How to Stop Headaches Using Science-Based Approaches

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. The limiting their ability to work, to socialize, to sleep, to exercise, essentially to live life in any kind of normal way. As we'll soon discuss, there are many different kinds of headache. We have migraine headaches, tension headaches, cluster headaches. Today I will review all the different types of headaches and what the underlying biology of each and every one of those types of headaches is, as well as fortunately the many excellent treatments that exist for the different types of headache. In fact, what we'll soon discuss is that by understanding which type of headache you have and a little bit about the underlying biology of each different type of headache, it becomes quite straightforward to select the best treatment options for you to, for instance, provide relief from frequent and recurring tension headaches, cluster headaches, even sinus headaches, the sorts of headaches that are associated with sinus infections and colds where the sinuses get clogged up and you experience headache. So. 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 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. Thesis makes custom nootropics and as many of you know, I'm not a fan of the word nootropics because nootropics means smart drugs and and as a neuroscientist, I can tell you there is no neural circuit in the brain for being smart. Thesis understands this and has designed different nootropics in order to bring your brain into specific states for specific types of work. So for instance, for creative work, or to engage with more focus, or to give you more energy for cognitive or physical work. So with Thesis, they'll design custom nootropics for you that will allow you more focus, better task switching, more creativity, and so on. And they'll be sure to include only the ingredients that you want and not the ingredients that you don't. I've been using Thesis for more than a year now, and I can confidently say that their nootropics have been a total game changer for me. I like the Clarity formula prior to long bouts of cognitive work, or the Energy formula prior to physical workouts. If you'd like to try your own personalized nootropic starter kit, go online to takethesis.com huberman. You'll take a brief three minute quiz and Thesis will send you four different formulas to try in your first month. Again, that's takethesis.com Huberman and use the code HUBERMAN at checkout for 10% off your first box. Today's episode is also brought to us by Element. Element is an electrolyte drink that has everything you need and nothing you don't. That means the exact ratios of electrolytes are an element, and those are sodium, magnesium and potassium, but it has no sugar. I've talked many times before on this podcast about the key role of hydration and electrolytes for nerve cell function, neuron function, as well as the function of all the cells and all the tissues and organ systems of the body. And if we have sodium, magnesium and potassium present in the proper ratios, all of those cells function properly and all our bodily systems can be optimized. If the electrolytes are not present and if hydration is low, we simply can't think as well as we would otherwise. Our mood is off, hormone systems go off, our ability to get into physical action, to engage in endurance and strength, and all sorts of other things is diminished. So with Element, you can make sure that you're staying on top of your hydration and that you're getting the proper ratios of electrolytes. If you'd like to try Element, you can go to drink element. That's lmnt.com huberman and you'll get a free Element sample pack with your purchase. They're all delicious. So again, if you want to try Element, you can go to elementlmnt.com huberman Today's episode is also brought to us by Maui Nui, which I can confidently say is the most nutrient dense and delicious red meat available. Maui Nui spent nearly a decade building a USDA certified wild harvesting system to help balance invasive deer populations on the island of Maui. I've talked before on this podcast and we've had guests on this podcast that have emphasized the critical role of getting quality protein not just for muscle repair and protein synthesis, but also for repair of all tissues including brain tissue on a day to day basis. And the general rule of thumb for that is one gram of quality protein per pound of body weight per day. With Maui Nui meats you can accomplish that very easily and you can do that without ingesting an excess of calories, which is also critical for immediate and long term health, I should say that Maui Nui meats are not only extremely hot quality, but they are also delicious. I particularly like their jerky. So they're venison jerky. I also have had Maui Nui venison in various recipes, including ground venison, some venison steaks, and I love the taste of the venison. It's lean, but it doesn't taste overly lean or dry at all. It's incredibly delicious. So if you'd like to try Maui Nui Venison, go to Mauinuivenessin.com Huberman to get 20% off your first order. Again, that's Mauinuivenessine.com Huberman to get 20 percent off your first order. The Huberman Lab Podcast is now partnered with Momentous Supplements. To find the supplements we discuss on the Huberman Lab podcast, you can go to livemomentous spelled o u s livemomentous.com Huberman and I should just mention that the library of those supplements is constantly expanding. Again, that's livemomentous.com huberman let's talk about headaches, and as we are soon going to learn, there are different types of headaches. And different types of headaches arise from changes in different types of tissues in the head area and indeed in the neck area as well. Now, one of the key things to understand is that if you want relief from a headache, you need to understand which tissue is mainly involved in creating that type of headache. So, for instance, many people suffer from what are called tension headaches. Now, tension headaches are a little bit of a misnomer because many people might think, oh, tension, I'm under a lot of tension and stress and therefore I get tension headaches. And indeed, stress can cause tension headaches. But tension headaches are really the sort of headache that you feel around the top part of the head. Not the very top, but sort of where you would put a headband so above the eyes and around the head. It doesn't have to be experienced all the way around the head. But the main underlying reason that is the tissue system that mainly underlies tension headaches is the muscular system. There are a lot of muscles on the skull, believe it or not, of course on the neck, and they allow you to move your neck and head. There are a lot of muscles that lie parallel to the skull, and oftentimes those muscles will undergo excessive amounts of constriction. Now, there are, of course, muscles 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, 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 sac or casing that's wrapped around it tight like Saran Wrap. It actually has a name, which is dura D U R A. And so you can remember dura durable. And having done some surgeries, many surgeries before, on brains of different types, ranging from human, even though I'm not a neurosurgeon, as a clinician, ranging from human to other types of species, what you find is that the dura is exceedingly durable. Getting through this thing really requires a very sharp razor blade. So the brain is actually sitting in a very fibrous like sac that you simply could not open up with your fingertips under any conditions. It's really durable. The meninges are in that general area. And also encasing the brain and the meninges provide an additional buffer between the brain and the dura and the skull. So again, you don't want to think about the brain as just sitting right next to the skull. It's close by. But there are a bunch of other thin fibrous tissues, many of which are very thin and fragile, and others of which, such as the dura, that are very, very strong because they're very fibrous. Almost like 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 ma. Now, the proximity of the dura and the meninges to the brain and the fact that everything is wrapped very tightly together and the fact that there's a lot of vasculature, so that would Be arteries, blood vessels and capillaries are all in that area on the top of the brain and throughout the brain. The fact that all of that is in very close proximity and wrapped really tight in this very durable sac is one of the reasons why when blood vessels or arteries or both become dilated, they open. There creates a pressure between the brain and those tissues. And because there isn't much distance between the tissues like the dura and the meninges and the skull, there's also pressure that allows for the brain to literally sneak up, or I should say, give the impression that your brain is expanding up against your skull. So the point here is that while muscular tension can give rise to headache, the other thing that can give rise to headache is so called vasodilation and 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 remove. Be removed from the skull. 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 tissue surrounding the brain, such as the dura, the meninges, and the vasculature that then reaches up, believe it or not, into the skull. The vasculature doesn't actually stop right beneath the skull. It actually blood vessels, it get into the skull, and they're actually portals by which blood can move within the skull itself. Well, what that means is that since all of the tissues are very close by and very compact with respect to one another, any increase in the size of the portals that allow movement of blood there, and the fact that there are what are called nociceptors. Noci. Nociceptors. These are essentially pain receptors. Because of the presence of pain receptors in the tissues around the brain, when there's an increase in the size of those vascular portals, the arteries, capillaries and vessels, we experience that as Intense pain and pressure. And fortunately, there are excellent treatments for dealing with that intense pain and pressure. But keep in mind that the intense pain and pressure that is the consequence of vasodilation, I.e. the widening of these different vascular portals, is very different than the type of pain that arises from muscular tension, as is the case with tension headache. Okay, so now we have two sources of pain. That is the ache in headache, and there are two more that we need to think about in trying to better understand the different types of headaches that we'll discuss. And in terms of trying to understand which are going to be the best treatments for the different types of headaches. And those are neural and inflammatory responses. So let's talk about the neural type first. There is 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 rising from deep within our head as opposed from the surface inward, because they are neural in origin. And there's a particular nerve pathway called the trigeminal nerve that often is the origin of these cluster headaches that people experience behind the eye. The trigeminal, as the name suggests, has three branches, 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. To the lip. And there's a branch that extends more or less to the. To the nasal area. And so this trigeminal nerve becomes inflamed or in other ways is 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. People are talking about, you know, 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 interested in. So for sake of this discussion about the head area is releasing molecules, cytokines, which sometimes are called inflammatory cytokines, but there are also non inflammatory or anti inflammatory cytokines, but inflammatory molecules that are signaling to the rest of the body. Hey, there's something going on here. There's either some intrusive object and indeed, if you were to get, you know, a BB or a splinter into a particular, you know, skin area, there'd be a lot of inflammation. So it could be the introduction of a foreign physical object into an area that will cause inflammation. It can be the presence of some sort of local toxin in that area. It could be a more systemic inflammation nonetheless, inflammation in the neck and head area 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, you know, a top with a jaw below it. It actually has all these small, what are called fenestrations, little holes and canals that run through the skull and through the depth of the skull like little tubes. You've got them down here on your mandible, you've got them above your lips. You have them on either sides of your nose. Those are the sinuses. The sinuses allow the passage of different fluids through the skull, because the skull, even though it's bone, it's not a dead tissue. Right. In a live person or animal, the skull is a very active living tissue indeed. All bone is active living tissue. And it needs to be nourished with blood. It needs to be nourished with cerebral spinal fluid. In the case of the skull, it needs to be nourished with all sorts of important things. So those sinuses oftentimes can become clogged, as is in the case with sinus headache, which we'll talk about in a little bit. But more generally, anytime there's inflammation of one given area of the body. So it could be a shoulder, it could be the neck, it could be the mouth, it could be the nose, or in the case of the headache, it could be any portion of the head or neck. What happens is inflammation. While it's a very efficient signal, it's much like the siren on an ambulance or a police car. And that it sends out a very broad signal that's very clear something is wrong here and needs to be dealt with. It's not very specific, so it's very robust, but it's not very specific. So, for instance, if there's a little bacterial infection or a little viral infection, the inflammation response to that site of infection tends to be far more widespread than the actual site of infection. It's a little bit different when you have a foreign object there, like a splinter or some other foreign object that tends to be a bit more localized. And the immune system is always trying to limit the. The extent of inflammation by putting in different scar tissues. Indeed, a lot of the things that we think of as kind of gross pussy, you know, pustules and boils and things like that. I know it's a gross topic. Are ways in which our body tries to restrict the amount of inflammation. But the face area and the head itself are so heavily infused with blood vessels, and there's a constant perfusion, as we say, of blood and cerebral spinal fluid and other things through this incredibly metabolically active tissue that we call our brain and our eyes. Those are by far the most metabolically active tissues in our entire body. Even if we're running hundreds of miles in 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. 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 and headache, we have neural origins of the ache and headache, and we have inflammation based origins of the ache and headache. And that pertains to all the different types of headaches that we're going to talk about. And it's important to keep in mind that there are these different sources of the ache and headache and that sometimes they exist alone and sometimes they exist in combination. However, and this is an important however, all pain, or I should say all experience of pain as a perception.