Episode 56 - Headaches


Dr. Chad Edwards: This is Dr. Chad Edwards and you’re listening to podcast number 56, of Against The Grain.
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Announcer: Welcome to Against The Grain podcast with Dr. Chad Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients, to help you on your way to a healthy lifestyle. Get ready because we’re about go against the grain.
Dr. Chad Edwards: Hello, hello, this is Dr. Chad Edwards and we are back for number 56 of our podcast. We are without Mr. Marshall Morris, and I’m a little sad today because of that. However, I have an amazing guest; she’s been here before and I’m excited to have her back today. And we’re talking about a topic that affects a lot of people. Dr. Krista Lewis, welcome.
Dr. Krista Lewis: Thank you, thank you.
Dr. Chad: So how are you doing today?
Dr. Krista: I’m doing good.
Dr. Chad: You’re excited to be here?
Dr. Krista: Yes, I’m always excited.
Dr. Chad: Always good to talk about these kinds of things and Tulsa prolotherapy.
Dr. Krista: It is actually. It’s kind of a little — when you know you’re doing what you’re supposed to do when you can talk about this stuff all day long.
Dr. Chad: I totally agree with that. And it’s always like do you want to surprise people with what the topic is or do you want to start with a story, or just like straight out and say it. I guess today, we’ll just straight out say it, I’m not much of a secret keeper. Today we’re talking about headache. It’s one of those things that affects a lot of people. You see a lot of headache in your practice?
Dr. Krista: Yes, I mean — and everybody has had a headache at least once in their life.
Dr. Chad: Yes, common stuff. When it becomes repetitive, obviously, it’s an issue and needs to be addressed. It brings to mind a patient that I saw. And the way we’ll manage it, we’ll get into this a little bit as we go. But I remember I was the medical director for a clinic in Edmond Oklahoma, and I would go work up there some. And I had a patient that came in that was a former active duty army, had never deployed to Iraq or Afghanistan, but went to another country as — like he was stationed there.
When he came in to see me, he told me his story. Basically, the problem was that he couldn’t — he was trying to go back to school and get some education so that he could function. And so we’re just talking through what were his issues. And the short story is he couldn’t function, he couldn’t. He was in school but he wasn’t doing well he was basically failing out of his classes. And so I was like, “Well, what’s going on? What’s the deal? When did your headache start?” and all this kind of things.
Basically, he was telling me that he had these headaches. So when he deployed to this — to where – I shouldn’t say deploy. When he got stationed at his permanent duty station, he started having headaches. And his headaches were debilitating and so bad that he couldn’t function and couldn’t do his job. So they ended up — they did all kinds of evaluation, all those things; couldn’t find anything wrong. So common you will hear people come in; they got all these complaints, they get their work up, their tests, all those things. And they’re like, “Well, there’s nothing wrong with you, and it’s must be in your head.” I guess in this case it was.
Dr. Krista: Literally.
Dr. Chad: But they ended up medically butting him out of the army. Now when he was seen at the VA after he was discharged from the army, they put him on a slew of medicines. I asked him to bring his medicines and he brought this bag and I think it was eight medications or so, all for his headaches. He had no other complaints other than these headaches. And he was on eight medications.
Now if you want to go back — for our listeners, if you want to go back and listen to one of our podcasts. It was several episodes ago, but it was on the number four cause of death in 1996 was properly prescribed medications. We’re giving patients a multitude of medications. And in this guy’s case, we gave him eight medications. He’s less than 30 years old and we gave him eight medications.
Dr. Krista: For one problem.
Dr. Chad: For one problem. And I said, “Okay, and now you can’t function?” He was like, “No I can’t. I don’t want to do anything. I just can’t think. My brain won’t go.” He was like – he had this very flat affect. And just talking with him, it was like, “How are things?” I was like am I talking to [unintelligible 00:04:53]. He was just very flat, “Yeah, I’m okay.” And there’s just no emotion there. And I said, “Okay. So we got you on these eight medications, so your headaches must be gone now, right? And he’s like, “Nope, I still have the same headaches I always had.” I was like, “Okay. Well you were someone with headaches; now you’re a zombie with headaches.”
Dr. Krista: Yes.
Dr. Chad: He said, “Yes, pretty much.” We did nothing, other than make him worse by giving him eight medications, none of which helped his headaches.
Dr. Krista: Correct.
Dr. Chad: It’s so common that we see stuff like this, and they never even asked the question about, “Why are you having headaches? And what can we do to make your headaches go away?” That’s the gist of what we’re going to talk about today. When you have a patient that comes in, you’re a — I can’t say that you’re a spec– well I can say it, but you can’t say that you’re a specialist  Tulsa prolotherapy.
Dr. Krista: Correct.
Dr. Chad: But your approach to chiropractic medicine is different.
Dr. Krista: It’s different than the traditional, yes.
Dr. Chad: Right. You’re an upper cervical chiropractor, and you practice NUCCA?
Dr. Krista: Yes, primarily NUCCA. Yes.
Dr. Chad: When someone comes in to see you and they’ve got headaches, what’s your general approach? What do you do?
Dr. Krista: Well I do, of course, a full history because we want to really find out why they’re having the headaches. And if we look at the list of types of headaches you can be diagnosed with, the International Headache Society has about five of them. And I don’t really worry about diagnosing the type of headache they have, because that doesn’t really tell me the cause, because if you look at some of the headaches and what they list as causes, it says “Unknown.” They don’t know what causes it.
So that doesn’t really help. But what I do is, I take a full history. And let’s say what’s going on in their life? So that typical thing that they would do if they come into revolution at all, where we were just doing a full exam. But my approach specifically is looking at misalignment and how the spine really primarily can play a role in setting up someone to have headaches. And, of course, it can be layers of things that can cause it; but if that spine is out of alignment, it can cause the muscles to move differently, it can cause things like trigger points, muscle tension, muscle stiffness. All of those things that need to be addressed, but those can’t be addressed long-term unless we address the misalignment initially Tulsa prolotherapy.
Dr. Chad: Makes absolute sense to me. I get a lot of patients that will say — they come to see me for their headaches and I’ll say– because I’m a — as an osteopathic physician, I believe in structural medicine, I believe in visceral somatic and somatic visceral reflexes. For our listeners — meaning that the organs affect the structure or the alignment, and the alignment or the structure affects the organs.
Dr. Krista: Correct.
Dr. Chad: It can go both ways. And so we believe in that, and we see evidence of that. They’ll come to see me and I’ll say, “Well, one of the things that I would recommend,” of course, I work in the emergency room also and I get the same thing, and it’s not uncommon that I’ll tell patients, “You really should see a chiropractor.”
Now, I’ve had mixed experience with chiropractors, I’m just being honest.
Dr. Krista: That can probably be said for any type of practitioner, yes?
Dr. Chad: Absolutely. And I’ve had some horrific experiences; I wouldn’t have sent my dog to this chiropractor, but I also know some physicians that I wouldn’t send my goldfish to either. It’s not to knock their profession, but I think there’s a danger of doing that. But I’ll ask them and they’ll say, “Oh, I went to a chiropractor, and it didn’t really make any difference.” And I think that’s one of the things that’s important to understand especially about upper cervical specific chiropractic. What — not what’s your approach, but what are your thoughts about that?
Dr. Krista: Well, someone not going to a chiropractor at all, and going to a chiropractor; I would prefer them to go to a chiropractor. There’s lots of things that we are trained in generally that can help, that isn’t looked at by the typical medical doctor. Dr. Edwards is a little bit different in that respect, but generally the only things that the medical profession typically does with the headache is medicate like we just talked about. And then if the medication doesn’t work, they pretty much just say, “Well we don’t know what to do, sorry.” Or, “It must be in your head,” or, “It must be so.”Chiropractors, we’re trained to look at other things. And look at the structural medicine and I know D.Os are to a certain extent, but sometimes that gets lost along the way too.
Dr. Chad: Without a question.
Dr. Krista: So we just have this real easy approach of just medicating. And those can come with the whole host of other issues as well. I would say, in general, chiropractors are great for any type of thing, any other type of ailment, especially if the medical profession isn’t being helpful. But for me specifically for our upper cervical specifically, we look at a little bit even differently than that. First of all the adjustment is not any twisting, popping or cracking. So it’s a little gentler approach typically.
Dr. Chad: It’s very, very gentle.
Dr Krista: Yes, sometimes people ask me, “Well, what did you do? You didn’t do anything.”
Dr. Chad: I have that same experience.
Dr. Krista: So, you got up and you feel better.
Dr. Chad: Right.
Dr. Krista: And so, but what it does is if you look at the body as levers and how it works, when you’re releasing that tension off of those specific areas with those muscles, it will –you don’t induce more pain or it make it more uncomfortable, you’re not pulling and tugging on those muscles like you can normally be, you’re actually aligning everything up very gently and it just naturally releases that tension off those muscles in the area, takes pressure off the brainstem, which can be another cause of headache and like I said, no matter what the cause of headaches, if we use this approach it addresses a lot of the root causes that it can be.
Dr. Chad: Yes, and I think you hit on several key points there and certainly from a traditional medical approach before I started looking at functional medicine and asking those tough questions of what’s really going on, what’s causing these headaches, my only response was, like so many things, “We could try physical therapy.” I’m sure I recommended chiropractic to some. In the army we had some chiropractors but it was a very limited — they had a limited scope of practice and limited things that they could do. So, I probably recommended some, but my only answer was medications Tulsa prolotherapy
Dr. Krista: Yes.
Dr. Chad: And we all heard about, especially like with migraine, which we’ll talk about in our next podcast but we learned about the triggers for migraine and you know certain chemicals and things in cheese and red wine, and in those kinds of things that can be triggers for migraine for many patients. So we learn those but we don’t ever memorized them.
Dr. Krista: You don’t memorize them and then you don’t how to implement that.
Dr. Chad: Exactly. And then you’ll get the patient, it never failed. If I did remember them, the patient that would come in to see me next, would say, “Well, I’ve already cut out cheese and red wine,” and they went down the list better than I could have done.
Dr. Krista: Then what do you do?
Dr. Chad: And it’s like “Whoa, shoot, you just took all the wind out of my sails. So here’s your medication. Have a nice day.”And I was listening to a continuing medical education thing on migraine, and there was a neurologist that was speaking and she said that she actually loved getting migraine because it was the easiest thing to fix with medication. So, patients have a migraine, you would give them a Triptan and they got better almost all the time. Now, the interesting thing to me is that they’re often and even if you look at the treatment algorithms for migraine, they start with very low level medications, like Tylenol or Ibuprofen. The interesting thing to me is if you take Tylenol or Ibuprofen all the time, you can get a rebound headache.
Dr. Krista: Yes.
Dr. Chad: So then, you’re on these medicines all the time and if you don’t take them you get a headache and if you — but you take them.
Dr. Krista: So, how do you ever get off of them?
Dr. Chad: Exactly.
Dr. Krista: And then you got to check your liver.
Dr. Chad: Right. And of course it can affect — the Ibuprofen and the anti-inflammatory going effect your kidneys. There’s just a whole host of problems that come with medications. Just go back and listen to our podcast on the number four cause of death in the United States in 1996. So, just really, really interesting about what is our common way of treating this, what do we do? So we’re going to take a quick break after we come back I want to hear about how you fix this stuff.
Dr. Krista: Okay. Sounds good.
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Dr. Chad: And we are back from our break. Joined by Dr. Lewis and today we’re talking about headaches, what causes them and what can we do about it? So, there’s lots of potential causes we talked a little bit about the structural alignment, function, those kind of things.
Dr. Krista: Yes.
Dr. Chad: Now, we’re going to get into treatment. Now, my traditional approach was medications, “Here’s what we’re doing for your headache and we’re just going to give you one or more medications, take as needed.” Or if you get headaches so frequently we may give you a prophylactic Amitriptyline or you know something like that, that you would take to try and prevent getting a headache, and sometimes that can be very helpful for some patients but we haven’t ever asked the question, “What’s causing this?”
Dr. Krista: What’s really causing it?
Dr. Chad: Now, since I started getting into functional medicine it obviously changed my approach to headache and I’ve had some tremendous success with a couple of things. The first one is hormone therapy and when I get patients that they get these migraines that are centered around their menstrual cycle, we got a hormone problem.
Dr. Krista: Correct.
Dr. Chad: And we can address that with either hormone replacement therapy or with a whole series of things that are options for enhancing normal hormone functions. So, like hormone foundations which we use to help with estrogen dominance, awesome supplement, great stuff and we’ve seen some great fantastic things for that. Hormones are definitely a huge benefit. I’ve got a patient that comes to us from another town, and she’s actually a physical therapist and she heard about prolotherapy for migraine. Now, she was having migraines, gosh, three times a week, it’s something ridiculous and we did three rounds of prolotherapy on her neck and her headaches went away for like five or six months. They started coming back and she came back to see me again and we did another three rounds and she hasn’t been back since. She has done absolutely amazing and her headaches are essentially resolved with prolotherapy. Which goes back to that, what’s the underlying cause? Let’s fix that underlying cause and from my perspective, you get patients with headaches and their neck is never non-tender.
Dr. Krista: Correct.
Dr. Chad: They’re always have tenderness.
Dr. Krista: Tightness, stiffness-
Dr. Chad: Exactly.
Dr. Krista: Yes, trigger points which we can talk about another time with that but just those are kind of like knots that are in those areas that are really tender.
Dr. Chad: Right. So, obviously we focus on hormones, I do a lot of prolotherapy, what’s your approach? How do you address these patients with headaches?
Dr. Krista: Since I’m an upper cervical chiropractor, that is going to be ultimately what I’m going to do. Now, I will add other adjunct therapies to that or talk about some other things that we can do, you know detoxing the system, looking at hormone imbalance, looking at blood pressure, all of those things play a role. And what I’ve found though, things like hormone imbalance, blood pressure, there’s actually studies that shows that upper cervical adjustments can lower blood pressure-
Dr. Chad: Yes, I’ve seen that.
Dr. Krista: There’s other things that can cause it as well, so we can’t just ignore those things. But if it is the blood pressure is causing it, getting an upper cervical adjustment is an easy way to relieve that take into, we’re looking at long-term, and we don’t want something that acts like, what I call — what we call a chiropractic aspirin sometimes, where you just still-
Dr. Chad: [laugh]
Dr. Krista: That’s not what we want, we want recovery.
Dr. Chad: Right.
Dr. Krista: We want them to get better, where they’re not have to rely to come in on a regular basis. So, with headaches, definitely looking at their spinal alignment, there’s ways I measure that, we come in and then I look at how do I need to adjust them. That’s something that won’t be different for the patient, they won’t know that I’m adjusting them different that another patient and because of what they feel or what they experienced is the same but I’m looking at direction and how the spine has misaligned in this distortion patterns that it has. We look at that and then, I also check musculature and trigger points and we address that and there’s ways we can do that that are not — to also talk about posture and some movements patterns that can help. But primarily making sure that spine is in alignment is going to set that foundation to let all of the other therapies, whether it’s hormone therapy, looking at why their blood pressure is high, looking at why their muscles are that way besides the alignment, is going to open that door. When you had mentioned about going to physical therapy or referring out, the problem I see with that is if they have a misaligned spine, physical therapy can only get them so far and sometimes it doesn’t work. But if you align the spine and then work on the muscular system, it works much, much better.
Dr. Chad: Yes. So, why would you encourage someone with headaches to come to see you as an upper cervical chiropractor versus just a traditional general practitioner chiropractor? Not speaking ill of them at all.
Dr. Krista: Correct.
Dr. Chad: But why would you encourage them to look at upper cervical versus total spine?
Dr. Krista: Well, even though I just upper cervical, I feel like it’s a whole body adjustment, a whole spine adjustment, so we’re addressing the spine-
Dr. Chad: And they’ve seen that?
Dr. Krista: Yes, as one. I mean it can – we’ll talk about it another time, we can help with knee problems, hip problems, all the way up. So, it’s not just for upper cervical issues but specifically for headaches, that’s a head-neck issue, for sure for most people. And so addressing that area, taking the tension off. And it’s gentle so there’s no discomfort or pain involved. I will say that the results offered a lot of people either immediate or within that first week; no headache. Or we have a significant reduction and there’s no harm in it. There’s no harm, there’s nothing that’s going to hurt you for coming in and getting an adjustment. If it doesn’t work, that’s about the worst thing that can happen.
Dr. Chad: Yes, and that’s one of the things that I love about it. And, of course, prolotherapy, very, very low-risk. I’ve never seen a complication from doing a cervical prolotherapy procedure, but I can’t tell you too many patients that say, “Hey, I got some free time, why don’t you go and stick a bunch of needles in my neck, just because.”
And even though there’s substantial benefits, it’s-
Dr. Krista: It’s a little bit harder to take to.
Dr. Chad: Yes, of course. We can do it under sedation. We can make patients comfortable; we don’t want them to have a bad experience. But when I first took board, when I was in medical school, and first taking boards, they told us, “Go with the most cost-effective and the least invasive.”
Dr. Krista: Yes.
Dr. Chad: And certainly upper cervical chiropractic is less invasive than prolotherapy; and I think it’s just a fantastic option. I very much appreciate you coming out here Tulsa prolotherapy.
Dr. Krista: Yes, thank you.
Dr. Chad: Anything else you want to say about headaches across the board?
Dr. Krista: In general, who wants to live with a headache on a regular basis? We all get them from time to time and that’s a different situation; we curb to manage that immediately. But if you have chronic headaches, there is help. You don’t have to live that way. And when I have a headache, I can’t — I don’t understand how people can live with that every day.
Dr. Chad: Exactly. If anybody is listening and they want to be evaluated for their headaches, obviously, we offer a fairly comprehensive approach in our clinic; Revolution, Health, and Wellness. Give us a call at 9189353636. Ask for Dr. Lewis; and she is accepting new patients, and would be happy to get your head on straight. I love saying that.
And also on headaches, don’t forget that one kind of headache can cause another kind of headache. You’ll get patients that will say, “I get like this typical headache, but then sometimes it gets really bad and it’s a little bit different.” It’s probably that one headache is triggering a migraine, but very commonly, a tension-type headache triggers a migraine.
And I’ve also seen other kinds of headaches that are not true migraine, and we’ll talk about this in the next episode. That aren’t true migraine that are really bad. And when we say, “It’s not a migraine,” it doesn’t mean it’s not a bad headache.
Dr. Krista: Correct.
Dr. Chad: Anyway, thank you guys so much for listening. Thank you Dr. Lewis for coming out-
Dr. Krista: Thank you.
Dr. Chad: And talking with us. And we’ll talk to you next time.
Announcer: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week, where we’ll be going against the grain.