Headaches: When to Worry and When to Relax

[0:00] If your head hurts every time you got to pay the bills, is that a medical condition or is that just self-preservation? Kathy: Depends. Do you also get sensitivity to light, nausea, and the urge to fake your own death? In that case, stay tuned because today we’re breaking down the different types of headaches, including the ones that you can handle and the ones that should send you running for help. And we’ll give you practical science-backed ways to shut down that pounding skull symphony without wrecking your liver. Plus, our game today is called Tournament of Brain Pain.

[0:33] Can’t wait. Stick around. This episode could save you from your next bad decision and your next bad headache. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Chiropractors and physical therapists don’t like each other. Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. I’m Dr. — I’m Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in PTCH.

[1:06] Oh, hello listeners and viewers. We’re back for another episode of the PTCH Podcast. Whoops. I’m one of your hosts. I’m Dr. Jason Young.

Kathy: And I’m back from break. This is Dr. Kathy Lynch.

Jason: Yeah, we’re so glad to have you here. This is so much fun. I think this is one of the funnest things that we do every single week. Right?

Kathy: Definitely.

Jason: Speaking of every single week, you know, a while ago we crossed a very important milestone. We passed our 26th episode. What’s the big deal about

[1:36] episode 26 on a weekly podcast?

Kathy: Half a year.

Jason: That’s half a year. We’ve done a lot of these. You could waste an entire day listening to us talk and still not get through all the episodes that we’ve done. 24 hours.

Kathy: This is amazing. How do we still have things to talk about, Kathy?

Jason: We got a lot of stuff. I — would you say that we’ve shared so much information. It’s enough to give one

Kathy: a headache.

Jason: A headache. Okay. Good.

[2:06] Well, I think that that’s maybe a good segue into what we’re talking about today. So, have you ever had a headache?

Jason: One time.

Kathy: One time. Okay.

Jason: Eighth grade.

Kathy: In eighth grade.

Jason: It was after the sit and reach test. Yeah. Were you beat by a child with a high top fade?

Kathy: I was somewhere in Oregon.

Jason: You know what’s amazing to me though? I think most people have had a headache at some point in their life, but I legitimately run into somebody every once in a while who has never

[2:37] experienced —

Kathy: Crazy.

Jason: It is crazy. Yeah. I mean, like sometimes I feel like just talking about headaches, I can produce one for myself.

Kathy: No doubt. No doubt.

Jason: Yeah. I used to get headaches all the time. Like when I was a kid, I got headaches like crazy. And some of them were really bad, some of them really debilitating,

Kathy: but man, I made one healthcare decision that ended up fixing most of my headaches.

Jason: Yes.

Kathy: I’m going to save that for later.

[3:07] Save it. Is it going to be behind the paywall?

Kathy: It’s going to be behind the paywall. Yes. Mm-hmm. No, but yeah, it’s a really complex topic and I think it’s also a topic where there’s a lot of people that wade into some pretty bad advice. And headaches, they could be debilitating. It could be something hanging out in the background. Either one of those could have the overall effect of wrecking your health if you’re not taking good proactive ways of

[3:38] identifying headaches and dealing with them the right way. So,

Jason: quick question though. Do people come to you for headaches? Like do physical therapists do a lot of headaches?

Kathy: Yes, actually.

Jason: Really? Tell me about that. Like do they come to you to get a headache or to fix a headache?

Kathy: I don’t know. I don’t think that that’s my knee-jerk reaction is like, “I’ve got a headache. Time to go see the physical therapist.” But do people —

Jason: Yeah.

Kathy: Yeah. Definitely. People come in, they’ll come in with tension

[4:08] headaches because the muscle behind their

Jason: skull

Kathy: is tender, causes headaches. The upper trap, that muscle can cause tension. And so people feel like that causes their headache. So they come to see if we can help mobilize their neck,

Jason: right?

Kathy: Yeah.

Jason: Yes. Okay, good. Well, it’s one of the most common complaints that people come to chiropractors with.

Kathy: I bet.

Jason: And sometimes people are actually surprised that chiropractors deal with headaches, but we deal with them a lot.

[4:40] And so, I think in this episode, I’m doing the heavy lifting for that reason. And we’ll even talk about headaches that are caused by heavy lifting. So, oh, here’s one of my big pet peeves, though, is when people say that they get a migraine. And it’s not because I don’t think that people get migraines, but I think that we use that word incorrectly. Like, “I’ve got a migraine.” And it’s like, yeah, you probably don’t.

Kathy: We’re sitting here talking like this and you’re like, “Ah, I’ve got a migraine.”

Jason: You just gave me a migraine.

[5:10] Oh, I’ve got a migraine. So, um, yeah, I guess we’ll just jump right into it. One of the things that’s important to understand about headaches is that there’s two types of headaches really. Like, you can break it down into two categories. There are primary headaches and there are secondary headaches. Now, that’s one way that you can divide up the almost 200 specific types

[5:40] of headaches that are out there. Yeah, 200. People usually think that there’s tension headaches and migraine headaches and that’s it, right? And maybe brain freeze every once in a while, right?

Kathy: Tension headaches, migraine headaches, brain freeze.

Jason: So, but there’s generally two classes, primary and secondary. And it’s important to understand the difference. So, a secondary headache is kind of the more dangerous type of headache in general. Mm-hmm.

[6:11] Jason: A secondary headache is when you get head pain, pain inside of your head, and it’s caused by another condition. For example, let’s get extreme. Maybe you’ve got a tumor, right? It’s like that scene from — what was it? — Kindergarten Cop. Kathy: Yes, Kindergarten Cop. Jason: Right? He’s like, “Oh, I’ve got a headache.” And the kid walks up: “Maybe you’ve got a tumor.” Kathy: “It’s not a tumor,” right? Jason: That’s a great example of a secondary headache. Kathy: And so we tend not to want those. We do not want the secondary ones. Jason: But there are some secondary headaches that are pretty benign. For example, the

[6:43] one that chiropractors deal best with is something called a cervicogenic headache, which we’ll get into exactly what that is. And then the other side of the fence, there are primary headaches. So after you’ve ruled out secondary headaches as a cause, then you start looking at primary headaches. And those are some of the ones that people think more about, like maybe a tension headache, for example, or, you know, like eye strain or dehydration — those types of things. Kathy: So when somebody comes to me and they

[7:15] have a headache, that’s my first task: is this a secondary headache? Is it a primary headache? Fortunately, the vast majority of them are primary headaches. Okay. So the way that we would separate those is we’re really looking for red flags, mostly. The red flags — there’s so many acronyms out there. I think the silliest one — there’s one called, I think it’s called SNOOP 10. Have you ever heard that? Kathy: I’ve never heard

[7:45] SNOOP. Jason: So, I mean, you know how it is with any sort of healthcare education. There’s a ton of acronyms and mnemonics and stuff like that. SNOOP 10 is one where, like, whenever you’re looking for red flag signs of a really bad or dangerous headache, people start with the S — like, I think it’s systemic symptoms. So are you having like fever, fatigue, nausea, those types of things.

[8:15] The N is — well, one of the N’s — I think there’s two N’s and then two O’s. There’s neoplasm, which is a word meaning cancer or like a tumor. Then the next one is, I think, nausea. And then after that there is “old,” right — if you’re old. So if you’re older, like over 50, and you have a new type of headache. Kathy: Oh yeah. Jason: Yeah. Oh,

[8:45] what’s P? Kathy: Oh, well, see, it is SNOOP 10 — there’s 10 P’s. Jason: Oh yeah, that’s what the 10 is about. There’s 10 P’s, right? Name one. Kathy: Like, is it progressive? Is it — you know, gosh, now I can’t remember. Oh, is it caused by a pharmaceutical? Like, because sometimes people get headaches as a side effect to medication. So the long and short of it is that there are some red flag symptoms that would make you think that you have a more serious headache.

[9:15] And so whenever you go and you talk to a doctor, these are the first questions that you’re going to get — like, do you have any other serious symptoms like nausea, fever, stiffness in your neck? Is this a unique headache? Like, have you had a headache like this before? There’s something called a thunderclap headache. Kathy: Oh yeah. Jason: Yes. You’ve heard of that before? Kathy: Yeah. So a thunderclap headache is a headache that will come on just in an instant — Jason: instantly.

[9:45] Kathy: And it’s severe. It’s going to get your attention. You can’t just like push through a thunderclap headache. Jason: And we worry about that whenever it is something that’s new. Like, if you don’t typically get this type of headache and it’s just like bam, all of a sudden you have one. Sometimes it is associated with things like physical exertion. Sometimes people are like lifting something heavy, or like really engaging their core and, like, a Valsalva — where you’re bearing down and kind of holding your breath — and then you get that thunderclap

[10:16] headache. That’s one that you worry about. Sometimes people — this will happen during like sexual intercourse — like somebody gets a sudden headache. Those are like more dangerous ones. That’s one where it’s like, “Okay, let’s get this checked out.” Kathy: Usually exertional. Jason: Yeah, usually exertional. So those are the types of things that would kind of give you a red flag, and it’s like, “Okay, we got to look into something that’s maybe more serious.” And I think that I want to talk about those and get those out of the way, because the other side of the story is once you get past those, a lot of

[10:47] headaches are really kind of pretty benign, maybe just annoying, Kathy: right? Jason: And there’s some ways to deal with them, ways not to deal with them. Kathy: And remember, I said there’s over 200 specific types of headaches. So we really got to work fast, because I want to get into detail about all 200. Jason: Okay, let’s go. No, we’re just going to hit a few of them. Kathy: Clock is ticking. Jason: The clock is ticking. Shoot. What should we start with? Like the tension, the migraine, like —

[11:17] Kathy: Well, let me ask you this. When a patient comes in and gives you their history, what are the things that you listen for when they’re talking about headaches to help you figure that out? Jason: Yeah. Okay. So, straight to those secondary symptoms. So, if, like, let’s say that you’re coming in and you’re already an existing patient and you’re like, “Man, I’m coming in because I got a headache this week.” Right? First thing I’m going to think about — if I’ve been working with you for a while — is, “Do you usually get headaches? Are you somebody who usually gets headaches?”

[11:47] Jason: And if you do get headaches all the time, then it kind of lowers our suspicion, because the question that we ask then is, “Does this feel like the type of headache that you usually get?” And if it’s yes, probably going to be okay. But if you’re describing something like a thunderclap headache, or “This is the worst headache I’ve ever had in my life,” I’m going to perk up and we’re going to listen some more. We’re going to ask things like, have you been doing anything differently? Like, has your routine changed? Have you had a change of medication? You know, how

[12:17] How is your sleep? Have you been getting enough hydration? Have you eaten any foods that you’re not used to? We ask about things like sensitivity to light, nausea, stiffness in the neck, fever, those kinds of things, because those are the things that are going to help us to kind of parse out like, are you in danger?

Kathy: Right.

Jason: Fortunately, most people say no. And I have had some times though when I have sent people up to the ER because there are some things that are kind of worrisome.

[12:48] Kathy: Too many red flags.

Jason: Yeah. And we don’t just want to be like, well, let’s just give you a token adjustment. Hopefully we get lucky, and we’ll send John up to the old hospital and—

Kathy: Yeah. So—

Jason: —let me give you an adjustment here before you head out. So, bill insurance—

Kathy: Right. Exactly. Oh, got to make my money real quick first. No. Hey, I can bill an E&M code and send somebody out, so it’s fine.

Kathy: Okay. But yeah, and that’s really the thing is, like, especially with chiropractic — chiropractic is not

[13:18] emergency medicine, right? So if you are going to benefit from getting an adjustment for your, you know, high-profile dangerous headache, you will still benefit from it after you go to the ER and get checked out, right? One of the things though that’s tricky about headaches is, like, there are sometimes when people are like, “I want to get an MRI because I got headaches.” And there’s usually not a lot to see on an MRI. Same with an X-ray. And the

[13:49] reason is because you can’t image pain, right? And so, that’s what a headache is. No, you can’t. No,

Jason: I know. And sometimes people, especially when they have some chronic headaches, they’re like, “Maybe I just need like an X-ray.” Like, well, if we could see the cause of your headache on an X-ray, you’re not going to like it, because we’re seeing probably a tumor or something.

Kathy: That is a bad thing.

Jason: Yeah. Yeah. Exactly. Now, of course, like when you’re thinking about worst case scenario, like one of the very worst things that a

[14:20] headache can be is a symptom of a stroke, right? So we worry about when a headache is a symptom of something worse. And so that is kind of one of those symptoms that you can get. So, for example, with a stroke you might get a thunderclap headache, and with that you get some paralysis on one side of your body. So you might get like drooping of the face on one side, can’t lift your arm, you’re having difficulty walking — those types of things. That is an emergency. Do not come to my clinic.

Kathy: Oh—

Jason: Drive straight past — straight past Helix.

[14:52] Continue north past Encore Physical Therapy on 9th Street, and don’t stop, don’t stop until you get to the emergency department at Good Samaritan Hospital. Right.

Kathy: Okay.

Jason: So, yeah. So those are really the big things. If you have those symptoms, don’t screw around with it. Just go straight to the hospital.

Kathy: Call 911. Actually, don’t—

Jason: Yes. Yes. Yes. Exactly. So, yeah, don’t screw around with it. The worst case scenario is, “Oh, I feel like a

[15:24] fool. I guess it wasn’t really a stroke. Oh, shucks.”

Kathy: I just haven’t had any water in—

Jason: Yeah.

Kathy: —72 hours.

Jason: Yeah, something like that. So, now that we’re through all the scary stuff, let’s get to more of the more common types of headaches. So you talked about tension headache. Yeah. Is that the most common one you see?

Jason: It’s very, very common. Right. And so here’s a disclaimer. Chiropractic care — like, well, I

[15:54] shouldn’t say this — not chiropractic care, chiropractic adjustments are not very effective for tension headaches.

Kathy: I believe that.

Jason: Yeah. And — what, you believe that? Come on, Kathy. And so this is a — I think this is a common kind of — I’ll say boo-boo that I see chiropractors make sometimes. They tell people, “Oh, yeah, you know, come on in. Adjustments are great for tension headaches.” I’m not saying that an adjustment can never work for a tension headache,

[16:25] right? Because what a tension headache is, is like you described — you get muscles that get really tight and tense. And when muscles get tight and tense, they start restricting blood flow. It’s like we did a whole episode on restricting. Right.

Kathy: Right.

Jason: Yeah. And then when you restrict blood flow, first of all, you’re going to get pain in muscles because you’re not able to flush out those metabolic waste products, and those muscles sometimes will refer pain up into your head or your neck. Sometimes you reduce that blood flow and

[16:55] you get just kind of a pattern of constriction of blood vessels that then starts causing pain inside your head. So, tension headaches — the short version of that is they don’t feel good.

Kathy: No. Okay. And like they sound, they are from tension. So a chiropractic adjustment can sometimes help relieve tension. So if you have a stiff joint or something like that and you get that moving, it can help a muscle to relax. But that’s not the primary treatment that you would use for that.

Kathy: Sounds like the case for a physical

[17:26] therapist.

Jason: Yeah, maybe a physical therapist would be great, right? Because a physical therapist would be — the reason I’m smiling is because of what I’m about to say. You’re going to hear it. Okay. A physical therapist would be good because if you have some sort of like pattern of, you know, dysfunction or tightness in the muscles, then fixing those patterns — or — here it comes — fixing those patterns of dysfunction in the muscles — is coming — would be addressing the

[17:58] root cause

Kathy: — the root cause —

Jason: — the root cause of the problem. So that would be — if you’re getting chronic tension headaches, physical therapist is a great option. You might also do things like acupuncture. You might do things like massage. Just anything that helps with tension.

Kathy: Biodynamic craniosacral therapy.

Jason: Biodynamic craniosacral therapy, if you happen to have one near you.

Kathy: Near you.

Jason: Yeah. But part of that is that, well, other things that are helpful for

[18:29] attention headache is actually exercise, a good conversation with somebody, like a cup of tea or something like that. Just anything that’s going to help you to reduce some muscle tension, some stress. All those things tend to work. And then also on the list, you could take like a Tylenol, but look out for autism. Okay, laughing about that. Oh my gosh. Yeah. I think that

[18:59] we’ve lost half our viewers. Yeah, that was it. Yeah, I had a patient who came in and — why are you — sorry. Oh, no. I had a patient who came in — did they ask about Tylenol? Well, no, no, no. I made an inappropriate joke about Tylenol, right? And this patient happens to be a little autistic, so I made a joke about it. I was like, I asked like, “What do you do for the pain?” And they were

[19:29] like, “Well, you know, sometimes I’ll take Tylenol.” And I was like, “Huh?” There’s our proof. Yeah. And then they said, “Well, you know, sometimes I like to top off the autism a little.” I was like, “Oh my gosh, I just wanted to get up and hug him.” That was just the best. Sometimes you just got to top off the ‘tism a little bit. So anyway, oh my gosh. But Tylenol — Tylenol is a medication that people can take for something like a tension headache, or people will take

[19:59] NSAIDs. NSAIDs have a little more risk, especially if you’re having to take them a lot, right? An occasional tension headache, not a bad thing. It’s not damaging. If you’re getting chronic tension headaches, definitely want to get that taken care of. Especially if you are — I hate it when people say this — eating Advil or eating Tylenol. When you say that you’re eating it, it’s like you’re doing it too often

[20:29] and you can actually introduce another kind of headache which is called a rebound headache. So rebound headache is when you are taking too much analgesic, too much of the NSAIDs, the ibuprofens, things like that. And then basically you start getting headaches as a rebound from taking that medication. So that’s bad. So tension headaches — first things first, address your stress, get some exercise, move, fix some of your movement patterns, get a massage, use some heat, stretch, those types of

[21:00] things. Okay. Since you’re kind of talking about meds, what do you say when someone comes in? “Oh yeah, I just take Excedrin and my headache goes away.” Mhm. Yeah. Well, it’s coming back. Yeah. Yeah. Uh-huh. Uh-huh. You didn’t address the root cause. That’s right. Yeah. Yeah. Well, Excedrin’s got caffeine in it. The whole reason you’re getting the headache is because you — Well, and I’m glad that you brought this up. So, caffeine is a good treatment for some types of headaches and we’ll get into that in a second, but caffeine is also a cause

[21:32] of some types of headaches, right? So if you are using caffeine on a regular basis and then you stop using caffeine, you can give yourself a headache from that too. Yeah. So you want to use your caffeine in moderation. Okay. Like you wouldn’t want to put an energy drink in this. No. Yeah. Okay. All right. So let’s get on to the next type of headache. And this is actually the type of headache that when people come in and

[22:03] tell me they have this type of headache, it gives me a headache, because this is maybe the most misdiagnosed headache type out there. And some of it is the fault of the patient. Sometimes it’s the fault of their doctor. It’s never my fault. No, because I’ll educate them about it. But the migraine headache. Okay. So migraine headaches, they’re characterized by pulsating pain. Now listen very, very carefully to this piece. Listen to this. The vast majority of migraine headaches

[22:35] are only going to be on one side and one side only in your head. Yes. And so along with that, you’re going to get pulsating pain, nausea. There’s some sensory stuff, some weird sensory stuff I’ll get to in a second. But the word migraine is actually a French form of the Greek word hemicrania, which means half the head. Half the head. Right. So if you’re like, I got a migraine — that’s the first

[23:05] question I ask people when they tell me they have a migraine. Well, can you point to where your migraine is? Oh, it’s just my whole head. You probably don’t have a migraine. You probably don’t. A migraine headache is very intense. It’s a complex type of headache. It’s vascular, meaning that there’s issues with dilation and constriction of blood vessels, which then put pressure on some of these structures. Usually, people will describe it as feeling like you have an ice pick in your eye. Which is like, well, how would they know they have an ice pick in their eye?

[23:35] Well, get a migraine headache and you’ll find out, right? Most people do not get migraines serially. Like, you’re not going to get like three migraines a week. You might have a migraine that can then last you several days, right? Some people unfortunately will have it for maybe up to a couple weeks, and that’s a more severe case. If you get chronic migraines, those definitely should be managed. Like, not to freak anybody out, but there’s some research out there that shows that people who have chronic migraines, it’s

[24:05] almost like they’re suffering little miniature strokes in terms of the vascular consequences of that. So if you’re having chronic migraines, you definitely want to get that checked out. Fortunately, most people don’t get migraines. And most of the people who do get migraines don’t get them often. And so that’s a good thing, too. But it’s a debilitating type of headache. It can shut you down for the rest of the day. Back to the sensory stuff, people tend to have sensitivity to light.

[24:36] They have sensitivity to smells, to loud noises. And so when people get migraines, they want to block themselves in a dark room —

Kathy: Yeah.

Jason: — with no sound, no light, nothing.

Kathy: Yes. Exactly. Sometimes you’ll get something called aura that goes with it. And usually this will be right before the headache. And you might see things like floaters in your vision. You might see like bright lights. Sometimes if people are driving at night and they’re getting some visual aura, like all the headlights look like stars, right? Like

[25:06] a star pattern.

Jason: Some people get smells.

Kathy: Yes. Yes. And this is where aura gets really weird, because this is the neurological part of it — you know, they can smell a bad smell.

Jason: Some people can taste something on their tongue. It’s just — it is like all of your sensory modalities are — yeah — are kicked off. So that’s what migraines are. Now, sometimes people are like, “Well, I go to the chiropractor to help me not get a migraine.” So is chiropractic a

[25:36] good treatment for migraines? Evidence says no. However, there is some weaker evidence that says that some people can avoid getting a migraine by maintaining like good mobility in their neck, right? So you could go to a chiropractor, you could go to a physical therapist, and if you’re doing those things,

Kathy: then you can help avoid some of those triggers of migraines.

Jason: One of the primary ways that you want to deal with migraines is by identifying the triggers of your migraines,

[26:06] right? Some people, that is nutrition triggers. Some people, they’re going to get it if they stay up too late, right.

Kathy: Some people it’s alcohol. Some people it is country music. Which is probably maybe the most common cause of migraines.

Jason: That’s usually what they come in to see me for.

Kathy: Yeah. You’re like, “Okay,

Jason: tell the truth. Were you listening to Willie Nelson?”

Kathy: “Was I? I’m listening to him right now.” Okay. Yeah, that’s some of that aura,

[26:37] right? So, yeah. Those are — that’s migraines in a nutshell. Okay. We got to get on to some other types of headaches.

Jason: All right. Cluster headache. This is another type that people come in all the time — “Oh, I get cluster headaches.” Okay. Now, cluster headache is a very specific type of headache,

Kathy: and it’s freaking miserable. They call it the suicide headache,

Jason: because cluster headaches can be bad enough that they drive people to commit suicide. They tend to be — it’s what would be called an intractable headache.

[27:08] So with a cluster headache, you’re going to take ibuprofen, Advil, whatever —

Kathy: anything.

Jason: It’s not going to touch it,

Kathy: right?

Jason: Okay. And it’s a very sharp, intense headache. These are extremely rare. It’s like 1% of the population that have it. Tends to be men, tends to show up between their 20s and 40s. And you will have — they call it a cluster because you will have a series of them, like four or five headaches in a row, and then you’ll go a period of time where you don’t have any.

Kathy: Now there’s some people that

[27:38] — you know, they’re sleeping 4 hours a day and they’re on their phone 24/7 giving themselves eye strain and they’re not eating good food and they have a headache every day and they say, “I’ve got cluster headaches.” No, you don’t. You’ve got a lifestyle problem, right?

Jason: Do we know why they affect more men?

Kathy: I don’t. Yeah. There’s probably a reason,

Jason: I’m sure.

Kathy: but I don’t know it.

Jason: I don’t know if the scientific community knows why.

[28:08] Yeah. Okay. Yeah. Who knows? So, and then the other type of headache that I want to talk about is a cervicogenic headache. This is my favorite kind. This is one I can do something about. Okay.

Kathy: Now, cervicogenic headache is not a primary headache. It’s a secondary headache. So a cervicogenic headache is the type of headache that you would get if you have neck pain. So if you have like an injury to the joint, or anything like — just some sort of origin in the neck. Cervico

[28:38] means neck. Genic means like born from, like

Jason: Genesis, right? It’s like the beginning of the Bible I’ve heard.

Kathy: where everything was created.

Jason: That’s how it starts.

Kathy: Yeah. Exactly. So you can tell if you have a cervicogenic headache — you can almost tell yourself — just because if you are like poking around your neck or something like that and you find a spot that then makes your head hurt worse, yeah, you probably got a cervical headache. Or if you’re like stretching a muscle and that makes your head hurt

[29:08] worse,

Jason: that’s probably a cervicogenic headache. And that’s the one that chiropractic actually does really pretty well for.

Kathy: Physical therapists treat cervicogenic headache.

Jason: Yes.

Kathy: What? There goes my market share. No. What do you do for cervicogenic headache?

Jason: Traction.

Kathy: Yeah.

Jason: Work on the suboccipital muscles.

Kathy: So those suboccipitals — those are the ones just right underneath the skull.

Jason: Mhm.

Kathy: Interesting thing about suboccipital muscles: there’s some who theorize that they’re involved with most types of

[29:39] headaches.

Jason: Oh,

Kathy: and it’s because of something — this is theoretical — something called a myodural bridge.

Jason: Okay.

Kathy: So myo means muscle. Dural refers to the covering around the brain. There’s three layers of dura that cover the brain. Those are your meninges.

Jason: Yes.

Kathy: Which is a fun word to say. Everybody — 1, 2, 3 — meninges. Okay. Yeah. So with the suboccipitals —

Jason: Mhm.

Kathy: There’s some of those muscle fibers that connect to the skull on one side,

[30:11] and then there’s some that connect to your top cervical vertebrae, and then there’s some of those fibers that are continuous to tissue — like they don’t go directly into the dura, but they’re connected to tissue that’s connected — it’s like my sister’s boyfriend’s cousin got it.

Jason: Yeah.

Kathy: That are connected to the meninges.

Jason: Oh. And so when you get tension in those suboccipital muscles, those muscle fibers pull on the sister’s cousin’s boyfriend’s

Kathy: neighbor, and which pulls on the the

[30:43] Jason: the meninges. Kathy: Yeah, the meninges. Thank you. And when you pull on the meninges, hold on a second. Like, I think I said this before, but did you know that your brain doesn’t feel pain? Kathy: I didn’t know that. Jason: Yeah. Pain is inside your brain, but if I was to open up your head and poke your brain, you don’t feel it, right? But what you do feel — you feel your meninges. So the covering that is very neurologically sensitive — tons of nerves around the meninges. Kathy: Yeah. So when you’re getting headaches,

[31:14] like, for example, if you have swelling on the brain or something like that, that is your meninges that you’re feeling. You’re not actually feeling your brain. And so when you get some pulling from those suboccipital muscles on the meninges, then it contributes to headaches. That’s the theory. Kathy: Yeah. Jason: I think there needs to be more science done there. Kathy: There needs to be more science on that. Jason: But it’s one of the reasons that theory exists — is because treating those suboccipital muscles can really help. Yeah. Kathy: A lot of headaches.

[31:44] Jason: Yep. So, do you ever give patients a way to work on those suboccipitals themselves? Like, do you give any myofascial releases? Kathy: Yeah. Like, what are you telling people to do? Jason: The old, you know, old-school — take two tennis balls and tape them together. Kathy: Yes. Right. And then you put that tennis ball — or the peanut. Jason: Mhm. Yes. At the base of your skull. Kathy: You lay on it. Jason: Yeah. They’re nice and soft. Kathy: Yeah. Jason: But they’re firm enough that — yeah.

[32:14] Kathy: Yeah. Give yourself a little bit of a — Jason: I like even a foam roller, right? If you could just kind of rest your neck on that foam roller and then just rotate side to side, that works pretty good, right? So yeah. And I think in general with headaches, regardless of what type of headache you have, I think that people have a lower risk of getting headaches if they’re just taking care of their general overall health, right? You’re hydrating well enough, you’re going to avoid a lot of headaches. If

[32:45] you’re getting sleep, you’re going to avoid a lot of headaches, right? If you’re physically active, you’re exercising, you’re going to avoid most kinds of headaches. Kathy: If doing physical exercise gives you a headache, then that’s when you probably need some help. Jason: Yeah. You probably got to — Kathy: Yeah. See somebody. Jason: Yeah. Either you got a vascular issue, right? Could be your blood pressure. It could be that you have some sort of dysfunction in those joints or muscles. But just in general, like,

[33:17] doing the basic things that come in the manual of life that is given to everybody when they were born. Kathy: That’s right. Just do the basics. Jason: Do those basic things, you’re going to — Kathy: Sleep. Exercise. Jason: Yes. And get adjusted. No. Yeah. Doing those basics will help you to avoid most types of headaches. And the nice thing about that is that when you do those and you’re avoiding most types of headaches, then it’s easier to spot the bad kind of headaches. Right. So

[33:47] Kathy: what’s your take on when people say, “Ah, the barometric pressure changed. I got a headache from —” Jason: Yes. So, totally — your take on that. Yeah. So that’s a real thing. And the reason is because that’s another type of headache, which is a sinus headache. Kathy: Sinus. Jason: Yeah. So your sinuses are these little cavities in your skull — little holes, little caves, right? And they’re lined with mucous membranes, so tissues that create mucus, right? And

[34:17] sometimes these can get inflamed. They can get infected. And these are sensitive to pressure changes outside the head, right? And it can actually cause your cranial bones to move some, and it can be uncomfortable. It can hurt and give you pain. Kathy: Probably pulls on the meninges. Jason: It might. Yeah, you might be tugging your meninges. Right. And then other types of headache — like eye strain is a very common type. Now, I left a little spoiler in the beginning.

[34:47] So that’s the medical procedure that actually fixed most of my headaches — was getting LASIK surgery. Kathy: Yeah. Yes. When I got LASIK surgery, I think I was like 20/40 vision. So it wasn’t terrible, but that was like my graduation gift to myself from chiropractic school — was I went $2,000 in debt. I went $2,000 in debt to get myself LASIK surgery, which is a great deal. Kathy: Yeah. Jason: And yeah, once my vision got fixed

[35:17] and now I have 20/15 vision, like I can — I can fly like a jet fighter. Absolutely. I could for the Air Force. I could. Yeah. No doubt. Kathy: But are you in shape enough? Jason: Oh, totally. Yeah, totally. You just need 20/15 vision and a 19-and-a-half-inch sit-and-reach. Kathy: That’s right. Jason: Yeah. Yeah, I got this. So, yeah. So what happened was I was wearing glasses before, or contacts, and those helped. I had good prescriptions, but they did not help my

[35:49] peripheral vision. Once I got my LASIK surgery, I had to do less movement with my neck. And so — yeah. So that was pretty awesome. Kathy: Interesting. Jason: But can I get sidetracked and tell you a weird story about my LASIK? Kathy: Absolutely. Absolutely. 100%. Jason: All right. So somebody was like, “Where’d you get this LASIK surgery done?” I was like, “Oh, I got it done up in Vancouver.” And they’re like, “Oh, what’s the name of the place?” I was like, “I don’t know. Let me Google it.” So I go looking for it, and I can’t find it exactly. But then I start seeing these freaking news

[36:20] reports coming up. And it turns out that the guy that I got my LASIK surgery from — he had a clinic that was there in Vancouver, but he had a couple others in Washington. Kathy: Oh, you got it from the same guy. Okay. Yeah. So, yeah. True story. Okay. What’s happening? Jason: So he had a couple clinics and he was working with his brother-in-law. Kathy: Okay. Jason: And his brother-in-law wanted to buy out the clinics. He didn’t want to sell. Kathy: Mhm. Jason: So his brother-in-law contracted somebody to kill the

[36:51] Jason: Dude. Kathy: Yeah. Jason: Yeah. Kathy: No. Jason: Yeah. And was he successful? Kathy: No. Okay. Thankfully, because this man was brilliant. Brilliant. Brilliant. LASIK surgeon — I don’t know what the word is for it, but Jason: He was pretty good. I don’t know if he’s brilliant, but he was good enough. Like, he fixed mine. Yeah. Totally fixed. Kathy: So, but yeah, interesting thing. So, yeah. And people were worried about going to see chiropractors now. ‘Cause he’s an optometrist, right? He’s a murdering optometrist. Murder-for-hire optometrist.

[37:21] Jason: So, was the brother-in-law an optometrist? Kathy: Yeah. Oh, Jason: yeah. Yeah. So, now he’s an inmate. Kathy: Yeah. We’re not medical advice. Jason: Oh, yes. This is a great time. This is a great time for a disclaimer. Yeah. We’re not giving any medical advice of any kind, especially if you’re in prison. Kathy: Yeah. Mhm. No, this is all just entertainment fun, right? Yeah. Entertainment. Go talk to your doctor if you need any help. So, yeah, that’s a crazy thing. Yeah.

[37:51] Jason: But yeah, so eye strain — give yourself a break from screens. Look up every once in a while. Like, just even spend a little time looking up at the sky, not into the sun. That’s a new — that’s a new headache, right? Kathy: So, all right. Well, I feel like there’s literally — we could do a whole other episode on headaches. I’m not done, but we’re getting to the end. Jason: Yeah, we’re — I think it’s — Kathy: I know there’s some people that are starting to feel a bit of a headache creep in listening to me talk about this. So, let’s see. Oh,

[38:21] so we should — I think that we should do the game. Jason: It’s game time. Kathy: All right. Okay. So, this is called the Tournament of Brain Pain. All right. And what I’ve done is I have put together kind of a tournament bracket. I’m the only one who can see it. But I’m going to give you two things that could potentially give you a headache. You’re gonna tell me which one is more likely to give you a headache. Jason: Okay. Kathy: Let’s see. Two, four, six, eight. We got eight things and we’re going to find the number one thing — sciencey — that is most likely

[38:52] to give a headache. Jason: Sciencey. Kathy: Let’s start at the bottom. Okay. These are like social media trends. Cat videos or ASMR? Jason: ASMR. Kathy: ASMR. Okay. More likely to give you a headache. Okay. More likely to give you a headache — cleaning toilets or unclogging drains? Jason: Oh, unclogging drains. Kathy: Okay. Drains. All right. Let’s see. Next. These

[39:23] are kind of administrative tasks. Taxes Jason: or prior auth? Kathy: Oh, prior auth. I’ll do taxes all day long. Jason: Yeah. So, a prior auth is when you have to get permission from an insurance company — who’s not a healthcare provider — to do your job that you went to school for. Kathy: Yes. Jason: All right. Here we go. Oregon Kathy: or USC? Jason: Oregon. No, no, no. Sorry. Sorry. Sorry. Sorry. USC. Your answer, not mine. Yeah.

[39:55] Yeah. Yeah. Yeah. Kathy: All right. Okay. We’re on to the semifinals here. Jason: Okay. ASMR or unclogging drains? Kathy: Unclogging drains. Jason: Okay, drains. Prior auth or USC? Kathy: That one. Jason: Yeah, rough. Kathy: I’ve got to go prior auth. Jason: Prior auth. We’ve been beating USC for the last several years, so Kathy: they don’t bother me. Jason: Yeah, it’s like you’ve been throwing Tylenol at USC for years. They’re fine.

[40:28] Jason: Okay, here we go. Oh, I think I already know how this is going to turn out. Unclogging drains or prior auth? Kathy: Prior auth. Jason: Okay, there we have it. Scientific evidence. This is exactly how I thought it was going to turn out. Pre-authorizations are the cause of most headaches. Kathy: Most headaches. Jason: Most headaches — because especially if you need help, Kathy: you’re not going to get it. Jason: You’re not going to get it. Kathy: No. No. Jason: No. So, all right, Kathy. Take that. I really liked your tangent about the meninges. Kathy: Yeah. Isn’t that cool? That is really

[40:58] cool. Jason: That’s crazy stuff. And meninges is so fun to say, dude. Kathy: Yeah, that’s why I like to keep saying it. Jason: Meninges. So, you know, I think one of the things I appreciate about this episode is it gave me a chance to get some of my headache pet peeves off of my chest. Kathy: There you go. You’re feeling good. Jason: You probably don’t have a migraine. And it’s funny too, because I’ll explain this to people like, “Oh, French word, and blah blah blah, and here are the symptoms,” and they’re like, “Yeah, so I’ve got a

[41:28] migraine.” “Do you have any of those symptoms?” “No, but it just hurts really bad.” Kathy: Definitely a migraine, right? Jason: My sister’s brother’s uncle Kathy: yeah, Jason: knows a doctor who told me it’s probably a migraine. Kathy: Oh, I was told when I was a kid that I got migraines, but Jason: yeah. Oh, there’s so much that we could have gotten into, like Kathy: headaches in pregnancy. Like, oh, we’ll just have to do it again. Yeah. Well, Jason: let’s find us a headache expert. Kathy: Let’s do that. Jason: Yeah. And then we could have them come on. Then they can correct all the misinformation that I gave.

[41:59] Jason: All right. And yeah, so definitely like and subscribe because this is the most interesting thing that you’ve done all day. Hopefully we have not triggered any headaches. Kathy: That’s great. Jason: And if we didn’t trigger a headache, next time you should try watching us, not just listening. Kathy: See if that’s a trigger. Jason: Absolutely. And the other thing that you must remember is there’s no “I” in PTCH.

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