How to Stop Headaches Using Science-Based Approaches | Huberman Lab Podcast

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday life

I'm Andrew huberman and I'm a professor

of neurobiology and Ophthalmology at

Stanford school of medicine today we are

discussing headaches headaches are

something that everybody will suffer at

some point in their lifetime of course

some people suffer from headaches far

more often than others and for many

people headaches can be incredibly

debilitating limiting their ability to

work to socialize to sleep to exercise

essentially to live life in any kind of

normal way as we'll soon discuss there

are many different kinds of headache we

have migraine headaches tension

headaches cluster headaches today I will

review all the different types of

headaches and what the underlying

biology of each and every one of those

types of headaches is as well as

fortunately the many excellent

treatments that exist for the different

types of headache in fact what we'll

soon discuss is that by understanding

which type of headache you have and a

little bit about the underlying biology

of each different type of headache it

becomes quite straightforward to select

the best treatment options for you to

for instance provide relief from

frequent and recurring tension headaches

cluster headaches even sinus headaches

the sorts of headaches that are

associated with sinus infections and

colds where the sinuses get clogged up

and you experience headache so while

today's episode focuses on all aspects

and types of headaches it will have

tremendous relevance for everybody so

for those of you that experience

headache every once in a while where

only when you're sick or have a sinus

headache or for those of you that suffer

from debilitating migraines today's

conversation actually has a bit of

optimism woven into it meaning there are

excellent treatments for each and every

one of the different types of headaches

and I was quite impressed and excited to

learn when researching this episode that

the treatments for headache range from

of course prescription drug treatments

and over-the-counter medications of the

sort of type that most of us have heard

about ibuprofen acetaminophen and so

forth so-called anti-inflammatory drugs

but it turns out there are many natural

treatments for headaches that when

compared to those over-the-counter drugs

and even some prescription drugs appear

to be easily as effective and in many

cases more effective than the typical

drug treatments many of which can carry

side effects that is the drug treatments

carry side effects whereas the natural

treatments appear to not carry side

effects now of course anytime we have a

discussion about natural treatments

there are likely to be some eye rolls

out there and people thinking oh you

know this is going to be a bunch of woo

science well far from it as you'll soon

learn today each and every one of the

treatments for each and every one of the

different kinds of headaches is grounded

in solid biological understanding of why

that particular treatment ought to work

and does work so for instance you'll

learn that some headache arises because

of muscular pain other headache arises

because of excessive vasodilation the

arteries and blood vessels get bigger

and wider and so there's a pressure and

a swelling within the cranium that

people experience as a headache and it

turns out that many of the more natural

treatments out there can address either

the muscular pain issue or the

vasodilation issue or other issues and

underlying mechanisms for headache so

again while headaches are very intrusive

irritating and in some cases

debilitating there is certainly light at

the end of this tunnel meaning by the

end of today's episode each and every

one of you will have an array of

excellent treatment options that you can

choose from in order to address and

provide relief from any of the different

types of headache before we begin I'd

like to emphasize that this podcast is

separate from my teaching and research

roles at Stanford it is however part of

my desire and effort to bring zero cost

to Consumer information about science

and science related tools to the general

public in keeping with that theme I'd

like to thank the sponsors of today's

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livemomentis.com huberman let's talk

about headaches and as we are soon going

to learn there are different types of

headaches and different types of

headaches arise from changes in

different types of tissues in the head

area and indeed in the neck area as well

now one of the key things to understand

is that if you want relief from a

headache you need to understand which

tissue is mainly involved in creating

that type of headache so for instance

many people suffer from what are called

tension headaches now tension headaches

are a little bit of a misnomer because

many people might think oh tension I'm

under a lot of tension and stress and

therefore I get tension headaches and

indeed stress can cause tension

headaches but tension headaches are

really the sort of headache that you

feel around the top part of the head not

the very top but sort of where you would

put a headband so above the eyes and

around the head it doesn't have to be

experienced all the way around the head

but the main underlying reason that is

the tissue system that mainly underlies

tension headaches is the muscular system

there are a lot of muscles on the skull

Believe It or Not of course on the neck

and they allow you to move your neck and

head

there are a lot of muscles that lie

parallel to the skull and oftentimes

those muscles will undergo excessive

amounts of constriction

now there are of course muscles and the

jaw that can also lead to headache and

jaw ache and things of that sort and

neck aches and headaches so what we're

really pointing out here is that the

muscles are a key player in the

formation of different types of headache

Tension Headache in particular but of

course muscles and muscle tension can be

evolved in the other types of headaches

as well okay so I just want to highlight

muscular issues as one particular source

of the ache in headaches the other

tissue that can be prominently involved

in generating the ache of a headache or

the so-called meninges now the meninges

in addition to being a fun word to say

or a bunch of tissues that line the

outside of the brain and reside between

the brain and the skull so you might

think okay between the brain and the

skull there's probably just a little bit

of fluid and the brain is right up next

to the skull but it turns out that's not

the case the brain is actually encased

in a very thick very durable Sac or

casing that's wrapped around it tight

like Saran wrap it actually has a name

which is dura d-u-r-a and so you can

remember Dura durable and having done

some surgeries many surgeries before on

brains of different types ranging from

Human even though I'm not a neurosurgeon

as a clinician ranging from Human to

other types of species what you find is

that the dura is exceedingly durable

getting through this thing really

requires an a very sharp razor blade so

the brain is actually sitting in a very

fibrous like Sac that you simply could

not open up with your fingertips under

any conditions it's really durable the

meninges are in that general area and

also encasing the brain and the meninges

provide an additional buffer between the

brain and the dura and the skull so

again you don't want to think about the

brain as just sitting right next to the

skull it's close by but there are a

bunch of other thin fibrous tissues many

of which are very thin and fragile and

others of which such as the dura that

are very very strong because they're

very fibrous almost like a uh if you've

ever felt for instance the sale of a of

a sailboat you might think oh it's just

this big flapping sheet in the wind it

is anything but a sheet in the Wind it

is a very very strong and durable

material now the proximity of the dura

and the meninges to the brain and the

fact that everything is wrapped very

tightly together and the fact that

there's a lot of vasculature so that

would be arteries blood vessels and

capillaries are all in that area on the

top of the brain and throughout the

brain the fact that all of that is in

very close proximity and wrapped really

tight in this very durable sac

is one of the reasons why when blood

vessels or arteries or both become

dilated they open there creates a

pressure between the brain and those

tissues and because there isn't much

distance between the tissues like the

dura and the meninges and the skull

there's also pressure that allows for

the brain to literally sneak up or I

should say give the impression that your

brain is expanding up against your skull

so the point here is that while muscular

tension can give rise to headache the

other thing that can give rise to

headache is so-called vasodilation the

expansion or the widening of the

arteries blood vessels and capillaries

and one of the reasons why that gives

rise to headache is because there's

simply not a lot of space for that

expansion to go it doesn't allow

anything except for the brain to push up

against that very durable tissue and

that very durable tissue to push up

against the skull and even though the

brain itself doesn't have pain receptors

that's right the brain itself doesn't

have pain receptors that is why a

neurosurgeon can take off a piece of

skull and can probe around in the brain

with an electrode and the person is

completely unaware and in order to get

through the skull of course that little

skin flap has to remove be removed from

the skull and that requires a little bit

of topical anesthetic but really you

don't need any anesthetic to go into the

brain itself because there aren't pain

receptors on the brain itself however

the tissues surrounding the brain such

as the dura the meninges and the

vasculature that then reaches up believe

it or not into the skull the vasculature

doesn't actually stop right beneath the

skull it actually blood vessels it get

into the skull and they're actually

portals by which blood can move within

the skull itself well what that means is

that since all of the tissues are very

close by and very compact

with respect to one another any increase

in the size of the portals that allow

movement of blood there

and the fact that there are what are

called nociceptors noci nociceptors

These are essentially pain receptors

because of the presence of pain

receptors in the tissues around the

brain

when there's an increase in the size of

those vascular portals the arteries

capillaries and vessels

we experience that as intense pain and

pressure and fortunately there are

excellent treatments for dealing with

that intense pain and pressure but keep

in mind that the intense pain and

pressure that is the consequence of

vasodilation that is the widening of

these different vascular portals

is very different than the type of pain

that arises from muscular tension as is

the case with Tension Headache okay so

now we have two sources of pain that is

the ache in headache and there are two

more that we need to think about in

trying to better understand the

different types of headaches that we'll

discuss and in terms of trying to

understand which are going to be the

best treatments for the different types

of headaches and those are neural and

inflammatory responses so let's talk

about the neural type first there is a

type of headache that many people

unfortunately suffer from we'll get into

this in a bunch more detail in a moment

but those are called cluster headaches

cluster headaches are headaches that

arise not from the surface people don't

experience them as kind of a tightening

of the forehead and the neck and the jaw

but rather it feels as if the headache

is coming from deep within the head and

in particular from behind the orbit of

one or the other eyes and sometimes both

eyes for those of you that have ever

experienced cluster headaches they are

extremely painful even the more where I

should say the relatively more minor

cluster headaches are extremely painful

and the severe ones are exceedingly

painful

cluster headaches arise from Deep where

this we get the Sensation that they are

rising from deep within our head as

opposed from the surface inward because

they are neural in origin and there's a

particular nerve pathway called the

trigeminal nerve that often is the

origin of these cluster headaches that

people experience behind the eye the

trigeminal as the name suggests has

three branches try Okay so there's a

branch that essentially extends to the

eye there's also a branch that extends

to the mandible right to the uh to the

lip and there's a branch that extends

more or less to the to the nasal area

and so this trigeminal nerve becomes

inflamed or in other ways is hyper

activated in some cases and that causes

the Deep pain below the eye because it

is that first branch of the trigeminal

nerve which is the ophthalmic branch

which tends to be activated first so

people start feeling as if there's a

pain behind their eye in particular on

one side oftentimes there's lacrimation

which is tearing up there can be some

nasal discharge another common symptom

of this type of headache that is the

cluster headache is that the pupil

sometimes will become very small the

pupils of the eyes and they won't dilate

even in darkness so there are a bunch of

things that are going on on one or both

sides of the face that seem to arise

from deep within the head or it's almost

as if it's coming from the brain outward

and that's because it's neural in origin

Okay so we've got muscular origins of

headaches we've got meningeal

origins of headaches that is the the

stuff around the brain and as it relates

to the vasculature and we have neural

origins of headaches and of course

there's inflammation origins of

headaches now inflammation is a term

that gets thrown around a lot these days

people are talking about you know this

reduces inflammation inflammation is bad

and and I I suppose in some cases and

when inflammation is really widespread

across the brainer body it's bad but I

don't think any of us should think about

inflammation per se as bad what I mean

is inflammation is just one form of

signaling in the body which of course

includes the brain

inflammation of a tissue is one way in

which a set of cells so these could be

for instance uh cells of the immune

system and we cover this in a detailed

episode all about the immune system if

you'd like to check that out you go to

hubermanlab.com just put into our search

function immune system and you can find

that episode by the way all of our

episodes are searchable by keyword

hubermanlab.com and it'll take you to

specific episodes and time stamps for

the topics you're interested in so for

sake of this discussion about headache

inflammation is going to be the case

when one particular tissue in and around

the head area is releasing molecules

cytokines which sometimes are called

inflammatory cytokines but there are

also non-inflammatory or

anti-inflammatory cytokines but

inflammatory molecules that are

signaling to the rest of the body hey

there's something going on here there's

either some intrusive object and indeed

if you were to get you know a bb or a

splinter into a particular uh you know

skin area there'd be a lot of

inflammation so it could be the

introduction of a foreign physical

object into an area that will cause

inflammation it can be the presence of

some sort of local toxin in that area it

could be a more systemic inflammation

nonetheless inflammation in the neck and

head area where frankly anywhere within

the sinus area so this would include the

mouth the nose around the eyes because

the sinuses many of us think of sinuses

as just our nose but actually if I were

to show you a skull a human skull or any

other kind of skull

you'd be very hopefully intrigued to

learn that the skull is just not one big

piece of solid bone or a you know a top

with a jaw below it it actually has all

these small what are called

fenestrations little holes and canals

that run through the skull and through

the depth of the skull like little tubes

you've got them down here on your

mandible you've got them above your lips

you have them um on either sides of your

nose those are the sinuses the sinuses

allow the passage of different fluids

through the skull because the skull even

though it's bone it's not a dead tissue

right in a live person or animal the

skull is a very active

living tissue indeed all bone is active

living tissue and it needs to be

nourished with blood it needs to be

nourished with cerebral spinal fluid in

the case of the skull it needs to be

nourished with all sorts of important

things so those sinuses oftentimes can

become clogged as is in the case with

sinus headache which we'll talk about in

a little bit but more generally anytime

there's inflammation of one given area

of the body so it could be a shoulder it

could be the neck it could be the mouth

it could be the nose or in the case of

the headache it could be any portion of

the head or neck

what happens is inflammation while it's

a very efficient signal it's much like

the siren on an ambulance or a police

car and that it sends out a very broad

signal that's very clear something is

wrong here and needs to be dealt with

it's not very specific so it's very

robust but it's not very specific so for

instance if there's a little bacterial

infection or a little viral infection

the inflammation response to that site

of infection tends to be far more

widespread than the actual site of

infection it's a little bit different

when you have a foreign object there

like a splinter or some other foreign

object that tends to be a bit more

localized and the immune system is

always trying to limit the the extent of

inflammation by putting in different

scar tissues indeed a lot of the things

that we think of as kind of gross

you know pustules and boils and things

like that I know it's a gross topic are

ways in which our body tries to restrict

the amount of inflammation but the face

area and the head itself are so heavily

infused with blood vessels and there's a

constant perfusion as we say of blood

and cerebral spinal fluid and other

things through this incredibly

metabolically active tissue that we call

our brain and our eyes those are by far

the most metabolically active tissues in

our entire body even if we're running

hundreds of miles in Ultra marathons

your brain is still far more

metabolically demanding than all the

muscles of your body combined no matter

what the conditions because of that

there tends to be a generalization or a

spreading out of any inflammatory

response and that inflammatory response

then can trigger the pain mechanisms or

what we've experience as pain mechanisms

in the other three types of tissues that

we talked about so for instance if you

have a systemic infection or you're

experiencing inflammation of any kind

and it has anything to do with or

encroaches on the face or head area that

can easily and almost always

spills over into activation of nerve

cells can give rise to neural based

headache or to the meninges and can give

rise to meningeal headaches and of

course to the muscles and to muscular

type headaches so we've got muscular

origins of the ache in headache we have

meningeal origins of the achin headache

we have neural origins of the aching

headache and we have inflammation-based

origins of the ache in headache and that

pertains to all the different types of

headaches that we're going to talk about

and it's important to keep in mind that

there are these different sources of the

ache and headache and that sometimes

they exist alone and sometimes they

exist in combination however this isn't

important however

all pain

or I should say all experience of pain

as a perception

is going to be neural in origin when we

experience pain whether or not it's a

pin prick or a cut stub our toe we trip

and fall or a headache it is neural in

origin it is the nervous system and

nerve cells that are going to carry that

signal that we perceive as pain so as we

talk about the different sources of pain

and different types of headache we will

also talk about of course I think what

most people are interested in today's

discussion the different treatments for

the different types of headache and why

each of those different treatments work

but by understanding a little bit about

how pain arises in the nervous system

and certainly by understanding the

different types of headaches you know

what is a tension headache I gave you

some impression that it's running around

your head like a headband in many cases

versus cluster headache which starts

deep below the eye often it feels as if

it's emerging from deep in the brain

versus migraine which we'll get into in

a moment by understanding the different

types of headaches you should be able to

quickly pinpoint what type of headache

you have what types of tissues are

likely involved and therefore what types

of treatments are going to most quickly

and most completely relieve that type of

headache okay so for the next three to

five minutes and I promise no more I'm

going to explain how pain arises at the

level of nerve cells and I suppose this

is one of those times when if I had a

highlighter pen that could go out and

across the the microphones and speakers

leading to your ears

I would use it here because what I'm

about to tell you is perhaps one of the

most important things to understand

about your nervous system that is your

brain and you which is that while you

have trillions of neurons and we hear

that you have trillions and different

types of neurons in your brain and they

come in different shapes and sizes and

do different things and some make

dopamine and some make serotonin and so

make glutamate and on and on

the key distinction among different

types of neurons that is the three types

of neurons that I believe everybody

scientists are no everybody should

understand exist are some neurons nerve

cells are what we call motor neurons in

the sense that they control the

contraction of muscles sometimes for

walking other neurons control the

movements of your fingers scientists

call those digits

other ones your toes

they also control the beating of your

heart

although that's a slightly different

mechanism and slightly different type of

tissue than is involved in generating

motor movements of your limbs

these are neurons that we call motor

neurons because their goal or their

purpose I should say they don't really

know what their their goal or purpose is

but what they do is they make sure that

muscles contract so that certain things

happen in your body like your heart

beats or you move your limbs you lift

your eyelids or your eyebrows rather

and so on and so forth

other types of neurons are what we call

Sensory neurons

they communicate

the same way that motor neurons do that

is they fire what we call Action

potentials which are just electrical

signals they release neurotransmitters

like any other neuron but they respond

to certain events in the environment or

the environment within the body

but they are not responsible for

generating muscular contractions so we

call these Sensory neurons some Sensory

neurons sense light touch other Sensory

neurons sense firm touch other sensory

neurons sense pain other Sensory neurons

sense light brushing on the skin in fact

you have Sensory neurons believe it or

not that respond specifically to the

light brushing of a hand across your

skin any region of your body and if that

particular region of your body happens

to have hair on it and you stroke the

skin in the direction that the hairs lay

down

we experience that as pleasurable

whereas if you stroke in the direction

opposite to the the way the hairs lay

down we experience that as not

pleasurable so these Sensory neurons

respond in some cases for instance

within the auditory system they respond

to sound waves and your eye they respond

to photons of light sometimes photons of

light of particular wavelengths that we

think of as red green blue and so on

Sensory neurons don't move muscles they

respond to things in the environment and

they exist within us so we have Sensory

neurons that sense for instance pressure

within our head or pressure within our

gut how full or empty our gut is

pain within our tissues like our liver

or or any kind of other internal organ

so we've got motor neurons Sensory

neurons and then the last kind of neuron

is what we call modulatory neurons these

are the ones that adjust the

relationship between the sensory neurons

and the motor neurons to determine

whether or not we do anything in

response to a sensory input that is

whether or not if a sensory neuron fires

sends it electrical potential whether or

not it will generate a motor change let

me give you a very simple example of

this so for those of you listening I'll

just explain what I'm doing and for

those of you watching you'll be able to

see I'm holding my hand out in front of

me

if I were to touch the top of my hand

with my fingertip I can deliberately

override that is I can modulate that

more typical reflex which is that when

something touches us if we're not aware

of where it's coming from we typically

move away from that thing that touches

this is a very natural response but we

can decide we're not going to move away

we can decide to stay still or we can

decide to move toward the thing that

touches us but typically if you were to

walk up to somebody and you were to

touch them they'd either turn toward you

on the side that you touch them or

they'd step away it's rare that they're

going to step into you but you could

decide that you were not going to move

away or you could step into the

direction of touch and that's because

you have modulatory neurons that can

adjust the conversation in a very

context-dependent way

as to whether or not the sensory neuron

will cause motor neurons to contract or

not okay so we've got motor neuron

Sensory neurons and modulatory neurons

and you're probably thinking by now why

are we talking about this I thought we

were talking about headache I thought

we're going to talk about treatments for

headache but this turns out to be very

important because you could imagine and

in a moment I'll explain how let's say

you have tension headaches you're

somebody that has the classic symptoms

of tension headache let me tell you what

those are these are headaches again that

occur more or less on on the in a kind

of a headband like fashion or they tend

to start there

and exist around that these are very

common they can arise from a number of

different sources rise from sleep

deprivation they can rise from excessive

use of caffeine intake we'll talk about

why that is they can arise from stress

they can arise from very low level viral

infections or bacterial infections but

we experience these as just as headaches

where you've been thinking too hard or

working too hard or life has been

stressful they're often also associated

with jaw pain and jaw tightness and neck

tightness so tension headaches

everything you'd imagine muscular

tension could cause well if you want to

treat tension headache

you can imagine that because all

headache is neural that you'd want to go

after some sort of neural mechanism to

treat them but of course we now know

that there are three types of neurons

there are motor neurons Sensory neurons

and modulatory neurons so we have

choices we can say okay do we want to

turn off the muscles in the head jaw and

neck that are hyper contracted

for instance you want to take a muscle

relaxer or relaxedant

or would you want to try and change the

sensory input itself maybe don't change

the way the muscles are behaving but

shut off the sensory part of it your

ability to sense it

there are certainly ways you can do that

or would you want to adjust the

modulatory neurons would you want to

make it such that you have the headache

but you don't perceive the headache that

is you cut off communication between the

sensor and the motor so that the muscles

relax turns out there are treatments and

approaches for each and every one of

those each and every one of those has

different advantages and disadvantages

but as you can quickly see we are going

to have different types of headaches and

different approaches to treating

headache but if you keep in the back of

your mind that you have neurons that

contract muscles to create movement or

tension of muscles remember you can turn

off those neurons and allow those

muscles to relax you have Sensory

neurons that sense input and actually

sense the pain and you have modulatory

neurons which can allow you to adjust

the relationship between the sensory

neurons and the motor neurons and of

course some of you are probably

screaming at me by now saying wait why

would you ever want to deal with the

motor neurons or or the modulatory

neurons once you want to just go

straight to the source and just cut off

the pain ah well the problem there is

that many painkillers

have other issues as well in particular

they can be sedative many of them can be

habit forming or even addictive and for

many people not all but many people they

don't want to take drugs whether or not

they're over-the-counter or prescription

drugs or even more natural supplement

based type treatments

and they would rather use for instance

a behavioral approach in which they can

modulate they can deliberately turn off

the communication between Sensory

neurons and motor neurons and turns out

those approaches exist as well okay so

at this point I promise you that I'm not

going to give you any more of a biology

lesson in terms of pain sensing and

headaches as a more uh conceptual

phenomenon instead what I'd like to do

next is talk about the different types

of headaches and I think this is

something that's very important and not

often discussed except for those people

out there that unfortunately suffer

repeatedly from certain kinds of

headaches like migraine or cluster or

tension headache but I think for most

people out there who experience headache

and again that is everybody at some

point experiences headache rather than

just think of headache as one thing

understanding the major types of

headache and how they differ from and

are similar to one another will really

help you identify what the best source

of treatments for those are so I'd like

to talk about what the different types

of headache are now the first type of

headache we're going to discuss is the

tension type headache again tension type

headaches tend to start off not always

but tend to start off as more or less a

Halo or a headband around the forehead

in the area above the eyes often also

include the jaw the neck muscles

and can extend even into the upper back

again this can be caused by some low

level of infection but more often than

not tension type headaches are going to

come on because of some chronic

psychological stress usually combined

with lack of sleep usually combined with

lifestyle issues and of course without

getting into a long discussion about it

anytime you have lack of sleep you're

going to have excessive stress anytime

you have excessive stress you're going

to have to make sure you're offsetting

that by getting proper sleep most people

don't when they're under excessive

stress by the way we have excellent

tools we're grounded in excellent

science available to you at zero cost if

you are experienced chronic stress or

even short-term stress we have a master

stress episode of the human Lab podcast

again just go to hubermanlab.com and all

that's time stamped for you tension type

headaches

begin in a more or less a headband

pattern but can really extend to other

tissues as well not so often in the face

but really the head and often will start

to climb up toward the top of the head

they are not always in this Halo pattern

sometimes they can be localized to one

area such as the you know the back of

the head or the front of the head or one

side of the head more than others and

that's often the case because of tension

within muscles of the neck that tend to

bias the ache towards one side of the

head I'd like to take a quick break and

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other type of headache that

unfortunately is very common is migraine

headaches migraine headaches are defined

generally as disorders of recurring

attacks of headaches so people who get

migraines often get them in a recurring

fashion some people get them very often

other people get them less often but

migraines are very debilitating the

numbers that is the prevalence of

migraine is still pretty debated one

thing that we know for sure is that

females suffer from migraine headaches

at a rate at least threefold higher than

do males and surprisingly this does not

seem to have any direct hormonal origin

because we're also going to talk about

hormonal headaches that is headaches

that relate to a dip in estrogen and

progesterone a particular phase of the

menstrual cycle that is the ovulatory

cycle so there's a bit of a mystery here

and the Mystery is why is it that

migraine headaches occur at such greater

frequency in females even independently

of the menstrual cycle so when you

control for changes in hormones that

still appears to be the case and overall

migraines are very common now the

numbers on migraine and just how common

migraine is

are extremely wide this was a little bit

frustrating for me in researching this

episode

you will find for instance that 17 of

women suffer from migraines you will

also hear that six percent of males

suffer from migraines you will also hear

that 43 43 percent of females suffer

from migraine that is recurring

headaches that qualify as migraine

headaches and that

17 percent of men suffer from migraine

headaches on a recurring basis which is

again the definition of a migraine

headache or one of the key definitions

so all we can say for sure is that many

many millions of people maybe even

billions of people suffer from migraine

headaches it's kind of a staggering

thing to contemplate but we know it's

extremely common and we know that it's

more prevalent in females in any of the

studies that you will find in terms of

that compare the overall prevalence of

headache it's going to be higher

substantially higher in females and

males does not seem to be related to the

ovulatory menstrual cycle

there are some interesting facts related

to that that I'll just you know touch on

for a moment

pregnancy for whatever reason seems to

be protective against migraine headaches

that is women who suffer from recurring

migraines

before they get pregnant when they get

pregnant and often after they give birth

they experience fewer migraine headaches

so there may be something hormonal it

may be something else what do we know

for sure we know that headache that is

the ache in headache is neural so

whether or not the origins are hormonal

or whether or not the origins are

inflammation or gut microbiome or some

other feature of the body brain axis

at this point all we know is that

neural pain or the experience of pain at

the neural level is the final common

pathway and it's more prevalent in

females so as I mentioned migraines tend

to be recurring so some people get them

once a week some people get them once a

month some people get them far more

frequently that they can be extremely

debilitating oftentimes people

experience migraine because it is a

recurring phenomenon will know when a

migraine is coming on they'll say my

migraine is coming on the kind of sense

it coming

there's this notion of Aura and we'll

talk about Aura in a little bit some

people think of Aura just as visual aura

or the sense of kind of a haloing of

light with the sense that there's

something outside the body the actual

definition of Aura is that

it's the experience that something is

about to happen it's this kind of

feeling of anticipation it's not deja vu

deja vu is different and very

interesting in its own right but

different it's this feeling that

something's about to happen and the fact

that aura is such a prominent feature of

migraine headaches or at least that

people feel that the headache is coming

on long before they feel the actual ache

of the headache and the other

debilitating symptoms suggests that

migraine has something of deep neural

origin that it arises from deep within

the nervous system spinal cord and brain

and that it's not something like a

tension headache that is going from

outside in you know the constriction of

the muscles in the jaw and head so

migraine headaches are very different

than tension headaches even in terms of

how they come on or their onset the

other feature of migraine headaches that

I think is important to note is that

dilation of the vessels remember the

vasodilation so the widening of those

pipes that we call arteries vessels and

capillaries is a very prominent feature

of migraine and fortunately that allows

for very particular types of treatment

and ways of dealing with this pain

specific to migraine headaches the other

feature that's common in migraine

headaches is so-called photophobia many

of you are probably familiar with

photophobia if you've ever been sleep

deprived

simply if you're sleep deprived

and you go outside in the morning the

light is going to seem very very bright

much brighter than were you to have had

a really good night's sleep and that's

because during sleep there are all sorts

of reset mechanisms in the brain there's

the washing out of metabolic debris and

things in the brain the so-called

lymphatic washout That's essential

there's also an adjustment of the neural

tissue of the eyes which as many of you

have heard me say before actually two

pieces of rain that have been extruded

from the cranial Vault so your eyes yes

indeed are two pieces of brain the only

two pieces of brain outside the cranial

Vault and within your eyes you have

neurons and mechanisms that adjust the

the sort of sensitivity of your eyes to

light and of your brain to light and

when you are sleep deprived or when you

have a low-level viral infection or a

cold or a flu of any kind

you tend to experience light as brighter

than it actually is when you're rested

or you're in the healthy state so

photophobia is something that's very

very common in migraine and often the

photophobia is a prominent feature of

the experience that a migraine is coming

on people will start saying oh you know

it's just too bright in here and

normally they'd be able to tolerate that

level of sunlight or of indoor lighting

with no problem

so

there are two aspects of migraine that I

think are particularly important to

understand for sake of of the treatment

and that's the dilation of vessels so we

if we want to treat migraine we're going

to have to think about things that can

constrict blood vessels in the brain

area but we also need to think about

photophobia not photophobia just as a

symptom of migraine but that maybe by

adjusting our sensitivity to light we

can actually short-circuit some of the

onset and subsequent pathology of the

migraine that is if we can prevent

photophobia

partially or completely can actually

offset a lot of the ache of the migraine

that would otherwise occur so that's an

exciting Avenue for addressing migraine

headaches we'll get into photophobia and

how to deal with that we'll also talk

about Aura a little bit more in a few

minutes but for the time being we've

talked about tension headaches we've now

talked about migraine headaches again

keep in mind knowing what kind of

headache you have is essential it's I

would say indispensable for selecting

the best treatment many people out there

will simply get a headache and decide oh

I'm going to pop a couple of aspirin

okay what does aspirin do aspirin's and

anti-inflammatory it also has pronounced

effects on the vasodilation and

vasoconstriction system it actually

allows more blood to flow through those

arteries vessels and capillaries a lot

of people actually use baby aspirin or

small amounts of aspirin as a way to

offset cardiovascular disease that's

another discussion but what do we know

we know that in migraine there's a hyper

dilation of the blood vessels a hyper

dilation of the very little portals that

exist in the brain and around the brain

and that are going to cause the pain

you're going to activate those Sensory

neurons those non-iceceptors that will

then give us the experience of extreme

headache and migraine so taking an

aspirin or something like it for

migraine in some cases the worst

possible Choice again so knowing what

kind of headache you are experiencing is

going to be essential here the other

thing that you'll sometimes hear is that

drinking a cup of coffee or getting

caffeine through tea is a great way to

deal with headache

why would that be well it turns out that

coffee can cause either vasoconstriction

or vasodilation depending on when you

take it and we'll get into the use of

caffeine as a treatment for headache

because indeed it can be a very potent

treatment for headache but you

absolutely need to know what kind of

headache you are experiencing because in

some cases drinking caffeine whether

it's in tea or coffee can absolutely

alleviate the pain of a headache

especially if you catch that onset of a

migraine or attention type headache

early on but in some cases it can make

it far far worse again knowing which

type of headache you're experiencing and

how the different treatments work is key

okay so we have tension type headaches

migraine type headaches I think you're

starting to get the picture they have

different underlying biologies

the next type of headache is cluster

headaches cluster headaches are the ones

I mentioned earlier that arise from deep

within the head they feel as if they're

coming from the inside out and they tend

to be on one side or the other what

scientists and clinicians call

unilateral and tends to originate behind

the eye and sometimes the nose region

sometimes in the mouth region as well it

feels kind of patchy but as if it's

coming from the inside out and again

that's because of that trigeminal nerve

for those of you listening and not

watching this on YouTube I've got three

fingers as if I'm putting up three

fingers and I'm I've got one pointed

toward my eye one pointed towards my

nose region and one towards my upper lip

the trigeminal nerve is an easy one to

remember and it will completely explain

cluster headaches and what to do about

cluster headaches in a moment if you

remember that the herpes one virus and

not herpes two not genital herpes but

herpes one virus is the one that gives

cold sores on the mouth

herpes one virus by the way is

exceedingly common up to 90 percent of

people many children in fact have these

again this is not a sexually transmitted

herpes although it can be of course

transmitted through kissing and sexual

contact but that's not the only origin

of it okay it can be passed by skin

contact and mucosal contact

um so mucosomucosal so that would be

kissing mucosa lying or even skin to

mucosal Linings that's why it's so

common and the reason why cold sores

develop on the mouth for people that

have herpes one is because the virus

actually lives on the trigeminal nerve

and yes it is true that sometimes the

virus will inflame the nerve and the

inflammation will occur at the level of

the eye so people do unfortunately

sometimes get herpes of the eye it

actually can be quite dangerous if you

have an infection of the eye of a herpes

infection in the eye you should see an

ophthalmologist or the nose region they

can experience pain in the mucosal

tissue of the nose more often than not

the most inflammation is occurring on

the the branch that innervates the lip

or the region close to the lip and

that's why a cold sword develops there

an immune response there signaling that

there's inflammation due to the herpes

virus which lives on that neuron for a

very long time neurons don't turn over

in the lifespan so it can live on there

for the extent of of the person's life

however most people

hopefully treat their HSV-1 but if they

don't the the sort of frequency and the

severity of infections tends to taper

off with time we'll have an entire

discussion about viruses and herpes in

particular in a future episode but the

thing to keep in mind here is that this

very nerve is the one that gets inflamed

in these cluster type headaches now

cluster type headaches are associated

with a bunch of very uncomfortable

symptoms again they tend to be

unilateral they tend to begin very deep

and they tend to be excruciatingly

painful excruciatingly painful they can

last anywhere from 30 minutes to three

hours some people experience these in

sleep in fact this is one of the cases

where men experience a headache more

than females

men experience cluster type headaches

that have a sudden onset during sleep at

five times the frequency than do females

the origins of that aren't exactly clear

they do seem to have something to do

with the biological clock mechanisms the

so-called circadian mechanisms so if you

are a man or woman for that matter and

you're waking up in the middle of the

night with a unilateral headache and it

seems like it's deep within your

um within your head or it's starting

there and it's on one side and localized

to the eye and maybe these other regions

the trigeminal is involved in you may be

suffering from cluster type headache and

you should talk to your physician the

other symptom that's quite common in

cluster type headache is a droopy eyelid

which should make sense because the

trigeminal innervates the eye region and

there are other nerves that control the

eyelid but they're in that General

region and they can be impacted the

other thing is something called meiosis

which is that you can't dilate the pupil

I mentioned this before so those your

pupils might get really really small and

they won't dilate and the other thing is

lacrimation tearing and then nasal

discharge all because of a neural

inflammation problem why do I tell you

with such detail about cluster headaches

well if you are somebody that's

experiencing the kind of pain that is

consistent with cluster headache taking

a standard anti-inflammatory or doing

something that is going to adjust the

vial the excuse me the dilation or

constriction of blood vessels may have

an indirect impact on cluster headache

but is unlikely to relieve cluster

headache either acutely meaning right

away or in preventing cluster headaches

you have to deal with this as a neural

issue and we'll talk about some of the

main causes of inflammation and

activation of these cluster type

headaches at the level of the trigeminal

nerve in a little bit because

fortunately there are some excellent

treatments the next type of headache

that is quite common are hormonal

headaches now the phrase hormonal

headache should already cue you to the

fact that it's far too General a term

because there's so many different

hormones testosterone estrogen thyroid

hormone growth hormone and on and on and

on

and they all have many different

functions in the brain and body every

single hormone and in particular the

so-called steroid hormones steroids

again not just limited to things that

people take for Sports in fact the

steroid hormones refers to estrogen

testosterone of the sort that we all

make that men and women

make naturally and those steroid

hormones can impact gene expression they

can are of course what turns on the

growth of the of the breast tissue of

the testicular tissue of the hair growth

and on and on and that's all because of

gene expression if you're really going

to change the identity and function of a

cell long term

right you're going to literally change

the breast tissue or change the penile

tissue or change the ovarian tissue in

some sort of consistent way across the

lifespan you can bet that there are

changes in gene expression and those

changes in gene expression occur because

these steroid hormones have this

incredible ability sort of like the

X-Men of hormones to pass through the

outer membrane of a cell which we call

the extracellular membrane and into the

so-called nuclear membrane they can go

into the area where genes are made and

turn on and off different genes however

they multitask in their life that is

these steroid hormones like estrogen in

particular and testosterone in

particular can also bind to the surface

of cells and impact all sorts of things

at the level of the cells that have

nothing to do with changes in gene

expression and that second mechanism of

binding to the surface of cells is one

of the ways in which estrogen can

control

different aspects of headache now that

doesn't necessarily mean the estrogen

gives you headaches in fact it's just

the opposite

it turns out that low estrogen and

another hormone low progesterone combine

to give rise to headache because of the

ways that low estrogen and low

progesterone impact vasodilation

and vasoconstriction and the

inflammatory response we'll talk about

how to deal with hormone-based headaches

a particular hormone was headaches that

occur because of low estrogen and

progesterone in a moment but the key

thing to know is something that we

covered in the fertility episode I did a

very long very detailed episode on

fertility so I'm not going going to go

into this in significant detail now you

can refer to that episode for probably

more detail than you ever wanted but

also a lot of tools as it relates to

fertility in both males and females but

right now I'm just going to give you a

course overview of that in about 60 to

120 seconds so that you'll understand

when hormonal headaches are most likely

to take place keep in mind that hormonal

headaches are most likely to take place

when estrogen and progesterone are

lowest

so if you understand that during the

follicular stage of the ovulatory slash

menstrual cycle okay so menstrual cycle

is about 28 days on average not in

everyone but it's about 20 days on

average and the first half of that

estrogen starts creeping up up up up up

up up up up up and as we learn in

endocrinology estrogen primes

progesterone so estrogen will then Peak

and then start to fall

pretty quickly right about the time that

the egg ovulates an egg is released and

will essentially be ready for

fertilization if the egg is fertilized a

whole bunch of other things happen as it

relates to pregnancy if not what ends up

happening is that during the ludial

phase which is the second half of the

menstrual cycle there's been a buildup

of the lining of the uterus

because of an increase in progesterone

so estrogen goes up during the

follicular phase then it goes down and

then progesterone goes up up up up up

which is important for generating that

thick lining of the uterus to allow the

fertilized egg if it's fertilized to

implant and if it's not fertilized all

of that gets released from the body in

this bleeding process that we call

menstruation if menstruation occurs and

day one of the menstrual cycle is

considered the first day in which

bleeding occurs well then what that

means is that estrogen is already low

because remember estrogen was low at the

start of the follicular phase and went

up up up up up up then it comes down

right at the time of ovulation and

progesterone goes up up up up up during

the luteal phase in fact it's more than

a thousand fold increase in progesterone

but if there's no fertilization of the

egg progesterone starts coming down down

down down down what does that mean that

means that on the first to about the

fourth or fifth day of the menstrual

cycle first being the first day of

bleeding until about the fourth or fifth

day of the menstrual cycle both estrogen

and progesterone are very very low and

it is at that time at the very beginning

of the menstrual cycle so about the

first week of the menstrual cycle that

many women are very prone to hormonal

headaches hormonal headaches not because

estrogens High that's a common

misconception rather because estrogen

and progesterone are both low and now

that you understand the Contour or the

under underlying reasons for hormonal

headache

you can start to ask well what happens

when estrogen is low well estrogen has a

strong impact on the vasodilation

vasoconstriction system as does

progesterone we'll talk about that a

little bit later but now that you know

what hormonal headache is at least this

one particular type of hormonal headache

which is very very common given the

number of women that are menstruating

and the fact that low estrogen low

progesterone is the cause of the

hormonal headache and the fact that of

course there are women who are no longer

menstruating so they're either in

perimenopause and menstruation is

becoming more infrequent or they're in

menopause and it deceased entirely well

now you understand what the origin of

the hormonal headache is and so all we

need to know is what do estrogen and

progesterone normally do in order to

prevent headache and thereby you'll know

exactly how to offset that is prevent or

treat hormonal headache in that first

week of the menstrual period the last

type of headache that I'd like to

discuss is headache associated with head

hits that is traumatic brain injury

although I definitely want to underscore

the fact that even people who do not

have traumatic brain injury can

experience headaches as the consequence

of hitting their head so the line

between traumatic brain injury and lower

level brain injury is one that still

seeks definition in fact this is one of

the major goals of the clinical field as

it relates to concussion you know it's

also what comes up a lot during the

discussion about football you know these

days you'll see players hit really hard

and depending on whether or not they're

laying there for five seconds 30 seconds

or three minutes you know the crowd and

the uh the people watching on television

and everywhere else are all speculating

as to whether or not the person should

be allowed to play and to be quite

direct there really is no way to assess

the extent of brain damage after the

consequence of hitting one's head or

having one's head hit

because

first of all almost all of the best ways

to detect traumatic brain injury except

the most severe ones

tend to require a lot of very large

equipment like MRI and functional MRI

and CT scans none of which are available

on the side of the field or in the

locker room but also because many many

if not most of the effects of traumatic

brain injury are going to occur not in

the immediate minutes or even hours

after the injury but several hours days

or even weeks after that injury this is

a discussion that we should hold off for

a longer full episode on traumatic brain

injury keeping in mind of course that

football is this very Salient example

of traumatic brain injury and concussion

as is boxing as is even soccer with

heading of the ball Believe It or Not

repeated low level impact to the

forehead and other parts of the head can

give rise to over time traumatic brain

injury without the need for any kind of

full-blown concussion or being quote

unquote knocked out but sports related

concussion actually occupies just a tiny

fraction of the majority of traumatic

brain injury and concussion

most traumatic brain injury and

concussion and low-level brain injury

that can accumulate over time to become

traumatic for sake of daily living that

is lowered cognition disruption and mood

sleep Etc

is actually the consequence of things

other than Sports so for instance

bicycle accidents playground accidents

construction accidents and this is often

forgotten for some reason all the sports

in particular football tend to grab all

the attention as it relates to

concussion keep in mind that while for

certain people is a path to a living for

most people traumatic brain injury is

going to occur in a car accident

construction work or other types of work

for which people generally don't have

many options in terms of the type of

work that they're doing so they are

prone to concussions and head injuries

simply by virtue of their work without

any you know millions of dollars

contracts or the opportunities

necessarily some cases they do but

necessarily to do other things and

certainly car accidents or bike bicycle

accidents are not voluntary events so

the point being traumatic brain injury

and headache related traumatic brain

injury extends far beyond the realm of

sports and in fact if you were to look

at the numbers what you find is that

more than 90 percent of traumatic brain

injury so people coming into the

hospital or clinic are people claiming

that they've got consistent headaches

they're not sleeping well their mood is

off they're feeling more irritable after

having hit their head even once

is not the consequence of sports it's

going to be the consequence of accidents

either on at the workplace or in terms

of a bicycle or other sorts of

Transportation based accident like a car

accident with that in mind any kind of

head hit certainly involves a concussion

or traumatic brain injury often leads to

headaches either infrequent but severe

headaches or chronic low-level headaches

or a feeling there's kind of a

stuffiness or a fullness to the head

there can be a lot of different Origins

to that

a common origin is going to be actual

swelling of the not necessarily the

brain tissue directly but if you recall

our discussion about the meninges which

include the dura and the other tissues

that surround the brain they're actually

three layers that we call the meninges

the durages being one of them and

there's a very little space between

those the brain the meninges that

surround it and the skull it's called

the subarachnoid space very cool right

arachnoid like spider

well if there's even a slight bit of

swelling in the brain or even distant

brain tissue so for instance even if the

there's Whiplash so there's swelling of

the tissue muscular tissue and neural

tissue in the neck area that can

constrict the flow of things like

cerebral spinal fluid blood flow and

indeed mucus and other other things that

are essential we all hear mucus and we

think Illness but mucus is a vital vital

substance within the body for a lot of

important reasons in health as well as

in sickness well if there's less of that

liquid and other fluids and mucus being

delivered to that space well then it can

clog up so sort of the plumbing is

clogged up or that it's caught at the

level of the site of hit or injury

because there's some local swelling and

inflammation there so there are many

different mechanisms that can underlie

headache associated with head hits or

traumatic brain injury now fortunately

there are some recent data pointing to

some what I would call non-obvious

treatments for headache in traumatic

brain injury keeping in mind that

anytime we're talking about injury or

disease or health for that matter mental

health or physical health we have to

highlight

a fact that's going to come up again and

again in every single episode of this

podcast and I think it's not being

overly redundant to do so which is that

regular

sufficient amounts of deep sleep each

night are going to be important for all

aspects of mental health physical health

and performance and have been shown over

and over again to reduce the frequency

of headache and to reduce the time to

repair after traumatic brain injury and

can improve cognition and on and on and

on so sleep is essential for all the

normal things that encourage healthy

activity of the different tissues that

are involved in brain and body to occur

so sleep deprivation of course is going

to limit those but I do want to point

out that sleep

sunlight and I've talked about this

almost ad nauseam on this podcast but

regular circadian Cycles getting

sunlight in your eyes early in the day

and in the evening as well and as much

as possible throughout the day without

burning your skin and limiting your

exposure to artificial lights at night

and on and on all of which is covered in

the light for health episode of The

huberman Lab podcast the master sleep

episode The huberman Lab podcast and in

the perfect your sleep episode The

huberman Lab podcast you can find all

that at hubermanlab.com getting light

and avoiding light at the proper times

of the 24 hour cycle is also going to

favor all the pathways ranging from gut

brain access to the inflammatory

anti-inflammatory Pathways neural

Pathways Etc that of course if you do

that you're going to improve and offset

any kind of detriment caused by

traumatic brain injury is it treating

traumatic brain injury directly no but

is not getting sufficient sleep not

getting sunlight at the right times of

day and getting too much artificial

light at night going to make any impact

of traumatic brain injury including

headache far worse yes there are

certainly a ton of data to support that

state statement as well and then of

course nutrition and exercise are also

important so we can list out sleep Sun

proper nutrition exercise and I would

put a proper social connection whatever

that means to you healthy social

connections include romantic

friendship familial and relationship to

self those five things sleep exercise

Sun nutrition and social connection are

all critical for maintaining baselines

of health and raising your baselines of

health and I mentioned that I can

segment this out now because I think

that anytime we're about to start

discussing pointed treatments that is

things that you can take or do to reduce

headache or things that you can take or

do to improve anything within mental

health physical health and performance

we have to remember that the foundation

of mental health physical health and

performance is only set at its highest

level by tending to those other things

and that nothing really surpasses any of

those things or put differently there's

no replacement for any of those things

in the form of a pill a powder even a

behavioral practice there are things you

can do to offset getting less than ideal

sleep the things that you can use like

bright artificial lights during the day

to try and partially offset lack of

sunlight but really there is no exercise

pill there is no sunlight device

although some bright lights are very

bright there's no no replace basement

for actual sunlight there's no

replacement for actual sleep there's no

replacement for actual nutrition and I

do feel it's an important conversation

to have as we head into the next segment

which is what can you take or do to

reduce headache and in order to address

this we're going to start first with the

headaches associated with head hits and

traumatic brain injury because turns out

there's a surprising and very useful

approach to doing that but

this same approach also can help offset

and treat headache in other conditions

as well meaning not just for headaches

caused by traumatic brain injury but

also headaches caused by sudden onset

Tension Headache or migraine headache or

even perhaps again perhaps cluster type

headaches so the first substance that

I'd like to highlight that has been

shown to significantly reduce the

intensity and or frequency of headaches

is creatine now creatine as many of you

know is something that people supplement

and take

most often creatine is discussed in the

context of muscle performance not just

for people who weightlift but for people

who do endurance exercise and it's often

been said that 5 to 10 grams per day of

creatine monohydrate depending on how

much you weigh 5 to 10 grams per day of

creatine monohydrate can increase

creatine phosphate stores in muscles can

bring more water into muscles can make

you stronger get increased power output

and that is all true that is all

completely true we discussed this in the

huberman lab podcast with Dr Andy Galpin

when he was a guest on the Hebrew and

Lab podcast or standard series and we

discussed this extensively in an

upcoming episode from Dr Andy Galpin in

his special

six-part guest Series where he is a

guest on the Hebrew Lab podcast but

where really he's the one doing the

majority of the teaching that series

covers everything from strength

hypertrophy endurance and there's an

episode on supplementation where we go

deep into the discussion about creatine

now in that discussion and again now

we highlight the fact that creatine

While most often discussed online and in

the media as a supplement for sports

performance for the reasons I just

mentioned

actually has far more data behind it

that is laboratory studies exploring the

role of creatine in the clinical setting

so I'd like to highlight a paper from

that literature now that will make very

clear as to why creatine is interesting

and in fact very effective for treating

headache and particular headache caused

by head hits or traumatic brain injury

the title of the paper is prevention of

traumatic headache dizziness and fatigue

with creatine Administration now keep in

mind this is a pilot study it was

performed in humans so when you hear the

words pre-clinical that is if you hear

there was a pre-clinical study on blank

that means almost always that the study

was performed on animal models mice rats

primates Etc

a clinical trial is something that's

carried out on humans and a pilot study

means that the study was carried out on

humans but on a fairly small cohort a

very fairly small group uh or limited

number of subjects nonetheless if the

data are robust as it is in this case of

this paper I think it's worth paying

attention to so in this study what they

looked at was creatine Administration so

what they did is they had people ingest

a certain amount of creatine I'll tell

you in a moment

in fluid so it could be taken in water

milk with or without food doesn't really

matter what time of day

they had people take creatine why would

they have people take creatine after

traumatic brain injury and in particular

for people that are suffering from

headache dizziness fatigue Etc the

reason is that

neurons nerve cells rely very heavily on

the regulation of calcium in order to

generate those Action potentials to

communicate with one another so it

doesn't matter if it's a motor neuron a

sensory neuron or a modulatory neuron

they all generate Action potentials or

something similar to it and calcium is

important for that process calcium

becomes dysregulated after traumatic

brain injury in a number of different

ways

in particular in ways that impact the

energy production systems of cells that

are related to ATP adenosine

triphosphate for those facionados out

there that want to look it up you can

simply look up calcium ATP and neurons

and you can learn about that cycle

creatine

can be stored in muscles as we talked

about before but creatine and in

particular the phosphorylated form of

creatine which is the readily available

fuel source

form of creatine can also be stored in

brain tissue and is actually quite

prominently stored in the forebrain the

area where the real estate of of your

brain just behind the forehead which is

involved in planning and action and

understanding context so it's very

important for cognition

it's important for personality too but

it's important for a number of different

aspects of life that have to do with

making plans being able to focus very

intensely on your work etc or on

anything for that matter all functions

that become heavily disrupted in people

who have traumatic brain injury and

concussion

creatine's ability to communicate with

the calcium in the ATP system was the

motivation behind the study that is the

authors hypothesize on the basis of

pre-clinical data in animals

that by increasing creatine stores

within the brain not just in the muscle

but in particular within the brain

that

the availability of creatine would allow

for better cognitive function in general

now they didn't look at cognition

specifically in this paper but they did

look at the other aspects that is that

the bad stuff associated with TBI and

they had people supplement with creatine

at a level that is much higher than the

typical level that people supplement

with creatine Simply for Sports

Performance so as I mentioned before

most people if they supplement with

creatine for sports performance they

take creatine monohydrate

typically five grams per day sometimes

10 grams per day if they're about 100

kilograms or or greater in body weight

100 kilograms is 200 approximately 220.

pounds so the dosage that was used for

supplementing creatine in this study

to address the potential impact of

creatine on headache dizziness and

fatigue was quite a bit higher than the

dosages used simply for muscle

performance in this study they had

people take a dose of 0.4 grams of

creatine monohydrate per kilogram of

body weight so for somebody that weighs

100 kilograms or 220 pounds that would

be 40 grams of creatine per day if

someone weighs half that much they would

take 20 grams of creatine per day and

they did that over a period of six

months and we know that when you take

creatine over and over day to day that

there's a buildup of creatine stores

both in the muscles and within the brain

tissue now what they found as a

consequence of this creatine

Administration was really striking and I

think quite exciting they found a very

significant decrease in the frequency of

headache in people that were

supplementing with creatine as opposed

to the controls now keep in mind that

this is a pilot study but the effects

are very dramatic they found a very

statistically significant decrease

increase in the frequency of headache in

people that were taking creatine in fact

if you look at the controls and you see

that they're basically getting headache

at a frequency of 90 percent or more

after TBI the reduction in headache

frequency is down to about 10 or 12

percent in the people taking creatine so

that's quite quite a dramatic effect and

if you look at the other measures they

took

keep in mind again this is a pilot study

so a limited number of subjects but

again the results are very impressive

what they found is that the number of

people experiencing dizziness was

significantly reduced in people

supplementing with creatine as was the

number of people experiencing fatigue

and acute fatigue and chronic fatigue

again not chronic fatigue syndrome per

se but chronic fatigue which was in this

study defined as a general sense of

bodily weakness and even mental weakness

mental weakness is a little bit hard to

quantify but they were very careful to

distinguish between cognitive and mental

fatigue versus physical and somatic

fatigue they acknowledge that both of

those occur in TBI or post-tbi the

headache is quite frequent basically the

takeaway of the study is that for people

experiencing headache dizziness and

fatigue

due to TBI and perhaps and I want to

underline perhaps because it hasn't

really been explored yet but perhaps

headache dizziness and fatigue due to

other conditions symptoms

or causes of headache creatine

monohydrate supplementation might be

again might be an excellent candidate

for people to try why do we say that

well first of all creatine monohydrate

is relatively inexpensive it's

considered safe at the dosages used in

this study and certainly for sports

performance as well and

there are very few other compounds that

have been shown to have as significant

an impact on headache over the long term

as has creatine monohydrate in these

studies of people with TBI it's also

important to highlight the fact that

many many people suffer from tbis I

mentioned earlier and as now there are

very few treatments for TBI you tend to

get the basic advice coming back and

again I think it's excellent advice you

know get proper amounts of sleep get

exercise but don't get another traumatic

brain injury that's obvious but you'd be

surprised how many people go right back

to work because they have to and you

know we have to be sympathetic to the

fact that many people just can't stop

working or go on disability

so many people have to go back to work

that could be sport or it could be other

kind of work where they are then subject

to perhaps getting more TBI maybe

they're getting less rest as a

consequence and stress obviously stress

is a confounding issue for TBI but sleep

exercise Sun nutrition

all of those things proper social

connection are what people are

encouraged to do when they have TBI but

there have been very few compounds in

particular very few over-the-counter

compounds that are known to be safe that

have shown efficacy in dealing with TBI

so I think that while this is a pilot

study and we can consider it preliminary

I think it's important enough and the

effects were dramatic enough that people

with headache and in particular people

with TBI ought to consider supplementing

with creatine in order to deal with

their headaches and of course I eagerly

await other studies exploring the role

of this high dosage of creatine which is

a relatively high dosage of creatine

monohydrate for offsetting headache

meanwhile I think there are a number of

people out there

suffering from headache who might

consider using creatine monohydrate in

an exploratory fashion and seeing

whether or not it helps offset their

headaches keep in mind of course anytime

you're going to add or remove anything

supplement or otherwise from your from

your treatment your nutrition Etc I do

suggest that you consult with your

physician in particular if you have

chronic headaches I don't say that to

protect me I say that of course to

protect you I'd like to take a brief

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I'd like to discuss next I find

extremely exciting why well what I'm

about to describe is a compound or I

should say a set of compounds that are

available over the counter that have

been shown to be very effective in

reducing the frequency and intensity of

headaches and not just one kind of

headache but multiple types of headaches

so what I'll describe has been shown to

have significant effects in reducing the

intensity or frequency of tension type

headaches migraine type headaches as

well as hormone type headaches that are

related to the menstrual cycles that I

described earlier now there are a lot of

data centered around this General topic

but I'm going to focus on three main

papers but I haven't told you yet of

course is what is the compound that I'm

referring to what is this

over-the-counter compound well it turns

out this over-the-counter compound is

not just available over the counter it's

also available in food so it turns out

that nutrition can have a very strong

impact on the frequency and intensity of

headache although supplementation with

this particular compound can accomplish

the same thing as well what I'm

referring to here are omega-3 fatty

acids many of you are probably familiar

with omega-3 fatty acids these are fatty

acids that come in the form of so-called

EPA and DHA and omega-3 fatty acids are

commonly distinguished from the

so-called omega-6 fatty acids omega-6

fatty acids come in a bunch of different

foods and they of course can be

supplemented as well omega-3 fatty acids

come in a bunch of different foods and

can be supplemented as well Common forms

of omega-3 fatty acids or I should say

common sources of omega-3 fatty acids in

Foods include fatty ocean fish including

salmon salmon skins sardines anchovies

things of that sort

common sources in supplement form are

so-called fish oil

capsules or liquid fish oil again

omega-3 fatty acids and almost always

when we're talking about omega-3 fatty

acids we're talking about a combination

of EPA and DHA but really it is the

quantity of EPA

omega-3 fatty acids that seems to be the

most impactful for the sorts of Health

metrics that we're going to talk about

in a few minutes

now with respect to omega-6 fatty acids

the most typical food sources of omega-6

fatty acids are seed oils I know

nowadays seed oils have become quite

controversial

I've given my stance on this in a prior

podcast but I'll just repeat it for

those of you that haven't heard it I am

not of the belief that all seed oils are

bad that they're all inflammatory that

they are killing us or making us sick

that they are the major cause of

metabolic dysfunction Etc however I

think it is very clear and I learned

this from Dr Lane Norton when he was a

guest on this podcast and taught us all

about nutrition in great depth I highly

recommend that episode if you're

interested in nutrition that people are

consuming a lot more oil generally and a

lot of those oils that people are

consuming more of nowadays include a lot

of the so-called omega-6 fatty acids and

a lot of those oils are seed oils the

particular omega-6 fatty acid that's

going to be relevant for today's

discussion is linoleic acid and that is

common in a lot of seed oils so again

I'm not going to tell you that seed oils

are bad however it does seem to be the

case that many people are consuming far

too many seed oils and in doing so are

consuming far too many calories and

perhaps are consuming too much of the

Omega six fatty acids relative to the

omega-3 fatty acids now with that said I

think there is General agreement among

nutritionists and health professionals

that we could all stand to get more

omega-3 fatty acids perhaps for

cardiovascular health although that's a

little bit debated but certainly for

immune system function

for mood and for functioning of the

brain and for the potent

anti-inflammatory effects of Omega-3 so

again Omega-3s can be sourced from food

both animal based and plant-based you

can simply go online and look up the

various food-based sources but

in thinking about headache and different

treatments for headache there are some

recent studies exploring how

supplementing with omega-3 fatty acids

and in one case how supplementing with

omega-3 fatty acids and deliberately

reducing the amount of linoleic acid the

omega-6 fatty acids how that can impact

headache so the first study I'd like to

describe in reference to the role of

omega-3 fatty acids and headache was

published in 2018 and the title of the

paper is long chain omega-3 fatty acids

and headache in the U.S population there

are a number of things that I really

like about this study a few of those

include the fact that they looked at an

enormous number of people that is they

included 12 317 men and women I like the

fact that they included men and women in

the study age 20 or older and that they

broke down the population into

categories that included age they

certainly looked at race and ethnicity

they looked at educational background

they looked at body mass total energy

intake which is really important if you

think about it people are going to be

eating and within the thing things that

they eat they're going to be consuming

some Omega-3s hopefully as well some

omega-6s and if they're eating far more

then they're going to get far more of

likely going to get far more of both of

those things than they would ordinarily

if they were eating smaller amounts so

they controlled for total caloric intake

in a way that I find

particularly useful for looking at these

kind of data so the reason they explored

Omega-3s is worth mentioning omega-3

fatty acids are known to have an

anti-inflammatory effect that

anti-inflammatory effect is mediated

through a couple of different Pathways

we won't go into these in too much

detail now but the omega-3 fatty acids

keep in mind actually make up various

parts of cells in the brain and body

that's right the membrane that remember

I talked before about how steroid

hormones can go through the different

membranes of the cells the outer

membrane and the inner membrane a lot of

those actual membranes the structural

constituents of neurons and other cells

are actually made up of or include

certain fatty acid long-chain fatty

acids and the omega-3 fatty acids are

important for or the actual construction

of those tissues as well as having

anti-inflammatory effects through things

like limiting prostaglandins and other

things that can cause inflammation okay

so there are a bunch of different ways

that omega-3 fatty acids can be useful

they refer in this study to an earlier

study that looked at the so-called

analgesic effect the pain relieving

effect analgesic means pain relieving

effect of omega-3 fatty acids in what

had been a randomized controlled trial

and in that previous paper what they

found was that diets high in Omega-3s

and low in omega-6s okay so high three

low six and as compared to diets that

were just reduced omega-6s they found a

greater analgesic effect of increasing

Omega-3s while also reducing omega-6

fatty acids so in the context of the

seed oil discussion although keeping in

mind that omega-6s can come from other

sources as well if omega-6s were just

reduced on their own there wasn't as

great in effect in terms of reducing

pain and inflammation as there was when

omega-3 fatty acids were deliberately

increased and omega-6 fatty acids were

reduced again in all of these studies

because these are the ones in which they

controlled things well as we should as

we say they are holding constant the

caloric intake so it's not just that

you're removing fat eating less fat

there's actually a removal of certain

fats and fatty acids and a replacement

of those with omega-3 fatty acids in one

case in the other case it's just a

reduction in omega-6s and you're using

other food types and macronutrients to

offset that that reduction in calories

caused by reducing omega-6s the basic

takeaway that they're relying on

marching into the study is that

increasing Omega-3s and reducing

omega-6s seems to be beneficial for

reducing pain and indeed in this study

they find something quite similar which

is that when you hold caloric intake

constant and when you look at omega-6s

whether or not you decrease omega-6

fatty acids or not you find is that

increasing omega-3 fatty acids

in the diet so either consumed through

food sources or by supplementation was

associated with a lower prevalence of

severe headache or migraine so severe

tension type headache or migraine so

this is promising and points to the fact

that long chain omega-3 fatty acids are

likely to have either a pain reducing

and there's evidence for that and or an

inflammation reducing effect that can

significantly reduce the severity of

headache in both tension type headache

and in migraine so that's the first

study the second study is a more recent

study it was published in 2021 that used

a I would say a more or less similar

type of overall design is the one I'd

refer to earlier the title of this paper

is dietary alteration of what they call

N3 but those are omega-3 and n6 omega-6

sorry for this shift in nomenclature I

didn't write the paper

dietary alteration of

omega-3 and omega-6 fatty acids for

headache reductions in adults with

migraine and this was a randomized

control trial randomized control trials

involve having people be in one

condition where they do one thing and

then they get swapped randomly into

another condition so they serve as their

own internal control and that controls

for all sorts of things like differences

in sex differences in age differences in

health background in any number of other

variables as best as one can

in this study they had people either

ingest a diet that had increased

Omega-3s so increased EPA and DHA or

increased

EPA and DHA and reduced amounts of

linoleic acid okay so that's going to

reduce omega-6s

or a control diet in which they had

people taking well it's essentially the

average intake of Omega-3s and omega-6s

and you can probably already guess what

the general results of the study are

going to be the general results were

that there were reductions in headaches

okay the really cool thing is it was a

massive reduction in headache okay this

was they refer to it as a robust

reduction in headache in particular for

the subjects that increase their

Omega-3s and reduce the amount of

linoleic acid that they took the other

thing that I really like about this

study is that while they don't know the

exact underlying mechanism for the

effect they did spend some time

delineating what it is that the omega-3

and omega-6 fatty acids are likely doing

to either offset or exacerbate headache

now I didn't say that omega-6 fatty

acids exacerbate headache but it does

seem that people who ingest more

linoleic acid and omega-6 are

experiencing more inflammation and that

is evident in a bunch of different

conditions one for instance is or

increases in things like cgrp cgrp is a

molecule that's associated with the

calcium signaling pathway it's involved

in vasodilation the expansion of the

blood vessels and capillaries and that's

known

as I mentioned earlier to exacerbate

certain forms of headache okay there are

also forms of headache that can be

caused by vasoconstriction we'll talk

about one very dramatic example perhaps

as we get toward the end it's a very

uncommon example but um it's a it's

called Thunderclap headache and trust me

you do not want Thunderclap headache um

and so we'll talk about Thunderclap

headache a little bit later that

involves constriction of the blood

vessels in any case

in this paper they they didn't study

mechanism directly but they're resting

on this known analgesic anti-pain as

well as known anti-inflammatory Pathways

related to increasing omega-3 intake and

simultaneously resting on the idea where

I think there's I think we now can say

conclusion that omega-6 fatty acids in

particular linoleic acid

can increase inflammation by way of

increasing things like cgrp vasodilation

and some other Pathways related to the

so-called inflammatory cytokine Pathways

and there's a whole discussion nowadays

of What's called the inflammatorium so

the basic takeaway is that if you are

interested in reducing headache it may

be beneficial at least according to

these two studies and another one I'll

talk about in a moment to increase

amounts of omega-3 fatty acids and that

can be done again through the ingestions

of foods although based on the dosages

that we'll talk about in a moment

increasing omega-3 fatty acids by taking

liquid form fish oil which is perhaps

the most cost effective way to

supplement Omega-3s or capsules which is

perhaps the most efficient way to

supplement Omega-3s relate to a level of

one gram or more of EPA per day again

that's the EPA form in particular so if

you're for instance taking supplemental

fish oil or you're getting your Omega-3s

from food and you're getting what you

determine to be 2 000 milligrams or two

grams per day of Omega-3s keep in mind

that's going to include EPA ndha and it

does seem that getting above one gram

per day of EPA omega-3 fatty acids

either through food or supplements or

both is going to be the critical

threshold for reductions in the

frequency and intensity of headaches

that include both tension headaches and

migraine headaches now some people will

find actually that ingesting far more

omega-3 fatty acids generally through

supplementation but again can be

accomplished through Foods as well

can also be beneficial for other things

such as mood and indeed there's a whole

literature related to effects of

ingesting one to three grams again three

grams per day of EPA so that's going to

require

quite a high intake of Omega-3s in

whatever form or supplement you decide

to take those into your body but that

that can improve mood and so forth the

basic range that I was able to find in

the meta-analysis so meta-analyzes are

where a researcher will look at the

results of a bunch of different studies

focused on the same thing look at the

different strength of those studies

they'll do all sorts of cool statistical

gymnastics like remove the most potent

study the one that had the greatest

effect and see whether or not they're

still an effect of some treatment or for

instance they will swap in and out

different studies and different

combinations to see whether or not any

one study is really leading to the

conclusion that a given treatment does

something in any case in the

meta-analysis of omega-3 fatty acids for

the treatment of headache and that

includes all the different kinds of

headache

they found

in exploring a huge range of Omega-3

supplementation ranging from 200

milligrams all the way up to 2 000

milligrams per day it really was at the

one gram or higher dosage per day where

the significant impact on reducing

headache frequency and intensity was

found and just very briefly earlier I

mentioned that not only is omega-3 fatty

acids supplementation been shown to be

effective in reducing the frequency and

intensity of headache in tension type

and migraine type headache but it's also

been shown to improve outcomes for

premenstrual syndrome related headaches

these are what we refer to earlier as

hormone-based headaches again

the low estrogen low progesterone

associated with certain phases of the

menstrual cycle as well as other phase

of the menstrual cycle are often

associated with headache in uh study

entitled effective omega-3 fatty acids

on premenstrual syndrome a systematic

review and again meta-analysis what they

found and here I'm paraphrasing the

conclusion was that

omega-3 fatty acids could yes

effectively reduce the severity of PMS

symptoms and one of the symptoms in

particular that they found what that was

reduced was the pain related symptoms

associated with headache and they

actually had some very nice hypotheses

as to why that likely would be and in

fact point out that in earlier studies

omega-3 fatty acids have actually been

considered as non-steroidal

anti-inflammatory drugs in some cases

and indeed there are prescription forms

of omega-3 fatty acids and I highlight

that not because I think people need to

run out and get the prescription form of

omega-3 fatty acids they're actually

quite hard to obtain and quite expensive

but because I think oftentimes when

we're talking about something like

omega-3 fatty acids

the fact that they are available over

the counter in a supplement or by liquid

or available in food for that matter

leads many people to conclude that oh

you know this is supplementation this is

something that

um you know it's going to have

relatively weak or minor impact on

things like headache or other health

metrics but let's just say that the fact

that it exists as a prescription drug

and its highest potency form at least in

my opinion points to the potency of

omega-3 fatty acids in dealing with

analgesic effects that is reducing pain

and anti-inflammation as well as some of

the known cardiovascular improvements

that are associated with increasing

omega-3 fatty acid intake put simply

Omega-3s are not just something that

comes from food or supplements they are

also being marketed as prescription

drugs so I do think they need to be

considered as quite potent and at least

as far as these papers that again

include meta-analyzes of many other

papers and data sets indicate that

supplementing with omega-3 fatty acids

to a point where you're getting above

one gram per day of EPA is not just

going to be beneficial for treating and

reducing the frequency and intensity of

one particular type of headache but many

types of headaches and when you combine

hormonal headaches tension headaches and

migraine headaches you account for more

than 70 percent of the total types of

headaches that are out there the effects

of Omega-3s on cluster headaches and

some of the other types of headaches at

least to my knowledge have not been

evaluated

there's no reason to think that Omega-3s

would not be beneficial for those types

of headaches but at least as far as the

data sets we talked about here are

concerned it is clear omega-3 fatty

acids are going to be a very potent way

to reduce pain and to reduce

inflammation in ways that can reduce the

frequency and the intensity of different