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, we’ll 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,

or 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 a 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 podcast.

Our first sponsor is Thesis.

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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 in 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 involved 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

are the so-called meninges.

Now, the meninges, in addition to being a fun word to say,

are 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 sack 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 a very sharp razor blade.

So the brain is actually sitting in a very fibrous-like sack

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, if you’ve ever felt, for instance,

the sail 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 sack

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, a little skin flap has to 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 get into the skull

and there are 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,

N-O-C-I, 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 and 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.

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, or I should say the relatively

more minor cluster headaches are extremely painful,

and the severe ones are exceedingly painful.

Cluster headaches arise from deep,

or we get the sensation that they are arising

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, tri, 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 lip,

and there’s a branch that extends

more or less to the nasal area.

And so this trigeminal nerve becomes inflamed,

or in other ways is hyperactivated 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 pupils 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 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,

this reduces inflammation and inflammation is bad.

And I suppose in some cases,

and when inflammation is really widespread

across the brain or 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, 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

at hubermanlab.com and it’ll take you to specific episodes

and timestamps 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 a BB or a splinter

into a particular skin area,

there’d be a lot of inflammation.

So it can 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

or 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 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 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

in 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 extent of inflammation

by putting in different scar tissues.

Indeed, a lot of the things that we think of

as kind of gross, pussy,

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 ultramarathons,

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 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 ache in headache,

we have neural origins of the ache in 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 in headache,

and that sometimes they exist alone,

and sometimes they exist in combination.

However, and this is an 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 pinprick 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

across 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 some 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 or 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 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 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 in 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 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 an 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 neurons, sensory neurons,

and modulatory neurons.

And you’re probably thinking by now,

why are we talking about this?

I thought we’re going to talk 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 in a kind of a headband-like fashion

or they tend to start there and exist around the head.

These are very common.

They can arise from a number of different sources,

arise from sleep deprivation.

They can arise 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 relaxtant, 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 the modulatory neurons?

Wouldn’t 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 it 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 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

or 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 Huberman Lab Podcast.

Again, just go to hubermanlab.com

and all that’s timestamped 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 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 acknowledge one of our sponsors, Athletic Greens.

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The 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 in 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 6% of males suffer from migraines.

You will also hear that 43, 43% of females

suffer from migraine, that is recurring headaches

that qualifies migraine headaches.

And that 17% 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 than males,

does not seem to be related

to the ovulatory menstrual cycle.

There are some interesting facts related to that

that I’ll just 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 who experience migraine

because it is a recurring phenomenon

will know when a migraine is coming on.

They’ll say, my migraine is coming on.

They 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

or 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,

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 glymphotic 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,

are actually two pieces of brain

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 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 indoor lighting with no problem.

So there are two aspects of migraine

that I think are particularly important to understand

for sake of the treatment,

and that’s the dilation of vessels.

So 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 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 is an 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 hyperdilation of the blood vessels,

a hyperdilation of the very little portals

that exist in the brain and around the brain

and that are going to cause the pain.

They’re going to activate those sensory neurons,

those nociceptors,

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 attention 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.

It 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’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% 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.

So mucosal, mucosal, so that would be kissing,

mucosal lining, or even skin to mucosal lining.

So 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,

herpes infection of 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 branch that innervates the lip

or the region close to the lip.

And that’s why a cold sore 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 the person’s life.

However, most people hopefully treat their HSV-1,

but if they don’t, 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 a 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 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 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 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 are 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.

Of course, what turns on the growth of the breast tissue,

of the testicular tissue, of 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

that 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,

in particular hormone-based 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 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 28 days on average,

and the first half of that,

estrogen starts creeping 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,

low, low, low, low, low, low, low, low, 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 luteal 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,

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

to 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 estrogen’s high,

that’s a common misconception,

rather because estrogen and progesterone are both low.

And now that you understand the contour

or the underlying reasons for hormonal headache,

you can start to ask,

well, what happens when estrogen is low?

Well, estrogen has 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 a 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.

And 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 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.

So 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 in mood,

sleep, et cetera,

is actually the consequence of things other than sports.

So for instance, bicycle accidents,

playground accidents, construction accidents.

And this is often forgotten.

And for some reason,

all the sports and 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 millions of dollars contracts

or the opportunity to necessarily,

some cases they do, but necessarily to do other things.

And certainly car accidents or 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%

of traumatic brain injury,

so people coming into the hospital or clinic

or 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 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 if it involves a concussion

or traumatic brain injury often leads to headaches,

either infrequent but severe headaches

or chronic low-level headaches

or a feeling that 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,

there are actually three layers that we call the meninges,

the dura just being one of them.

And there’s a very little space between 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 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 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’s 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 nauseum

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 Your Sleep episode of the Huberman Lab podcast,

and in the Perfect Your Sleep episode

of 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

from gut-brain access to the inflammatory,

anti-inflammatory pathways, neural pathways, et cetera,

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 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 kind of 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 replacement 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 it 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 weight lift,

but for people who do endurance exercise.

And it’s often been said that five to 10 grams per day

of creatine monohydrate, depending on how much you weigh,

five 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,

can increase 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 Huberman Lab Podcast 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 Huberman Lab Podcast,

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,

in 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 preclinical,

that is if you hear there was a preclinical study on blank,

that means almost always that the study was performed

on animal models, mice, rats, primates, et cetera.

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 fairly small group 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 or 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, et cetera.

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 aficionados 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 it is actually quite prominently stored

in the forebrain, the area where the real estate

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, et cetera,

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

and the ATP system was the motivation behind this study.

That is, the authors hypothesized on the basis

of preclinical 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 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 greater in body weight.

100 kilograms is 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

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% or more after TBI,

the reduction in headache frequency

is down to about 10 or 12% in the people taking creatine.

So that’s 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,

kind of 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 acknowledged that both of those occur in TBI

or post-TBI, that 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 TBI,

as 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,

or I should say 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 treatment,

your nutrition, et cetera,

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 break

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What 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.

What 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, et cetera.

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-6 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,

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

in 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 things that they eat,

they’re going to be consuming some omega-3s, hopefully,

as well as 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, 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 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 control 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 an 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 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 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

is published in 2021 that used a,

I would say a more or less similar type of overall design

as the one I referred 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 the 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

and 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

what’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

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 increased their omega-3s

and reduced 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 than omega-6

are experiencing more inflammation.

And that is evident in a bunch of different conditions.

One, for instance, is increases in things like CGRP.

CGRP is a molecule that’s associated

with a 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.

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 it’s called the thunderclap headache.

And trust me, you do not want a thunderclap headache.

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 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,

or 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 inflammatome.

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,

really 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 and DHA.

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 can improve mood and so forth.

The basic range that I was able to find in the meta-analysis,

so meta-analyses 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 there’s 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-analyses 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

in reducing headache frequency and intensity was found.

And just very briefly, earlier I mentioned

that not only has omega-3 fatty acid 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 referred to earlier

as hormone-based headaches.

Again, the low estrogen, low progesterone

associated with certain phases of the menstrual cycle,

as well as other phases of the menstrual cycle

are often associated with headache.

In a 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 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, 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 in 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-analyses 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% 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 kinds of headache.

Before we continue our discussion

about many not commonly known and yet very potent treatments

for different forms of headache,

I want to touch on a topic we mentioned

a little bit earlier and also provide a treatment

that is a way to alleviate something,

and that’s photophobia and aura.

Now, keep in mind that earlier I referred to aura

as this sense that something’s about to happen.

That is true, meaning that is an accurate description

of aura, but oftentimes people also come to understand aura

as feeling that something surrounds a given object visually

or even that people have a sense

that something’s around them.

So again, this can be a little bit vague,

but this idea that aura is a sense

of something about to happen or that visually

or in an auditory way, and or maybe even in kind of a sense

that something is about to happen in a certain environment.

And the reason I’m making kind of arc shapes with my hands,

for those of you that are just listening,

I’m making arc shapes with my hands,

is that aura is often described as kind of a halo

or a emanating out from one’s body

or from something that they’re looking at.

Again, nothing spiritual about this

in the context of the discussion about migraine

and headache, but rather many people experience photophobia,

sometimes with aura, sometimes no.

And I just want to touch on a couple of the mechanisms

by which aura and photophobia occur

and mention just briefly a pretty well-established way

that people can start to offset photophobia.

And again, I mentioned that

because many people experience photophobia in headache,

but there are also a number of people

that experience photophobia,

even if they don’t have intense headaches.

So photophobia is pretty common, pretty debilitating.

It actually, it’s one of the reasons

why people feel not well and need to leave work

or not go to school or leave school,

these kinds of things,

or lay in bed all day or dim the lights, not go outside.

Again, sunlight being so congruent with health,

you can imagine how photophobia can lead

to all sorts of negative downstream consequences.

Okay, so what is aura and what is photophobia?

The exact origins of aura aren’t exactly clear,

but it is generally thought that what aura represents

is what’s called spreading depression.

And this is not depression of one’s mood,

although it can be associated with that.

This is depression of neuronal activity.

Again, neurons communicate with one another

by generating electrical impulses

that travel down the length of their so-called axons,

which are like little wires,

and then they dump neurotransmitter out

at the so-called synapse

and impact the electrical activity of other neurons.

Depression is a electrical,

or I should say a chemo-electrical,

is the proper term,

phenomenon in which the excitability of neurons is reduced.

So again, doesn’t have anything to do

with depression as a mood state per se,

rather it is a reduced excitability of neurons.

And it’s been shown in some imaging studies

that aura is associated with a back to front,

so from the back of the brain to front,

spreading depression like a wave

of lowering levels of electrical excitability,

and because this originates in the visual cortex,

which is in the back,

so that’s the part of your brain

that is making sense of visual images

coming in through the eyes

and relayed through other stations in the brain,

that people will start to see a kind of halo of light

or that they’ll start to feel that the light around them

is literally surrounding their body

or some other object or body that they’re looking at,

and then it spreads forward in the brain,

and that’s when it tends to stretch over

into other so-called sensory modalities.

Sensory modalities being things like touch or hearing,

so people will get the sense

that they’re kind of seeing something

in their periphery of their vision,

then they’ll start feeling something around them,

there’s a sense that something’s about to happen,

so as this spreading wave of depression

goes from back to front,

people experience a number of these different

semi-abstract sensory phenomena that we call aura, okay?

So that’s how aura originates.

Now, photophobia is a little bit different.

Photophobia, we now understand

because of some beautiful work

that was done at Cliff Saper’s lab

at Harvard Medical School and some other laboratories,

showing that photophobia originates

from a specific set of neurons in the eye,

we call these the intrinsically photosensitive

melanopsin ganglion cells,

which is really just a mouthful of nerd speak,

for neurons in the eye that connect to the brain,

these so-called ganglion cells,

that respond most robustly to bright blue light

or other short wavelength light.

So you’ve got short wavelength light

that is blue and greens, or short wavelengths,

and then long wavelength light, which is red,

or it can even be out past where it would be infrared.

We don’t detect infrared consciously, other species do,

like pit vipers can see in the infrared,

they can even heat sense.

So short wavelength light is going to be light

that’s bright blue, green,

it’s what’s very common in fluorescent bulbs

that are commonly used in household lighting

and workplace lighting,

and other forms of artificial lighting.

It’s also, of course, present in sunlight.

Sunlight includes a huge range of wavelengths,

including long wavelength light, of course.

You’ve seen that as the reds and oranges

in the sunset and so on.

Those intrinsically photosensitive

retinal ganglion cells in the eye

respond best to bright green or blue light,

and they send connections

to a bunch of different places in the brain,

including the so-called central circadian clock,

suprachiasmatic nucleus,

that sets your day, night, sleep, wake rhythms.

This is why I encourage people

to view sunlight in the morning

to set this system in motion,

to avoid bright light exposure at night

from artificial sources

in order to not send wake up signals

from the eye to the brain

and then onto the rest of the body.

But these intrinsically photosensitive

retinal ganglion cells

are also known to connect with other areas of the brain,

many other areas of the brain, in fact.

And one of the important areas of the brain

they connect to as it relates to photophobia

is an area of a structure called the thalamus.

The thalamus is an egg-like structure

that sits in the center of the brain,

and it serves as a kind of a switchboard,

like a sensory relay

by which information coming from the eyes,

from the ears, from the touch system, et cetera,

are funneled into different compartments in the thalamus

and then sent to different other areas of the brain.

So think of it kind of like an old-fashioned switchboard,

or you could think of it sort of like in an airport,

you go to a particular wing of the airport,

then you go to a particular gate and so on.

You’re getting funneled progressively

through narrower and narrower channels

until you arrive at your particular plane.

Much in the same way,

the thalamus has a bunch of different entry points.

So it’s sensory information coming in

from a bunch of different sources,

and those sources get routed

into progressively narrower and narrower funnels

to eventually arrive at the accurate place

for their function.

So these intrinsically photosensitive ganglion cells

send connections to a small but important area

of the thalamus called LP.

It’s denoted L, the letter, and P,

lateral posterior thalamus,

or I should say it’s the lateral posterior nucleus

of the thalamus for you aficionados out there.

And then the neurons in that location are going to respond.

That is, they’re going to be activated

by bright blue light, green light,

or any kind of bright light

originating from artificial sources or from sunlight.

And the neurons there that respond to that

have a very interesting pattern of connections.

They send connections up to the so-called sensory cortex.

So a bunch of different layers throughout the cortex

that are not associated with visual perception.

That is, they’re not associated with understanding

that there are shapes and contours in the environment,

but rather to neurons that are involved

in the detection of pressure, pain,

and other forms of sensory information

at the level of what?

The meninges.

And we talked about the meninges earlier.

So again, while the brain itself does not have

a sensory system to detect pain,

the tissues around it do.

And the tissues around those tissues,

that is the stuff around the meninges,

themselves can respond to pain.

And intracranial pressure is also relayed

through the meninges to our conscious awareness

that there’s pain.

So what does this mean for photophobia?

It means that bright blue light and green light,

and of course light from sunlight,

will activate these neurons in the eye,

these intrinsically photosensitive ganglion cells,

which then activate the lateral posterior neurons,

LP neurons, and those LP neurons communicate

with areas of the brain that are specifically tuned

to different sensory phenomenon, and in particular pain,

at the level of the meninges and intracranial pressure.

What this means is that when we have headache,

or if we simply have photophobia on its own,

that bright light is actually the trigger

for pain sensing and even the creation of pain

at the level of the meninges and intracranial pressure.

What does this mean in terms of dealing with

or treating photophobia?

Well, most people deal with photophobia

by deciding to turn off or dim all the lights

and simply getting under the covers

or wearing a very low brim hat and putting on sunglasses

and they want to lie down,

and sometimes because migraine can be associated

with nausea or even vomiting in severe instances rather.

But one very simple way to avoid activation

of these retinal ganglion cells

that would trigger photophobia

is that if you are starting to feel

like you have a migraine coming on

or you have photophobia coming on,

to shift to using patterns of light

that are in the longer wavelength domain.

What that means practically is shifting

to using very orange, ideally dim,

but very orange and a red light.

Now, this is not a call for people to go out

and invest in expensive red light therapies.

Admittedly, there are some excellent case uses

for red light therapy,

particular for acne, wound healing,

even for improving vision,

especially in people beyond the age of 40,

for some hormone augmentation.

We talked all about that in the episode

that I did on light and health.

Again, you can find that at hubermanlab.com,

everything timestamped.

What I’m talking about here would be simply

having some red light bulbs on hand

for any time that you need to remain awake,

but you’re starting to experience photophobia.

These red light bulbs can be purchased very inexpensively,

you know, as party lights.

You can buy these online.

So there is no specific need to get any,

I would say, red light that’s designed specifically

for photophobia or anything of that sort.

You can find the cheapest red light available out there,

and those will simply work.

The idea being that for many people

who are experiencing photophobia,

they want to reduce that feeling of pain

and pressure in their head

experienced through photophobia.

They also might want to stay awake,

get some work done and do things.

So operating under red light,

or I should say living, working, et cetera,

under red light would allow you to stay awake,

not have to hide under the covers

if you’re experiencing photophobia.

In addition, and I mentioned this

at the beginning of the episode,

but many people find photophobia

to be a entry point or a trigger to headache.

So what happens is they start to experience some aura,

some onset of photophobia,

and then the photophobia itself

leads to this feeling of malaise

that then converts into headache.

And so while there are not a lot of clinical data

on this just yet,

an emerging idea in the realm of headache treatment

is the idea that if you can offset some of the early signs,

you can offset some of that photophobia and aura,

perhaps through the use of dim red lights

or red lights as I’ve described a moment ago,

then you might be able to reduce the probability

that you’re going to have a migraine

or other type of headache entirely.

So again, no need for expensive red lights,

but you can find red lights very easily online

and simply have them on hand

or replace the current lights that you have

on your nightstand or in whatever room you happen to be in

with these red lights.

These red lights are also, I should mention,

very useful in limiting the amount of cortisol,

a stress hormone that is very healthy

for us to release at high levels early in the day.

In fact, viewing sunlight will increase cortisol levels.

That’s another reason why what I’m about to say

is relevant to photophobia.

But if you want to keep cortisol levels low

in the evening and at night,

and indeed you do,

and improve the transition to sleep

and indeed your sleep overall,

reducing cortisol at evening time and at nighttime

is extremely beneficial

and red lights will help you accomplish that.

I talked about that in the episode on light and health.

So the point here is that

if you suffer from photophobia with or without aura,

using red lights and not simply dimming

ordinary artificial lights

or feeling that you have to turn off all lights entirely

is going to be one relatively inexpensive,

or I should say very inexpensive in some cases,

because these red lights

can be found very inexpensively online,

way to be able to continue with your daily activities,

at least in an indoor environment

if you are suffering from photophobia.

So shifting back to ways to reduce the intensity

and frequency of different kinds of headaches,

we haven’t talked so much

about tension headaches specifically.

So that’s what I’d like to do now.

As you recall,

tension headaches are going to be muscular in origin.

Again, keeping in mind that everything’s neural

when it comes to pain,

everything’s neural when it comes to everything, frankly,

because every organ and tissue system in our body

is ultimately controlled by our nervous system.

But tension headaches are often associated

with tension of the muscles that are on the skull,

of the jaw, of the neck,

and can be quite painful for many people and debilitating.

And the most common treatment for this

that most people rely on that is,

is to take non-steroid anti-inflammatories.

So things like acetaminophen, ibuprofen,

sometimes aspirin and things of that sort.

And oftentimes those can be helpful.

There are a couple of things to keep in mind, however.

The NSAIDs, non-steroid anti-inflammatory drugs,

oftentimes will work very well at first,

but people quickly develop a tolerance to them,

meaning they’re going to have to take more and more

in order to get the same effect.

And oftentimes they can’t take more and more

because some of them are very hard on the liver.

And in addition to that,

some of them can offset some other things

that you really want.

So for instance, it’s now known

that non-steroid anti-inflammatory drugs

can offset some of the benefits of exercise.

And that makes sense

because a lot of the adaptive benefits of exercise

actually come from experiencing

a lot of inflammation acutely.

That means you actually want inflammation

during your resistance training workout,

or even your endurance workout.

But then that inflammation triggers an adaptation event

or series of adaptation events

that leads to greater strength, greater speed,

more muscle, more endurance,

whatever it is that you happen to be training for.

So reducing pain can be good, of course,

but not if you have to take more and more of a given drug

that it has side effects on the liver

and can offset the effects of exercise and so forth.

The other issue with non-steroid anti-inflammatory drugs

is that many of them simply do not work for many people.

Or again, they’ll work the first time and the second time,

but then they stop working.

They also tend to lower body temperature.

I think most people are aware of this

because many of these same drugs are used

in order to reduce fever.

But if you are taking non-steroid anti-inflammatory drugs

simply to reduce your headache

and you’re lowering core body temperature,

that can have all sorts of downstream issues

related to sleep-wake cycles, to metabolism,

to immune system function more generally, and on and on.

For that reason, there’s been quite a lot of exploration

of alternatives to non-steroid anti-inflammatory drugs

for the treatment of headache and indeed pain generally.

But today we’re talking about headache.

Now, as it relates to tension headache,

one of the more advanced kind of modern treatments

that you sometimes hear about is Botox, right?

Botox, I think most people are familiar with

as the thing that people get injected into their face

around the eyes or around the lips or elsewhere

in order to quote, unquote, reduce wrinkles.

It was discovered some years ago

when Botox treatments were being done for cosmetic reasons

that it could often be very effective for relieving headache

if injected into the muscles.

And the way that it works is that, of course,

tension headache involves a tension of the muscles,

we’ll call it clenching or cinching up of the muscles,

but we’re really talking about

is contraction of the muscles,

and that’s controlled by neurons.

Neurons, which are neuromuscular,

so neuromuscular neurons that don’t form synapses

with or connections with other neurons,

they form synapses with muscle,

they release acetylcholine onto the muscle

and that makes the muscle contract.

This is the way you move the limbs of your body,

this is also the way the muscles of your head contract

and can give you tension type headaches.

Botox arises from, or is rather botulinum neurotoxin.

Botulinum neurotoxin is a toxin that’s found in canned goods

not all canned goods, of course.

And what it does is it prevents a certain step

in the release of so-called neurotransmitter

in the little packets that they live in,

which are called vesicles,

little spheres of neurotransmitter

live at the end of neuron nerve terminals

and are released onto the muscle, make the muscle contract.

Botulinum neurotoxin cleaves a particular protein in there,

for you aficionados who want to look this up,

it’s a really cool mechanism,

it cleaves something called SNAP-25.

SNAP-25 is involved in the fusion of those little spheres

with the membrane of the neuron

and releasing of the neurotransmitter.

So when botulinum neurotoxin

is present at the nerve muscle interface,

those nerves cannot communicate with the muscle.

And as a consequence,

the muscles undergo kind of flaccid tone.

They just kind of relax there underneath the skin.

Sure, wrinkles are relieved,

but if Botox is injected into the muscles themselves,

it can provide long lasting relief

of certain types of headaches,

in particular tension type headaches.

So while it seems like a bit of an extreme treatment,

people who suffer very badly from tension type headaches

due to hypercontraction of the muscles of the forehead

or around the temples or around the jaws

or certain parts of the neck

and the muscles of the neck

that encroach on the back of the skull

or that actually connect to the back of the skull

can achieve tremendous long lasting relief

from these Botox injections.

Sometimes for weeks or months or even longer,

people go in for periodic re-ups of Botox.

It actually is quite safe

despite the fact that botulinum neurotoxin

is quite dangerous.

It’s given in very low doses and given locally.

So those are the only muscles affected.

So that’s how Botox is used to treat headaches

and is a very effective treatment at that.

Of course, many people I imagine are interested

in not just drug-based treatments

and not Botox type treatments for treating headache,

but other types of treatments for headache

that are of the more sort of,

let’s call them natural or non-drug treatments.

And here we’re starting to get into the realm

of the kind of herbal and oil-based treatments for headache.

Now, I confess when I first started researching

this area of headache and treatment for headaches, that is,

I found myself approaching it with a bit of trepidation

because when I started to hear about essential oils

and about herbal medications and things of that sort,

I thought, okay, well, there’ll probably be some effects.

I mean, admittedly, we’ve talked before on this podcast

about things like apigenin.

Apigenin is one of the core components of chamomile.

And chamomile is known to make people feel

a little bit sleepy and can enhance sleep.

Well, apigenin in high concentration

can indeed augment sleep.

We talk about this in our sleep toolkit.

By the way, we don’t just have episodes about sleep,

master your sleep, perfect your sleep, et cetera.

But if you go to the hubermanlab.com website

and you go to the menu and you click on newsletter,

you can scroll down and you’ll see

that we have a toolkit for sleep.

There’s completely zero cost to access.

You don’t even have to sign up.

Although if you’d like to sign up for future newsletters,

you can get those.

One of the key components of the toolkit for sleep

in addition to behavioral tools

and things that are not supplement-based is apigenin,

which is this component from chamomile.

So the idea that certain herbal derivatives or herbs

or oils could be very useful

for improving symptoms of whatever,

in this case, improving sleep with apigenin

is not unheard of.

And in fact, the data continued to be released all the time

that many of the things that we think of as herbal, et cetera

can actually have quite potent effects.

And so while I myself was approaching the discussion

about essential oils and I should say oils, right?

Who’s to say if they’re essential or not.

Oils and herbs in the treatment of headache,

I finished out my research on this literature

feeling quite, I should say, surprised

and as if I need to really check myself a bit

because what I found is that there are certain herbs

and oils, for instance, that far outperform

non-steroid and anti-inflammatory drugs

for the treatment of headache.

That’s right, there are certain oils

that are available over the counter

that when looked at in many studies, meta-analyses,

and I’ll tell you about one particular study

and a meta-analysis in a moment,

they show that they can reduce the frequency

and intensity of headache in a manner that far outpaces

what you observe with non-steroid anti-inflammatory drugs

with apparently none of the same issues

associated with non-steroid anti-inflammatory drugs.

So I think it’s really worth paying attention to.

The first of those studies I’d like to describe to you

is one that has now become kind of a classic

in the literature, I should say,

at least for those that are interested

in the atypical treatments for headache.

And the title of this paper is

Effect of Peppermint and Eucalyptus Oil Preparations

on Neurophysiological and Experimental

Algeometric Headache Parameters.

Okay, what does that mean?

Well, this is an interesting study

because rather than look at the effectiveness

of peppermint and eucalyptus oil and other oils on headache,

what they did is because they want to look

at the mechanisms underlying headache,

which I confess I love,

the fact that they want to understand the neurophysiology

and not just get subjective ratings of headache,

although they did that too,

but they really want to understand

how these oils can impact things like muscular tension

or perception of pain.

What they did is they recreated headache in human subjects

by using tightening cuffs of the head.

They cut off blood supply to certain areas of the head.

They basically induced headache,

and then they measured things like the EMG,

the muscle response at the level of electrophysiology

in the muscle, and of course, subjective measures

of how much people perceive to be in pain or not in pain.

I’ll give you the broad contour of the study

because I want to make sure that it’s the conclusions

that come through most clearly,

and we will provide a link to the study

in our show note captions.

So what they did is they had people use

one of four different preparations.

So they had preparation one,

which includes some peppermint oil and some eucalyptus oil,

and all the details about the amount

and the relative percentages are in the paper

for you to peruse online through the link I mentioned before.

So they had four different groups.

They had one group apply peppermint oil,

but that peppermint oil also contained eucalyptus oil.

They had another group use just peppermint oil.

They had another group use just tiny traces

of peppermint oil and smaller doses of eucalyptus oil.

And then they had a fourth group,

which was just using placebo.

When I say using, what they were doing

is they were sponge applying the oil

to the temples and forehead of people.

And then what they did is they use these different approaches

to measure the activation of muscles, to measure pain,

and they then induced head pain, they induced headache.

So, and they looked at the temporal muscles on the side,

they looked at forehead muscles, things of that sort.

So they use three different types of pain stimuli.

They looked at people’s sensitivity

to experimentally induced pain

by either providing pressure.

So this was kind of a cuff around the forehead

or thermal pain.

So they actually had them basically heated up

at the level of the skin.

And actually they brought the heat up pretty high

to the point where people were rating the pain

almost to the point of excessive pain and pain limits.

So they obviously couldn’t take them

to the point of extreme pain.

And they had a constriction type condition

in which they cut off blood circulation

to the pericranial muscles using an inflatable collar

around the cranium and they inflated that

to pretty high pressure.

So kind of a brutal experiment to be involved in,

but look, they’re trying to mimic headache.

And I think by using these different approaches,

they’re able to mimic the different aspects of headache

and make sure, and here’s the key point,

that every person in the study

is not just getting the same treatment for headache,

but is getting the same headache.

And that’s something that I think gives this study power.

It’s not the only way to do a study like this,

but it gives it a lot of power

in trying to understand which types of interventions

are going to assist in headache

and maybe even specific dimensions

of the pain and headache.

And basically what they found in the study

is that of all the treatments they used,

the essential plant oil preparations

that contained peppermint,

and I’ll just mention as an aside,

and in other studies, menthol,

so these minty type essential,

minty type what we think of as flavors,

but are really aromas as well.

And as I’ll point out the mechanism in a moment,

they had the effect of significantly reducing

the intensity of the pain.

That is subjects could tolerate the pain far better

and experienced less pain subjectively.

And the magnitude of the effects

were really pretty impressive.

Again, I went into all of this thinking essential oils,

okay, that’s like some really woo stuff.

You know, I don’t know about that,

but it turns out that these essential oils,

at least the ones that contain peppermint oil

with or without eucalyptus oil

perform very well in reducing pain.

The key takeaway from the study is,

and here I’m paraphrasing from the study

that the combination of peppermint oil, eucalyptus oil,

and these are basically in a ethanol suspension.

Again, people are not drinking these essential oils.

I want to be very clear.

They’re applying these to the skin

around the area that’s in pain,

in particular, the temple and the foreheads.

Increased cognitive performance.

I didn’t talk about that,

but this is the ability to maintain cognitive functioning

while in pain.

You know, here we’re talking about headache up until now,

just as kind of pain,

but that pain can be very debilitating

for your ability to work and perform and do other things.

So this combination of peppermint oil and eucalyptus oil

applied to the skin

allowed people to increase their cognitive performance

while under pain,

and it had a very muscle relaxing

and mentally relaxing effect.

Mental relaxation was of course measured subjectively,

but remember, one of the things

that led me to feature this study

in this episode in particular

is that they didn’t just say,

oh, my muscles feel more relaxed.

They actually saw that the muscles

of the forehead and temples

and some surrounding muscles were more relaxed

when people had these oils on,

applied to their forehead and the temples.

Not perhaps to the same degree

that one would observe with Botox

or for the same extent or duration

as one would experience with Botox,

but much in the same way,

which then raises the question of,

well, what’s going on here?

I mean, is this all placebo effect?

Well, no, because they compared to placebo

and they controlled for the odor, of course,

of the oil that was applied

so that everyone thought that they were getting

essentially the same thing, pun intended.

But in this case, what they found

is that if they applied the essential oil

to the forehead and temples,

that people experience more or less a cooling sensation

or they could feel as if something was happening

in the underlying muscle.

Well, what was happening?

We now know that menthol, peppermint

and other things that smell that way and taste that way

actually have an impact on the sensory neurons

at the level of the skin

and can actually inhibit certain sensory neurons

and can activate other sensory neurons.

Okay, so in order to understand this,

we have to go back to what I said

at the beginning of the episode,

which is that you have motor neurons.

These are neurons that constrict muscles or, excuse me,

that cause contraction of muscles.

They don’t constrict them.

They cause contraction of muscles.

You have sensory neurons, which sense different things,

light, sound, or touch.

And you have modulatory neurons.

Menthol and eucalyptus are actually known

to activate certain channels in the sensory neurons

that respond not just to touch,

but also the sensation of cooling.

Okay, so when we think of menthol and peppermint,

we think of kind of cool scents and flavors,

cool meaning cold.

And when we think of things like hot peppers, capsaicin,

we think of anything that has a hot temperature,

we tend to think of spicy.

So spicy and hot go together

and peppermint and menthol and cool go together

much in the way that the gum commercials

or the mint commercials would lead you to believe.

And in fact, they’re right.

So what’s happening here is that the application

of these oils is very likely activating channels

in the sensory neurons, including the trip channels,

but others as well that are leading

to the analgesic effect by shutting down

the heat and pain pathways.

Because heat and pain,

while they’re not exactly the same in our nervous system,

they are funneled through common pathways

where has cooling and pain relief

are funneled through alternate,

what we call parallel pathways.

So the study on peppermint and eucalyptus oil preparations

in reducing pain of headache

and different aspects of pain due to headache,

I think are really important

because they don’t just illustrate the fact that,

yes, indeed, and I’ll go on record saying it

because that’s what the data say.

And there are other papers to support

this statement as well.

Essential oils applied to the skin

can reduce the symptoms of tension headache

in a significant way and actually can lead

to some offset of some of the cognitive defects

seen with headaches.

So that’s itself very impressive, I must say,

but surprising for me,

kind of put me in my place as somebody who thought,

oh, essential oils is going to be like, okay.

But it’s actually seemed to really hold some merit.

And when you compare the magnitude of the effect,

even though this was an enormous number of subjects,

you compare the magnitude of the effect

in a paper like this or similar papers

on these essential oils to the impact

of non-steroid anti-inflammatory drugs.

And they really hold their own.

And in some cases exceed the positive impact

of anti-inflammatory drugs.

So for that reason,

I think we can look at peppermint oils

and peppermint and eucalyptus containing oils,

menthol containing oils applied to the skin

for the treatment of tension type headache

as among the more potent treatments available out there.

Now, another way to approach treatment of tension headache

is something that many of you

have probably heard about before.

And then I’ve talked a little bit about on this podcast

in previous episodes, and that’s acupuncture.

We will do an entire episode all about acupuncture,

but much in the same way that essential oils,

I think for many people, not all,

but for many people are considered kind of a woo biology

or people think of it as very alternative medicine.

Keep in mind that as the underlying mechanisms

of things like these peppermint oils

are starting to be discovered

or omega-3s are starting to be discovered,

mechanistically, they hold up very well.

There’s a logic there.

There’s an underlying understanding

of not just why they should work,

but in many cases, how they work.

In the same way, acupuncture,

which of course has existed for thousands of years,

has been used very successfully to treat headache

and other forms of pain,

so much so that many insurance companies

will now pay for acupuncture as an insured practice,

not all, but many will.

And in addition to that,

the scientific community is starting to understand

mechanistically how acupuncture works.

So I don’t want to make this the major focus for now,

but very briefly,

there’s a laboratory at Harvard Medical School

run by Chufu Ma.

Chufu is well-known in the neuroscience community

for doing excellent work

in parsing the mechanisms of touch sensation

and pain in particular.

So not just touch at the level of skin,

but pain and pain pathways.

And in recent years,

his laboratory has started to do studies

on how acupuncture works

because indeed acupuncture has been known to work

to alleviate pain for a long time,

but the underlying mechanisms haven’t been clear.

What Chufu’s lab has published now

in excellent journals like Nature, Science,

and other journals is that

the precise insertion sites of different needles

lead to activation of sensory neurons

and their downstream pathways

in ways that can potently reduce inflammation

and that can be used to potently reduce the activity

of certain muscles.

For instance, muscles in the forehead and temples.

So when you hear acupuncture can reduce pain,

I think some people think,

oh, well, if there’s needles sticking out of your face,

first of all, that must hurt.

And actually the needles are very fine needles

and skilled acupuncturists can insert them

without any pain or actually the person receiving it

doesn’t even usually recognize that the needles are in.

That’s how quickly and efficiently they can put them in

and people don’t detect any pain.

But that has been shown to greatly reduce pain

in particular headache-related pain

and back-related pain and some other forms of pain.

Chufu’s lab has shown

that the specific needle insertion sites

can activate the sensory pathways

and can deactivate the sensory motor pathways.

And now you’re familiar with sensory neurons,

motor neurons, and modulatory neurons,

and can modulate the activity of the pain pathways

by way of impacting the activity

of all sorts of different organs,

including organs that give rise

to some of the inflammatory cytokines.

So basically what I’m saying here

is that thanks to thousands of years of acupuncture

and the maps of different insertion sites,

we now know, or I should say people have long known

and people in the West are starting to adopt

the understanding that acupuncture, yes, indeed,

it really does work for relieving pain.

And laboratories, both in the United States,

which is Chufu’s, and elsewhere

are starting to find the underlying mechanisms.

And those mechanisms include deactivation

of the pain pathways,

activation of some of the parallel pathways

that assist in shutting down pain

or in relaxing the muscles

that are causing tension-type headache,

as well as activation of neural pathways

that impinge on organs that then cause

or reduce the release of molecules into the body

that give us the experience of pain.

So reduced inflammation, and in many cases,

increasing anti-inflammatory pathways.

So I just wanted to be sure to mention acupuncture

and a little bit of mechanistic understanding

of why acupuncture works,

because indeed, acupuncture is shown to be quite effective

for the treatment of tension-type headache,

and to some extent, migraine headache as well.

So we talked about omega-3 fatty acids.

We talked about essential oils.

We talked about acupuncture.

So this episode is starting to sound like

alternative treatments to headache, including migraine.

But I want to be very clear.

This is not about alternative treatments.

Everything that I’m talking about here

has a mechanistic basis.

And what we’re talking about today

are approaches to dealing with headache that, yes,

are typically over-the-counter compounds

or are grounded in nutrition

or in the case of acupuncture, behavioral practices,

but that are not necessarily meant as replacements

for things like non-steroid anti-inflammatory drugs

or prescription drugs.

Of course, those things can still be taken.

Many people derive benefit from them.

But the goal is always, I believe, or I should hope,

for people to find ways that they can control

their health outcomes and reduce things like headache

using a minimum number of things

that have other side effects.

And that, of course, can also include

the use of essential oils in conjunction with things

like non-steroid anti-inflammatory drugs

or the use of red light to offset photophobia

in conjunction with any number of different treatments,

either prescription or otherwise.

So I do want to make that clear.

And I especially want to make that clear

as I transition to the next segment

where I’m going to tell you

about herbal treatments for migraine.

And this is based on what I consider

a very comprehensive review

of many randomized control studies.

Indeed, the title of the paper

is Herbal Treatments for Migraine,

A Systematic Review of Randomized Controlled Studies.

And this was published in 2020.

And this contains an immense amount of information.

So we will provide a link to it

for those of you that really want to dive deep on this.

In this paper, they focus on a number of different reviews

and analyses of data focused on compounds

for the treatment of migraine,

ranging from and including things

like menthol and peppermint oil.

So we already covered that.

So I won’t cover that again in detail,

but in this review,

they highlight the results I referred to before,

plus other results that show that menthol

and peppermint oil can be quite effective

in the treatment of tension-type headache,

and in this case, migraine headache as well.

So that’s interesting that menthol

and peppermint oils can be used

not just to treat tension-type headaches,

but migraine headaches as well.

And they look at an enormous number

of other types of herbal and essential oil-type treatments,

everything from coriander to citron to damask rose,

chamomile, lavender, a bunch of things.

So I’m not going to go through each and every one of these

in a lot of detail.

What I’ve intended to do today,

and I’m going to do now,

is to highlight the most potent

of these different treatments.

Again, menthol, peppermint oil being among the most potent.

In addition to that,

there’s a particular pathway

that’s associated with headache.

And when I say that, I mean the different types of headache,

which includes the activation of this thing

that we call CGRP.

CGRP, again, is involved in this calcium regulation pathway

and leads to vasodilation of the vessels

and arteries and capillaries

in a way that can create pain

and this feeling of pressure inside the head,

which can be very uncomfortable, of course.

Now, earlier in the episode,

I mentioned that I was going to touch on caffeine.

And so I’m going to do that now.

Now, the reason I mentioned caffeine

is that there’s a sort of lore out there

that if you have a headache,

drinking a cup of coffee can eliminate that headache.

A few things about that point.

First of all, if you are somebody

who ingests caffeine every day

and you do not ingest caffeine,

you will indeed get a headache

and drinking caffeine will relieve that particular headache.

So it’s absolutely true that caffeine

can relieve the lack of caffeine-induced headache.

That’s sort of a duh,

but that leads actually to a very important question,

which is why would that be the case?

Well, it turns out that caffeine

is both a vasodilator and a vasoconstrictor.

How does it do that?

Well, one of the main ways

in which caffeine makes us more alert

is that it occupies the receptors

for something called adenosine.

Adenosine is a molecule that builds up in the brain and body

more and more the longer we’ve been awake.

It’s one of the things that makes us feel sleepy.

So when we drink caffeine,

that caffeine occupies the adenosine receptor

and the adenosine cannot have its normal effect

of making us sleepy.

When that caffeine wears off,

the adenosine can bind and we feel sleepy.

Adenosine is a vasodilator.

So when we drink caffeine,

because it blocks the effects of adenosine,

there is a vasoconstriction

associated with drinking caffeine.

So if you have a headache

that is associated with excessive vasodilation

and pressure in the head,

indeed drinking some caffeine

can cause some vasoconstriction

by preventing that adenosine pathway

that would normally lead to vasoconstriction

and you can get some relief from that headache.

However, caffeine is also a vasodilator.

Caffeine has the ability to impinge

on the so-called NO pathway, the nitric oxide pathway,

which is a nerve to blood pathway

that involves a few different enzymes

that we won’t get into right now,

but maybe in a future episode,

that causes dilation of the blood vessels.

And as a consequence,

drinking caffeine can also increase vasodilation.

So it’s sort of a two-pronged effect.

Now, one of the ways in which you might think about this

and perhaps utilize this

is that if you are well-rested

or if it’s early in the day

and you’ve had some sleep the previous night,

adenosine levels are very likely to be low,

especially if you slept very well the night before.

Under those conditions, when you ingest caffeine,

you are not going to experience

the vasoconstriction effects of caffeine

that would ordinarily be there by inhibiting adenosine.

Why?

Because adenosine is not present at all.

And under those conditions,

drinking coffee ought to lead to some vasodilation.

Not a lot, but nonetheless, vasodilation.

If, however, you haven’t slept well

or it’s late in the day

and you’ve been up for a long time,

drinking caffeine is likely to have

more of a vasoconstriction effect.

And this is important

because some of the treatments that you hear about

that involve using caffeine to treat headache

are as extreme as, okay, if you have a headache at night,

drink a cup of coffee and then go to sleep.

I actually saw that in the literature,

which I couldn’t quite believe

because yes, indeed, some people can fall asleep

after drinking caffeine,

but we know very well,

thanks to the beautiful work and science communications

of people like Dr. Matthew Walker

from University of California, Berkeley,

and who’s been a guest on this and many other podcasts,

that even if you can fall asleep after drinking caffeine,

ingesting caffeine within the 10 to 12 hours

prior to bedtime is simply not a good idea

because of the ways it disrupts the architecture of sleep.

So what’s the takeaway about caffeine and headache

and vasodilation?

You need to be very clear on whether or not

caffeine tends to remove your headache or exacerbate it.

Now, this is going to depend on time of day

and the amount of adenosine in your system,

as I mentioned before,

but also there seems to be a kind of bimodal distribution

whereby some people, when they drink caffeine,

it really improves their headache.

And so in some cases, very significant effects,

whereas other people, when they drink caffeine,

it really exacerbates their headache.

And at least as far as I could tell from the literature,

it’s not easy to predict who those people are going to be.

What is reassuring, however,

is it does not seem to be the case

that if you’re somebody who experiences relief from headaches

by drinking caffeine, that suddenly one day to the next,

you’re going to experience a worsening of your headache

and vice versa is also true.

So if you’re somebody that drinks caffeine

and your headaches get worse,

I don’t think there’s any reason to think that caffeine

one day or from one day to the next rather

is going to somehow alleviate your headache.

So you have to determine for yourself

whether or not headaches are relieved or exacerbated

by drinking caffeine.

And if you’re wondering why it’s so confusing,

it’s because caffeine hits both the vasodilation

and the vasoconstriction pathways,

and there’s nothing you or I

or anyone else can do about it.

Now, the last thing I’d like to talk about

in terms of relief for headaches

is something that I’m guessing about probably 25%

of you are familiar with and 75% of you are not,

which is curcumin.

Curcumin is often also referred to as turmeric

and turmeric is a root

and curcumin is one of the key components of that root.

Curcumin is known to have

very potent anti-inflammatory properties.

I don’t think that’s debated at all.

In fact, it’s so potent as an anti-inflammatory

that some people have cautioned

against taking high levels of curcumin prior to,

for instance, resistance training workouts

or even cardiovascular workouts,

because it so prevents inflammation

that it also can prevent the adaptation response.

Because remember, the inflammation

that occurs during exercise,

both resistance and cardiovascular exercise,

is at least in part the trigger for the adaptation

that is going to lead to enhanced endurance,

enhanced strength, hypertrophy, et cetera.

Nonetheless, curcumin has been explored

in the context of treatment of migraine,

and it’s one of the compounds

that was analyzed in extensive detail

in this wonderful review

that I mentioned a little bit earlier.

What I like about this study

is that they were able to explore the effects of curcumin

as explored in previous research studies

and compare those across a large range of different dosages

and a large range of combinations

with other things like coenzyme Q10,

which we’ve talked about on this podcast before.

But I think for sake of this discussion,

just really focusing on what curcumin does alone

or in conjunction with the omega-3 fatty acids

is what turns out to be the most interesting.

First of all, curcumin has been shown

to be generally safe for most people.

At dosages as high as 8,000 milligrams per day

or eight grams per day.

Now, I want to be very clear.

I do not recommend that anyone take dosages of curcumin,

aka turmeric, that are that high.

Why?

Well, curcumin and turmeric,

not only are anti-inflammatory,

but they also can impinge on other pathways,

in particular hormonal pathways.

And in fact, curcumin, aka turmeric,

can alter the synthesis

of something called dihydrotestosterone.

Dihydrotestosterone is involved in an enormous range

of different bodily functions.

It’s involved in libido.

It’s involved in men and beard growth

and in the regulation of a number of different tissues,

both in the reproductive axis

and outside the reproductive axis.

And curcumin is a potent inhibitor of DHT.

So I do want to caution that people

who take high doses of curcumin

and some people who are very sensitive to curcumin

will even at low doses experience reductions in DHT

that lead to things that they would not like,

such as sufficient reductions in libido.

However, curcumin has been shown to be effective

as an anti-inflammatory

and has been shown to be very effective

in treating different types of headache,

in particular migraine headache.

One of the ways in which curcumin does that

is to inhibit this thing

that I talked about a few minutes ago,

which is nitric oxide or NO, which causes vasodilation.

And in doing that can reduce the feeling

that one has a lot of intracranial pressure.

Okay, so curcumin dosages come in enormous ranges

as I mentioned before,

dosages that range anywhere from 80 milligrams taken,

80 milligrams per day that is,

taken for eight weeks time that’s been examined.

It’s been explored at 80 milligram dosages

taken alongside two and a half grams

of omega-3 fatty acids or omega-3 fatty acids alone

and against placebo.

And the general conclusion of these studies

is that curcumin when taken at dosages

of about 80 milligrams,

although for those of you very sensitive to curcumin

probably as low as 25 or even 50 milligrams per day

in conjunction with,

although not necessarily at the same time,

but taken daily alongside omega-3 fatty acids

at two and a half grams per day

led to significant improvements in migraine

and other forms of headache.

Meaning both the frequency

and the intensity of the headaches that occurred

was greatly reduced.

One important point about curcumin to keep in mind

is that curcumin is known to inhibit something

called cytochrome P450.

That’s associated with an enzymatic pathway

and some other things that relate to blood coagulation.

So for people that are taking medications

that are anticoagulants to prevent clotting,

you do need to be very cautious about using curcumin.

And of course, with curcumin or any other supplement,

you should always talk to your doctor

prior to including it or removing it

from your supplement regimen.

So as you can see, there are a number of different things

that in addition to prescription drugs

and over-the-counter pain medications,

things like non-steroid anti-inflammatory drugs

can really impact the different aspects of headache

and different types of headache.

In some cases, differentially.

Now, today we talked mainly about tension type

and migraine type headaches

because those are the most common forms of headache.

There are, of course, the cluster type headaches

that are of neural origin.

Talked about hormonal headaches

and indeed some treatments such as omega-3s,

which have been shown to be beneficial

for offsetting the menstrual related headaches.

Now, in the context of the discussion about omega-3s,

keep in mind that omega-3s can be obtained

from supplementation or from nutrition.

So you don’t necessarily have to take omega-3 capsules

or liquid form omega-3s if you want to use omega-3s

to target different symptoms of headache.

But that probably is going to be

the most efficient way to do it

given that many foods do contain omega-3s,

but it’s hard to get above that one gram dosage.

And in fact, most of the studies that we talked about today

involved getting two or even two and a half,

or in some cases on this podcast with previous guests,

such as Dr. Rhonda Patrick.

She talked about the advantages of getting

as high as three grams of omega-3s per day,

which almost with certainty is going to require

some external form of supplementation,

even for those of you that are making a point

to eat fatty ocean fish with the skin on.

So I just want to make sure that I highlight that.

Before we wrap up, I can’t help myself,

but to talk about something that I heard about

on the news several years ago,

and it sounded too outrageous to be true,

but then was confirmed as accurate

by one of my neurologist colleagues.

And that’s the fact that eating certain very spicy peppers

can induce headache, and in some cases,

can induce brain damage.

And bear with me here.

I’m not talking about your traditional jalapeno,

and I’m acknowledging the fact that certain people

can tolerate far more spicy tastes than do others.

Some people are very sensitive to spicy.

Some people can tolerate very spicy food,

and that one can build up a tolerance to spicy food

by ingesting progressively spicier, excuse me,

spicier and spicier foods over time.

Nonetheless, there are these pepper eating contests

out there that, while not very common, do exist,

and people challenge each other to eat peppers

of extreme spiciness.

And there’s one in particular that’s referred to

as the Carolina Reaper.

By the way, that’s not a person, as far as I know.

That’s a pepper, the Carolina Reaper,

which is known to have the most potent spice of any pepper.

And here’s why you would not want

to eat the Carolina Reaper.

A few years ago at one of these pepper eating contests,

a man ate a Carolina Reaper as part of the competition

and suddenly experienced what’s called thunderclap headache.

Thunderclap headache is a unique type of headache,

very different from all the other types of headache.

It is not from the surface in,

so it’s not tension headache.

It’s not even the cluster type headache

of the nerve activation of the trigeminal.

It’s actually a hyper constriction of the vasculature

in the brain caused by the ingestion of the pepper,

an inflammatory response.

And remember that heat and spicy go together

in these neural pathways.

And a bunch of different heat-related

and spice-related pathways get activated simultaneously

when one ingests something of extreme spice.

And the blood vessels,

and indeed some of the smaller arteries

feeding neural tissue shut down.

And he experienced this thunderclap headache,

which is a brutal headache.

And sadly, in his case, permanent brain damage,

so loss of neuronal tissue

because neuronal tissue is very metabolically active.

You cut off the blood supply to that tissue.

Not only would you feel miserable, maybe even pass out,

but lose vision and certain brain areas will actually die off

in the absence of a blood flow to those areas.

We know this more commonly as stroke.

So I don’t want to strike fear in anybody

about eating a jalapeno

or even a very spicy meal from time to time.

But if you’re not somebody who’s familiar

with eating very spicy foods,

you certainly don’t want to enter one of these competitions

and just realize that the pathways from menthol and cool

or spicy and hot, those aren’t just subjective pathways.

These are actually neural pathways that, again,

originate in our so-called,

nerds call it the sensory epithelium,

so our skin, our hearing, our eyes,

and that feed that information into the body

to make use of that information,

some case motor movement, so sensory motor.

In other cases, the information can be fed

through nerve pathways that goes to the vasculature

and causes the vasculature to either dilate or constrict

these very spicy peppers causing, as I just mentioned,

extreme cerebro of the head,

vasoconstriction and brain damage.

Again, that’s not going to be a common thing out there,

but nonetheless, I encourage people to be very cautious

about the Carolina Reaper.

So today we talked about headaches,

and first we highlighted the different types of headache,

making it clear that understanding which headache

you might be experiencing can be very beneficial

for understanding which sorts of treatments

ought to be best and perhaps also best avoided

in trying to alleviate those headaches

or prevent them from happening at all.

We talked about tension headaches, migraine headaches,

hormone-based headaches, cluster headaches,

and traumatic brain injury-related headaches.

We talked about different types of treatments

ranging from creatine to omega-3 fatty acid supplementation,

some herbal and indeed some essential oil treatments

as well as acupuncture, all of which have been shown

to have significant impact in reducing the frequency

and intensity of headaches, and in many cases,

reductions in the frequency and intensity of headaches

that are at least as great as the results

that are seen with non-steroid anti-inflammatory drugs.

Again, I want to highlight that none of these approaches

are necessarily designed to be done on their own

or in replacement of prescription drugs from your physician.

There are excellent prescription drugs out there

that your physician can prescribe for you

for the treatment of headache.

Nonetheless, I think many people

who are listeners of this podcast

are interested in the things that they can do

in order to inoculate themselves

or at least reduce the likelihood of experiencing headache,

especially for people

who are experiencing chronic recurring headaches

such as migraine or the other forms of headache

which can be so debilitating.

Thank you for joining me for today’s discussion.

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During today’s episode and on many previous episodes

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Thank you once again for joining me for today’s discussion

all about the science and treatment of headaches.

And last, but certainly not least,

thank you for your interest in science.