By Dr. Richard L. Bruno
At least once a week I get a sharp pain on one side of my head, sometimes
the left, most often on the right. I sometimes I wake up with a headache, but
also get one at the end of the day when I am tired. My neck also hurts on the
side where my head hurts and I often feel nauseated. One doctor says I have fibromyalgia. Another says migraines. But I don't have flashes in front of my eyes and I don't throw up. Is my headache a migraine?
Is it due to fibromyalgia?
Probably neither. Patients tell me they have migraine headaches because
there is pain on one side of the head plus nausea. But despite nausea, most
people with headaches don't have migraines. Headaches are most often the
result of muscle spasms in the neck, upper back and shoulder muscles. When a
muscle on one side of the neck goes into spasm it causes not only a one-sided
headache but also pushes on the vagus nerve in the neck -- the nerve that
makes the stomach "turn on" -- and causes nausea.
Such single-sided headaches sound like migraines, but aren't. What's more,
we see many people with headaches, back and neck pain who are diagnosed
with fibromyalgia but whose pain is actually due to muscle spasms.
What causes muscle spasms? Spasms are triggered by physical and
emotional stress. Physical stress can be doing too much and becoming
fatigued or having "painful" posture. Painful posture is sitting or standing
with your back looking like a C: your head falling forward, upper back
curled over, shoulders elevated, being bent forward at the waist or tilting to one side (by the way, sitting at the computer may be the #1 cause of
painful posture.) Emotional stress can be anything from the slings and
arrows of living in the 21st century to the hard-driving, pressured,
overachieving, work-till-you-drop Type A lifestyles that many CFS/ME patients
How do you treat headaches and other muscle spasm pain? First you need to
make sure that the pain is indeed caused by a spasm. A morning headache can
be a symptom of a sleep disorder like sleep apnea. A daytime headache can be a sign of high blood pressure or hypoglycemia. Having a breakfast with 16 grams of protein and an 8 gram protein snack at 10:00 am and 3:00 pm can significantly decrease spasms and pain.
If spasms are causing pain you need to take the stress off yourself and your
muscles. You need to slow down, pace activities and rest during the day, even
lie down to take the load off your muscle for 15-minute rest breaks, one in
the morning and one in the afternoon. You also need to balance your body --
front to back and side to side, while sitting, standing and walking -- so
that muscles don't have to fight gravity to keep you upright.
A physical therapist (PT) with lots of experience treating chronic pain can help you turn off long-standing spasms. PTs can teach proper posture and suggest assistive devices to balance your body while standing and walking. Using a lumbar cushion while sitting, and a contoured, fiber-filled cervical pillow while sleeping on your back, insure good posture and turn off back and neck spasms day and night. Since heat is usually more helpful for spasms than is ice, PTs can do ultrasound (the deep heating of muscle using sound waves) and you can warm your muscles at home by taking a hot bath or shower and by using a heating pad.
Actually, you always need to keep your painful muscles warm, especially those
in your neck and shoulders, since cold also triggers muscle spasms. The
change of seasons -- especially the transition from summer to fall -- is very
troublesome for those with spasms since your body isn't sure just what the
temperature is. Dress in layers and bring along a sweater to keep your
cold-sensitive muscles warm wherever you are, inside or out.
And be careful if you go to a physical therapist. Too many PTs use the "shake
and bake" method: gentle massage after your muscles have been heated by a hot
pack. Although massage and heat can relax muscle spasms and make you feel
better for a few hours, if you don't take the stress off your muscles and
change your posture all day long the spasms and pain will return.
Once your spasms start to relax a home stretching program is indispensable.
With help from your PT you can find a few stretches for the specific muscles
in spasm. Stretch just before bed, first thing in the morning, every half
hour during the day and whenever you feel muscles tightening. A handful of
stretches combined with reduced physical and emotional stress, proper posture
and staying warm will keep muscles relaxed day and night and stop muscle
spasm pain, including those nasty headaches.
About the author: Dr. Richard Bruno is Director of Fatigue Management Programs and The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Understanding and Treating "Post-Polio Syndrome" and Chronic Fatigue
, is published by Warner Books.) E-mail questions to Dr. Bruno at PolioParadox@aol.com.