460 | for which people generally don't have many options

00:56:21.000 | in terms of the type of work that they're doing.

00:56:22.420 | So they are prone to concussions and head injuries

00:56:24.900 | simply by virtue of their work

00:56:26.900 | without any millions of dollars contracts

00:56:29.200 | or the opportunity necessarily,

00:56:31.540 | in some cases they do, but necessarily to do other things.

00:56:33.580 | And certainly car accidents or bicycle accidents

00:56:36.220 | are not voluntary events.

00:56:38.500 | So the point being traumatic brain injury

00:56:41.240 | and headache related traumatic brain injury

00:56:43.380 | extends far beyond the realm of sports.

00:56:45.380 | And in fact, if you were to look at the numbers,

00:56:47.120 | what you'll find is that

00:56:48.000 | more than 90% of traumatic brain injury,

00:56:50.280 | so people coming into the hospital or clinic

00:56:51.940 | or people claiming that they've got consistent headaches,

00:56:54.960 | they're not sleeping well, their mood is off,

00:56:56.940 | they're feeling more irritable

00:56:58.060 | after having hit their head even once

00:57:00.740 | is not the consequence of sports.

00:57:02.060 | It's going to be the consequence of accidents

00:57:03.860 | either at the workplace or in terms of a bicycle

00:57:07.960 | or other sorts of transportation based accident

00:57:09.980 | like a car accident.

00:57:11.080 | With that in mind, any kind of head hit,

00:57:14.480 | certainly if it involves a concussion

00:57:16.220 | or traumatic brain injury often leads to headaches,

00:57:19.780 | either infrequent but severe headaches

00:57:22.660 | or chronic low-level headaches

00:57:24.100 | or a feeling that there's kind of a stuffiness

00:57:25.580 | or a fullness to the head.

00:57:27.020 | There can be a lot of different origins to that.

00:57:29.620 | A common origin is going to be actual swelling

00:57:32.340 | of the, not necessarily the brain tissue directly,

00:57:35.000 | but if you recall our discussion about the meninges,

00:57:37.100 | which include the dura

00:57:38.500 | and the other tissues that surround the brain,

00:57:40.540 | there are actually three layers that we call the meninges,

00:57:42.780 | the dura just being one of them.

00:57:44.100 | And there's a very little space between the brain,

00:57:47.000 | the meninges that surround it and the skull,

00:57:48.880 | it's called the subarachnoid space.

00:57:50.500 | Very cool, right, arachnoid like spider.

00:57:52.980 | Well, if there's even a slight bit of swelling in the brain

00:57:56.280 | or even distant brain tissue.

00:57:57.620 | So for instance, even if there's whiplash,

00:58:00.000 | so there's swelling of the tissue, muscular tissue

00:58:02.740 | and neural tissue in the neck area,

00:58:05.140 | that can constrict the flow of things

00:58:07.020 | like cerebral spinal fluid, blood flow,

00:58:09.440 | and indeed mucus and other things that are essential.

00:58:11.760 | We all hear mucus and we think illness,

00:58:13.880 | but mucus is a vital, vital substance within the body

00:58:18.540 | for a lot of important reasons,

00:58:20.640 | in health as well as in sickness.

00:58:22.680 | Well, if there's less of that liquid and other fluids

00:58:25.540 | and mucus being delivered to that space,

00:58:27.920 | well, then it can clog up.

00:58:28.980 | So sort of the plumbing is clogged up

00:58:31.320 | or that it's caught at the level of the site of hit or injury

00:58:35.780 | because there's some local swelling and inflammation there.

00:58:38.020 | So there are many different mechanisms

00:58:39.300 | that can underlie headache associated

00:58:41.380 | with head hits or traumatic brain injury.

00:58:43.200 | Now, fortunately, there's some recent data pointing to

00:58:46.540 | some what I would call non-obvious treatments

00:58:49.540 | for headache in traumatic brain injury,

00:58:51.540 | keeping in mind that anytime we're talking about injury

00:58:56.540 | or disease or health for that matter,

00:58:59.200 | mental health or physical health,

00:59:00.580 | we have to highlight a fact that's going to come up

00:59:04.000 | again and again in every single episode of this podcast.

00:59:07.540 | And I think it's not being overly redundant to do so,

00:59:11.380 | which is that regular sufficient amounts of deep sleep

00:59:16.620 | each night are going to be important for all aspects

00:59:19.380 | of mental health, physical health, and performance,

00:59:21.060 | and have been shown over and over again

00:59:23.380 | to reduce the frequency of headache

00:59:25.360 | and to reduce the time to repair after traumatic brain injury

00:59:28.860 | and can improve cognition and on and on and on.

00:59:30.960 | So sleep is essential for all the normal things

00:59:33.540 | that encourage healthy activity of the different tissues

00:59:36.380 | that are involved in brain and body to occur.

00:59:39.620 | So sleep deprivation, of course, is going to limit those.

00:59:41.980 | But I do want to point out that sleep, sunlight,

00:59:45.660 | and I've talked about this almost ad nauseum on this podcast,

00:59:48.820 | but regular circadian cycles,

00:59:50.460 | getting sunlight in your eyes early in the day

00:59:52.160 | and in the evening as well and as much as possible

00:59:54.220 | throughout the day without burning your skin

00:59:55.820 | and limiting your exposure to artificial lights at night

00:59:58.800 | and on and on, all of which is covered

01:00:00.440 | in the Light for Health episode of the Huberman Lab Podcast,

01:00:02.660 | the Master Your Sleep episode of the Huberman Lab Podcast,

01:00:05.000 | and in the Perfect Your Sleep episode

01:00:07.820 | of the Huberman Lab Podcast.

01:00:08.820 | You can find all that at hubermanlab.com.

01:00:11.120 | Getting light and avoiding light

01:00:12.860 | at the proper times of the 24-hour cycle

01:00:14.740 | is also going to favor all the pathways

01:00:16.940 | ranging from gut brain access to the inflammatory,

01:00:19.760 | anti-inflammatory pathways, neural pathways, et cetera,

01:00:22.720 | that, of course, if you do that,

01:00:24.500 | you're going to improve and offset any kind of detriment

01:00:28.340 | caused by traumatic brain injury.

01:00:29.940 | Is it treating traumatic brain injury directly?

01:00:32.100 | No, but is not getting sufficient sleep,

01:00:34.420 | not getting sunlight at the right times of day

01:00:36.160 | and getting too much artificial light at night

01:00:38.140 | going to make any impact of traumatic brain injury,

01:00:40.740 | including headache, far worse?

01:00:42.140 | Yes, there are certainly a ton of data

01:00:43.940 | to support that statement as well.

01:00:45.380 | And then, of course, nutrition and exercise

01:00:47.100 | are also important.

01:00:47.940 | So we can list out sleep, sun, proper nutrition, exercise,

01:00:52.820 | and I would put proper social connection,

01:00:54.980 | whatever that means to you.

01:00:55.980 | Healthy social connections include romantic,

01:00:59.420 | friendship, familial, and relationship to self.

01:01:02.720 | Those five things, sleep, exercise, sun, nutrition,

01:01:05.000 | and social connection are all critical

01:01:07.220 | for maintaining baselines of health

01:01:08.720 | and raising your baselines of health.

01:01:10.460 | And I mentioned that, I kind of segment this out now

01:01:12.820 | because I think that anytime we're about

01:01:14.900 | to start discussing pointed treatments,

01:01:17.700 | that is things that you can take or do to reduce headache

01:01:21.140 | or things that you can take or do to improve anything

01:01:23.640 | within mental health, physical health, and performance,

01:01:25.880 | we have to remember that the foundation of mental health,

01:01:27.980 | physical health, and performance is only set

01:01:29.820 | at its highest level by tending to those other things

01:01:32.280 | and that nothing really surpasses any of those things.

01:01:35.160 | Or put differently, there's no replacement

01:01:37.620 | for any of those things in the form of a pill,

01:01:39.940 | a powder, even a behavioral practice.

01:01:41.700 | There are things you can do to offset

01:01:43.460 | getting less than ideal sleep,

01:01:45.340 | the things that you can use like bright artificial lights

01:01:47.980 | during the day to try and partially offset lack of sunlight,

01:01:50.720 | but really there is no exercise pill.

01:01:53.140 | There is no sunlight device,

01:01:55.740 | although some bright lights are very bright.

01:01:57.580 | There's no replacement for actual sunlight.

01:02:00.460 | There's no replacement for actual sleep.

01:02:01.900 | There's no replacement for actual nutrition.

01:02:03.520 | And I do feel it's an important conversation to have

01:02:05.540 | as we head into the next segment,

01:02:06.960 | which is what can you take or do to reduce headache?

01:02:11.300 | And in order to address this,

01:02:12.380 | we're going to start first with the headaches associated

01:02:14.660 | with head hits and traumatic brain injury,

01:02:17.200 | because it turns out there's a surprising

01:02:19.320 | and very useful approach to doing that.

01:02:22.660 | But this same approach also can help offset

01:02:26.780 | and treat headache in other conditions as well,

01:02:28.900 | meaning not just for headaches caused

01:02:30.700 | by traumatic brain injury,

01:02:31.680 | but also headaches caused by sudden onset tension headache

01:02:35.780 | or migraine headache, or even perhaps, again,

01:02:38.860 | perhaps cluster type headaches.

01:02:40.340 | So the first substance that I'd like to highlight

01:02:42.700 | that has been shown to significantly reduce the intensity

01:02:46.440 | and or frequency of headaches is creatine.

01:02:50.300 | Now, creatine, as many of you know,

01:02:52.560 | is something that people supplement and take.

01:02:54.800 | Most often, creatine is discussed

01:02:58.220 | in the context of muscle performance,

01:02:59.700 | not just for people who weight lift,

01:03:00.900 | but for people who do endurance exercise.

01:03:03.060 | And it's often been said that five to 10 grams per day

01:03:06.260 | of creatine monohydrate, depending on how much you weigh,

01:03:08.200 | five to 10 grams per day of creatine monohydrate,

01:03:10.680 | can increase creatine phosphate stores in muscles,

01:03:13.740 | can bring more water into muscles,

01:03:15.080 | can make you stronger, can increase power output.

01:03:17.080 | And that is all true.

01:03:18.560 | That is all completely true.

01:03:19.560 | We discussed this in the Huberman Lab podcast

01:03:21.640 | with Dr. Andy Galpin when he was a guest

01:03:23.960 | on the Huberman Lab podcast or standard series.

01:03:26.880 | And we discussed this extensively in an upcoming episode

01:03:30.360 | from Dr. Andy Galpin in his special six-part guest series,

01:03:35.360 | where he is a guest on the Huberman Lab podcast,

01:03:37.960 | but where really he's the one

01:03:39.200 | doing the majority of the teaching.

01:03:40.840 | That series covers everything

01:03:42.000 | from strength, hypertrophy, endurance.

01:03:43.420 | And there's an episode on supplementation

01:03:45.100 | where we go deep into the discussion about creatine.

01:03:47.680 | Now, in that discussion, and again now,

01:03:50.240 | we highlight the fact that creatine,

01:03:52.760 | while most often discussed online and in the media

01:03:55.880 | as a supplement for sports performance,

01:03:58.360 | for the reasons I just mentioned,

01:04:00.280 | actually has far more data behind it.

01:04:02.760 | That is laboratory studies exploring the role of creatine

01:04:05.720 | in the clinical setting.

01:04:07.240 | So I'd like to highlight a paper from that literature now

01:04:09.200 | that will make very clear as to why creatine is interesting

01:04:12.160 | and in fact, very effective for treating headache,

01:04:14.620 | in particular, headache caused by head hits

01:04:16.320 | or traumatic brain injury.

01:04:17.460 | The title of the paper is prevention of traumatic headache,

01:04:20.540 | dizziness, and fatigue with creatine administration.

01:04:23.400 | Now, keep in mind, this is a pilot study.

01:04:25.560 | It was performed in humans.

01:04:26.880 | So when you hear the words preclinical,

01:04:28.640 | that is if you hear there was a preclinical study on blank,

01:04:31.500 | that means almost always that the study was performed

01:04:34.040 | on animal models, mice, rats, primates, et cetera.

01:04:37.640 | A clinical trial is something that's carried out on humans

01:04:40.040 | and a pilot study means that the study was carried out

01:04:43.320 | on humans, but on a fairly small cohort,

01:04:45.760 | a fairly small group or limited number of subjects.

01:04:49.480 | Nonetheless, if the data are robust,

01:04:51.040 | as it is in this case of this paper,

01:04:53.240 | I think it's worth paying attention to.

01:04:54.960 | So in this study,

01:04:55.780 | what they looked at was creatine administration.

01:04:58.040 | So what they did is they had people ingest

01:05:00.240 | a certain amount of creatine, I'll tell you in a moment,

01:05:02.880 | in fluids, so it could be taken in water or milk

01:05:04.800 | with or without food,

01:05:05.720 | doesn't really matter what time of day.

01:05:07.860 | They had people take creatine.

01:05:09.440 | Why would they have people take creatine

01:05:10.800 | after traumatic brain injury?

01:05:12.780 | And in particular for people that are suffering

01:05:14.920 | from headache, dizziness, fatigue, et cetera.

01:05:17.620 | The reason is that neurons, nerve cells,

01:05:21.000 | rely very heavily on the regulation of calcium

01:05:24.600 | in order to generate those action potentials

01:05:26.440 | to communicate with one another.

01:05:27.660 | So it doesn't matter if it's a motor neuron,

01:05:29.000 | a sensory neuron, or a modulatory neuron,

01:05:30.680 | they all generate action potentials

01:05:32.040 | or something similar to it.

01:05:33.280 | And calcium is important for that process.

01:05:35.800 | Calcium becomes dysregulated after traumatic brain injury

01:05:39.760 | in a number of different ways.

01:05:41.260 | In particular, in ways that impact

01:05:43.880 | the energy production systems of cells

01:05:46.340 | that are related to ATP, adenosine triphosphate

01:05:48.840 | for those aficionados out there that want to look it up,

01:05:51.040 | you can simply look up calcium, ATP, and neurons,

01:05:53.360 | and you can learn about that cycle.

01:05:55.720 | Creatine can be stored in muscles as we talked about before,

01:05:59.120 | but creatine, and in particular,

01:06:00.520 | the phosphorylated form of creatine,

01:06:02.440 | which is the readily available fuel source form of creatine,

01:06:07.440 | can also be stored in brain tissue.

01:06:10.180 | And that is actually quite prominently stored

01:06:12.320 | in the forebrain, the area where the real estate

01:06:14.680 | of your brain just behind the forehead,

01:06:16.240 | which is involved in planning and action

01:06:18.640 | and understanding context.

01:06:19.960 | So it's very important for cognition.

01:06:22.040 | It's important for personality too,

01:06:23.820 | but it's important for a number of different aspects of life

01:06:25.960 | that have to do with making plans,

01:06:27.320 | being able to focus very intensely on your work, et cetera,

01:06:30.320 | or on anything for that matter,

01:06:32.160 | all functions that become heavily disrupted

01:06:34.660 | in people who have traumatic brain injury and concussion.

01:06:37.520 | Creatine's ability to communicate

01:06:40.480 | with the calcium and the ATP system

01:06:43.000 | was the motivation behind this study.

01:06:44.360 | That is the authors hypothesized

01:06:45.800 | on the basis of preclinical data in animals

01:06:48.160 | that by increasing creatine stores within the brain,

01:06:52.400 | not just in the muscle, but in particular within the brain,

01:06:56.120 | that the availability of creatine would allow

01:06:59.080 | for better cognitive function in general.

01:07:01.560 | Now, they didn't look at cognition specifically

01:07:03.280 | in this paper, but they did look at the other aspects,

01:07:05.980 | that is that the bad stuff associated with TBI.

01:07:08.920 | And they had people supplement with creatine

01:07:11.320 | at a level that is much higher than the typical level

01:07:14.280 | that people supplement with creatine

01:07:16.120 | simply for sports performance.

01:07:17.900 | So as I mentioned before, most people,

01:07:19.920 | if they supplement with creatine for sports performance,

01:07:22.000 | they take creatine monohydrate, typically five grams per day,

01:07:25.920 | sometimes 10 grams per day

01:07:27.200 | if they're about 100 kilograms or greater in body weight.

01:07:30.720 | 100 kilograms is approximately 220 pounds.

01:07:35.520 | So the dosage that was used for supplementing creatine

01:07:37.840 | in this study to address the potential impact of creatine

01:07:42.320 | on headache, dizziness, and fatigue was quite a bit higher

01:07:46.960 | than the dosages used simply for muscle performance.

01:07:49.760 | In this study, they had people take a dose of 0.4 grams

01:07:54.740 | of creatine monohydrate per kilogram of body weight.

01:07:58.280 | So for somebody that weighs 100 kilograms or 220 pounds,

01:08:01.160 | that would be 40 grams of creatine per day.

01:08:04.960 | If someone weighs half that much,

01:08:06.480 | they would take 20 grams of creatine per day.

01:08:09.000 | And they did that over a period of six months.

01:08:11.360 | And we know that when you take creatine over and over,

01:08:13.560 | day to day, that there's a buildup of creatine stores

01:08:16.060 | both in the muscles and within the brain tissue.

01:08:18.560 | Now, what they found as a consequence

01:08:19.960 | of this creatine administration was really striking

01:08:22.220 | and I think quite exciting.

01:08:23.780 | They found a very significant decrease

01:08:26.760 | in the frequency of headache

01:08:28.520 | in people that were supplementing with creatine

01:08:30.620 | as opposed to the controls.

01:08:32.340 | Now, keep in mind that this is a pilot study,

01:08:34.440 | but the effects are very dramatic.

01:08:36.360 | They found a very statistically significant decrease

01:08:39.680 | in the frequency of headache

01:08:41.600 | in people that were taking creatine.

01:08:43.440 | In fact, if you look at the controls and you see

01:08:45.600 | that they're basically getting headache at a frequency

01:08:48.100 | of 90% or more after TBI,

01:08:51.300 | the reduction in headache frequency is down to about 10

01:08:54.420 | or 12% in the people taking creatine.

01:08:57.060 | So that's quite a dramatic effect.

01:08:58.900 | And if you look at the other measures they took,

01:09:01.460 | keep in mind again, this is a pilot study,

01:09:03.480 | so a limited number of subjects,

01:09:04.880 | but again, the results are very impressive.

01:09:07.560 | What they found is that the number of people

01:09:10.800 | experiencing dizziness was significantly reduced

01:09:13.840 | in people supplementing with creatine

01:09:15.280 | as was the number of people experiencing fatigue,

01:09:18.360 | kind of acute fatigue and chronic fatigue.

01:09:20.300 | Again, not chronic fatigue syndrome per se,

01:09:22.600 | but chronic fatigue, which was in this study defined

01:09:25.660 | as a general sense of bodily weakness

01:09:27.480 | and even mental weakness.

01:09:29.640 | Mental weakness is a little bit hard to quantify,

01:09:32.000 | but they were very careful to distinguish

01:09:34.420 | between cognitive and mental fatigue

01:09:36.180 | versus physical and somatic fatigue.

01:09:38.480 | They acknowledged that both of those occur in TBI

01:09:41.280 | or post TBI, the headache is quite frequent.

01:09:44.240 | Basically the takeaway of the study is that

01:09:46.160 | for people experiencing headache, dizziness and fatigue

01:09:49.400 | due to TBI and perhaps, and I want to underline perhaps

01:09:52.400 | because it hasn't really been explored yet,

01:09:53.880 | but perhaps headache, dizziness and fatigue

01:09:56.960 | due to other conditions, symptoms or causes of headache,

01:10:01.960 | creatine monohydrate supplementation might be,

01:10:05.240 | again, might be an excellent candidate for people to try.

01:10:08.060 | Why do we say that?

01:10:08.900 | Well, first of all,

01:10:10.260 | creatine monohydrate is relatively inexpensive.

01:10:12.800 | It's considered safe at the dosages used in this study

01:10:16.140 | and certainly for sports performance as well.

01:10:20.060 | And there are very few other compounds

01:10:23.900 | that have been shown to have as significant an impact

01:10:26.500 | on headache over the long-term as has creatine monohydrate

01:10:31.080 | in these studies of people with TBI.

01:10:33.300 | It's also important to highlight the fact that

01:10:35.780 | many, many people suffer from TBI as I mentioned earlier.

01:10:38.660 | And as now there are very few treatments for TBI.

01:10:43.200 | You tend to get the basic advice coming back.

01:10:45.380 | And again, I think it's excellent advice,

01:10:47.300 | get proper amounts of sleep, get exercise,

01:10:49.500 | but don't get another traumatic brain injury.

01:10:51.180 | That's obvious, but you'd be surprised how many people

01:10:54.300 | go right back to work because they have to.

01:10:56.220 | And we have to be sympathetic to the fact that

01:10:59.100 | many people just can't stop working or go on disability.

01:11:02.620 | So many people have to go back to work.

01:11:04.260 | That could be sport or it could be other kind of work

01:11:05.900 | where they are then subject to perhaps getting more TBI.

01:11:09.640 | Maybe they're getting less rest as a consequence and stress.

01:11:12.040 | Obviously stress is a confounding issue for TBI,

01:11:15.560 | but sleep, exercise, sun, nutrition, all of those things,

01:11:19.620 | proper social connection are what people are encouraged to do

01:11:22.600 | when they have TBI.

01:11:23.800 | But there have been very few compounds in particular,

01:11:25.580 | very few over-the-counter compounds that are known to be

01:11:28.420 | safe that have shown efficacy in dealing with TBI.

01:11:31.480 | So I think that while this is a pilot study

01:11:34.480 | and we can consider it preliminary,

01:11:36.440 | I think it's important enough and the effects were dramatic

01:11:39.280 | enough that people with headache and in particular,

01:11:41.880 | people with TBI ought to consider supplementing with creatine

01:11:45.760 | in order to deal with their headaches.

01:11:47.320 | And of course, I eagerly await other studies exploring the

01:11:51.160 | role of this high dosage of creatine,

01:11:53.260 | or I should say relatively high dosage of creatine

01:11:55.100 | monohydrate for offsetting headache.

01:11:57.080 | Meanwhile, I think there are a number of people out there

01:11:59.520 | suffering from headache who might consider using

01:12:03.000 | creatine monohydrate in an exploratory fashion

01:12:05.800 | and seeing whether it helps offset their headaches.

01:12:07.960 | Keep in mind, of course,

01:12:09.000 | anytime you're going to add or remove anything,

01:12:11.400 | supplement or otherwise from your treatment,

01:12:13.840 | your nutrition, et cetera,

01:12:14.760 | I do suggest that you consult with your physician,

01:12:16.960 | in particular, if you have chronic headaches.

01:12:18.800 | I don't say that to protect me.

01:12:19.960 | I say that of course, to protect you.

01:12:22.080 | I'd like to take a brief break

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01:13:56.280 | What I'd like to discuss next, I find extremely exciting.

01:13:59.860 | Why?

01:14:00.720 | Well, what I'm about to describe is a compound,

01:14:03.340 | or I should say a set of compounds,

01:14:05.120 | that are available over the counter

01:14:07.440 | that have been shown to be very effective

01:14:10.000 | in reducing the frequency and intensity of headaches,

01:14:12.480 | and not just one kind of headache,

01:14:13.800 | but multiple types of headaches.

01:14:15.400 | So what I'll describe has been shown

01:14:17.320 | to have significant effects in reducing the intensity

01:14:20.920 | or frequency of tension-type headaches,

01:14:23.220 | migraine-type headaches, as well as hormone-type headaches

01:14:26.560 | that are related to the menstrual cycles

01:14:28.240 | that I described earlier.

01:14:29.420 | Now, there are a lot of data

01:14:30.760 | centered around this general topic,

01:14:32.960 | but I'm going to focus on three main papers.

01:14:35.480 | What I haven't told you yet, of course,

01:14:37.040 | is what is the compound that I'm referring to?

01:14:38.740 | What is this over-the-counter compound?

01:14:40.800 | Well, it turns out this over-the-counter compound

01:14:43.060 | is not just available over the counter,

01:14:44.760 | it's also available in food.

01:14:46.880 | So it turns out that nutrition can have a very strong impact

01:14:50.080 | on the frequency and intensity of headache,

01:14:52.200 | although supplementation with this particular compound

01:14:54.840 | can accomplish the same thing as well.

01:14:56.720 | What I'm referring to here are omega-3 fatty acids.

01:15:00.320 | Many of you are probably familiar with omega-3 fatty acids.

01:15:02.720 | These are fatty acids that come in the form

01:15:05.160 | of so-called EPA and DHA,

01:15:07.520 | and omega-3 fatty acids are commonly distinguished

01:15:10.320 | from the so-called omega-6 fatty acids.

01:15:13.400 | Omega-6 fatty acids come in a bunch of different foods,

01:15:16.920 | and they, of course, can be supplemented as well.

01:15:18.880 | Omega-3 fatty acids come in a bunch of different foods

01:15:21.000 | and can be supplemented as well.

01:15:22.560 | Common forms of omega-3 fatty acids,

01:15:24.800 | or I should say common sources of omega-3 fatty acids

01:15:27.720 | in foods include fatty ocean fish,

01:15:30.720 | including salmon, salmon skins, sardines, anchovies,

01:15:34.020 | things of that sort.

01:15:35.680 | Common sources in supplement form are so-called fish oil,

01:15:39.960 | capsules, or liquid fish oil.

01:15:41.920 | Again, omega-3 fatty acids,

01:15:43.640 | and almost always when we're talking

01:15:45.640 | about omega-3 fatty acids,

01:15:47.000 | we're talking about a combination of EPA and DHA,

01:15:50.640 | but really it is the quantity of EPA omega-3 fatty acids

01:15:55.640 | that seems to be the most impactful

01:15:57.400 | for the sorts of health metrics

01:15:58.720 | that we're going to talk about in a few minutes.

01:16:01.160 | Now, with respect to omega-6 fatty acids,

01:16:04.440 | the most typical food sources of omega-6 fatty acids

01:16:07.120 | are seed oils.

01:16:08.300 | I know nowadays seed oils have become quite controversial.

01:16:12.040 | I've given my stance on this in a prior podcast,

01:16:14.820 | but I'll just repeat it

01:16:15.660 | for those of you that haven't heard it.

01:16:17.060 | I am not of the belief that all seed oils are bad,

01:16:20.320 | that they're all inflammatory,

01:16:22.020 | that they are killing us or making us sick,

01:16:24.360 | that they are the major cause

01:16:25.600 | of metabolic dysfunction, et cetera.

01:16:27.080 | However, I think it is very clear,

01:16:28.980 | and I learned this from Dr. Lay Norton

01:16:30.480 | when he was a guest on this podcast

01:16:31.920 | and taught us all about nutrition in great depth.

01:16:35.200 | I highly recommend that episode

01:16:36.420 | if you're interested in nutrition,

01:16:37.960 | that people are consuming a lot more oil generally,

01:16:41.360 | and a lot of those oils

01:16:42.660 | that people are consuming more of nowadays

01:16:45.400 | include a lot of the so-called omega-6 fatty acids,

01:16:48.800 | and a lot of those oils are seed oils.

01:16:50.940 | The particular omega-6 fatty acid

01:16:52.720 | that's going to be relevant for today's discussion

01:16:54.520 | is linoleic acid,

01:16:56.240 | and that is common in a lot of seed oils.

01:16:58.440 | So again, I'm not going to tell you that seed oils are bad.

01:17:01.700 | However, it does seem to be the case

01:17:03.400 | that many people are consuming far too many seed oils,

01:17:07.000 | and in doing so are consuming far too many calories,

01:17:09.420 | and perhaps are consuming too much of the omega-6 fatty acids

01:17:13.840 | relative to the omega-3 fatty acids.

01:17:16.000 | Now, with that said,

01:17:16.840 | I think there is general agreement

01:17:18.400 | among nutritionists and health professionals

01:17:21.480 | that we could all stand to get more omega-3 fatty acids,

01:17:25.760 | perhaps for cardiovascular health,

01:17:27.280 | although that's a little bit debated,

01:17:28.640 | but certainly for immune system function,

01:17:31.440 | for mood, and for functioning of the brain,

01:17:33.360 | and for the potent anti-inflammatory effects of omega-3.

01:17:37.600 | So again, omega-3s can be sourced from food,

01:17:40.240 | both animal-based and plant-based.

01:17:41.640 | You can simply go online

01:17:42.800 | and look up the various food-based sources,

01:17:45.080 | but in thinking about headache

01:17:47.860 | and different treatments for headache,

01:17:49.000 | there are some recent studies exploring

01:17:50.680 | how supplementing with omega-3 fatty acids,

01:17:53.240 | and in one case, how supplementing with omega-3 fatty acids

01:17:56.320 | and deliberately reducing the amount of linoleic acid,

01:17:59.840 | the omega-6 fatty acids, how that can impact headache.

01:18:03.200 | So the first study I'd like to describe

01:18:04.680 | in reference to the role of omega-3 fatty acids in headache

01:18:07.840 | was published in 2018,

01:18:09.620 | and the title of the paper is

01:18:10.800 | Long Chain Omega-3 Fatty Acids and Headache

01:18:13.280 | in the US Population.

01:18:14.600 | There are a number of things

01:18:15.440 | that I really like about this study.

01:18:16.960 | A few of those include the fact

01:18:18.520 | that they looked at an enormous number of people.

01:18:21.880 | That is, they included 12,317 men and women.

01:18:25.520 | I like the fact that they included men and women

01:18:27.140 | in the study, age 20 or older,

01:18:29.320 | and that they broke down the population

01:18:31.440 | into categories that included age.

01:18:34.600 | They certainly looked at race and ethnicity.

01:18:37.040 | They looked at educational background.

01:18:39.100 | They looked at body mass, total energy intake,

01:18:41.600 | which is really important.

01:18:42.600 | If you think about it, people are going to be eating,

01:18:45.040 | and within the things that they eat,

01:18:47.120 | they're going to be consuming some omega-3s, hopefully,

01:18:50.320 | as well as some omega-6s,

01:18:51.880 | and if they're eating far more,

01:18:52.960 | then they're likely going to get far more

01:18:56.560 | of both of those things than they would ordinarily

01:18:58.440 | if they were eating smaller amounts.

01:18:59.840 | So they controlled for total caloric intake

01:19:02.240 | in a way that I find particularly useful

01:19:05.680 | for looking at these kind of data.

01:19:07.240 | So the reason they explored omega-3s is worth mentioning.

01:19:09.860 | Omega-3 fatty acids are known to have

01:19:11.800 | an anti-inflammatory effect.

01:19:14.720 | That anti-inflammatory effect is mediated

01:19:16.800 | through a couple of different pathways.

01:19:18.040 | We won't go into these in too much detail now,

01:19:20.220 | but the omega-3 fatty acids, keep in mind,

01:19:22.940 | actually make up various parts of cells

01:19:25.900 | in the brain and body.

01:19:27.140 | That's right, the membrane that,

01:19:29.100 | remember I talked before about how steroid hormones

01:19:30.960 | can go through the different membranes of the cells,

01:19:32.600 | the outer membrane and the inner membrane.

01:19:34.400 | A lot of those actual membranes,

01:19:35.920 | the structural constituents of neurons and other cells

01:19:39.420 | are actually made up of or include certain fatty acid,

01:19:42.880 | long-chain fatty acids,

01:19:44.160 | and the omega-3 fatty acids are important

01:19:46.280 | for the actual construction of those tissues,

01:19:48.900 | as well as having anti-inflammatory effects

01:19:51.520 | through things like limiting prostaglandins

01:19:53.480 | and other things that can cause inflammation.

01:19:55.280 | Okay, so there are a bunch of different ways

01:19:56.560 | that omega-3 fatty acids can be useful.

01:19:59.000 | They refer in this study to an earlier study

01:20:02.000 | that looked at the so-called analgesic effect,

01:20:03.940 | the pain relieving effect.

01:20:05.280 | Analgesic means pain relieving effect

01:20:07.300 | of omega-3 fatty acids

01:20:09.500 | in what had been a randomized control trial.

01:20:12.720 | And in that previous paper,

01:20:14.240 | what they found was that diets high in omega-3s

01:20:17.880 | and low in omega-6s, okay, so high three, low six,

01:20:22.080 | and as compared to diets that were just reduced omega-6s,

01:20:27.080 | they found a greater analgesic effect

01:20:29.360 | of increasing omega-3s

01:20:30.740 | while also reducing omega-6 fatty acids.

01:20:33.040 | So in the context of the seed oil discussion,

01:20:35.380 | although keeping in mind that omega-6s

01:20:36.900 | can come from other sources as well,

01:20:38.960 | if omega-6s were just reduced on their own,

01:20:41.540 | there wasn't as great an effect

01:20:44.040 | in terms of reducing pain and inflammation

01:20:46.040 | as there was when omega-3 fatty acids

01:20:48.780 | were deliberately increased

01:20:49.980 | and omega-6 fatty acids were reduced.

01:20:52.360 | Again, in all of these studies,

01:20:54.880 | because these are the ones

01:20:55.840 | in which they controlled things well, as we say,

01:20:59.480 | they are holding constant the caloric intake.

01:21:02.220 | So it's not just that you're removing fat, eating less fat,

01:21:04.500 | there's actually a removal of certain fats and fatty acids

01:21:07.480 | and a replacement of those with omega-3 fatty acids.

01:21:10.440 | In one case, in the other case,

01:21:11.800 | it's just a reduction in omega-6s

01:21:14.000 | and you're using other food types and macronutrients

01:21:16.440 | to offset that reduction in calories

01:21:18.840 | caused by reducing omega-6s.

01:21:20.680 | The basic takeaway that they're relying on

01:21:22.860 | marching into the study

01:21:23.840 | is that increasing omega-3s and reducing omega-6s

01:21:27.280 | seems to be beneficial for reducing pain.

01:21:29.240 | And indeed in this study, they find something quite similar,

01:21:32.560 | which is that when you hold caloric intake constant

01:21:36.000 | and when you look at omega-6s,

01:21:38.360 | whether or not you decrease omega-6 fatty acids or not,

01:21:41.520 | you find is that increasing omega-3 fatty acids in the diet,

01:21:46.520 | so either consumed through food sources or by supplementation

01:21:50.360 | was associated with a lower prevalence

01:21:52.200 | of severe headache or migraine.

01:21:54.120 | So severe tension type headache or migraine.

01:21:56.960 | So this is promising and points to the fact

01:21:59.200 | that long chain omega-3 fatty acids

01:22:01.480 | are likely to have either a pain reducing,

01:22:04.720 | and there's evidence for that,

01:22:06.280 | and/or an inflammation reducing effect

01:22:09.280 | that can significantly reduce the severity of headache

01:22:12.400 | in both tension type headache and in migraine.

01:22:14.920 | So that's the first study.

01:22:16.200 | The second study is a more recent study,

01:22:18.840 | it was published in 2021,

01:22:20.680 | that used a, I would say a more or less similar type

01:22:24.400 | of overall design as the one I referred to earlier.

01:22:27.000 | The title of this paper is dietary alteration

01:22:29.520 | of what they call N3, but those are omega-3 and N6,

01:22:33.260 | omega-6, sorry for the shift in nomenclature,

01:22:35.480 | I didn't write the paper.

01:22:37.140 | Dietary alteration of omega-3 and omega-6 fatty acids

01:22:42.020 | for headache reductions in adults with migraine,

01:22:44.200 | and this was a randomized control trial.

01:22:46.700 | Randomized control trials involve having people

01:22:48.500 | be in one condition where they do one thing

01:22:50.700 | and then they get swapped randomly into another condition,

01:22:53.620 | so they serve as their own internal control,

01:22:55.780 | and that controls for all sorts of things

01:22:57.800 | like differences in sex, differences in age,

01:23:00.860 | differences in health background,

01:23:02.560 | and any number of other variables as best as one can.

01:23:06.040 | In this study, they had people either ingest a diet

01:23:09.200 | that had increased omega-3s, so increased EPA and DHA,

01:23:14.200 | or increased EPA and DHA

01:23:18.520 | and reduced amounts of linoleic acid, okay,

01:23:21.420 | so that's going to reduce omega-6s,

01:23:24.280 | or a control diet in which they had people taking

01:23:28.300 | what's essentially the average intake

01:23:30.260 | of omega-3s and omega-6s,

01:23:32.060 | and you can probably already guess

01:23:33.540 | what the general results of this study are going to be.

01:23:36.120 | The general results were that there were reductions

01:23:38.460 | in headaches, okay?

01:23:40.020 | The really cool thing is it was a massive reduction

01:23:42.960 | in headache, okay?

01:23:43.800 | This was, they referred to it as a robust reduction

01:23:46.500 | in headache in particular for the subjects

01:23:49.440 | that increased their omega-3s

01:23:51.020 | and reduced the amount of linoleic acid that they took.

01:23:53.600 | The other thing that I really like about this study

01:23:55.620 | is that while they don't know the exact underlying mechanism

01:23:58.260 | for the effect, they did spend some time delineating

01:24:02.900 | what it is that the omega-3 and omega-6 fatty acids

01:24:05.900 | are likely doing to either offset or exacerbate headache.

01:24:09.140 | Now, I didn't say that omega-6 fatty acids

01:24:11.180 | exacerbate headache, but it does seem that people

01:24:13.800 | who ingest more linoleic acid and omega-6

01:24:16.780 | are experiencing more inflammation,

01:24:19.140 | and that is evident in a bunch of different conditions.

01:24:22.540 | One, for instance, is increases in things like CGRP.

01:24:25.900 | CGRP is a molecule that's associated

01:24:28.220 | with a calcium signaling pathway.

01:24:29.540 | It's involved in vasodilation,

01:24:31.380 | the expansion of the blood vessels and capillaries,

01:24:33.700 | and that's known, as I mentioned earlier,

01:24:36.700 | to exacerbate certain forms of headache, okay?

01:24:39.520 | There are also forms of headache

01:24:40.700 | that can be caused by vasoconstriction.

01:24:42.220 | We'll talk about one very dramatic example,

01:24:43.980 | perhaps, as we get toward the end.

01:24:45.700 | It's a very uncommon example,

01:24:47.280 | but it's called thunderclap headache,

01:24:50.180 | and trust me, you do not want a thunderclap headache,

01:24:52.960 | and so we'll talk about thunderclap headache

01:24:54.580 | a little bit later.

01:24:55.420 | That involves constriction of the blood vessels.

01:24:57.020 | In any case, in this paper,

01:24:59.700 | they didn't study mechanism directly,

01:25:02.920 | but they're resting on this known analgesic, anti-pain,

01:25:06.780 | as well as known anti-inflammatory pathways

01:25:09.100 | related to increasing omega-3 intake,

01:25:11.160 | and simultaneously resting on the idea,

01:25:14.340 | or I think we now can say conclusion,

01:25:17.380 | that omega-6 fatty acids, in particular linoleic acid,

01:25:21.860 | can increase inflammation by way of increasing things

01:25:24.720 | like CGRP, vasodilation, and some other pathways

01:25:29.060 | related to the so-called inflammatory cytokine pathways,

01:25:32.340 | and there's a whole discussion nowadays

01:25:34.220 | of what's called the inflammatome.

01:25:35.820 | So the basic takeaway is that

01:25:38.100 | if you are interested in reducing headache,

01:25:40.620 | it may be beneficial,

01:25:41.960 | at least according to these two studies,

01:25:43.580 | and another one I'll talk about in a moment,

01:25:45.460 | to increase amounts of omega-3 fatty acids,

01:25:48.080 | and that can be done, again,

01:25:48.920 | through the ingestions of foods,

01:25:50.860 | although based on the dosages

01:25:53.180 | that we'll talk about in a moment,

01:25:55.320 | increasing omega-3 fatty acids

01:25:56.860 | by taking liquid-form fish oil,

01:25:58.500 | which is perhaps the most cost-effective way

01:26:01.060 | to supplement omega-3s,

01:26:02.700 | or capsules, which is perhaps the most efficient way

01:26:05.480 | to supplement omega-3s,

01:26:07.060 | really to a level of one gram or more of EPA per day.

01:26:11.460 | Again, that's the EPA form in particular.

01:26:14.100 | So if you're, for instance, taking supplemental fish oil,

01:26:16.720 | or you're getting your omega-3s from food,

01:26:18.460 | and you're getting what you determine to be 2,000 milligrams

01:26:22.960 | or two grams per day of omega-3s,

01:26:25.660 | keep in mind that's going to include EPA and DHA,

01:26:28.720 | and it does seem that getting above one gram per day

01:26:31.940 | of EPA omega-3 fatty acids,

01:26:34.100 | either through food or supplements or both,

01:26:36.620 | is going to be the critical threshold for reductions

01:26:39.580 | in the frequency and intensity of headaches

01:26:41.540 | that include both tension headaches and migraine headaches.

01:26:44.920 | Now, some people will find, actually,

01:26:46.620 | that ingesting far more omega-3 fatty acids,

01:26:50.260 | generally through supplementation,

01:26:51.600 | but again, can be accomplished through foods as well,

01:26:54.480 | can also be beneficial for other things, such as mood,

01:26:57.580 | and indeed, there's a whole literature

01:26:58.800 | related to effects of ingesting one to three grams,

01:27:02.860 | again, three grams per day of EPA,

01:27:05.620 | so that's going to require quite a high intake

01:27:08.660 | of omega-3s in whatever form or supplement

01:27:10.940 | you decide to take those into your body,

01:27:13.020 | but that can improve mood and so forth.

01:27:15.380 | The basic range that I was able to find in the meta-analyses,

01:27:18.960 | so meta-analyses are where a researcher

01:27:21.000 | will look at the results of a bunch of different studies

01:27:23.500 | focused on the same thing,

01:27:24.980 | look at the different strength of those studies,

01:27:27.540 | they'll do all sorts of cool statistical gymnastics,

01:27:30.320 | like remove the most potent study,

01:27:32.540 | the one that had the greatest effect,

01:27:34.160 | and see whether or not there's still an effect

01:27:35.840 | of some treatment, or for instance,

01:27:38.060 | they will swap in and out different studies

01:27:41.220 | and different combinations to see whether or not

01:27:43.140 | any one study is really leading to the conclusion

01:27:45.460 | that a given treatment does something.

01:27:47.140 | In any case, in the meta-analyses of omega-3 fatty acids

01:27:50.200 | for the treatment of headache,

01:27:51.100 | and that includes all the different kinds of headache,

01:27:53.740 | what they found in exploring a huge range

01:27:56.820 | of omega-3 supplementation ranging from 200 milligrams

01:27:59.780 | all the way up to 2,000 milligrams per day,

01:28:02.140 | it really was at the one gram or higher dosage per day

01:28:06.760 | where the significant impact in reducing headache frequency

01:28:10.060 | and intensity was found.

01:28:11.320 | And just very briefly, earlier I mentioned

01:28:13.780 | that not only has omega-3 fatty acid supplementation

01:28:16.540 | been shown to be effective in reducing

01:28:18.420 | the frequency and intensity of headache,

01:28:20.460 | in tension type and migraine type headache,

01:28:23.000 | but it's also been shown to improve outcomes

01:28:26.240 | for premenstrual syndrome related headaches.

01:28:29.000 | These are what we referred to earlier

01:28:30.740 | as hormone-based headaches.

01:28:32.420 | Again, the low estrogen, low progesterone associated

01:28:36.860 | with certain phases of the menstrual cycle

01:28:38.580 | as well as other phases of the menstrual cycle

01:28:40.500 | are often associated with headache.

01:28:42.020 | In a study entitled "Effect of Omega-3 Fatty Acids

01:28:45.720 | on Premenstrual Syndrome, a Systematic Review"

01:28:47.820 | and again, meta-analysis, what they found,

01:28:50.480 | and here I'm paraphrasing the conclusion,

01:28:52.260 | was that omega-3 fatty acids could, yes,

01:28:55.740 | effectively reduce the severity of PMS symptoms.

01:28:59.480 | And one of the symptoms in particular

01:29:01.160 | that they found that was reduced

01:29:02.720 | was the pain-related symptoms associated with headache.

01:29:06.340 | And they actually had some very nice hypotheses

01:29:08.260 | as to why that likely would be.

01:29:11.240 | And in fact, point out that in earlier studies,

01:29:14.300 | omega-3 fatty acids have actually been considered

01:29:16.840 | as nonsteroidal anti-inflammatory drugs in some cases.

01:29:20.620 | And indeed there are prescription forms

01:29:23.040 | of omega-3 fatty acids.

01:29:24.680 | And I highlight that not because I think people need

01:29:26.440 | to run out and get the prescription form

01:29:28.320 | of omega-3 fatty acids.

01:29:29.520 | They're actually quite hard to obtain and quite expensive.

01:29:33.060 | But because I think oftentimes when we're talking

01:29:35.540 | about something like omega-3 fatty acids,

01:29:37.640 | the fact that they are available over the counter

01:29:40.620 | in a supplement or by liquid or available in food

01:29:43.340 | for that matter, leads many people to conclude that,

01:29:45.900 | oh, this is supplementation.

01:29:47.640 | This is something that it's going to have relatively weak

01:29:51.380 | or minor impact on things like headache

01:29:53.300 | or other health metrics.

01:29:54.660 | But let's just say that the fact that it exists

01:29:58.340 | as a prescription drug in its highest potency form,

01:30:01.580 | at least in my opinion, points to the potency

01:30:04.980 | of omega-3 fatty acids in dealing with analgesic effects,

01:30:09.620 | that is reducing pain and anti-inflammation,

01:30:12.060 | as well as some of the known cardiovascular improvements

01:30:14.660 | that are associated with increasing

01:30:16.220 | omega-3 fatty acid intake.

01:30:18.080 | Put simply, omega-3s are not just something

01:30:20.640 | that comes from food or supplements,

01:30:21.800 | they are also being marketed as prescription drugs.

01:30:24.140 | So I do think they need to be considered as quite potent.

01:30:26.800 | And at least as far as these papers that, again,

01:30:29.440 | include meta-analyses of many other papers and datasets,

01:30:33.100 | indicate that supplementing with omega-3 fatty acids

01:30:36.820 | to a point where you're getting above one gram per day

01:30:40.100 | of EPA is not just going to be beneficial for treating

01:30:43.360 | and reducing the frequency and intensity

01:30:45.540 | of one particular type of headache,

01:30:47.440 | but many types of headaches.

01:30:49.280 | And when you combine hormonal headaches,

01:30:50.920 | tension headaches, and migraine headaches,

01:30:52.660 | you account for more than 70% of the total types of headaches

01:30:55.540 | that are out there.

01:30:56.840 | The effects of omega-3s on cluster headaches

01:30:58.920 | and some of the other types of headaches,

01:31:00.200 | at least to my knowledge, have not been evaluated.

01:31:03.040 | There's no reason to think that omega-3s

01:31:04.900 | would not be beneficial for those types of headaches.

01:31:07.720 | But at least as far as the datasets we talked about here

01:31:11.200 | are concerned, it is clear omega-3 fatty acids

01:31:14.140 | are going to be a very potent way to reduce pain

01:31:18.240 | and to reduce inflammation in ways

01:31:20.180 | that can reduce the frequency and the intensity

01:31:23.560 | of different kinds of headache.

01:31:24.760 | Before we continue our discussion

01:31:26.400 | about many not commonly known and yet very potent treatments

01:31:30.320 | for different forms of headache,

01:31:31.840 | I want to touch on a topic we mentioned

01:31:33.680 | a little bit earlier and also provide a treatment

01:31:37.000 | that is a way to alleviate something,

01:31:39.240 | and that's photophobia and aura.

01:31:41.720 | Now, keep in mind that earlier I referred to aura

01:31:44.120 | as this sense that something's about to happen.

01:31:46.920 | That is true, meaning that is an accurate description of aura

01:31:50.880 | but oftentimes people also come to understand aura

01:31:54.200 | as the feeling that something surrounds

01:31:56.560 | a given object visually or even that people have a sense

01:32:00.220 | that something's around them.

01:32:01.860 | So again, this can be a little bit vague,

01:32:03.840 | but this idea that aura is a sense of something

01:32:06.320 | about to happen or that visually or in an auditory way

01:32:09.480 | and or maybe even in kind of a sense

01:32:11.900 | that something is about to happen in a certain environment.

01:32:15.960 | And the reason I'm making kind of arc shapes with my hands,

01:32:18.680 | for those of you that are just listening,

01:32:19.640 | I'm making arc shapes with my hands,

01:32:21.320 | is that aura is often described as kind of a halo

01:32:24.320 | or a emanating out from one's body

01:32:27.320 | or from something that they're looking at.

01:32:28.720 | Again, nothing spiritual about this

01:32:31.200 | in the context of the discussion about migraine and headache,

01:32:34.200 | but rather many people experience photophobia

01:32:36.800 | sometimes with aura, sometimes no.

01:32:39.240 | And I just want to touch on a couple of the mechanisms

01:32:42.560 | by which aura and photophobia occur

01:32:44.580 | and mention just briefly a pretty well-established way

01:32:48.360 | that people can start to offset photophobia.

01:32:51.600 | And again, I mentioned that

01:32:52.520 | because many people experience photophobia in headache,

01:32:55.180 | but there are also a number of people

01:32:56.480 | that experience photophobia

01:32:57.840 | even if they don't have intense headache.

01:32:59.640 | So photophobia is pretty common, pretty debilitating.

01:33:02.800 | It actually is one of the reasons why people feel not well

01:33:05.360 | and need to leave work or not go to school or leave school,

01:33:09.840 | these kinds of things or lay in bed all day

01:33:11.480 | or dim the lights, not go outside.

01:33:13.820 | Again, sunlight being so congruent with health,

01:33:17.220 | you can imagine how photophobia can lead

01:33:18.760 | to all sorts of negative downstream consequences.

01:33:21.620 | Okay, so what is aura and what is photophobia?

01:33:24.560 | The exact origins of aura aren't exactly clear,

01:33:28.680 | but it is generally thought that what aura represents

01:33:32.440 | is what's called spreading depression.

01:33:34.480 | And this is not depression of one's mood,

01:33:37.720 | although it can be associated with that.

01:33:40.320 | This is depression of neuronal activity.

01:33:43.040 | Again, neurons communicate with one another

01:33:44.880 | by generating electrical impulses

01:33:46.720 | that travel down the length of their so-called axons,

01:33:50.040 | which are like little wires,

01:33:51.160 | and then they dump neurotransmitter out

01:33:53.280 | at the so-called synapse

01:33:54.240 | and impact the electrical activity of other neurons.

01:33:57.760 | Depression is a electrical,

01:34:00.280 | or I should say a chemoelectrical,

01:34:02.920 | chemoelectrical is the proper term,

01:34:05.240 | phenomenon in which the excitability of neurons is reduced.

01:34:09.280 | So again, doesn't have anything to do with depression

01:34:12.120 | as a mood state per se,

01:34:14.320 | rather it is a reduced excitability of neurons.

01:34:17.100 | And it's been shown in some imaging studies

01:34:20.600 | that aura is associated with a back to front.

01:34:24.420 | So from the back of the brain to front,

01:34:26.280 | spreading depression like a wave

01:34:28.320 | of lowering levels of electrical excitability.

01:34:32.560 | And because this originates in the visual cortex,

01:34:34.920 | which is in the back,

01:34:35.760 | so that's the part of your brain

01:34:36.920 | that is making sense of visual images

01:34:38.640 | coming in through the eyes

01:34:39.800 | and relayed through other stations in the brain,

01:34:42.680 | that people will start to see a kind of halo of light

01:34:46.780 | or that they'll start to feel that the light around them

01:34:50.140 | is literally surrounding their body

01:34:52.140 | or some other object or body that they're looking at.

01:34:55.120 | And then it spreads forward in the brain.

01:34:57.760 | And that's when it tends to stretch over

01:34:59.840 | into other so-called sensory modalities.

01:35:02.500 | Sensory modalities being things like touch or hearing.

01:35:06.160 | So people will get the sense

01:35:07.380 | that they're kind of seeing something

01:35:08.960 | in their periphery of their vision.

01:35:10.880 | Then they'll start feeling something around them.

01:35:12.740 | There's a sense that something's about to happen.

01:35:14.820 | So as this spreading wave of depression

01:35:17.600 | goes from back to front,

01:35:18.820 | people experience a number of these different

01:35:20.760 | semi-abstract sensory phenomena that we call aura.

01:35:24.660 | Okay, so that's how aura originates.

01:35:26.380 | Now, photophobia is a little bit different.

01:35:28.860 | Photophobia, we now understand

01:35:31.100 | because of some beautiful work that was done

01:35:33.460 | at Cliff Saper's lab at Harvard Medical School

01:35:35.740 | and some other laboratories,

01:35:37.780 | showing that photophobia originates

01:35:39.980 | from a specific set of neurons in the eye.

01:35:42.860 | We call these the intrinsically photosensitive

01:35:44.900 | melanopsin ganglion cells,

01:35:46.220 | which is really just a mouthful of nerd speak

01:35:48.860 | for neurons in the eye that connect to the brain,

01:35:52.140 | these so-called ganglion cells,

01:35:54.280 | that respond most robustly to bright blue light

01:35:59.080 | or other short wavelength light.

01:36:00.760 | So you've got short wavelength light

01:36:02.340 | that is blue and greens are short wavelengths,

01:36:05.400 | and then long wavelength light, which is red,

01:36:07.560 | or it can even be out past where it will be infrared.

01:36:10.520 | We don't detect infrared consciously.

01:36:12.040 | Other species do, like pit vipers can see in the infrared.

01:36:14.820 | They can even heat sense.

01:36:16.500 | So short wavelength light is going to be light

01:36:18.400 | that's bright blue, green.

01:36:22.200 | It's what's very common in fluorescent bulbs

01:36:24.500 | that are commonly used in household lighting

01:36:27.580 | and workplace lighting

01:36:29.080 | and other forms of artificial lighting.

01:36:30.540 | It's also, of course, present in sunlight.

01:36:32.900 | Sunlight includes a huge range of wavelengths,

01:36:35.220 | including long wavelength light, of course.

01:36:37.500 | You've seen that as the reds and oranges

01:36:39.580 | in the sunset and so on.

01:36:40.780 | Those intrinsically photosensitive retinal ganglion cells

01:36:45.100 | in the eye respond best to bright green or blue light,

01:36:49.140 | and they send connections to a bunch of different places

01:36:51.720 | in the brain, including the so-called

01:36:53.920 | central circadian clock, suprachiasmatic nucleus

01:36:56.100 | that sets your day, night, sleep, wake rhythms.

01:36:58.600 | This is why I encourage people to view sunlight

01:37:00.500 | in the morning to set the system in motion

01:37:02.520 | to avoid bright light exposure at night

01:37:05.620 | from artificial sources in order to not send wake up signals

01:37:09.660 | from the eye to the brain and then onto the rest of the body

01:37:12.420 | but these intrinsically photosensitive retinal ganglion cells

01:37:15.540 | are also known to connect with other areas of the brain,

01:37:18.540 | many other areas of the brain, in fact,

01:37:20.540 | and one of the important areas of the brain they connect to

01:37:23.220 | as it relates to photophobia

01:37:24.860 | is an area of a structure called the thalamus.

01:37:27.180 | The thalamus is an egg-like structure

01:37:28.620 | that sits in the center of the brain,

01:37:30.100 | and it serves as a kind of a switchboard,

01:37:32.540 | like a sensory relay by which information

01:37:35.700 | coming from the eyes, from the ears,

01:37:37.700 | from the touch system, et cetera,

01:37:38.980 | are funneled into different compartments in the thalamus

01:37:41.180 | and then sent to different other areas of the brain.

01:37:43.560 | So think of it kind of like an old fashioned switchboard,

01:37:46.260 | or you could think of it sort of like in an airport,

01:37:50.420 | you go to a particular wing of the airport,

01:37:53.980 | then you go to a particular gate and so on,

01:37:55.860 | you're getting funneled progressively

01:37:57.380 | through narrower and narrower channels

01:37:59.100 | until you arrive at your particular plane.

01:38:02.300 | Much in the same way,

01:38:03.140 | the thalamus has a bunch of different entry points,

01:38:06.060 | so it's sensory information

01:38:07.140 | coming in from a bunch of different sources,

01:38:08.780 | and those sources get routed

01:38:10.380 | into progressively narrower and narrower funnels

01:38:13.300 | to eventually arrive at the accurate place

01:38:15.860 | for their function.

01:38:17.040 | So these intrinsically photosensitive ganglion cells

01:38:19.060 | send connections to a small but important area

01:38:22.720 | of the thalamus called LP.

01:38:24.580 | It's denoted L, the letter, and P,

01:38:26.900 | with lateral posterior thalamus,

01:38:29.180 | or I should say it's the lateral posterior nucleus

01:38:33.060 | of the thalamus for you ufascinados out there.

01:38:35.460 | And then the neurons in that location are going to respond,

01:38:38.620 | that is, they're going to be activated

01:38:40.060 | by bright blue light, green light,

01:38:42.420 | or any kind of bright light

01:38:44.580 | originating from artificial sources or from sunlight.

01:38:47.100 | And the neurons there that respond to that

01:38:49.400 | have a very interesting pattern of connections.

01:38:51.220 | They send connections up to the so-called sensory cortex,

01:38:55.440 | so a bunch of different layers throughout the cortex

01:38:58.020 | that are not associated with visual perception,

01:39:00.380 | that is, they're not associated with understanding

01:39:03.140 | that there are shapes and contours in the environment,

01:39:04.980 | but rather to neurons that are involved

01:39:07.900 | in the detection of pressure, pain,

01:39:11.480 | and other forms of sensory information

01:39:13.840 | at the level of what?

01:39:15.560 | The meninges.

01:39:16.500 | And we talked about the meninges earlier.

01:39:18.220 | So again, while the brain itself

01:39:19.980 | does not have a sensory system to detect pain,

01:39:24.980 | the tissues around it do,

01:39:27.700 | and the tissues around those tissues,

01:39:30.660 | that is the stuff around the meninges,

01:39:32.900 | themselves can respond to pain,

01:39:34.260 | and intracranial pressure is also relayed

01:39:37.260 | through the meninges to our conscious awareness

01:39:39.940 | that there's pain.

01:39:40.760 | So what does this mean for photophobia?

01:39:41.920 | It means that bright blue light and green light,

01:39:45.780 | and of course, light from sunlight,

01:39:48.020 | will activate these neurons in the eye,

01:39:49.940 | these intrinsically photosensitive ganglion cells,

01:39:51.820 | which then activate the lateral posterior neurons,

01:39:54.260 | LP neurons, and those LP neurons communicate

01:39:56.680 | with areas of the brain that are specifically tuned

01:39:59.660 | to different sensory phenomenon and in particular pain

01:40:04.100 | at the level of the meninges and intracranial pressure.

01:40:07.420 | What this means is that when we have headache,

01:40:11.060 | or if we simply have photophobia on its own,

01:40:13.700 | that bright light is actually the trigger

01:40:16.380 | for pain sensing and even the creation of pain

01:40:19.820 | at the level of the meninges and intracranial pressure.

01:40:22.460 | What does this mean in terms of dealing with

01:40:24.380 | or treating photophobia?

01:40:25.600 | Well, most people deal with photophobia

01:40:27.560 | by deciding to turn off or dim all the lights

01:40:29.820 | and simply getting under the covers

01:40:31.320 | or wearing a very low brimmed hat and putting on sunglasses,

01:40:35.220 | and they want to lie down,

01:40:37.580 | and sometimes because migraine can be associated with nausea

01:40:40.780 | or even vomiting in severe instances rather.

01:40:44.400 | But one very simple way to avoid activation

01:40:48.180 | of these retinal ganglion cells

01:40:49.480 | that would trigger photophobia is that

01:40:52.140 | if you are starting to feel like you have a migraine

01:40:54.020 | coming on or you have photophobia coming on,

01:40:56.240 | to shift to using patterns of light

01:40:58.140 | that are in the longer wavelength domain.

01:41:01.080 | What that means practically is shifting to using very orange,

01:41:06.080 | ideally dim, but very orange and a red light.

01:41:09.480 | Now, this is not a call for people to go out

01:41:12.360 | and invest in expensive red light therapies.

01:41:15.360 | Admittedly, there are some excellent case uses

01:41:18.160 | for red light therapy,

01:41:19.560 | particularly for acne, wound healing,

01:41:21.620 | even for improving vision,

01:41:23.280 | especially in people beyond the age of 40,

01:41:25.160 | for some hormone augmentation.

01:41:26.600 | We talked all about that in the episode

01:41:28.360 | that I did on light and health.

01:41:29.940 | Again, you can find that at hubermanlab.com,

01:41:32.000 | everything timestamped.

01:41:33.600 | What I'm talking about here would be simply

01:41:35.720 | having some red light bulbs on hand

01:41:38.580 | for any time that you need to remain awake,

01:41:40.960 | but you're starting to experience photophobia.

01:41:43.000 | These red light bulbs can be purchased very inexpensively

01:41:46.080 | as party lights.

01:41:48.760 | You can buy these online.

01:41:49.760 | So there is no specific need to get any,

01:41:52.360 | I would say, red light that's designed specifically

01:41:55.980 | for photophobia or anything of that sort.

01:41:57.520 | You can find the cheapest red light available out there,

01:42:01.740 | and those will simply work.

01:42:03.680 | The idea being that for many people

01:42:05.200 | who are experiencing photophobia,

01:42:06.960 | they want to reduce that feeling of pain and pressure

01:42:09.160 | in their head experienced through photophobia.

01:42:10.760 | They also might want to stay awake,

01:42:11.960 | get some work done and do things.

01:42:13.080 | So operating under red light,

01:42:15.080 | or I should say living, working, et cetera,

01:42:17.400 | under red light would allow you to stay awake,

01:42:19.120 | not have to hide under the covers

01:42:20.440 | if you're experiencing photophobia.

01:42:22.140 | In addition, and I mentioned this

01:42:23.360 | at the beginning of the episode,

01:42:24.440 | but many people find photophobia to be a entry point

01:42:28.560 | or a trigger to headache.

01:42:30.720 | So what happens is they start to experience some aura,

01:42:33.620 | some onset of photophobia, and then the photophobia itself

01:42:37.140 | leads to this feeling of malaise

01:42:38.560 | that then converts into headache.

01:42:40.380 | And so while there are not a lot of clinical data

01:42:42.380 | on this just yet, an emerging idea

01:42:45.060 | in the realm of headache treatment

01:42:46.620 | is the idea that if you can offset some of the early signs,

01:42:49.540 | you can offset some of that photophobia and aura,

01:42:53.280 | perhaps to the use of dim red lights

01:42:55.340 | or red lights as I've described a moment ago,

01:42:58.020 | then you might be able to reduce the probability

01:43:00.340 | that you're going to have a migraine

01:43:01.800 | or other type of headache entirely.

01:43:03.720 | So again, no need for expensive red lights,

01:43:06.040 | but you can find red lights very easily online

01:43:09.000 | and simply have them on hand or replace the current lights

01:43:11.980 | that you have on your nightstand

01:43:13.080 | or in whatever room you happen to be in

01:43:14.780 | with these red lights.

01:43:16.040 | These red lights are also, I should mention,

01:43:17.500 | very useful in limiting the amount of cortisol,

01:43:19.760 | a stress hormone that is very healthy for us

01:43:22.120 | to release at high levels early in the day.

01:43:23.680 | In fact, viewing sunlight will increase cortisol levels.

01:43:26.600 | That's another reason why what I'm about to say

01:43:29.640 | is relevant to photophobia.

01:43:30.880 | But if you want to keep cortisol levels low

01:43:33.380 | in the evening and at night,

01:43:34.440 | and indeed you do and improve the transition to sleep

01:43:37.160 | and indeed your sleep overall,

01:43:38.960 | reducing cortisol at evening time and at nighttime

01:43:41.880 | is extremely beneficial,

01:43:43.280 | and red lights will help you accomplish that.

01:43:45.040 | I talked about that in the episode on light and health.

01:43:47.240 | So the point here is that if you suffer from photophobia

01:43:50.120 | with or without aura,

01:43:51.960 | using red lights and not simply dimming

01:43:55.040 | ordinary artificial lights

01:43:56.200 | or feeling that you have to turn off all lights entirely

01:43:58.840 | is going to be one relatively inexpensive,

01:44:01.680 | or I should say very inexpensive in some cases

01:44:04.720 | because these red lights can be found

01:44:06.200 | very inexpensively online,

01:44:08.020 | way to be able to continue with your daily activities,

01:44:10.920 | at least in an indoor environment

01:44:12.980 | if you are suffering from photophobia.

01:44:14.840 | So shifting back to ways to reduce the intensity

01:44:17.480 | and frequency of different kinds of headaches,

01:44:20.240 | we haven't talked so much about tension headaches

01:44:22.400 | specifically, so that's what I'd like to do now.

01:44:24.100 | As you recall, tension headaches

01:44:25.640 | are going to be muscular in origin.

01:44:27.960 | Again, keeping in mind that everything's neural

01:44:29.780 | when it comes to pain,

01:44:30.960 | everything's neural when it comes to everything, frankly,

01:44:32.600 | 'cause every organ and tissue system in our body

01:44:34.800 | is ultimately controlled by our nervous system,

01:44:36.880 | but tension headaches are often associated

01:44:40.240 | with tension of the muscles that are on the skull,

01:44:43.880 | of the jaw, of the neck,

01:44:46.200 | and can be quite painful for many people and debilitating.

01:44:49.720 | And the most common treatment for this

01:44:51.340 | that most people rely on that is,

01:44:53.280 | is to take non-steroid anti-inflammatory.

01:44:56.400 | So things like acetaminophen, ibuprofen,

01:44:59.160 | sometimes aspirin and things of that sort.

01:45:01.240 | And oftentimes those can be helpful.

01:45:03.320 | There are a couple of things to keep in mind, however.

01:45:05.320 | The NSAIDs, non-steroid anti-inflammatory drugs,

01:45:08.960 | oftentimes will work very well at first,

01:45:11.880 | but people quickly develop a tolerance to them,

01:45:15.200 | meaning they're going to have to take more and more

01:45:16.720 | in order to get the same effect.

01:45:19.000 | And oftentimes they can't take more and more

01:45:20.480 | because some of them are very hard on the liver.

01:45:23.240 | And in addition to that,

01:45:24.520 | some of them can offset some other things

01:45:26.400 | that you really want.

01:45:27.240 | So for instance, it's now known

01:45:28.520 | that non-steroid anti-inflammatory drugs

01:45:30.640 | can offset some of the benefits of exercise.

01:45:32.540 | And that makes sense

01:45:33.380 | because a lot of the adaptive benefits of exercise

01:45:35.060 | actually come from experiencing

01:45:36.780 | a lot of inflammation acutely.

01:45:38.600 | That means you actually want inflammation

01:45:40.180 | during your resistance training workout

01:45:41.560 | or even your endurance workout.

01:45:43.120 | But then that inflammation triggers an adaptation event

01:45:45.840 | or series of adaptation events

01:45:47.520 | that leads to greater strength, greater speed,

01:45:49.480 | more muscle, more endurance,

01:45:51.500 | whatever it is that you happen to be training for.

01:45:53.420 | So reducing pain can be good, of course,

01:45:55.880 | but not if you have to take more and more of a given drug

01:45:58.800 | that has side effects on the liver

01:46:00.740 | and can offset the effects of exercise and so forth.

01:46:03.600 | The other issue with non-steroid anti-inflammatory drugs

01:46:06.240 | is that many of them simply do not work for many people.

01:46:09.340 | Or again, they'll work the first time and the second time,

01:46:11.520 | but then they stop working.

01:46:12.560 | They also tend to lower body temperature.

01:46:14.920 | I think most people are aware of this

01:46:16.960 | because many of these same drugs are used

01:46:19.240 | in order to reduce fever.

01:46:21.060 | But if you are taking non-steroid anti-inflammatory drugs

01:46:24.500 | simply to reduce your headache

01:46:26.120 | and your lowing core body temperature,

01:46:27.820 | that can have all sorts of downstream issues

01:46:30.360 | related to sleep-wake cycles, to metabolism,

01:46:32.920 | to immune system function more generally, and on and on.

01:46:35.960 | For that reason, there's been quite a lot of exploration

01:46:39.560 | of alternatives to non-steroid anti-inflammatory drugs

01:46:43.560 | for the treatment of headache and indeed pain generally.

01:46:47.400 | But today we're talking about headache.

01:46:48.920 | Now, as it relates to tension headache,

01:46:51.200 | one of the more advanced kind of modern treatments

01:46:53.980 | that you sometimes hear about is Botox, right?

01:46:56.580 | Botox, I think most people are familiar with

01:46:58.840 | as the thing that people get injected into their face

01:47:01.780 | around the eyes or around the lips or elsewhere

01:47:04.000 | in order to quote unquote reduce wrinkles.

01:47:06.540 | It was discovered some years ago

01:47:07.860 | when Botox treatments were being done for cosmetic reasons

01:47:10.840 | that it could often be very effective for relieving headache

01:47:14.380 | if injected into the muscles.

01:47:16.240 | And the way that it works is that of course,

01:47:18.620 | tension headache involves a tension of the muscles,

01:47:21.120 | kind of a, we'll call it clinching

01:47:23.460 | or synching up with the muscles,

01:47:24.420 | but we're really talking about is contraction of the muscles

01:47:26.480 | and that's controlled by neurons.

01:47:29.480 | Neurons, which are neuromuscular,

01:47:31.820 | so neuromuscular neurons that don't form synapses with,

01:47:35.660 | or connections with other neurons,

01:47:36.980 | they form synapses with muscle.

01:47:38.780 | They release acetylcholine onto the muscle

01:47:40.940 | and that makes the muscle contract.

01:47:42.300 | This is the way you move the limbs of your body.

01:47:44.180 | This is also the way the muscles of your head contract

01:47:47.340 | and can give you tension type headaches.

01:47:50.020 | Botox arises from, or is rather botulinum neurotoxin.

01:47:55.020 | Botulinum neurotoxin is a toxin that's found in canned goods,

01:47:59.540 | not all canned goods of course.

01:48:00.860 | And what it does is it prevents a certain step

01:48:04.420 | in the release of so-called neurotransmitter

01:48:08.540 | in the little packets that they live in,

01:48:10.540 | which are called vesicles,

01:48:11.460 | little spheres of neurotransmitter

01:48:13.740 | live at the end of neuron nerve terminals

01:48:15.740 | and are released onto the muscle, make the muscle contract.

01:48:18.180 | Botulinum neurotoxin cleaves a particular protein in there.

01:48:22.020 | For you aficionados who want to look this up,

01:48:23.600 | it's a really cool mechanism.

01:48:24.920 | It cleaves something called SNAP-25.

01:48:27.680 | SNAP-25 is involved in the fusion of those little spheres

01:48:31.580 | with the membrane of the neuron

01:48:32.840 | and releasing of the neurotransmitter.

01:48:34.420 | So when botulinum neurotoxin

01:48:36.260 | is present at the nerve muscle interface,

01:48:39.140 | those nerves cannot communicate with the muscle

01:48:41.380 | and as a consequence,

01:48:42.380 | the muscles undergo kind of flaccid tone.

01:48:45.780 | They just kind of relax there underneath the skin.

01:48:48.940 | Sure, wrinkles are relieved,

01:48:50.400 | but if Botox is injected into the muscles themselves,

01:48:53.760 | it can provide long lasting relief

01:48:55.840 | of certain types of headaches,

01:48:57.460 | in particular tension type headaches.

01:48:59.180 | So while it seems like a bit of an extreme treatment,

01:49:01.940 | people who suffer very badly from tension type headaches

01:49:04.500 | due to hyper contraction of the muscles of the forehead

01:49:08.580 | or around the temples or around the jaws

01:49:10.780 | or certain parts of the neck and the muscles of the neck

01:49:14.140 | that encroach on the back of the skull,

01:49:16.960 | or that actually connect to the back of the skull,

01:49:19.380 | can achieve tremendous long lasting relief

01:49:21.700 | from these Botox injections.

01:49:23.000 | Sometimes for weeks or months or even longer,

01:49:25.820 | people go in for periodic re-ups of Botox.

01:49:29.640 | It actually is quite safe despite the fact

01:49:32.020 | that botulinum neurotoxin is quite dangerous.

01:49:34.580 | It's given in very low doses and given locally,

01:49:36.860 | so those are the only muscles affected.

01:49:38.500 | So that's how Botox is used to treat headaches

01:49:40.940 | and is a very effective treatment at that.

01:49:43.420 | Of course, many people, I imagine,

01:49:45.100 | are interested in not just drug-based treatments

01:49:48.420 | and not Botox type treatments for treating headache,

01:49:52.180 | but other types of treatments for headache

01:49:54.740 | that are of the more,

01:49:56.020 | so let's call them natural or non-drug treatments.

01:49:59.820 | And here we're starting to get into the realm

01:50:01.700 | of the kind of herbal and oil-based treatments for headache.

01:50:05.500 | Now, I confess when I first started researching

01:50:07.700 | this area of headache and treatment for headaches, that is,

01:50:10.700 | I found myself approaching it with a bit of trepidation

01:50:14.980 | because when I started to hear about essential oils

01:50:17.340 | and about herbal medications and things of that sort,

01:50:21.000 | I thought, okay, well, there'll probably be some effects.

01:50:23.280 | I mean, admittedly, we've talked before on this podcast

01:50:25.300 | about things like apigenin.

01:50:27.100 | Apigenin is one of the core components of chamomile

01:50:31.620 | and chamomile is known to make people

01:50:33.700 | feel a little bit sleepy and can enhance sleep.

01:50:36.040 | Well, apigenin in high concentration

01:50:38.380 | can indeed augment sleep.

01:50:39.680 | We talk about this in our sleep toolkit.

01:50:41.900 | By the way, we don't just have episodes about sleep,

01:50:43.980 | master your sleep, perfect your sleep, et cetera.

01:50:45.900 | But if you go to the Hubertmanlab.com website

01:50:47.940 | and you go to the menu and you click on newsletter,

01:50:50.460 | you can scroll down and you'll see

01:50:51.420 | that we have a toolkit for sleep.

01:50:52.700 | There's completely zero cost to access.

01:50:54.180 | You don't even have to sign up,

01:50:55.140 | although if you'd like to sign up for future newsletters,

01:50:57.820 | you can get those.

01:50:58.680 | One of the key components of the toolkit for sleep

01:51:02.360 | in addition to behavioral tools

01:51:03.820 | and things that are not supplement-based

01:51:05.540 | is apigenin, which is this component from chamomile.

01:51:08.840 | So the idea that certain herbal derivatives or herbs

01:51:13.520 | or oils could be very useful

01:51:15.880 | for improving symptoms of whatever,

01:51:18.240 | in this case, improving sleep with apigenin

01:51:21.200 | is not unheard of and in fact,

01:51:22.680 | the data continued to be released all the time,

01:51:25.460 | that many of the things that we think of as herbal, et cetera

01:51:28.200 | can actually have quite potent effects.

01:51:29.940 | And so while I myself was approaching the discussion

01:51:33.680 | about essential oils and, or I should say oils, right?

01:51:37.000 | Who's to say if they're essential or not?

01:51:39.080 | Oils and herbs in the treatment of headache,

01:51:41.960 | I finished out my research on this literature,

01:51:45.360 | feeling quite, I should say, surprised

01:51:49.620 | and as if I need to really check myself a bit

01:51:52.680 | because what I found is that there are certain herbs

01:51:54.920 | and oils, for instance, that far outperform non-steroid

01:51:59.300 | and anti-inflammatory drugs for the treatment of headache.

01:52:02.200 | That's right, there are certain oils

01:52:03.640 | that are available over the counter

01:52:05.260 | that when looked at in many studies, meta-analyses,

01:52:09.120 | and I'll tell you about one particular study

01:52:10.540 | and a meta-analysis in a moment,

01:52:12.220 | they show that they can reduce the frequency

01:52:15.700 | and intensity of headache in a manner

01:52:18.160 | that far outpaces what you observe

01:52:20.660 | with non-steroid anti-inflammatory drugs

01:52:22.620 | with apparently none of the same issues

01:52:24.400 | associated with non-steroid anti-inflammatory drugs.

01:52:26.640 | So I think it's really worth paying attention to.

01:52:29.560 | The first of those studies that I'd like to describe to you

01:52:31.840 | is one that has now become kind of a classic

01:52:34.320 | in the literature, I should say,

01:52:35.680 | at least for those that are interested

01:52:37.000 | in the atypical treatments for headache.

01:52:39.340 | And the title of this paper

01:52:40.720 | is Effect of Peppermint and Eucalyptus Oil Preparations

01:52:43.880 | on Neurophysiological and Experimental

01:52:47.120 | Algismetric Headache Parameters.

01:52:49.800 | Okay, what does that mean?

01:52:51.000 | Well, this is an interesting study

01:52:52.640 | because rather than look at the effectiveness

01:52:55.040 | of peppermint and eucalyptus oil and other oils on headache,

01:52:58.260 | what they did is because they want to look

01:53:00.840 | at the mechanisms underlying headache,

01:53:02.760 | which I confess I love,

01:53:03.800 | the fact that they want to understand the neurophysiology

01:53:06.660 | and not just get subjective ratings of headache,

01:53:08.460 | although they did that too,

01:53:09.300 | but they really want to understand

01:53:11.100 | how these oils can impact things like muscular tension

01:53:14.000 | or perception of pain.

01:53:15.720 | What they did is they recreated headache in human subjects

01:53:19.420 | by using tightening cuffs of the head.

01:53:22.880 | They cut off blood supply to certain areas of the head.

01:53:25.600 | They basically induced headache,

01:53:27.160 | and then they measured things like the EMG,

01:53:30.040 | the muscle response at the level of electrophysiology

01:53:32.800 | in the muscle, and of course,

01:53:34.400 | subjective measures of how much people perceive

01:53:36.320 | to be in pain or not in pain.

01:53:38.700 | I'll give you the broad contour of the study

01:53:40.260 | because I want to make sure that it's the conclusions

01:53:42.260 | that come through most clearly,

01:53:43.280 | and we will provide a link to the study

01:53:44.920 | in our show note captions.

01:53:46.680 | So what they did is they had people use

01:53:50.200 | one of four different preparations.

01:53:52.240 | So they had preparation one,

01:53:53.120 | which includes some peppermint oil and some eucalyptus oil,

01:53:56.840 | and all the details about the amount

01:53:58.700 | and the relative percentages are in the paper

01:54:00.300 | for you to peruse online through the link

01:54:03.000 | I mentioned before.

01:54:03.980 | So they had four different groups.

01:54:05.160 | They had one group apply peppermint oil,

01:54:08.900 | but that peppermint oil also contained eucalyptus oil.

01:54:12.020 | They had another group use just peppermint oil.

01:54:14.440 | They had another group use just tiny traces of peppermint oil

01:54:18.100 | and smaller doses of eucalyptus oil.

01:54:21.160 | And then they had a fourth group,

01:54:22.720 | which was just using placebo.

01:54:24.820 | When I say using, what they were doing

01:54:26.100 | is they were sponge applying the oil

01:54:29.320 | to the temples and forehead of people.

01:54:31.960 | And then what they did

01:54:33.400 | is they used these different approaches

01:54:35.640 | to measure the activation of muscles, to measure pain,

01:54:40.360 | and they then induced head pain, they induced headache.

01:54:44.540 | So, and they looked at the temporal muscles on the side,

01:54:46.700 | they looked at forehead muscles, things of that sort.

01:54:48.740 | So they used three different types of pain stimuli.

01:54:51.260 | They looked at people's sensitivity

01:54:53.760 | to experimentally induced pain by either providing pressure.

01:54:58.760 | So this was kind of a cuff around the forehead

01:55:02.120 | or thermal pain.

01:55:03.460 | So they actually had them basically heated up

01:55:06.960 | at the level of the skin.

01:55:08.360 | And actually they brought the heat up pretty high

01:55:12.040 | to the point where people were rating the pain

01:55:14.080 | almost to the point of excessive pain and pain limits.

01:55:17.580 | So they obviously couldn't take them

01:55:19.000 | to the point of extreme pain.

01:55:20.760 | And they had a constriction type condition

01:55:24.100 | in which they cut off blood circulation

01:55:26.120 | to the pericranial muscles

01:55:27.600 | using an inflatable collar around the cranium

01:55:30.080 | and they inflated that to pretty high pressure.

01:55:32.360 | So kind of a brutal experiment to be involved in,

01:55:35.640 | but look, they're trying to mimic headache.

01:55:37.240 | And I think by using these different approaches,

01:55:40.040 | they're able to mimic the different aspects of headache

01:55:42.160 | and make sure, and here's the key point,

01:55:44.520 | that every person in the study

01:55:46.280 | is not just getting the same treatment for headache,

01:55:48.160 | but is getting the same headache.

01:55:49.680 | And that's something that I think gives this study power.

01:55:52.440 | It's not the only way to do a study like this,

01:55:54.040 | but it gives it a lot of power in trying to understand

01:55:56.600 | which types of interventions are going to assist

01:55:58.960 | in headache and maybe even specific dimensions

01:56:01.220 | of the pain and headache.

01:56:02.280 | And basically what they found in the study

01:56:04.360 | is that of all the treatments they used,

01:56:06.520 | the essential plant oil preparations

01:56:08.840 | that contained peppermint,

01:56:11.480 | and I'll just mention as an aside,

01:56:13.440 | and in other studies, menthol,

01:56:15.480 | so these minty type essential, what we think of as flavors,

01:56:20.480 | but are really aromas as well.

01:56:23.400 | And as I'll point out the mechanism in a moment,

01:56:25.820 | they had the effect of significantly reducing

01:56:27.880 | the intensity of the pain.

01:56:29.060 | That is, subjects could tolerate the pain far better

01:56:31.820 | and experienced less pain subjectively.

01:56:34.600 | And the magnitude of the effects

01:56:36.080 | were really pretty impressive.

01:56:37.560 | Again, I went into all of this thinking essential oils,

01:56:39.600 | okay, that's like some really woo stuff.

01:56:41.800 | You know, I don't know about that,

01:56:43.800 | but it turns out that these essential oils,

01:56:47.320 | at least the ones that contain peppermint oil

01:56:49.680 | with or without eucalyptus oil

01:56:51.760 | performed very well in reducing pain.

01:56:54.120 | The key takeaway from the study is,

01:56:55.740 | and here I'm paraphrasing from the study

01:56:57.280 | that the combination of peppermint oil, eucalyptus oil,

01:57:00.920 | and these are basically in a ethanol suspension.

01:57:03.600 | Again, people are not drinking these essential oils.

01:57:05.880 | I want to be very clear.

01:57:06.720 | They're applying these to the skin

01:57:09.480 | around the area that's in pain

01:57:11.180 | and particularly the temple and the foreheads.

01:57:14.080 | Increased cognitive performance.

01:57:15.540 | I didn't talk about that,

01:57:16.420 | but this is the ability to maintain cognitive functioning

01:57:18.980 | while in pain.

01:57:19.820 | You know, here we're talking about headache up until now,

01:57:22.720 | just as kind of pain,

01:57:24.360 | but that pain can be very debilitating

01:57:26.440 | for your ability to work and perform and do other things.

01:57:28.960 | So this combination of peppermint oil and eucalyptus oil

01:57:32.100 | applied to the skin

01:57:33.380 | allowed people to increase their cognitive performance

01:57:35.580 | while under pain,

01:57:36.440 | and it had a very muscle relaxing

01:57:39.480 | and mentally relaxing effect.

01:57:40.960 | Mental relaxation was of course measured subjectively,

01:57:43.920 | but remember one of the things

01:57:45.140 | that led me to feature this study

01:57:47.800 | in this episode in particular is that

01:57:49.720 | they didn't just say, "Oh, my muscles feel more relaxed."

01:57:52.080 | They actually saw that the muscles

01:57:54.440 | of the forehead and temples

01:57:56.120 | and some surrounding muscles were more relaxed

01:57:58.680 | when people had these oils applied to their forehead

01:58:02.460 | and the temples.

01:58:03.640 | Not perhaps to the same degree

01:58:05.380 | that one would observe with Botox

01:58:07.340 | or for the same extent or duration

01:58:09.060 | as one would experience with Botox,

01:58:10.540 | but much in the same way,

01:58:12.040 | which then raises the question of,

01:58:13.440 | well, what's going on here?

01:58:14.420 | I mean, is this all placebo effect?

01:58:15.740 | Well, no, because they compared to placebo

01:58:17.560 | and they controlled for the odor, of course,

01:58:20.300 | of the oil that was applied

01:58:21.520 | so that everyone thought that they were getting

01:58:23.920 | essentially the same thing, pun intended.

01:58:27.040 | But in this case, what they found

01:58:29.140 | is that if they applied the essential oil

01:58:32.960 | to the forehead and temples,

01:58:34.940 | that people experience more or less a cooling sensation

01:58:38.620 | or they could feel as if something was happening

01:58:40.540 | in the underlying muscle.

01:58:41.860 | Well, what was happening?

01:58:43.100 | We now know that menthol, peppermint,

01:58:46.300 | and other things that smell that way and taste that way

01:58:49.840 | actually have an impact on the sensory neurons

01:58:51.960 | at the level of the skin

01:58:53.760 | and can actually inhibit certain sensory neurons

01:58:57.080 | and can activate other sensory neurons.

01:58:59.760 | Okay, so in order to understand this,

01:59:01.880 | we have to go back to what I said

01:59:02.960 | at the beginning of the episode,

01:59:03.960 | which is that you have motor neurons.

01:59:05.260 | These are neurons that constrict muscles,

01:59:06.780 | or excuse me, that cause contraction of muscles.

01:59:10.480 | They don't constrict them.

01:59:11.320 | They cause contraction of muscles.

01:59:12.700 | You have sensory neurons, which sense different things,

01:59:15.080 | light, sound, or touch, and you have modulatory neurons.

01:59:19.200 | Menthol and eucalyptus are actually known

01:59:21.380 | to activate certain channels in the sensory neurons

01:59:25.040 | that respond not just to touch,

01:59:27.020 | but also the sensation of cooling.

01:59:29.440 | Okay, so when we think of menthol and peppermint,

01:59:31.480 | we think of kind of cool scents and flavors,

01:59:34.720 | cool meaning cold.

01:59:36.520 | And when we think of things like hot peppers, capsaicin,

01:59:40.120 | we think of anything that has a hot temperature,

01:59:42.760 | we tend to think of spicy.

01:59:44.160 | So spicy and hot go together,

01:59:46.020 | and peppermint and menthol and cool go together,

01:59:50.680 | much in the way that the gum commercials

01:59:53.100 | or the mint commercials would lead you to believe,

01:59:55.300 | and in fact, they're right.

01:59:57.000 | So what's happening here is that the application

01:59:58.960 | of these oils is very likely activating channels

02:00:01.260 | in these sensory neurons, including the TRIP channels,

02:00:03.080 | but others as well, that are leading to the energies

02:00:05.840 | effect by shutting down the heat and pain pathways,

02:00:10.660 | because heat and pain, while they're not exactly the same

02:00:13.640 | in our nervous system,

02:00:14.700 | they are funneled through common pathways,

02:00:17.280 | whereas cooling and pain relief are funneled

02:00:20.440 | through alternate, what we call parallel pathways.

02:00:23.160 | So the study on peppermint and eucalyptus oil preparations

02:00:26.960 | in reducing pain of headache

02:00:30.240 | and different aspects of pain due to headache,

02:00:32.400 | I think are really important

02:00:33.680 | because they don't just illustrate the fact

02:00:35.440 | that yes, indeed, I'll go on record saying it,

02:00:38.020 | 'cause that's what the data say,

02:00:39.040 | and there are other papers

02:00:40.360 | to support this statement as well.

02:00:41.980 | Essential oils applied to the skin can reduce the symptoms

02:00:44.940 | of tension headache in a significant way,

02:00:46.800 | and actually can lead to some offset

02:00:49.060 | of some of the cognitive defects seen with headaches.

02:00:52.200 | So that's itself very impressive, I must say,

02:00:55.200 | but surprising for me, kind of put me in my place

02:00:57.140 | as somebody who thought, oh, essential oils

02:00:58.680 | is going to be like, okay,

02:01:00.100 | but it's actually seemed to really hold some merit.

02:01:02.840 | And when you compare the magnitude of the effect,

02:01:05.120 | even though this wasn't an enormous number of subjects,

02:01:07.540 | you compare the magnitude of the effect

02:01:09.480 | in a paper like this or similar papers

02:01:11.640 | on these essential oils

02:01:12.720 | to the impact of non-steroid anti-inflammatory drugs,

02:01:15.880 | and they really hold their own,

02:01:17.360 | and in some cases exceed the positive impact

02:01:20.400 | of anti-inflammatory drugs.

02:01:22.180 | So for that reason, I think we can look at peppermint oils

02:01:24.960 | and peppermint and eucalyptus containing oils,

02:01:27.080 | menthol containing oils applied to the skin

02:01:29.600 | for the treatment of tension type headache

02:01:31.680 | as among the more potent treatments available out there.

02:01:34.880 | Now, another way to approach treatment of tension headache

02:01:37.920 | is something that many of you

02:01:38.920 | have probably heard about before.

02:01:41.000 | And then I've talked a little bit about on this podcast

02:01:43.360 | in previous episodes, and that's acupuncture.

02:01:45.760 | We will do an entire episode all about acupuncture,

02:01:48.240 | but much in the same way that essential oils,

02:01:50.760 | I think for many people, not all,

02:01:52.380 | but for many people are considered kind of a woo biology

02:01:55.480 | or people think of it as very alternative medicine.

02:01:57.840 | Keep in mind that as the underlying mechanisms

02:02:01.160 | of things like these peppermint oils

02:02:02.680 | are starting to be discovered

02:02:03.720 | or omega-3s are starting to be discovered,

02:02:06.000 | mechanistically, they hold up very well.

02:02:08.060 | There's a logic there.

02:02:09.080 | There's an underlying understanding

02:02:11.280 | of not just why they should work,

02:02:13.360 | but in many cases, how they work.

02:02:15.480 | In the same way, acupuncture,

02:02:17.260 | which of course has existed for thousands of years,

02:02:19.720 | has been used very successfully

02:02:21.920 | to treat headache and other forms of pain,

02:02:24.100 | so much so that many insurance companies

02:02:26.680 | will now pay for acupuncture as an insured practice,

02:02:30.560 | not all, but many will.

02:02:32.320 | And in addition to that,

02:02:34.080 | the scientific community is starting to understand

02:02:36.000 | mechanistically how acupuncture works.

02:02:37.840 | So I don't want to make this the major focus for now,

02:02:40.920 | but very briefly, there's a laboratory

02:02:44.280 | at Harvard Medical School run by Chufu Ma.

02:02:47.040 | Chufu is well-known in the neuroscience community

02:02:49.600 | for doing excellent work in parsing the mechanisms

02:02:53.440 | of touch sensation and pain in particular.

02:02:56.720 | So not just touch at the level of skin,

02:02:58.200 | but pain and pain pathways.

02:02:59.880 | And in recent years,

02:03:00.800 | his laboratory has started to do studies

02:03:02.840 | on how acupuncture works,

02:03:04.680 | because indeed acupuncture has been known to work

02:03:07.140 | to alleviate pain for a long time,

02:03:08.580 | but the underlying mechanisms haven't been clear.

02:03:11.480 | What Chufu's lab has published now in excellent journals

02:03:14.280 | like "Nature," "Science," and other journals

02:03:16.880 | is that the precise insertion sites of different needles

02:03:21.880 | lead to activation of sensory neurons

02:03:25.760 | and their downstream pathways

02:03:27.160 | in ways that can potently reduce inflammation

02:03:29.720 | and that can be used to potently reduce the activity

02:03:33.500 | of certain muscles.

02:03:35.560 | For instance, muscles in the forehead and temples.

02:03:38.380 | So when you hear acupuncture can reduce pain,

02:03:40.880 | I think some people think,

02:03:41.720 | "Oh, well, if there's needles sticking out of your face,

02:03:43.580 | first of all, that must hurt."

02:03:44.420 | And actually the needles are very fine needles

02:03:46.120 | and skilled acupuncturists can insert them

02:03:48.160 | without any pain or actually the person receiving it

02:03:51.200 | doesn't even usually recognize that the needles are in.

02:03:53.880 | That's how quickly and efficiently they can put them in

02:03:56.840 | and people don't detect any pain.

02:03:58.740 | But that has been shown to greatly reduce pain

02:04:02.340 | in particular headache-related pain and back-related pain

02:04:06.060 | and some other forms of pain.

02:04:07.600 | Chufu's lab has shown

02:04:09.300 | that the specific needle insertion sites

02:04:11.780 | can activate the sensory pathways

02:04:14.140 | and can deactivate the sensory motor pathways,

02:04:18.620 | and now you're familiar with sensory neurons,

02:04:20.220 | motor neurons, and modulatory neurons,

02:04:22.040 | and can modulate the activity of the pain pathways

02:04:26.560 | by way of impacting the activity of all sorts

02:04:29.180 | of different organs, including organs that give rise

02:04:31.640 | to some of the inflammatory cytokines.

02:04:33.580 | So basically what I'm saying here

02:04:35.340 | is that thanks to thousands of years of acupuncture

02:04:38.840 | and the maps of different insertion sites,

02:04:41.120 | we now know, or I should say people have long known

02:04:44.440 | and people in the West are starting to adopt

02:04:47.320 | the understanding that acupuncture,

02:04:49.100 | yes, indeed, it really does work for relieving pain.

02:04:51.960 | And laboratories, both in the United States,

02:04:54.060 | such as Chufu's and elsewhere,

02:04:56.480 | are starting to find the underlying mechanisms.

02:04:58.460 | And those mechanisms include deactivation

02:05:01.920 | of the pain pathways,

02:05:03.620 | activation of some of the parallel pathways

02:05:05.880 | that assist in shutting down pain

02:05:07.980 | or in relaxing the muscles

02:05:09.780 | that are causing tension type headache,

02:05:11.520 | as well as activation of neural pathways

02:05:15.440 | that impinge on organs that then cause

02:05:18.040 | or reduce the release of molecules into the body

02:05:21.120 | that give us the experience of pain.

02:05:22.440 | So reduced inflammation and in many cases,

02:05:24.560 | increasing anti-inflammatory pathways.

02:05:27.540 | So I just wanted to be sure to mention acupuncture

02:05:30.440 | and a little bit of mechanistic understanding

02:05:32.280 | of why acupuncture works,

02:05:33.640 | because indeed acupuncture is shown to be quite effective

02:05:36.560 | for the treatment of tension type headache

02:05:38.200 | and to some extent, migraine headache as well.

02:05:40.700 | So we talked about omega-3 fatty acids.

02:05:42.900 | We talked about essential oils.

02:05:44.420 | We talked about acupuncture.

02:05:46.520 | So this episode is starting to sound

02:05:47.940 | like alternative treatments to headache, including migraine,

02:05:51.460 | but I want to be very clear.

02:05:53.720 | This is not about alternative treatments.

02:05:56.140 | Everything that I'm talking about here

02:05:57.440 | has a mechanistic basis.

02:05:59.660 | And what we're talking about today

02:06:01.660 | are approaches to dealing with headache

02:06:04.100 | that yes, are typically over-the-counter compounds

02:06:07.760 | or are grounded in nutrition

02:06:09.820 | or in the case of acupuncture, behavioral practices,

02:06:13.080 | but that are not necessarily meant as replacements

02:06:16.640 | for things like non-steroid and inflammatory drugs

02:06:18.980 | or prescription drugs.

02:06:19.920 | Of course, those things can still be taken.

02:06:21.960 | Many people derive benefit from them,

02:06:24.080 | but the goal is always, I believe,

02:06:26.660 | or I should hope, for people to find ways

02:06:29.060 | that they can control their health outcomes

02:06:31.640 | and reduce things like headache

02:06:33.640 | using a minimum number of things

02:06:35.540 | that have other side effects.

02:06:37.560 | And that of course can also include the use of essential oils

02:06:40.660 | in conjunction with things

02:06:41.820 | like non-steroid anti-inflammatory drugs

02:06:44.100 | or the use of red light to offset photophobia

02:06:46.560 | in conjunction with any number of different treatments,

02:06:49.640 | either prescription or otherwise.

02:06:51.100 | So I do want to make that clear.

02:06:52.580 | And I especially want to make that clear

02:06:53.900 | as I transition to the next segment

02:06:56.100 | where I'm going to tell you

02:06:57.040 | about herbal treatments for migraine.

02:06:59.660 | And this is based on what I consider

02:07:01.580 | a very comprehensive review

02:07:04.020 | of many randomized control studies.

02:07:06.660 | Indeed, the title of the paper

02:07:07.880 | is "Herbal Treatments for Migraine,

02:07:09.260 | "A Systematic Review of Randomized Controlled Studies."

02:07:12.220 | And this was published in 2020,

02:07:14.020 | and this contains an immense amount of information.

02:07:16.620 | So we will provide a link to it

02:07:18.420 | for those of you that really want to dive deep on this.

02:07:20.480 | In this paper, they focus on a number of different reviews

02:07:23.240 | and analysis of data focused on compounds

02:07:25.740 | for the treatment of migraine,

02:07:27.140 | ranging from and including things like menthol

02:07:30.640 | and peppermint oil.

02:07:31.700 | So we already covered that,

02:07:32.640 | so I won't cover that again in detail.

02:07:34.140 | But in this review, they highlight the results

02:07:37.120 | I referred to before plus other results

02:07:39.440 | that show that menthol and peppermint oil

02:07:41.960 | can be quite effective in the treatment

02:07:44.060 | of tension type headache,

02:07:45.660 | and in this case, migraine headache as well.

02:07:48.440 | So that's interesting that menthol and peppermint oils

02:07:51.040 | can be used not just to treat tension type headaches,

02:07:54.060 | but migraine headaches as well.

02:07:56.880 | And they look at an enormous number of other types

02:07:59.900 | of herbal and essential oil type treatments,

02:08:02.460 | everything from coriander to citron to damask rose,

02:08:05.780 | chamomile, lavender, a bunch of things.

02:08:07.620 | So I'm not going to go through each and every one of these

02:08:10.340 | in a lot of detail.

02:08:11.940 | What I've tended to do today and I'm going to do now

02:08:14.300 | is to highlight the most potent

02:08:16.220 | of these different treatments.

02:08:18.980 | Again, menthol peppermint oil being among the most potent.

02:08:22.220 | In addition to that, there's a particular pathway

02:08:25.080 | that's associated with headache.

02:08:27.460 | And when I say that, I mean the different types of headache,

02:08:30.760 | which includes the activation of this thing

02:08:33.180 | that we call CGRP.

02:08:34.420 | CGRP, again, is involved in this calcium regulation pathway

02:08:37.740 | and leads to vasodilation of the vessels

02:08:41.940 | and arteries and capillaries

02:08:43.580 | in a way that can create pain

02:08:44.820 | and this feeling of pressure inside the head,

02:08:47.360 | which can be very uncomfortable, of course.

02:08:49.900 | Now, earlier in the episode,

02:08:51.620 | I mentioned that I was going to touch on caffeine.

02:08:54.660 | And so I'm going to do that now.

02:08:56.300 | Now, the reason I mentioned caffeine

02:08:57.780 | is that there's a sort of lore out there

02:09:00.520 | that if you have a headache,

02:09:01.740 | drinking a cup of coffee can eliminate that headache.

02:09:05.020 | A few things about that point.

02:09:06.300 | First of all, if you are somebody

02:09:08.220 | who ingests caffeine every day

02:09:11.020 | and you do not ingest caffeine,

02:09:13.100 | you will indeed get a headache

02:09:15.060 | and drinking caffeine will relieve that particular headache.

02:09:18.600 | So it's absolutely true that caffeine can relieve

02:09:21.300 | the lack of caffeine induced headache.

02:09:23.860 | That's sort of a duh.

02:09:25.220 | But that leads actually to a very important question,

02:09:29.300 | which is why would that be the case?

02:09:30.980 | Well, it turns out that caffeine is both a vasodilator

02:09:35.300 | and a vasoconstrictor.

02:09:38.020 | How does it do that?

02:09:38.900 | Well, one of the main ways in which caffeine

02:09:41.040 | makes us more alert is that it occupies the receptors

02:09:44.380 | for something called adenosine.

02:09:45.660 | Adenosine is a molecule that builds up in the brain and body

02:09:48.820 | more and more the longer we've been awake.

02:09:50.800 | It's one of the things that makes us feel sleepy.

02:09:53.680 | So when we drink caffeine,

02:09:55.260 | that caffeine occupies the adenosine receptor

02:09:57.900 | and the adenosine cannot have its normal effect

02:10:00.060 | of making us sleepy.

02:10:01.320 | When that caffeine wears off,

02:10:02.560 | the adenosine combine and we feel sleepy.

02:10:05.020 | Adenosine is a vasodilator.

02:10:08.120 | So when we drink caffeine,

02:10:09.900 | because it blocks the effects of adenosine,

02:10:12.580 | there is a vasoconstriction

02:10:14.920 | associated with drinking caffeine.

02:10:17.020 | So if you have a headache that is associated

02:10:19.300 | with excessive vasodilation and pressure in the head,

02:10:22.080 | indeed drinking some caffeine can cause some vasoconstriction

02:10:26.280 | by preventing that adenosine pathway

02:10:28.720 | that would normally lead to vasoconstriction

02:10:30.440 | and you can get some relief from that headache.

02:10:32.580 | However, caffeine is also a vasodilator.

02:10:35.940 | Caffeine has the ability to impinge

02:10:37.860 | on the so-called NO pathway, the nitric oxide pathway,

02:10:40.880 | which is a nerve to blood pathway

02:10:43.920 | that involves a few different enzymes

02:10:45.360 | that we won't get into right now,

02:10:46.420 | but maybe in a future episode

02:10:48.400 | that causes dilation of the blood vessels.

02:10:51.060 | And as a consequence,

02:10:52.000 | drinking caffeine can also increase vasodilation.

02:10:54.440 | So it's sort of a two-pronged effect.

02:10:56.320 | Now, one of the ways in which you might think about this

02:10:59.020 | and perhaps utilize this is that if you are well-rested

02:11:03.020 | or if it's early in the day

02:11:04.380 | and you've had some sleep the previous night,

02:11:07.040 | adenosine levels are very likely to be low,

02:11:09.800 | especially if you slept very well the night before.

02:11:12.400 | Under those conditions, when you ingest caffeine,

02:11:16.260 | you are not going to experience

02:11:18.200 | the vasoconstriction effects of caffeine

02:11:21.520 | that would ordinarily be there by inhibiting adenosine.

02:11:24.660 | Why?

02:11:25.500 | Because adenosine is not present at all.

02:11:27.760 | And under those conditions,

02:11:28.840 | drinking coffee ought to lead to some vasodilation.

02:11:31.920 | Not a lot, but nonetheless vasodilation.

02:11:35.160 | If, however, you haven't slept well

02:11:37.120 | or it's late in the day

02:11:37.960 | and you've been up for a long time,

02:11:39.000 | drinking caffeine is likely to have

02:11:40.680 | more of a vasoconstriction effect.

02:11:42.520 | And this is important

02:11:43.680 | because some of the treatments that you hear about

02:11:45.640 | that involve using caffeine to treat headache

02:11:48.280 | are as extreme as, okay, if you have a headache at night,

02:11:50.840 | drink a cup of coffee and then go to sleep.

02:11:52.560 | I actually saw that in the literature,

02:11:53.980 | which I couldn't quite believe because yes, indeed,

02:11:56.920 | some people can fall asleep after drinking caffeine,

02:11:58.760 | but we know very well,

02:12:00.240 | thanks to the beautiful work and science communications

02:12:03.040 | of people like Dr. Matthew Walker from University of

02:12:05.400 | California, Berkeley,

02:12:06.560 | and who's been a guest on this and many other podcasts

02:12:09.260 | that even if you can fall asleep after drinking caffeine,

02:12:12.080 | ingesting caffeine within the 10 to 12 hours

02:12:14.220 | prior to bedtime is simply not a good idea

02:12:15.940 | because of the ways it disrupts the architecture of sleep.

02:12:18.500 | So what's the takeaway about caffeine and headache

02:12:20.760 | and vasodilation?

02:12:22.080 | You need to be very clear on whether or not

02:12:25.040 | caffeine tends to remove your headache or exacerbate it.

02:12:27.720 | Now, this is going to depend on time of day

02:12:29.440 | and the amount of adenosine in your system,

02:12:30.860 | as I mentioned before,

02:12:31.700 | but also there seems to be a kind of bimodal distribution

02:12:34.940 | whereby some people, when they drink caffeine,

02:12:36.900 | it really improves their headache.

02:12:38.920 | And so in some cases, very significant effects,

02:12:41.480 | whereas other people, when they drink caffeine,

02:12:42.980 | it really exacerbates their headache.

02:12:44.880 | And as least as far as I could tell from the literature,

02:12:47.320 | it's not easy to predict who those people are going to be.

02:12:50.540 | What is reassuring, however,

02:12:52.080 | is it does not seem to be the case that if you're somebody

02:12:54.740 | who experiences relief from headaches by drinking caffeine,

02:12:57.780 | that suddenly one day to the next,

02:13:00.320 | you're going to experience a worsening of your headache

02:13:02.860 | and vice versa is also true.

02:13:04.480 | So if you're somebody that drinks caffeine

02:13:06.480 | and your headaches get worse,

02:13:07.720 | I don't think there's any reason to think

02:13:08.900 | that caffeine one day or from one day to the next rather

02:13:11.860 | is going to somehow alleviate your headache.

02:13:13.460 | So you have to determine for yourself

02:13:14.760 | whether or not headaches are relieved or exacerbated

02:13:17.160 | by drinking caffeine.

02:13:18.300 | And if you're wondering why it's so confusing,

02:13:19.800 | it's because caffeine hits both the vasodilation

02:13:21.780 | and the vasoconstriction pathways,

02:13:23.680 | and there's nothing you or I or anyone else can do about it.

02:13:26.360 | Now, the last thing I'd like to talk about

02:13:27.780 | in terms of relief for headaches

02:13:29.680 | is something that I'm guessing about

02:13:32.060 | probably 25% of you are familiar with

02:13:33.880 | and 75% of you are not, which is curcumin.

02:13:37.100 | Curcumin is often also referred to as turmeric

02:13:40.200 | and turmeric is a root

02:13:41.860 | and curcumin is one of the key components of that root.

02:13:44.740 | Curcumin is known to have

02:13:46.620 | very potent anti-inflammatory properties.

02:13:50.300 | I don't think that's debated at all.

02:13:51.940 | In fact, it's so potent as an anti-inflammatory

02:13:54.760 | that some people have cautioned against taking

02:13:57.220 | high levels of curcumin prior to, for instance,

02:13:59.800 | resistance training workouts or even cardiovascular workouts

02:14:02.360 | because it so prevents inflammation

02:14:05.040 | that it also can prevent the adaptation response.

02:14:08.480 | Because remember, the inflammation that occurs

02:14:10.380 | during exercise, both resistance and cardiovascular exercise

02:14:13.720 | is at least in part the trigger for the adaptation

02:14:18.420 | that it's going to lead to enhanced endurance,

02:14:20.640 | enhanced strength, hypertrophy, et cetera.

02:14:22.680 | Nonetheless, curcumin has been explored

02:14:24.600 | in the context of treatment of migraine

02:14:26.240 | and it's one of the compounds that was analyzed

02:14:29.140 | in extensive detail in this wonderful review

02:14:31.520 | that I mentioned a little bit earlier.

02:14:33.360 | What I like about this study is that they were able to

02:14:35.480 | explore the effects of curcumin

02:14:37.520 | as explored in previous research studies

02:14:40.480 | and compare those across a large range of different dosages

02:14:44.660 | and a large range of combinations

02:14:47.480 | with other things like coenzyme Q10,

02:14:49.280 | which we've talked about on this podcast before.

02:14:50.960 | But I think for sake of this discussion,

02:14:52.960 | just really focusing on what curcumin does alone

02:14:57.080 | or in conjunction with the omega-3 fatty acids

02:15:00.300 | is what turns out to be the most interesting.

02:15:02.020 | First of all, curcumin has been shown to be

02:15:04.600 | generally safe for most people

02:15:06.600 | at dosages as high as 8,000 milligrams per day

02:15:10.120 | or eight grams per day.

02:15:11.460 | Now, I want to be very clear.

02:15:12.660 | I do not recommend that anyone take dosages of curcumin,

02:15:16.520 | AKA turmeric, that are that high.

02:15:18.600 | Why?

02:15:19.440 | Because curcumin and turmeric not only are anti-inflammatory

02:15:24.000 | but they also can impinge on other pathways

02:15:26.000 | in particular hormonal pathways.

02:15:28.280 | And in fact, curcumin, AKA turmeric,

02:15:31.460 | can alter the synthesis of something called

02:15:35.120 | dihydrotestosterone.

02:15:36.400 | Dihydrotestosterone is involved in an enormous range

02:15:38.880 | of different bodily functions.

02:15:40.120 | It's involved in libido.

02:15:41.500 | It's involved in men and beard growth

02:15:43.640 | and in the regulation of a number of different tissues,

02:15:46.900 | both in the reproductive axis

02:15:48.320 | and outside the reproductive axis.

02:15:49.840 | And curcumin is a potent inhibitor of DHT.

02:15:53.600 | So I do want to caution that people who take high doses

02:15:56.380 | of curcumin and some people who are very sensitive

02:15:58.480 | to curcumin will even at low doses experience reductions

02:16:02.200 | in DHT that lead to things that they would not like,

02:16:05.520 | such as sufficient reductions in libido.

02:16:08.720 | However, curcumin has been shown to be effective

02:16:11.280 | as an anti-inflammatory and has been shown

02:16:13.760 | to be very effective in treating different types of headache

02:16:17.340 | in particular migraine headache.

02:16:18.840 | One of the ways in which curcumin does that is to inhibit

02:16:22.480 | this thing that I talked about a few minutes ago,

02:16:23.940 | which is nitric oxide or NO, which causes vasodilation.

02:16:28.080 | And in doing that can reduce the feeling

02:16:31.200 | that one has a lot of intracranial pressure, okay?

02:16:33.920 | So curcumin dosages come in an enormous range,

02:16:37.160 | as I mentioned before, dosages that range anywhere

02:16:39.860 | from 80 milligrams, taken 80 milligrams per day, that is,

02:16:44.120 | taken for eight weeks time, that's been examined.

02:16:46.720 | It's been explored at 80 milligram dosages,

02:16:49.140 | taken alongside two and a half grams

02:16:52.360 | of omega-3 fatty acids or omega-3 fatty acids alone

02:16:57.040 | and against placebo.

02:16:59.100 | And the general conclusion of these studies is

02:17:01.020 | that curcumin when taken at dosages of about 80 milligrams,

02:17:05.620 | although for those of you very sensitive to curcumin,

02:17:07.860 | probably as low as 25 or even 50 milligrams per day

02:17:11.480 | in conjunction with, although not necessarily

02:17:13.420 | at the same time, but taken daily alongside

02:17:17.520 | omega-3 fatty acids at two and a half grams per day

02:17:21.160 | led to significant improvements in migraine

02:17:25.400 | and other forms of headache, meaning both the frequency

02:17:28.080 | and the intensity of the headaches that occurred

02:17:30.260 | was greatly reduced.

02:17:31.560 | One important point about curcumin to keep in mind

02:17:34.480 | is that curcumin is known to inhibit something

02:17:36.360 | called cytochrome P450.

02:17:39.400 | That's associated with an enzymatic pathway

02:17:41.700 | and some other things that relate to blood coagulation.

02:17:44.960 | So for people that are taking medications

02:17:46.920 | that are anticoagulants to prevent clotting,

02:17:49.840 | you do need to be very cautious about using curcumin.

02:17:52.320 | And of course, with curcumin or any other supplements,

02:17:54.820 | you should always talk to your doctor prior to including it

02:17:57.520 | or removing it from your supplement regimen.

02:18:00.080 | So as you can see, there are a number of different things

02:18:02.300 | that in addition to prescription drugs

02:18:05.080 | and over-the-counter pain medications,

02:18:07.080 | things like non-steroid anti-inflammatory drugs,

02:18:09.940 | can really impact the different aspects of headache

02:18:13.480 | and different types of headache,

02:18:15.300 | in some cases, differentially.

02:18:16.480 | Now, today, we talked mainly about tension type

02:18:19.320 | and migraine type headaches,

02:18:20.460 | because those are the most common forms of headache.

02:18:22.840 | There are, of course, the cluster type headaches

02:18:24.720 | that are of neural origin, talked about hormonal headaches,

02:18:27.400 | and indeed, some treatments such as omega-3s,

02:18:29.840 | which have been shown to be beneficial

02:18:31.400 | for offsetting the menstrual-related headaches.

02:18:34.640 | Now, in the context of the discussion about omega-3s,

02:18:37.600 | keep in mind that omega-3s can be obtained

02:18:40.020 | from supplementation or from nutrition.

02:18:42.420 | So you don't necessarily have to take omega-3 capsules

02:18:45.820 | or liquid form omega-3s if you want to use omega-3s

02:18:48.860 | to target different symptoms of headache,

02:18:51.200 | but that probably is going to be

02:18:52.660 | the most efficient way to do it,

02:18:54.140 | given that many foods do contain omega-3s,

02:18:57.460 | but it's hard to get above that one gram dosage.

02:19:00.100 | And in fact, most of the studies that we talked about today

02:19:03.940 | involved getting two or even two and a half,

02:19:07.200 | or in some cases on this podcast with previous guests,

02:19:09.380 | such as Dr. Rhonda Patrick,

02:19:10.900 | she talked about the advantages

02:19:11.980 | of getting as high as three grams of omega-3s per day,

02:19:14.860 | which almost with certainty

02:19:16.540 | is going to require some external form of supplementation,

02:19:19.520 | even for those of you that are making a point

02:19:21.440 | to eat a fatty ocean fish with the skin on.

02:19:24.440 | So I just want to make sure that I highlight that.

02:19:26.380 | Before we wrap up, I can't help myself,

02:19:28.680 | but to talk about something

02:19:30.200 | that I heard about on the news several years ago,

02:19:32.040 | and it sounded too outrageous to be true,

02:19:33.700 | but then was confirmed as accurate

02:19:36.240 | by one of my neurologist colleagues.

02:19:37.940 | And that's the fact that eating certain very spicy peppers

02:19:42.060 | can induce headache,

02:19:43.920 | and in some cases can induce brain damage.

02:19:47.140 | And bear with me here,

02:19:48.460 | I'm not talking about your traditional jalapeno,

02:19:51.280 | and I'm acknowledging the fact that certain people

02:19:54.160 | can tolerate far more spicy tastes than do others.

02:19:58.540 | Some people are very sensitive to spicy,

02:20:00.120 | some people can tolerate very spicy food,

02:20:02.280 | and that one can build up a tolerance to spicy food

02:20:04.800 | by ingesting progressively spicier, excuse me,

02:20:07.480 | spicier and spicier foods over time.

02:20:10.760 | Nonetheless, there are these pepper eating contests

02:20:13.960 | out there that, while not very common, do exist,

02:20:17.120 | and people challenge each other to eat peppers

02:20:19.340 | of extreme spiciness.

02:20:21.320 | And there's one in particular that's referred to

02:20:23.440 | as the Carolina Reaper.

02:20:24.840 | By the way, that's not a person, as far as I know.

02:20:27.440 | That's a pepper, the Carolina Reaper,

02:20:29.480 | which is known to have the most potent spice of any pepper.

02:20:33.160 | And here's why you would not want to eat the Carolina Reaper.

02:20:36.040 | A few years ago at one of these pepper eating contests,

02:20:38.840 | man ate a Carolina Reaper as part of the competition,

02:20:42.980 | and suddenly experienced what's called

02:20:44.720 | thunderclap headache.

02:20:45.840 | Thunderclap headache is a unique type of headache,

02:20:49.000 | very different from all the other types of headache.

02:20:51.680 | It is not from the surface in, so it's not tension headache.

02:20:55.280 | It's not even the cluster type headache

02:20:57.100 | of the nerve activation of the trigeminal.

02:20:59.780 | It's actually a hyper constriction of the vasculature

02:21:03.500 | in the brain caused by the ingestion of the pepper,

02:21:06.580 | an inflammatory response.

02:21:08.340 | And remember that heat and spicy go together

02:21:11.460 | in these neural pathways,

02:21:12.940 | and a bunch of different heat-related

02:21:15.160 | and spice-related pathways get activated simultaneously

02:21:18.940 | when one ingests something of extreme spice,

02:21:21.300 | and the blood vessels, and indeed some of the

02:21:24.700 | smaller arteries feeding neural tissue shut down,

02:21:27.860 | and he experienced this thunderclap headache,

02:21:29.700 | which is a brutal headache, and sadly, in his case,

02:21:33.020 | permanent brain damage, so loss of neuronal tissue,

02:21:35.420 | because neuronal tissue is very metabolically active.

02:21:37.620 | You cut off the blood supply to that tissue.

02:21:39.540 | Not only would you feel miserable, maybe even pass out,

02:21:43.540 | but lose vision, and certain brain areas

02:21:46.180 | will actually die off in the absence of

02:21:48.700 | a blood flow to those areas.

02:21:50.680 | We know this more commonly as stroke.

02:21:53.560 | So I don't want to strike fear in anybody

02:21:57.040 | about eating a jalapeno or even a very spicy meal

02:22:01.060 | from time to time, but if you're not somebody

02:22:02.840 | who's familiar with eating very spicy foods,

02:22:05.780 | you certainly don't want to enter one of these competitions

02:22:08.500 | and just realize that the pathways from menthol and cool

02:22:12.900 | or spicy and hot, those aren't just subjective pathways.

02:22:16.580 | These are actually neural pathways that, again,

02:22:18.820 | originate in our so-called, nerds call it

02:22:21.340 | the sensory epitheliums, so our skin, our hearing, our eyes,

02:22:25.820 | and that feed that information into the body

02:22:29.160 | to make use of that information.

02:22:31.160 | In some case, motor movements, so sensory motor.

02:22:33.060 | In other cases, the information can be fed

02:22:36.400 | through nerve pathways that goes to the vasculature

02:22:38.960 | and causes the vasculature to either dilate or constrict.

02:22:41.880 | These very spicy peppers causing, as I just mentioned,

02:22:44.280 | extreme cerebro of the head, vasoconstriction,

02:22:48.160 | and brain damage.

02:22:49.100 | Again, that's not going to be a common thing out there,

02:22:52.500 | but nonetheless, I encourage people to be very cautious

02:22:55.700 | about the Carolina Reaper.

02:22:57.480 | So today we talked about headaches,

02:22:59.780 | and first we highlighted the different types of headache,

02:23:02.540 | making it clear that understanding which headache

02:23:04.960 | you might be experiencing can be very beneficial

02:23:08.180 | for understanding which sorts of treatments

02:23:10.420 | ought to be best and perhaps also best avoided

02:23:13.940 | in trying to alleviate those headaches

02:23:15.920 | or prevent them from happening at all.

02:23:18.020 | We talked about tension headaches, migraine headaches,

02:23:19.960 | hormone-based headaches, cluster headaches,

02:23:22.240 | and traumatic brain injury-related headaches.

02:23:24.660 | We talked about different types of treatments

02:23:26.380 | ranging from creatine to omega-3 fatty acid supplementation,

02:23:30.740 | some herbal and indeed some essential oil treatments,

02:23:33.560 | as well as acupuncture, all of which have been shown

02:23:36.660 | to have significant impact in reducing the frequency

02:23:39.180 | and intensity of headaches.

02:23:40.460 | And in many cases, reductions in the frequency

02:23:43.100 | and intensity of headaches that are at least as great

02:23:45.660 | as the results that are seen

02:23:47.180 | with non-steroid anti-inflammatory drugs.

02:23:49.460 | Again, I want to highlight that none of these approaches

02:23:52.680 | are necessarily designed to be done on their own

02:23:55.120 | or in replacement of prescription drugs from your physician.

02:23:57.740 | There are excellent prescription drugs out there

02:23:59.640 | that your physician can prescribe for you

02:24:01.380 | for the treatment of headache.

02:24:02.940 | Nonetheless, I think many people

02:24:04.780 | who are listeners of this podcast

02:24:06.020 | are interested in the things that they can do

02:24:07.940 | in order to inoculate themselves

02:24:10.200 | or at least reduce the likelihood of experiencing headache,

02:24:13.280 | especially for people who are experiencing

02:24:15.740 | chronic recurring headaches,

02:24:17.900 | such as migraine or the other forms of headache,

02:24:19.900 | which can be so debilitating.

02:24:21.540 | Thank you for joining me for today's discussion.

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02:26:30.700 | Thank you once again for joining me for today's discussion,

02:26:32.860 | all about the science and treatment of headaches.

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How to Stop Headaches Using Science-Based Approaches | Huberman Lab Podcast

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