How to Stop Headaches Using Science-Based Approaches | Huberman Lab Podcast
Andrew Huberman2023-02-06
andrew huberman#huberman lab podcast#huberman podcast#dr. andrew huberman#neuroscience#huberman lab#andrew huberman podcast#the huberman lab podcast#science podcast#headaches#migraine#headache#headache treatment#migraine treatment
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💫 Short Summary
The video discusses various types of headaches, their biological origins, and treatment options, including natural remedies like creatine, omega-3 fatty acids, essential oils, and acupuncture. It emphasizes the importance of understanding the specific headache type for effective treatment and introduces potential solutions for reducing headache frequency and intensity. The segment also touches on the importance of hormonal balance, traumatic brain injuries, and lifestyle factors like sleep, nutrition, and exercise in managing headaches. Additionally, it promotes science-based tools and alternative approaches to traditional painkillers for headache relief.
✨ Highlights
📊 Transcript
✦
Different types of headaches, their biology, and treatment options.
00:15Understanding specific headache type is crucial for effective treatment.
Misconceptions about natural remedies are addressed, emphasizing biological principles.
Sponsors offer custom nootropics, electrolyte drink, and nutrient-dense red meat.
The podcast focuses on science-based tools for everyday life, consumer education, and zero-cost information dissemination.
✦
Importance of Protein in Overall Health and Muscle Repair.
06:43Protein intake of one gram per pound of body weight daily is recommended for muscle and tissue repair, including brain tissue.
Maui Nui meats provide high-quality protein options such as venison.
Understanding the Role of Muscular Tension in Headaches.
Headaches can be caused by muscular tension, specifically in muscles on the skull and neck.
✦
Causes of Head Pain
13:19The brain does not have pain receptors, but surrounding tissues such as the dura and vasculature can cause intense pain when blood vessels widen.
Cluster headaches are neural in origin and are felt deep within the head, often behind the eye due to inflammation of the trigeminal nerve branches.
Inflammation is a response to stimuli like foreign objects or toxins and can affect areas like the sinuses with small passages in the skull allowing fluid movement.
✦
Importance of Understanding Headache Pain Mechanisms.
19:07Inflammation in the skull triggers pain mechanisms in the body.
All pain experiences are neural and carried by nerve cells.
Identifying types of headaches can help determine appropriate treatments.
Neurons in the brain control muscle contractions and bodily functions.
✦
Overview of different types of neurons: motor, sensory, and modulatory neurons.
26:17Motor neurons control muscle movement, sensory neurons sense environmental stimuli, and modulatory neurons adjust the relationship between sensory and motor neurons.
Importance of neurons in treating conditions like tension headaches, with different treatment approaches targeting muscle relaxation, sensory input, or modulatory neuron function.
Emphasis on the complexity of neural mechanisms in managing pain and the potential drawbacks of traditional painkillers.
Promotion of alternative behavioral approaches to address headaches.
✦
Types of headaches discussed in the video segment: tension type headaches and migraine headaches.
31:46Tension type headaches are often caused by chronic psychological stress and lack of sleep.
Migraine headaches are more prevalent in females and can be reduced in frequency during pregnancy.
The origin of headaches, whether hormonal, inflammatory, or related to the gut microbiome, is not fully understood.
Neural pain is identified as the final common pathway for headaches, with a higher prevalence in females.
✦
Key highlights on Migraine Headaches.
38:36Migraine headaches often involve Aura as a prominent feature, signaling an impending attack.
The deep neural origin of migraines suggests involvement of the nervous system, spinal cord, and brain.
Dilation of vessels is a key aspect of migraines, allowing for specific treatment approaches.
Understanding the type of headache is crucial for effective treatment, as different headaches have distinct underlying biologies.
✦
Role of the trigeminal nerve in cluster headaches and cold sores.
43:51Cold sores caused by the herpes one virus can be transmitted through skin contact or kissing.
Inflammation of the trigeminal nerve can lead to eye infections and nasal issues.
Cluster headaches are excruciatingly painful and more common in men, often occurring during sleep.
Hormonal headaches, influenced by estrogen and testosterone, impact gene expression and cell function.
✦
Causes and Management of Hormonal Headaches
50:24Hormonal headaches are triggered by low estrogen and progesterone levels, often at the beginning of the menstrual cycle.
Understanding the hormonal changes throughout the menstrual cycle is important in dealing with these headaches.
Traumatic Brain Injuries in Sports
Sports like football and boxing pose risks for traumatic brain injuries, such as concussions, with potential long-term consequences.
It is essential to monitor for symptoms and seek medical help to properly assess and manage brain injuries.
✦
Importance of holistic health for traumatic brain injury and headaches.
57:00Over 90% of traumatic brain injuries are not related to sports, often caused by accidents like car crashes or workplace incidents.
Adequate sleep is essential for mental and physical health, helping to reduce headaches and aid in recovery from brain injuries.
Other crucial factors for health include sunlight exposure, proper nutrition, exercise, and social connections.
Foundational elements like these are vital for overall health and well-being, with no replacement in the form of pills or supplements.
✦
Creatine's impact on reducing headaches and improving brain function.
01:02:39Study found creatine can reduce intensity and frequency of headaches, especially those caused by head hits or traumatic brain injury.
Creatine can be stored in brain tissue, particularly in the forebrain, improving cognition and overall brain function.
Participants in the study took higher dosages of creatine than usual for sports performance, showing potential benefits for post-injury symptoms like headache, dizziness, and fatigue.
✦
Benefits of Creatine Supplementation for TBI Symptoms.
01:08:35Creatine supplementation led to a significant decrease in headache frequency, particularly after traumatic brain injury.
Dizziness and fatigue were also reduced in TBI patients who supplemented with creatine.
Creatine monohydrate is safe, affordable, and effective in managing headaches long-term.
Creatine is a promising option for addressing TBI symptoms, but consultation with a physician is recommended before starting any supplementation regimen.
✦
Omega-3 fatty acids found in fish oil can reduce headache frequency and intensity by reducing inflammation.
01:17:41Omega-3s are crucial for brain and immune system function, and supplementation can help alleviate headaches.
Diets high in omega-3s and low in omega-6s, like seed oils, have a greater pain-relieving effect.
Increasing omega-3 intake is recommended for overall health benefits, including cardiovascular health and mood regulation.
✦
Benefits of increasing omega-3 fatty acids and reducing omega-6 fatty acids for reducing headaches.
01:23:22Studies show a significant reduction in headaches with increased intake of omega-3 fatty acids, especially EPA and DHA, and decreased intake of linoleic acid.
Omega-6 fatty acids, like linoleic acid, may increase inflammation and worsen headaches.
Supplementing with at least one gram of EPA per day, either through food or supplements, is recommended for reducing headache frequency and intensity.
Higher omega-3 intake may also have positive effects on mood and overall health.
✦
Omega-3 fatty acids and their impact on reducing headache frequency and intensity.
01:27:55Omega-3s are effective in treating tension-type, migraine, and premenstrual syndrome-related headaches.
They act as potent analgesics and anti-inflammatories with cardiovascular benefits.
Omega-3 supplementation above one gram per day of EPA is beneficial for various headache types, including hormonal, tension, and migraine headaches.
Over 70% of headaches can be treated with omega-3 supplementation.
✦
Explanation of aura in spreading depression and photophobia.
01:34:25Aura is related to spreading depression, an electrical and chemical process that reduces neuronal excitability.
It originates in the visual cortex and causes visual disturbances such as halos of light.
Photophobia is linked to intrinsically photosensitive ganglion cells in the eye, which respond to bright blue or green light.
These cells connect to the thalamus, specifically the lateral posterior nucleus, activating neurons related to sensory processing rather than visual perception.
✦
LP neurons communicate with brain areas sensitive to sensory phenomena like pain, causing photophobia in response to bright light.
01:40:07Dim red lights can help ease photophobia and reduce migraine occurrences.
Red lights are a cost-effective solution and can lower cortisol levels for improved sleep quality.
Tension headaches have a muscular origin and the segment discusses the limitations of non-steroidal anti-inflammatory drugs in providing lasting relief.
Non-steroidal anti-inflammatory drugs may lead to tolerance development and potential side effects over time.
✦
Herbal and oil-based treatments can be more effective than non-steroid anti-inflammatory drugs for treating headaches.
01:47:51Studies and meta-analyses have shown that specific oils available over the counter can effectively reduce headache symptoms.
These natural treatments target muscle contractions, providing long-lasting relief for tension type headaches.
Botox injections have been proven effective for certain types of headaches, offering relief for weeks or months.
Despite initial skepticism, herbal and oil-based remedies have shown potent effects in improving headache symptoms.
✦
Essential oils, specifically peppermint and eucalyptus, showed significant reduction in headache intensity and improved pain tolerance in study subjects.
01:55:39Different oil combinations applied to the skin resulted in increased cognitive performance and muscle relaxation.
The study accounted for placebo and odor effects, confirming the effectiveness of essential oils in pain management.
Essential oils were found to relax muscles in the forehead and temples, potentially providing an alternative to traditional headache relief treatments.
✦
Essential oils like Menthol and Eucalyptus can activate sensory neurons, inhibit pain pathways, and provide pain relief similar to non-steroidal anti-inflammatory drugs.
02:01:20Studies show significant reduction in tension headache symptoms and cognitive defects with essential oil application.
Acupuncture, like essential oils, is gaining recognition for its pain-relieving effects supported by scientific understanding of its mechanisms.
Research at Harvard Medical School reveals acupuncture's ability to reduce inflammation and muscle activity through specific needle insertion sites, impacting pain pathways and sensory neurons.
Acupuncture has been successful in alleviating headache and other pain forms, prompting insurance coverage and wider acceptance.
✦
Mechanisms for treating headaches including deactivation of pain pathways, activation of parallel pathways, and neural pathways.
02:05:46Alternative treatments like acupuncture and essential oils are discussed as well.
Importance of understanding the mechanistic basis of treatments to control health outcomes with minimal side effects.
Role of caffeine in treating headaches, how it can both relieve and induce headaches based on individual caffeine consumption habits and impact on vasodilation and vasoconstriction.
✦
Curcumin, also known as turmeric, has potent anti-inflammatory properties and has been explored in treating migraine headaches.
02:15:41Dosages of 80 milligrams per day, taken with omega-3 fatty acids, led to significant improvements in migraine and other headaches.
High doses of curcumin can impact hormonal pathways and reduce DHT levels, affecting libido and other bodily functions.
It is crucial to be cautious with dosages and monitor individual responses to curcumin consumption.
✦
Risks of eating extremely spicy peppers, like the Carolina Reaper, include Thunderclap headaches and potential brain damage.
02:19:42Various types of headaches were covered, with treatments like creatine, omega-3 fatty acids, herbal remedies, essential oils, and acupuncture showing promise in reducing headache frequency and intensity.
Alternative treatments can be as effective as non-steroidal anti-inflammatory drugs, but should not replace prescribed medications from a physician.
✦
Ways to reduce headaches for those with chronic migraines.
02:24:10Importance of subscribing to various platforms to support the podcast.
Momentous Supplements recommended for improving sleep, hormone support, and focus.
Encouragement for international viewers to explore podcast sponsors and supplements.
Huberman Lab podcast discussed as valuable content for science-related supplements and tools.
00:00welcome to the huberman Lab podcast
00:01where we discuss science and
00:03science-based tools for everyday life
00:08I'm Andrew huberman and I'm a professor
00:10of neurobiology and Ophthalmology at
00:13Stanford school of medicine today we are
00:15discussing headaches headaches are
00:17something that everybody will suffer at
00:20some point in their lifetime of course
00:21some people suffer from headaches far
00:23more often than others and for many
00:25people headaches can be incredibly
00:27debilitating limiting their ability to
00:29work to socialize to sleep to exercise
00:32essentially to live life in any kind of
00:35normal way as we'll soon discuss there
00:38are many different kinds of headache we
00:40have migraine headaches tension
00:41headaches cluster headaches today I will
00:43review all the different types of
00:44headaches and what the underlying
00:47biology of each and every one of those
00:48types of headaches is as well as
00:51fortunately the many excellent
00:53treatments that exist for the different
00:55types of headache in fact what we'll
00:56soon discuss is that by understanding
00:59which type of headache you have and a
01:01little bit about the underlying biology
01:03of each different type of headache it
01:05becomes quite straightforward to select
01:07the best treatment options for you to
01:09for instance provide relief from
01:11frequent and recurring tension headaches
01:13cluster headaches even sinus headaches
01:15the sorts of headaches that are
01:16associated with sinus infections and
01:18colds where the sinuses get clogged up
01:20and you experience headache so while
01:22today's episode focuses on all aspects
01:24and types of headaches it will have
01:26tremendous relevance for everybody so
01:28for those of you that experience
01:29headache every once in a while where
01:31only when you're sick or have a sinus
01:33headache or for those of you that suffer
01:35from debilitating migraines today's
01:37conversation actually has a bit of
01:39optimism woven into it meaning there are
01:42excellent treatments for each and every
01:43one of the different types of headaches
01:45and I was quite impressed and excited to
01:48learn when researching this episode that
01:50the treatments for headache range from
01:52of course prescription drug treatments
01:54and over-the-counter medications of the
01:56sort of type that most of us have heard
01:58about ibuprofen acetaminophen and so
02:00forth so-called anti-inflammatory drugs
02:03but it turns out there are many natural
02:05treatments for headaches that when
02:08compared to those over-the-counter drugs
02:10and even some prescription drugs appear
02:13to be easily as effective and in many
02:15cases more effective than the typical
02:18drug treatments many of which can carry
02:20side effects that is the drug treatments
02:22carry side effects whereas the natural
02:23treatments appear to not carry side
02:25effects now of course anytime we have a
02:27discussion about natural treatments
02:29there are likely to be some eye rolls
02:31out there and people thinking oh you
02:32know this is going to be a bunch of woo
02:34science well far from it as you'll soon
02:37learn today each and every one of the
02:39treatments for each and every one of the
02:40different kinds of headaches is grounded
02:43in solid biological understanding of why
02:45that particular treatment ought to work
02:47and does work so for instance you'll
02:49learn that some headache arises because
02:51of muscular pain other headache arises
02:52because of excessive vasodilation the
02:55arteries and blood vessels get bigger
02:57and wider and so there's a pressure and
02:59a swelling within the cranium that
03:01people experience as a headache and it
03:03turns out that many of the more natural
03:05treatments out there can address either
03:07the muscular pain issue or the
03:10vasodilation issue or other issues and
03:12underlying mechanisms for headache so
03:15again while headaches are very intrusive
03:17irritating and in some cases
03:19debilitating there is certainly light at
03:21the end of this tunnel meaning by the
03:23end of today's episode each and every
03:25one of you will have an array of
03:27excellent treatment options that you can
03:29choose from in order to address and
03:32provide relief from any of the different
03:33types of headache before we begin I'd
03:36like to emphasize that this podcast is
03:38separate from my teaching and research
03:39roles at Stanford it is however part of
03:41my desire and effort to bring zero cost
03:43to Consumer information about science
03:45and science related tools to the general
03:47public in keeping with that theme I'd
03:49like to thank the sponsors of today's
03:51podcast our first sponsor is thesis
03:53thesis makes custom nootropics and as
03:56many of you know I'm not a fan of the
03:58word nootropics because nootropics means
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05:27if we have sodium magnesium and
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05:36if the electrolytes are not present and
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07:44livemomentis.com huberman let's talk
07:47about headaches and as we are soon going
07:50to learn there are different types of
07:51headaches and different types of
07:54headaches arise from changes in
07:56different types of tissues in the head
07:58area and indeed in the neck area as well
08:01now one of the key things to understand
08:03is that if you want relief from a
08:06headache you need to understand which
08:08tissue is mainly involved in creating
08:11that type of headache so for instance
08:13many people suffer from what are called
08:14tension headaches now tension headaches
08:16are a little bit of a misnomer because
08:18many people might think oh tension I'm
08:20under a lot of tension and stress and
08:21therefore I get tension headaches and
08:23indeed stress can cause tension
08:25headaches but tension headaches are
08:27really the sort of headache that you
08:28feel around the top part of the head not
08:31the very top but sort of where you would
08:33put a headband so above the eyes and
08:35around the head it doesn't have to be
08:36experienced all the way around the head
08:38but the main underlying reason that is
08:40the tissue system that mainly underlies
08:43tension headaches is the muscular system
08:45there are a lot of muscles on the skull
08:48Believe It or Not of course on the neck
08:50and they allow you to move your neck and
08:51head
08:52there are a lot of muscles that lie
08:54parallel to the skull and oftentimes
08:57those muscles will undergo excessive
08:59amounts of constriction
09:01now there are of course muscles and the
09:03jaw that can also lead to headache and
09:04jaw ache and things of that sort and
09:06neck aches and headaches so what we're
09:08really pointing out here is that the
09:10muscles are a key player in the
09:13formation of different types of headache
09:14Tension Headache in particular but of
09:17course muscles and muscle tension can be
09:20evolved in the other types of headaches
09:21as well okay so I just want to highlight
09:23muscular issues as one particular source
09:26of the ache in headaches the other
09:29tissue that can be prominently involved
09:31in generating the ache of a headache or
09:33the so-called meninges now the meninges
09:36in addition to being a fun word to say
09:38or a bunch of tissues that line the
09:42outside of the brain and reside between
09:45the brain and the skull so you might
09:47think okay between the brain and the
09:48skull there's probably just a little bit
09:49of fluid and the brain is right up next
09:51to the skull but it turns out that's not
09:52the case the brain is actually encased
09:54in a very thick very durable Sac or
09:58casing that's wrapped around it tight
10:00like Saran wrap it actually has a name
10:02which is dura d-u-r-a and so you can
10:05remember Dura durable and having done
10:07some surgeries many surgeries before on
10:10brains of different types ranging from
10:12Human even though I'm not a neurosurgeon
10:14as a clinician ranging from Human to
10:17other types of species what you find is
10:20that the dura is exceedingly durable
10:22getting through this thing really
10:23requires an a very sharp razor blade so
10:26the brain is actually sitting in a very
10:28fibrous like Sac that you simply could
10:31not open up with your fingertips under
10:33any conditions it's really durable the
10:36meninges are in that general area and
10:39also encasing the brain and the meninges
10:42provide an additional buffer between the
10:44brain and the dura and the skull so
10:47again you don't want to think about the
10:48brain as just sitting right next to the
10:50skull it's close by but there are a
10:51bunch of other thin fibrous tissues many
10:54of which are very thin and fragile and
10:56others of which such as the dura that
10:58are very very strong because they're
11:01very fibrous almost like a uh if you've
11:03ever felt for instance the sale of a of
11:06a sailboat you might think oh it's just
11:08this big flapping sheet in the wind it
11:09is anything but a sheet in the Wind it
11:12is a very very strong and durable
11:14material now the proximity of the dura
11:16and the meninges to the brain and the
11:17fact that everything is wrapped very
11:19tightly together and the fact that
11:21there's a lot of vasculature so that
11:22would be arteries blood vessels and
11:24capillaries are all in that area on the
11:26top of the brain and throughout the
11:27brain the fact that all of that is in
11:29very close proximity and wrapped really
11:30tight in this very durable sac
11:34is one of the reasons why when blood
11:37vessels or arteries or both become
11:40dilated they open there creates a
11:43pressure between the brain and those
11:45tissues and because there isn't much
11:47distance between the tissues like the
11:49dura and the meninges and the skull
11:51there's also pressure that allows for
11:54the brain to literally sneak up or I
11:56should say give the impression that your
11:59brain is expanding up against your skull
12:01so the point here is that while muscular
12:03tension can give rise to headache the
12:05other thing that can give rise to
12:06headache is so-called vasodilation the
12:08expansion or the widening of the
12:11arteries blood vessels and capillaries
12:13and one of the reasons why that gives
12:14rise to headache is because there's
12:15simply not a lot of space for that
12:18expansion to go it doesn't allow
12:21anything except for the brain to push up
12:23against that very durable tissue and
12:25that very durable tissue to push up
12:26against the skull and even though the
12:29brain itself doesn't have pain receptors
12:31that's right the brain itself doesn't
12:33have pain receptors that is why a
12:35neurosurgeon can take off a piece of
12:36skull and can probe around in the brain
12:38with an electrode and the person is
12:39completely unaware and in order to get
12:42through the skull of course that little
12:43skin flap has to remove be removed from
12:45the skull and that requires a little bit
12:47of topical anesthetic but really you
12:49don't need any anesthetic to go into the
12:51brain itself because there aren't pain
12:52receptors on the brain itself however
12:54the tissues surrounding the brain such
12:57as the dura the meninges and the
13:00vasculature that then reaches up believe
13:02it or not into the skull the vasculature
13:04doesn't actually stop right beneath the
13:06skull it actually blood vessels it get
13:07into the skull and they're actually
13:09portals by which blood can move within
13:11the skull itself well what that means is
13:13that since all of the tissues are very
13:15close by and very compact
13:17with respect to one another any increase
13:19in the size of the portals that allow
13:22movement of blood there
13:24and the fact that there are what are
13:26called nociceptors noci nociceptors
13:29These are essentially pain receptors
13:31because of the presence of pain
13:33receptors in the tissues around the
13:35brain
13:37when there's an increase in the size of
13:39those vascular portals the arteries
13:41capillaries and vessels
13:43we experience that as intense pain and
13:46pressure and fortunately there are
13:48excellent treatments for dealing with
13:49that intense pain and pressure but keep
13:52in mind that the intense pain and
13:54pressure that is the consequence of
13:56vasodilation that is the widening of
13:58these different vascular portals
14:00is very different than the type of pain
14:01that arises from muscular tension as is
14:04the case with Tension Headache okay so
14:06now we have two sources of pain that is
14:09the ache in headache and there are two
14:10more that we need to think about in
14:12trying to better understand the
14:13different types of headaches that we'll
14:15discuss and in terms of trying to
14:16understand which are going to be the
14:18best treatments for the different types
14:19of headaches and those are neural and
14:22inflammatory responses so let's talk
14:24about the neural type first there is a
14:26type of headache that many people
14:27unfortunately suffer from we'll get into
14:30this in a bunch more detail in a moment
14:32but those are called cluster headaches
14:34cluster headaches are headaches that
14:36arise not from the surface people don't
14:39experience them as kind of a tightening
14:41of the forehead and the neck and the jaw
14:42but rather it feels as if the headache
14:44is coming from deep within the head and
14:46in particular from behind the orbit of
14:48one or the other eyes and sometimes both
14:51eyes for those of you that have ever
14:52experienced cluster headaches they are
14:54extremely painful even the more where I
14:57should say the relatively more minor
14:59cluster headaches are extremely painful
15:01and the severe ones are exceedingly
15:02painful
15:04cluster headaches arise from Deep where
15:07this we get the Sensation that they are
15:08rising from deep within our head as
15:10opposed from the surface inward because
15:12they are neural in origin and there's a
15:15particular nerve pathway called the
15:17trigeminal nerve that often is the
15:21origin of these cluster headaches that
15:22people experience behind the eye the
15:24trigeminal as the name suggests has
15:26three branches try Okay so there's a
15:28branch that essentially extends to the
15:31eye there's also a branch that extends
15:33to the mandible right to the uh to the
15:36lip and there's a branch that extends
15:38more or less to the to the nasal area
15:41and so this trigeminal nerve becomes
15:44inflamed or in other ways is hyper
15:47activated in some cases and that causes
15:50the Deep pain below the eye because it
15:53is that first branch of the trigeminal
15:55nerve which is the ophthalmic branch
15:56which tends to be activated first so
15:59people start feeling as if there's a
16:00pain behind their eye in particular on
16:02one side oftentimes there's lacrimation
16:04which is tearing up there can be some
16:06nasal discharge another common symptom
16:08of this type of headache that is the
16:10cluster headache is that the pupil
16:12sometimes will become very small the
16:14pupils of the eyes and they won't dilate
16:16even in darkness so there are a bunch of
16:18things that are going on on one or both
16:20sides of the face that seem to arise
16:22from deep within the head or it's almost
16:25as if it's coming from the brain outward
16:27and that's because it's neural in origin
16:28Okay so we've got muscular origins of
16:31headaches we've got meningeal
16:33origins of headaches that is the the
16:35stuff around the brain and as it relates
16:37to the vasculature and we have neural
16:39origins of headaches and of course
16:42there's inflammation origins of
16:44headaches now inflammation is a term
16:46that gets thrown around a lot these days
16:47people are talking about you know this
16:48reduces inflammation inflammation is bad
16:50and and I I suppose in some cases and
16:53when inflammation is really widespread
16:55across the brainer body it's bad but I
16:57don't think any of us should think about
16:58inflammation per se as bad what I mean
17:01is inflammation is just one form of
17:04signaling in the body which of course
17:06includes the brain
17:08inflammation of a tissue is one way in
17:11which a set of cells so these could be
17:13for instance uh cells of the immune
17:15system and we cover this in a detailed
17:18episode all about the immune system if
17:19you'd like to check that out you go to
17:20hubermanlab.com just put into our search
17:22function immune system and you can find
17:24that episode by the way all of our
17:25episodes are searchable by keyword
17:27hubermanlab.com and it'll take you to
17:28specific episodes and time stamps for
17:31the topics you're interested in so for
17:33sake of this discussion about headache
17:36inflammation is going to be the case
17:39when one particular tissue in and around
17:41the head area is releasing molecules
17:44cytokines which sometimes are called
17:46inflammatory cytokines but there are
17:48also non-inflammatory or
17:49anti-inflammatory cytokines but
17:51inflammatory molecules that are
17:53signaling to the rest of the body hey
17:55there's something going on here there's
17:56either some intrusive object and indeed
17:59if you were to get you know a bb or a
18:01splinter into a particular uh you know
18:03skin area there'd be a lot of
18:04inflammation so it could be the
18:05introduction of a foreign physical
18:06object into an area that will cause
18:08inflammation it can be the presence of
18:10some sort of local toxin in that area it
18:13could be a more systemic inflammation
18:16nonetheless inflammation in the neck and
18:20head area where frankly anywhere within
18:23the sinus area so this would include the
18:24mouth the nose around the eyes because
18:26the sinuses many of us think of sinuses
18:28as just our nose but actually if I were
18:30to show you a skull a human skull or any
18:32other kind of skull
18:33you'd be very hopefully intrigued to
18:36learn that the skull is just not one big
18:39piece of solid bone or a you know a top
18:41with a jaw below it it actually has all
18:44these small what are called
18:45fenestrations little holes and canals
18:47that run through the skull and through
18:49the depth of the skull like little tubes
18:51you've got them down here on your
18:52mandible you've got them above your lips
18:55you have them um on either sides of your
18:57nose those are the sinuses the sinuses
18:59allow the passage of different fluids
19:00through the skull because the skull even
19:03though it's bone it's not a dead tissue
19:05right in a live person or animal the
19:07skull is a very active
19:09living tissue indeed all bone is active
19:12living tissue and it needs to be
19:14nourished with blood it needs to be
19:16nourished with cerebral spinal fluid in
19:18the case of the skull it needs to be
19:19nourished with all sorts of important
19:20things so those sinuses oftentimes can
19:23become clogged as is in the case with
19:24sinus headache which we'll talk about in
19:26a little bit but more generally anytime
19:29there's inflammation of one given area
19:31of the body so it could be a shoulder it
19:33could be the neck it could be the mouth
19:35it could be the nose or in the case of
19:36the headache it could be any portion of
19:40the head or neck
19:41what happens is inflammation while it's
19:44a very efficient signal it's much like
19:46the siren on an ambulance or a police
19:49car and that it sends out a very broad
19:50signal that's very clear something is
19:52wrong here and needs to be dealt with
19:54it's not very specific so it's very
19:58robust but it's not very specific so for
20:00instance if there's a little bacterial
20:02infection or a little viral infection
20:04the inflammation response to that site
20:06of infection tends to be far more
20:08widespread than the actual site of
20:11infection it's a little bit different
20:12when you have a foreign object there
20:14like a splinter or some other foreign
20:15object that tends to be a bit more
20:17localized and the immune system is
20:19always trying to limit the the extent of
20:21inflammation by putting in different
20:23scar tissues indeed a lot of the things
20:25that we think of as kind of gross
20:26you know pustules and boils and things
20:28like that I know it's a gross topic are
20:30ways in which our body tries to restrict
20:32the amount of inflammation but the face
20:35area and the head itself are so heavily
20:38infused with blood vessels and there's a
20:41constant perfusion as we say of blood
20:43and cerebral spinal fluid and other
20:44things through this incredibly
20:46metabolically active tissue that we call
20:47our brain and our eyes those are by far
20:50the most metabolically active tissues in
20:52our entire body even if we're running
20:53hundreds of miles in Ultra marathons
20:56your brain is still far more
20:58metabolically demanding than all the
20:59muscles of your body combined no matter
21:01what the conditions because of that
21:03there tends to be a generalization or a
21:05spreading out of any inflammatory
21:07response and that inflammatory response
21:09then can trigger the pain mechanisms or
21:13what we've experience as pain mechanisms
21:15in the other three types of tissues that
21:17we talked about so for instance if you
21:18have a systemic infection or you're
21:21experiencing inflammation of any kind
21:22and it has anything to do with or
21:24encroaches on the face or head area that
21:27can easily and almost always
21:30spills over into activation of nerve
21:32cells can give rise to neural based
21:34headache or to the meninges and can give
21:36rise to meningeal headaches and of
21:38course to the muscles and to muscular
21:40type headaches so we've got muscular
21:42origins of the ache in headache we have
21:45meningeal origins of the achin headache
21:47we have neural origins of the aching
21:49headache and we have inflammation-based
21:52origins of the ache in headache and that
21:54pertains to all the different types of
21:56headaches that we're going to talk about
21:57and it's important to keep in mind that
21:59there are these different sources of the
22:01ache and headache and that sometimes
22:03they exist alone and sometimes they
22:04exist in combination however this isn't
22:07important however
22:08all pain
22:10or I should say all experience of pain
22:13as a perception
22:14is going to be neural in origin when we
22:17experience pain whether or not it's a
22:19pin prick or a cut stub our toe we trip
22:22and fall or a headache it is neural in
22:25origin it is the nervous system and
22:27nerve cells that are going to carry that
22:29signal that we perceive as pain so as we
22:32talk about the different sources of pain
22:34and different types of headache we will
22:36also talk about of course I think what
22:38most people are interested in today's
22:39discussion the different treatments for
22:41the different types of headache and why
22:42each of those different treatments work
22:44but by understanding a little bit about
22:46how pain arises in the nervous system
22:48and certainly by understanding the
22:50different types of headaches you know
22:52what is a tension headache I gave you
22:53some impression that it's running around
22:55your head like a headband in many cases
22:57versus cluster headache which starts
23:00deep below the eye often it feels as if
23:02it's emerging from deep in the brain
23:03versus migraine which we'll get into in
23:05a moment by understanding the different
23:07types of headaches you should be able to
23:09quickly pinpoint what type of headache
23:11you have what types of tissues are
23:14likely involved and therefore what types
23:17of treatments are going to most quickly
23:18and most completely relieve that type of
23:21headache okay so for the next three to
23:23five minutes and I promise no more I'm
23:25going to explain how pain arises at the
23:27level of nerve cells and I suppose this
23:30is one of those times when if I had a
23:32highlighter pen that could go out and
23:34across the the microphones and speakers
23:37leading to your ears
23:39I would use it here because what I'm
23:41about to tell you is perhaps one of the
23:42most important things to understand
23:43about your nervous system that is your
23:45brain and you which is that while you
23:48have trillions of neurons and we hear
23:49that you have trillions and different
23:50types of neurons in your brain and they
23:52come in different shapes and sizes and
23:53do different things and some make
23:54dopamine and some make serotonin and so
23:57make glutamate and on and on
24:00the key distinction among different
24:02types of neurons that is the three types
24:05of neurons that I believe everybody
24:06scientists are no everybody should
24:08understand exist are some neurons nerve
24:12cells are what we call motor neurons in
24:14the sense that they control the
24:16contraction of muscles sometimes for
24:18walking other neurons control the
24:22movements of your fingers scientists
24:23call those digits
24:25other ones your toes
24:27they also control the beating of your
24:29heart
24:29although that's a slightly different
24:31mechanism and slightly different type of
24:33tissue than is involved in generating
24:36motor movements of your limbs
24:38these are neurons that we call motor
24:40neurons because their goal or their
24:43purpose I should say they don't really
24:45know what their their goal or purpose is
24:46but what they do is they make sure that
24:48muscles contract so that certain things
24:51happen in your body like your heart
24:52beats or you move your limbs you lift
24:54your eyelids or your eyebrows rather
24:57and so on and so forth
24:59other types of neurons are what we call
25:01Sensory neurons
25:02they communicate
25:04the same way that motor neurons do that
25:06is they fire what we call Action
25:08potentials which are just electrical
25:09signals they release neurotransmitters
25:10like any other neuron but they respond
25:13to certain events in the environment or
25:17the environment within the body
25:19but they are not responsible for
25:21generating muscular contractions so we
25:23call these Sensory neurons some Sensory
25:25neurons sense light touch other Sensory
25:28neurons sense firm touch other sensory
25:30neurons sense pain other Sensory neurons
25:33sense light brushing on the skin in fact
25:36you have Sensory neurons believe it or
25:37not that respond specifically to the
25:40light brushing of a hand across your
25:42skin any region of your body and if that
25:45particular region of your body happens
25:46to have hair on it and you stroke the
25:49skin in the direction that the hairs lay
25:51down
25:52we experience that as pleasurable
25:54whereas if you stroke in the direction
25:55opposite to the the way the hairs lay
25:58down we experience that as not
25:59pleasurable so these Sensory neurons
26:01respond in some cases for instance
26:03within the auditory system they respond
26:06to sound waves and your eye they respond
26:07to photons of light sometimes photons of
26:09light of particular wavelengths that we
26:11think of as red green blue and so on
26:12Sensory neurons don't move muscles they
26:15respond to things in the environment and
26:17they exist within us so we have Sensory
26:19neurons that sense for instance pressure
26:21within our head or pressure within our
26:24gut how full or empty our gut is
26:27pain within our tissues like our liver
26:30or or any kind of other internal organ
26:32so we've got motor neurons Sensory
26:34neurons and then the last kind of neuron
26:36is what we call modulatory neurons these
26:39are the ones that adjust the
26:41relationship between the sensory neurons
26:43and the motor neurons to determine
26:44whether or not we do anything in
26:47response to a sensory input that is
26:50whether or not if a sensory neuron fires
26:52sends it electrical potential whether or
26:54not it will generate a motor change let
26:58me give you a very simple example of
26:59this so for those of you listening I'll
27:02just explain what I'm doing and for
27:03those of you watching you'll be able to
27:04see I'm holding my hand out in front of
27:06me
27:06if I were to touch the top of my hand
27:08with my fingertip I can deliberately
27:11override that is I can modulate that
27:15more typical reflex which is that when
27:16something touches us if we're not aware
27:18of where it's coming from we typically
27:19move away from that thing that touches
27:21this is a very natural response but we
27:23can decide we're not going to move away
27:24we can decide to stay still or we can
27:26decide to move toward the thing that
27:27touches us but typically if you were to
27:29walk up to somebody and you were to
27:30touch them they'd either turn toward you
27:32on the side that you touch them or
27:33they'd step away it's rare that they're
27:35going to step into you but you could
27:37decide that you were not going to move
27:39away or you could step into the
27:40direction of touch and that's because
27:42you have modulatory neurons that can
27:43adjust the conversation in a very
27:45context-dependent way
27:48as to whether or not the sensory neuron
27:50will cause motor neurons to contract or
27:54not okay so we've got motor neuron
27:56Sensory neurons and modulatory neurons
27:58and you're probably thinking by now why
27:59are we talking about this I thought we
28:00were talking about headache I thought
28:01we're going to talk about treatments for
28:02headache but this turns out to be very
28:03important because you could imagine and
28:06in a moment I'll explain how let's say
28:08you have tension headaches you're
28:09somebody that has the classic symptoms
28:11of tension headache let me tell you what
28:13those are these are headaches again that
28:16occur more or less on on the in a kind
28:18of a headband like fashion or they tend
28:20to start there
28:21and exist around that these are very
28:23common they can arise from a number of
28:25different sources rise from sleep
28:28deprivation they can rise from excessive
28:30use of caffeine intake we'll talk about
28:32why that is they can arise from stress
28:34they can arise from very low level viral
28:38infections or bacterial infections but
28:40we experience these as just as headaches
28:42where you've been thinking too hard or
28:44working too hard or life has been
28:45stressful they're often also associated
28:47with jaw pain and jaw tightness and neck
28:49tightness so tension headaches
28:51everything you'd imagine muscular
28:52tension could cause well if you want to
28:54treat tension headache
28:56you can imagine that because all
28:58headache is neural that you'd want to go
29:00after some sort of neural mechanism to
29:02treat them but of course we now know
29:04that there are three types of neurons
29:07there are motor neurons Sensory neurons
29:09and modulatory neurons so we have
29:11choices we can say okay do we want to
29:13turn off the muscles in the head jaw and
29:16neck that are hyper contracted
29:18for instance you want to take a muscle
29:20relaxer or relaxedant
29:23or would you want to try and change the
29:26sensory input itself maybe don't change
29:28the way the muscles are behaving but
29:30shut off the sensory part of it your
29:33ability to sense it
29:34there are certainly ways you can do that
29:37or would you want to adjust the
29:39modulatory neurons would you want to
29:40make it such that you have the headache
29:42but you don't perceive the headache that
29:44is you cut off communication between the
29:46sensor and the motor so that the muscles
29:48relax turns out there are treatments and
29:51approaches for each and every one of
29:52those each and every one of those has
29:54different advantages and disadvantages
29:56but as you can quickly see we are going
29:59to have different types of headaches and
30:00different approaches to treating
30:02headache but if you keep in the back of
30:03your mind that you have neurons that
30:04contract muscles to create movement or
30:07tension of muscles remember you can turn
30:09off those neurons and allow those
30:11muscles to relax you have Sensory
30:12neurons that sense input and actually
30:14sense the pain and you have modulatory
30:16neurons which can allow you to adjust
30:18the relationship between the sensory
30:20neurons and the motor neurons and of
30:22course some of you are probably
30:22screaming at me by now saying wait why
30:25would you ever want to deal with the
30:26motor neurons or or the modulatory
30:28neurons once you want to just go
30:29straight to the source and just cut off
30:31the pain ah well the problem there is
30:33that many painkillers
30:36have other issues as well in particular
30:38they can be sedative many of them can be
30:40habit forming or even addictive and for
30:43many people not all but many people they
30:45don't want to take drugs whether or not
30:46they're over-the-counter or prescription
30:48drugs or even more natural supplement
30:50based type treatments
30:52and they would rather use for instance
30:55a behavioral approach in which they can
30:57modulate they can deliberately turn off
30:59the communication between Sensory
31:01neurons and motor neurons and turns out
31:02those approaches exist as well okay so
31:05at this point I promise you that I'm not
31:07going to give you any more of a biology
31:09lesson in terms of pain sensing and
31:11headaches as a more uh conceptual
31:14phenomenon instead what I'd like to do
31:16next is talk about the different types
31:17of headaches and I think this is
31:19something that's very important and not
31:21often discussed except for those people
31:22out there that unfortunately suffer
31:24repeatedly from certain kinds of
31:26headaches like migraine or cluster or
31:28tension headache but I think for most
31:30people out there who experience headache
31:31and again that is everybody at some
31:33point experiences headache rather than
31:36just think of headache as one thing
31:38understanding the major types of
31:40headache and how they differ from and
31:43are similar to one another will really
31:45help you identify what the best source
31:46of treatments for those are so I'd like
31:48to talk about what the different types
31:49of headache are now the first type of
31:52headache we're going to discuss is the
31:53tension type headache again tension type
31:55headaches tend to start off not always
31:58but tend to start off as more or less a
32:01Halo or a headband around the forehead
32:03in the area above the eyes often also
32:06include the jaw the neck muscles
32:08and can extend even into the upper back
32:11again this can be caused by some low
32:14level of infection but more often than
32:16not tension type headaches are going to
32:17come on because of some chronic
32:20psychological stress usually combined
32:22with lack of sleep usually combined with
32:24lifestyle issues and of course without
32:27getting into a long discussion about it
32:29anytime you have lack of sleep you're
32:30going to have excessive stress anytime
32:32you have excessive stress you're going
32:34to have to make sure you're offsetting
32:36that by getting proper sleep most people
32:37don't when they're under excessive
32:39stress by the way we have excellent
32:40tools we're grounded in excellent
32:42science available to you at zero cost if
32:44you are experienced chronic stress or
32:46even short-term stress we have a master
32:48stress episode of the human Lab podcast
32:50again just go to hubermanlab.com and all
32:52that's time stamped for you tension type
32:54headaches
32:55begin in a more or less a headband
32:58pattern but can really extend to other
33:00tissues as well not so often in the face
33:02but really the head and often will start
33:05to climb up toward the top of the head
33:07they are not always in this Halo pattern
33:09sometimes they can be localized to one
33:11area such as the you know the back of
33:13the head or the front of the head or one
33:15side of the head more than others and
33:17that's often the case because of tension
33:20within muscles of the neck that tend to
33:22bias the ache towards one side of the
33:24head I'd like to take a quick break and
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33:42athletic greens and the reason I still
33:44take athletic greens once or usually
33:46twice a day is that it gets to be the
33:49probiotics that I need for gut health
33:50our gut is very important it's populated
33:53by gut microbiota that communicate with
33:55the brain in the immune system and
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33:58our body to strongly impact our
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34:39other type of headache that
34:40unfortunately is very common is migraine
34:43headaches migraine headaches are defined
34:45generally as disorders of recurring
34:48attacks of headaches so people who get
34:49migraines often get them in a recurring
34:52fashion some people get them very often
34:54other people get them less often but
34:56migraines are very debilitating the
34:59numbers that is the prevalence of
35:01migraine is still pretty debated one
35:04thing that we know for sure is that
35:06females suffer from migraine headaches
35:09at a rate at least threefold higher than
35:12do males and surprisingly this does not
35:15seem to have any direct hormonal origin
35:18because we're also going to talk about
35:19hormonal headaches that is headaches
35:22that relate to a dip in estrogen and
35:24progesterone a particular phase of the
35:26menstrual cycle that is the ovulatory
35:27cycle so there's a bit of a mystery here
35:29and the Mystery is why is it that
35:31migraine headaches occur at such greater
35:33frequency in females even independently
35:36of the menstrual cycle so when you
35:37control for changes in hormones that
35:39still appears to be the case and overall
35:41migraines are very common now the
35:43numbers on migraine and just how common
35:44migraine is
35:46are extremely wide this was a little bit
35:48frustrating for me in researching this
35:50episode
35:51you will find for instance that 17 of
35:55women suffer from migraines you will
35:57also hear that six percent of males
35:58suffer from migraines you will also hear
36:00that 43 43 percent of females suffer
36:05from migraine that is recurring
36:07headaches that qualify as migraine
36:08headaches and that
36:1017 percent of men suffer from migraine
36:13headaches on a recurring basis which is
36:14again the definition of a migraine
36:16headache or one of the key definitions
36:17so all we can say for sure is that many
36:20many millions of people maybe even
36:23billions of people suffer from migraine
36:25headaches it's kind of a staggering
36:27thing to contemplate but we know it's
36:30extremely common and we know that it's
36:33more prevalent in females in any of the
36:35studies that you will find in terms of
36:37that compare the overall prevalence of
36:39headache it's going to be higher
36:41substantially higher in females and
36:42males does not seem to be related to the
36:44ovulatory menstrual cycle
36:46there are some interesting facts related
36:48to that that I'll just you know touch on
36:49for a moment
36:51pregnancy for whatever reason seems to
36:53be protective against migraine headaches
36:55that is women who suffer from recurring
36:57migraines
36:58before they get pregnant when they get
37:01pregnant and often after they give birth
37:04they experience fewer migraine headaches
37:06so there may be something hormonal it
37:08may be something else what do we know
37:10for sure we know that headache that is
37:13the ache in headache is neural so
37:15whether or not the origins are hormonal
37:17or whether or not the origins are
37:18inflammation or gut microbiome or some
37:21other feature of the body brain axis
37:24at this point all we know is that
37:27neural pain or the experience of pain at
37:30the neural level is the final common
37:31pathway and it's more prevalent in
37:33females so as I mentioned migraines tend
37:35to be recurring so some people get them
37:37once a week some people get them once a
37:38month some people get them far more
37:40frequently that they can be extremely
37:43debilitating oftentimes people
37:45experience migraine because it is a
37:46recurring phenomenon will know when a
37:48migraine is coming on they'll say my
37:50migraine is coming on the kind of sense
37:52it coming
37:53there's this notion of Aura and we'll
37:55talk about Aura in a little bit some
37:57people think of Aura just as visual aura
38:00or the sense of kind of a haloing of
38:01light with the sense that there's
38:03something outside the body the actual
38:06definition of Aura is that
38:09it's the experience that something is
38:10about to happen it's this kind of
38:12feeling of anticipation it's not deja vu
38:15deja vu is different and very
38:16interesting in its own right but
38:17different it's this feeling that
38:19something's about to happen and the fact
38:20that aura is such a prominent feature of
38:22migraine headaches or at least that
38:24people feel that the headache is coming
38:25on long before they feel the actual ache
38:28of the headache and the other
38:29debilitating symptoms suggests that
38:31migraine has something of deep neural
38:34origin that it arises from deep within
38:36the nervous system spinal cord and brain
38:38and that it's not something like a
38:40tension headache that is going from
38:42outside in you know the constriction of
38:44the muscles in the jaw and head so
38:45migraine headaches are very different
38:46than tension headaches even in terms of
38:48how they come on or their onset the
38:52other feature of migraine headaches that
38:53I think is important to note is that
38:55dilation of the vessels remember the
38:58vasodilation so the widening of those
39:01pipes that we call arteries vessels and
39:04capillaries is a very prominent feature
39:06of migraine and fortunately that allows
39:08for very particular types of treatment
39:10and ways of dealing with this pain
39:13specific to migraine headaches the other
39:16feature that's common in migraine
39:17headaches is so-called photophobia many
39:19of you are probably familiar with
39:21photophobia if you've ever been sleep
39:22deprived
39:23simply if you're sleep deprived
39:26and you go outside in the morning the
39:28light is going to seem very very bright
39:29much brighter than were you to have had
39:32a really good night's sleep and that's
39:33because during sleep there are all sorts
39:34of reset mechanisms in the brain there's
39:36the washing out of metabolic debris and
39:38things in the brain the so-called
39:39lymphatic washout That's essential
39:41there's also an adjustment of the neural
39:43tissue of the eyes which as many of you
39:45have heard me say before actually two
39:46pieces of rain that have been extruded
39:48from the cranial Vault so your eyes yes
39:49indeed are two pieces of brain the only
39:51two pieces of brain outside the cranial
39:52Vault and within your eyes you have
39:55neurons and mechanisms that adjust the
39:58the sort of sensitivity of your eyes to
40:01light and of your brain to light and
40:04when you are sleep deprived or when you
40:05have a low-level viral infection or a
40:07cold or a flu of any kind
40:09you tend to experience light as brighter
40:12than it actually is when you're rested
40:14or you're in the healthy state so
40:15photophobia is something that's very
40:17very common in migraine and often the
40:19photophobia is a prominent feature of
40:22the experience that a migraine is coming
40:24on people will start saying oh you know
40:26it's just too bright in here and
40:28normally they'd be able to tolerate that
40:29level of sunlight or of indoor lighting
40:32with no problem
40:33so
40:34there are two aspects of migraine that I
40:37think are particularly important to
40:38understand for sake of of the treatment
40:39and that's the dilation of vessels so we
40:42if we want to treat migraine we're going
40:43to have to think about things that can
40:45constrict blood vessels in the brain
40:47area but we also need to think about
40:48photophobia not photophobia just as a
40:51symptom of migraine but that maybe by
40:53adjusting our sensitivity to light we
40:55can actually short-circuit some of the
40:58onset and subsequent pathology of the
41:01migraine that is if we can prevent
41:03photophobia
41:05partially or completely can actually
41:07offset a lot of the ache of the migraine
41:10that would otherwise occur so that's an
41:12exciting Avenue for addressing migraine
41:14headaches we'll get into photophobia and
41:16how to deal with that we'll also talk
41:17about Aura a little bit more in a few
41:20minutes but for the time being we've
41:21talked about tension headaches we've now
41:23talked about migraine headaches again
41:24keep in mind knowing what kind of
41:26headache you have is essential it's I
41:29would say indispensable for selecting
41:31the best treatment many people out there
41:33will simply get a headache and decide oh
41:36I'm going to pop a couple of aspirin
41:38okay what does aspirin do aspirin's and
41:40anti-inflammatory it also has pronounced
41:42effects on the vasodilation and
41:44vasoconstriction system it actually
41:46allows more blood to flow through those
41:49arteries vessels and capillaries a lot
41:50of people actually use baby aspirin or
41:52small amounts of aspirin as a way to
41:54offset cardiovascular disease that's
41:56another discussion but what do we know
41:58we know that in migraine there's a hyper
42:01dilation of the blood vessels a hyper
42:02dilation of the very little portals that
42:05exist in the brain and around the brain
42:07and that are going to cause the pain
42:08you're going to activate those Sensory
42:10neurons those non-iceceptors that will
42:12then give us the experience of extreme
42:14headache and migraine so taking an
42:16aspirin or something like it for
42:18migraine in some cases the worst
42:20possible Choice again so knowing what
42:22kind of headache you are experiencing is
42:24going to be essential here the other
42:25thing that you'll sometimes hear is that
42:26drinking a cup of coffee or getting
42:28caffeine through tea is a great way to
42:30deal with headache
42:32why would that be well it turns out that
42:35coffee can cause either vasoconstriction
42:37or vasodilation depending on when you
42:39take it and we'll get into the use of
42:40caffeine as a treatment for headache
42:43because indeed it can be a very potent
42:44treatment for headache but you
42:47absolutely need to know what kind of
42:48headache you are experiencing because in
42:51some cases drinking caffeine whether
42:53it's in tea or coffee can absolutely
42:56alleviate the pain of a headache
42:57especially if you catch that onset of a
43:00migraine or attention type headache
43:01early on but in some cases it can make
43:03it far far worse again knowing which
43:06type of headache you're experiencing and
43:07how the different treatments work is key
43:09okay so we have tension type headaches
43:11migraine type headaches I think you're
43:12starting to get the picture they have
43:13different underlying biologies
43:18the next type of headache is cluster
43:20headaches cluster headaches are the ones
43:21I mentioned earlier that arise from deep
43:23within the head they feel as if they're
43:25coming from the inside out and they tend
43:27to be on one side or the other what
43:29scientists and clinicians call
43:30unilateral and tends to originate behind
43:32the eye and sometimes the nose region
43:34sometimes in the mouth region as well it
43:36feels kind of patchy but as if it's
43:38coming from the inside out and again
43:40that's because of that trigeminal nerve
43:42for those of you listening and not
43:44watching this on YouTube I've got three
43:46fingers as if I'm putting up three
43:47fingers and I'm I've got one pointed
43:49toward my eye one pointed towards my
43:51nose region and one towards my upper lip
43:53the trigeminal nerve is an easy one to
43:56remember and it will completely explain
43:58cluster headaches and what to do about
44:00cluster headaches in a moment if you
44:02remember that the herpes one virus and
44:04not herpes two not genital herpes but
44:06herpes one virus is the one that gives
44:08cold sores on the mouth
44:10herpes one virus by the way is
44:12exceedingly common up to 90 percent of
44:13people many children in fact have these
44:15again this is not a sexually transmitted
44:17herpes although it can be of course
44:19transmitted through kissing and sexual
44:21contact but that's not the only origin
44:23of it okay it can be passed by skin
44:25contact and mucosal contact
44:28um so mucosomucosal so that would be
44:30kissing mucosa lying or even skin to
44:32mucosal Linings that's why it's so
44:34common and the reason why cold sores
44:36develop on the mouth for people that
44:38have herpes one is because the virus
44:41actually lives on the trigeminal nerve
44:44and yes it is true that sometimes the
44:47virus will inflame the nerve and the
44:49inflammation will occur at the level of
44:50the eye so people do unfortunately
44:51sometimes get herpes of the eye it
44:53actually can be quite dangerous if you
44:54have an infection of the eye of a herpes
44:56infection in the eye you should see an
44:57ophthalmologist or the nose region they
44:59can experience pain in the mucosal
45:01tissue of the nose more often than not
45:03the most inflammation is occurring on
45:05the the branch that innervates the lip
45:08or the region close to the lip and
45:09that's why a cold sword develops there
45:11an immune response there signaling that
45:14there's inflammation due to the herpes
45:15virus which lives on that neuron for a
45:18very long time neurons don't turn over
45:20in the lifespan so it can live on there
45:22for the extent of of the person's life
45:24however most people
45:27hopefully treat their HSV-1 but if they
45:29don't the the sort of frequency and the
45:33severity of infections tends to taper
45:34off with time we'll have an entire
45:36discussion about viruses and herpes in
45:38particular in a future episode but the
45:41thing to keep in mind here is that this
45:43very nerve is the one that gets inflamed
45:46in these cluster type headaches now
45:48cluster type headaches are associated
45:50with a bunch of very uncomfortable
45:52symptoms again they tend to be
45:54unilateral they tend to begin very deep
45:56and they tend to be excruciatingly
45:59painful excruciatingly painful they can
46:01last anywhere from 30 minutes to three
46:02hours some people experience these in
46:05sleep in fact this is one of the cases
46:07where men experience a headache more
46:09than females
46:10men experience cluster type headaches
46:13that have a sudden onset during sleep at
46:15five times the frequency than do females
46:17the origins of that aren't exactly clear
46:19they do seem to have something to do
46:20with the biological clock mechanisms the
46:22so-called circadian mechanisms so if you
46:25are a man or woman for that matter and
46:28you're waking up in the middle of the
46:29night with a unilateral headache and it
46:30seems like it's deep within your
46:32um within your head or it's starting
46:34there and it's on one side and localized
46:36to the eye and maybe these other regions
46:37the trigeminal is involved in you may be
46:39suffering from cluster type headache and
46:41you should talk to your physician the
46:42other symptom that's quite common in
46:44cluster type headache is a droopy eyelid
46:46which should make sense because the
46:47trigeminal innervates the eye region and
46:49there are other nerves that control the
46:50eyelid but they're in that General
46:52region and they can be impacted the
46:54other thing is something called meiosis
46:55which is that you can't dilate the pupil
46:57I mentioned this before so those your
46:58pupils might get really really small and
46:59they won't dilate and the other thing is
47:02lacrimation tearing and then nasal
47:04discharge all because of a neural
47:05inflammation problem why do I tell you
47:08with such detail about cluster headaches
47:10well if you are somebody that's
47:11experiencing the kind of pain that is
47:14consistent with cluster headache taking
47:16a standard anti-inflammatory or doing
47:19something that is going to adjust the
47:21vial the excuse me the dilation or
47:23constriction of blood vessels may have
47:25an indirect impact on cluster headache
47:27but is unlikely to relieve cluster
47:29headache either acutely meaning right
47:31away or in preventing cluster headaches
47:34you have to deal with this as a neural
47:36issue and we'll talk about some of the
47:38main causes of inflammation and
47:40activation of these cluster type
47:41headaches at the level of the trigeminal
47:43nerve in a little bit because
47:44fortunately there are some excellent
47:46treatments the next type of headache
47:47that is quite common are hormonal
47:50headaches now the phrase hormonal
47:52headache should already cue you to the
47:53fact that it's far too General a term
47:56because there's so many different
47:57hormones testosterone estrogen thyroid
47:59hormone growth hormone and on and on and
48:00on
48:01and they all have many different
48:03functions in the brain and body every
48:05single hormone and in particular the
48:07so-called steroid hormones steroids
48:09again not just limited to things that
48:12people take for Sports in fact the
48:13steroid hormones refers to estrogen
48:15testosterone of the sort that we all
48:18make that men and women
48:19make naturally and those steroid
48:23hormones can impact gene expression they
48:25can are of course what turns on the
48:27growth of the of the breast tissue of
48:29the testicular tissue of the hair growth
48:32and on and on and that's all because of
48:34gene expression if you're really going
48:35to change the identity and function of a
48:37cell long term
48:38right you're going to literally change
48:40the breast tissue or change the penile
48:41tissue or change the ovarian tissue in
48:44some sort of consistent way across the
48:45lifespan you can bet that there are
48:47changes in gene expression and those
48:48changes in gene expression occur because
48:50these steroid hormones have this
48:51incredible ability sort of like the
48:53X-Men of hormones to pass through the
48:56outer membrane of a cell which we call
48:58the extracellular membrane and into the
48:59so-called nuclear membrane they can go
49:01into the area where genes are made and
49:03turn on and off different genes however
49:05they multitask in their life that is
49:09these steroid hormones like estrogen in
49:11particular and testosterone in
49:12particular can also bind to the surface
49:14of cells and impact all sorts of things
49:16at the level of the cells that have
49:18nothing to do with changes in gene
49:19expression and that second mechanism of
49:22binding to the surface of cells is one
49:23of the ways in which estrogen can
49:25control
49:26different aspects of headache now that
49:30doesn't necessarily mean the estrogen
49:31gives you headaches in fact it's just
49:34the opposite
49:35it turns out that low estrogen and
49:37another hormone low progesterone combine
49:41to give rise to headache because of the
49:43ways that low estrogen and low
49:45progesterone impact vasodilation
49:48and vasoconstriction and the
49:51inflammatory response we'll talk about
49:52how to deal with hormone-based headaches
49:55a particular hormone was headaches that
49:57occur because of low estrogen and
49:58progesterone in a moment but the key
50:01thing to know is something that we
50:02covered in the fertility episode I did a
50:05very long very detailed episode on
50:06fertility so I'm not going going to go
50:08into this in significant detail now you
50:10can refer to that episode for probably
50:13more detail than you ever wanted but
50:14also a lot of tools as it relates to
50:16fertility in both males and females but
50:18right now I'm just going to give you a
50:19course overview of that in about 60 to
50:22120 seconds so that you'll understand
50:24when hormonal headaches are most likely
50:27to take place keep in mind that hormonal
50:30headaches are most likely to take place
50:32when estrogen and progesterone are
50:34lowest
50:35so if you understand that during the
50:37follicular stage of the ovulatory slash
50:41menstrual cycle okay so menstrual cycle
50:43is about 28 days on average not in
50:45everyone but it's about 20 days on
50:46average and the first half of that
50:47estrogen starts creeping up up up up up
50:50up up up up up and as we learn in
50:52endocrinology estrogen primes
50:54progesterone so estrogen will then Peak
50:56and then start to fall
50:58pretty quickly right about the time that
51:01the egg ovulates an egg is released and
51:05will essentially be ready for
51:07fertilization if the egg is fertilized a
51:10whole bunch of other things happen as it
51:11relates to pregnancy if not what ends up
51:14happening is that during the ludial
51:16phase which is the second half of the
51:18menstrual cycle there's been a buildup
51:20of the lining of the uterus
51:22because of an increase in progesterone
51:24so estrogen goes up during the
51:25follicular phase then it goes down and
51:28then progesterone goes up up up up up
51:30which is important for generating that
51:33thick lining of the uterus to allow the
51:36fertilized egg if it's fertilized to
51:37implant and if it's not fertilized all
51:39of that gets released from the body in
51:41this bleeding process that we call
51:42menstruation if menstruation occurs and
51:45day one of the menstrual cycle is
51:46considered the first day in which
51:47bleeding occurs well then what that
51:48means is that estrogen is already low
51:50because remember estrogen was low at the
51:53start of the follicular phase and went
51:54up up up up up up then it comes down
51:56right at the time of ovulation and
51:58progesterone goes up up up up up during
52:01the luteal phase in fact it's more than
52:03a thousand fold increase in progesterone
52:05but if there's no fertilization of the
52:07egg progesterone starts coming down down
52:09down down down what does that mean that
52:11means that on the first to about the
52:13fourth or fifth day of the menstrual
52:14cycle first being the first day of
52:16bleeding until about the fourth or fifth
52:19day of the menstrual cycle both estrogen
52:21and progesterone are very very low and
52:23it is at that time at the very beginning
52:26of the menstrual cycle so about the
52:28first week of the menstrual cycle that
52:29many women are very prone to hormonal
52:31headaches hormonal headaches not because
52:33estrogens High that's a common
52:35misconception rather because estrogen
52:37and progesterone are both low and now
52:40that you understand the Contour or the
52:43under underlying reasons for hormonal
52:45headache
52:46you can start to ask well what happens
52:48when estrogen is low well estrogen has a
52:51strong impact on the vasodilation
52:53vasoconstriction system as does
52:54progesterone we'll talk about that a
52:56little bit later but now that you know
52:57what hormonal headache is at least this
52:59one particular type of hormonal headache
53:01which is very very common given the
53:03number of women that are menstruating
53:05and the fact that low estrogen low
53:06progesterone is the cause of the
53:09hormonal headache and the fact that of
53:12course there are women who are no longer
53:13menstruating so they're either in
53:15perimenopause and menstruation is
53:16becoming more infrequent or they're in
53:17menopause and it deceased entirely well
53:20now you understand what the origin of
53:22the hormonal headache is and so all we
53:24need to know is what do estrogen and
53:26progesterone normally do in order to
53:28prevent headache and thereby you'll know
53:30exactly how to offset that is prevent or
53:34treat hormonal headache in that first
53:36week of the menstrual period the last
53:38type of headache that I'd like to
53:39discuss is headache associated with head
53:41hits that is traumatic brain injury
53:43although I definitely want to underscore
53:45the fact that even people who do not
53:48have traumatic brain injury can
53:50experience headaches as the consequence
53:52of hitting their head so the line
53:54between traumatic brain injury and lower
53:56level brain injury is one that still
53:59seeks definition in fact this is one of
54:01the major goals of the clinical field as
54:04it relates to concussion you know it's
54:05also what comes up a lot during the
54:07discussion about football you know these
54:09days you'll see players hit really hard
54:11and depending on whether or not they're
54:13laying there for five seconds 30 seconds
54:15or three minutes you know the crowd and
54:18the uh the people watching on television
54:20and everywhere else are all speculating
54:21as to whether or not the person should
54:22be allowed to play and to be quite
54:24direct there really is no way to assess
54:27the extent of brain damage after the
54:29consequence of hitting one's head or
54:30having one's head hit
54:32because
54:34first of all almost all of the best ways
54:36to detect traumatic brain injury except
54:38the most severe ones
54:40tend to require a lot of very large
54:42equipment like MRI and functional MRI
54:44and CT scans none of which are available
54:47on the side of the field or in the
54:49locker room but also because many many
54:52if not most of the effects of traumatic
54:55brain injury are going to occur not in
54:57the immediate minutes or even hours
54:59after the injury but several hours days
55:01or even weeks after that injury this is
55:04a discussion that we should hold off for
55:06a longer full episode on traumatic brain
55:09injury keeping in mind of course that
55:10football is this very Salient example
55:13of traumatic brain injury and concussion
55:15as is boxing as is even soccer with
55:17heading of the ball Believe It or Not
55:18repeated low level impact to the
55:21forehead and other parts of the head can
55:24give rise to over time traumatic brain
55:26injury without the need for any kind of
55:28full-blown concussion or being quote
55:29unquote knocked out but sports related
55:32concussion actually occupies just a tiny
55:35fraction of the majority of traumatic
55:37brain injury and concussion
55:39most traumatic brain injury and
55:41concussion and low-level brain injury
55:43that can accumulate over time to become
55:45traumatic for sake of daily living that
55:47is lowered cognition disruption and mood
55:49sleep Etc
55:51is actually the consequence of things
55:53other than Sports so for instance
55:54bicycle accidents playground accidents
55:57construction accidents and this is often
55:59forgotten for some reason all the sports
56:01in particular football tend to grab all
56:04the attention as it relates to
56:05concussion keep in mind that while for
56:08certain people is a path to a living for
56:12most people traumatic brain injury is
56:14going to occur in a car accident
56:15construction work or other types of work
56:17for which people generally don't have
56:20many options in terms of the type of
56:21work that they're doing so they are
56:23prone to concussions and head injuries
56:24simply by virtue of their work without
56:27any you know millions of dollars
56:28contracts or the opportunities
56:30necessarily some cases they do but
56:32necessarily to do other things and
56:33certainly car accidents or bike bicycle
56:35accidents are not voluntary events so
56:38the point being traumatic brain injury
56:40and headache related traumatic brain
56:43injury extends far beyond the realm of
56:45sports and in fact if you were to look
56:46at the numbers what you find is that
56:48more than 90 percent of traumatic brain
56:49injury so people coming into the
56:51hospital or clinic are people claiming
56:53that they've got consistent headaches
56:54they're not sleeping well their mood is
56:56off they're feeling more irritable after
56:58having hit their head even once
57:00is not the consequence of sports it's
57:02going to be the consequence of accidents
57:03either on at the workplace or in terms
57:07of a bicycle or other sorts of
57:08Transportation based accident like a car
57:10accident with that in mind any kind of
57:13head hit certainly involves a concussion
57:16or traumatic brain injury often leads to
57:19headaches either infrequent but severe
57:22headaches or chronic low-level headaches
57:24or a feeling there's kind of a
57:25stuffiness or a fullness to the head
57:26there can be a lot of different Origins
57:28to that
57:29a common origin is going to be actual
57:31swelling of the not necessarily the
57:33brain tissue directly but if you recall
57:35our discussion about the meninges which
57:37include the dura and the other tissues
57:39that surround the brain they're actually
57:40three layers that we call the meninges
57:42the durages being one of them and
57:44there's a very little space between
57:45those the brain the meninges that
57:47surround it and the skull it's called
57:49the subarachnoid space very cool right
57:51arachnoid like spider
57:52well if there's even a slight bit of
57:55swelling in the brain or even distant
57:57brain tissue so for instance even if the
57:58there's Whiplash so there's swelling of
58:01the tissue muscular tissue and neural
58:03tissue in the neck area that can
58:05constrict the flow of things like
58:07cerebral spinal fluid blood flow and
58:09indeed mucus and other other things that
58:11are essential we all hear mucus and we
58:13think Illness but mucus is a vital vital
58:16substance within the body for a lot of
58:19important reasons in health as well as
58:21in sickness well if there's less of that
58:23liquid and other fluids and mucus being
58:26delivered to that space well then it can
58:28clog up so sort of the plumbing is
58:30clogged up or that it's caught at the
58:33level of the site of hit or injury
58:35because there's some local swelling and
58:37inflammation there so there are many
58:38different mechanisms that can underlie
58:40headache associated with head hits or
58:42traumatic brain injury now fortunately
58:43there are some recent data pointing to
58:46some what I would call non-obvious
58:48treatments for headache in traumatic
58:51brain injury keeping in mind that
58:54anytime we're talking about injury or
58:57disease or health for that matter mental
58:59health or physical health we have to
59:01highlight
59:02a fact that's going to come up again and
59:04again in every single episode of this
59:07podcast and I think it's not being
59:10overly redundant to do so which is that
59:13regular
59:14sufficient amounts of deep sleep each
59:16night are going to be important for all
59:19aspects of mental health physical health
59:20and performance and have been shown over
59:22and over again to reduce the frequency
59:24of headache and to reduce the time to
59:26repair after traumatic brain injury and
59:29can improve cognition and on and on and
59:30on so sleep is essential for all the
59:32normal things that encourage healthy
59:35activity of the different tissues that
59:36are involved in brain and body to occur
59:39so sleep deprivation of course is going
59:41to limit those but I do want to point
59:42out that sleep
59:44sunlight and I've talked about this
59:46almost ad nauseam on this podcast but
59:49regular circadian Cycles getting
59:50sunlight in your eyes early in the day
59:52and in the evening as well and as much
59:53as possible throughout the day without
59:55burning your skin and limiting your
59:56exposure to artificial lights at night
59:58and on and on all of which is covered in
01:00:00the light for health episode of The
01:00:01huberman Lab podcast the master sleep
01:00:03episode The huberman Lab podcast and in
01:00:06the perfect your sleep episode The
01:00:07huberman Lab podcast you can find all
01:00:09that at hubermanlab.com getting light
01:00:12and avoiding light at the proper times
01:00:13of the 24 hour cycle is also going to
01:00:15favor all the pathways ranging from gut
01:00:18brain access to the inflammatory
01:00:19anti-inflammatory Pathways neural
01:00:21Pathways Etc that of course if you do
01:00:24that you're going to improve and offset
01:00:26any kind of detriment caused by
01:00:28traumatic brain injury is it treating
01:00:30traumatic brain injury directly no but
01:00:33is not getting sufficient sleep not
01:00:34getting sunlight at the right times of
01:00:36day and getting too much artificial
01:00:37light at night going to make any impact
01:00:39of traumatic brain injury including
01:00:41headache far worse yes there are
01:00:43certainly a ton of data to support that
01:00:44state statement as well and then of
01:00:46course nutrition and exercise are also
01:00:47important so we can list out sleep Sun
01:00:51proper nutrition exercise and I would
01:00:53put a proper social connection whatever
01:00:55that means to you healthy social
01:00:56connections include romantic
01:00:59friendship familial and relationship to
01:01:02self those five things sleep exercise
01:01:04Sun nutrition and social connection are
01:01:06all critical for maintaining baselines
01:01:08of health and raising your baselines of
01:01:09health and I mentioned that I can
01:01:11segment this out now because I think
01:01:13that anytime we're about to start
01:01:15discussing pointed treatments that is
01:01:18things that you can take or do to reduce
01:01:20headache or things that you can take or
01:01:22do to improve anything within mental
01:01:24health physical health and performance
01:01:25we have to remember that the foundation
01:01:27of mental health physical health and
01:01:28performance is only set at its highest
01:01:30level by tending to those other things
01:01:32and that nothing really surpasses any of
01:01:34those things or put differently there's
01:01:36no replacement for any of those things
01:01:38in the form of a pill a powder even a
01:01:41behavioral practice there are things you
01:01:42can do to offset getting less than ideal
01:01:45sleep the things that you can use like
01:01:47bright artificial lights during the day
01:01:48to try and partially offset lack of
01:01:50sunlight but really there is no exercise
01:01:52pill there is no sunlight device
01:01:55although some bright lights are very
01:01:57bright there's no no replace basement
01:01:59for actual sunlight there's no
01:02:00replacement for actual sleep there's no
01:02:02replacement for actual nutrition and I
01:02:03do feel it's an important conversation
01:02:05to have as we head into the next segment
01:02:07which is what can you take or do to
01:02:10reduce headache and in order to address
01:02:12this we're going to start first with the
01:02:13headaches associated with head hits and
01:02:15traumatic brain injury because turns out
01:02:18there's a surprising and very useful
01:02:20approach to doing that but
01:02:23this same approach also can help offset
01:02:26and treat headache in other conditions
01:02:28as well meaning not just for headaches
01:02:30caused by traumatic brain injury but
01:02:31also headaches caused by sudden onset
01:02:35Tension Headache or migraine headache or
01:02:37even perhaps again perhaps cluster type
01:02:39headaches so the first substance that
01:02:41I'd like to highlight that has been
01:02:43shown to significantly reduce the
01:02:45intensity and or frequency of headaches
01:02:48is creatine now creatine as many of you
01:02:51know is something that people supplement
01:02:54and take
01:02:56most often creatine is discussed in the
01:02:58context of muscle performance not just
01:03:00for people who weightlift but for people
01:03:01who do endurance exercise and it's often
01:03:03been said that 5 to 10 grams per day of
01:03:06creatine monohydrate depending on how
01:03:07much you weigh 5 to 10 grams per day of
01:03:09creatine monohydrate can increase
01:03:11creatine phosphate stores in muscles can
01:03:13bring more water into muscles can make
01:03:15you stronger get increased power output
01:03:16and that is all true that is all
01:03:19completely true we discussed this in the
01:03:20huberman lab podcast with Dr Andy Galpin
01:03:22when he was a guest on the Hebrew and
01:03:25Lab podcast or standard series and we
01:03:28discussed this extensively in an
01:03:29upcoming episode from Dr Andy Galpin in
01:03:32his special
01:03:34six-part guest Series where he is a
01:03:36guest on the Hebrew Lab podcast but
01:03:38where really he's the one doing the
01:03:39majority of the teaching that series
01:03:41covers everything from strength
01:03:42hypertrophy endurance and there's an
01:03:44episode on supplementation where we go
01:03:45deep into the discussion about creatine
01:03:47now in that discussion and again now
01:03:50we highlight the fact that creatine
01:03:52While most often discussed online and in
01:03:55the media as a supplement for sports
01:03:57performance for the reasons I just
01:03:59mentioned
01:04:00actually has far more data behind it
01:04:02that is laboratory studies exploring the
01:04:04role of creatine in the clinical setting
01:04:07so I'd like to highlight a paper from
01:04:08that literature now that will make very
01:04:09clear as to why creatine is interesting
01:04:12and in fact very effective for treating
01:04:14headache and particular headache caused
01:04:15by head hits or traumatic brain injury
01:04:17the title of the paper is prevention of
01:04:19traumatic headache dizziness and fatigue
01:04:21with creatine Administration now keep in
01:04:23mind this is a pilot study it was
01:04:26performed in humans so when you hear the
01:04:27words pre-clinical that is if you hear
01:04:29there was a pre-clinical study on blank
01:04:31that means almost always that the study
01:04:33was performed on animal models mice rats
01:04:35primates Etc
01:04:37a clinical trial is something that's
01:04:39carried out on humans and a pilot study
01:04:41means that the study was carried out on
01:04:43humans but on a fairly small cohort a
01:04:46very fairly small group uh or limited
01:04:48number of subjects nonetheless if the
01:04:50data are robust as it is in this case of
01:04:52this paper I think it's worth paying
01:04:54attention to so in this study what they
01:04:56looked at was creatine Administration so
01:04:58what they did is they had people ingest
01:04:59a certain amount of creatine I'll tell
01:05:01you in a moment
01:05:02in fluid so it could be taken in water
01:05:04milk with or without food doesn't really
01:05:06matter what time of day
01:05:07they had people take creatine why would
01:05:09they have people take creatine after
01:05:11traumatic brain injury and in particular
01:05:13for people that are suffering from
01:05:15headache dizziness fatigue Etc the
01:05:18reason is that
01:05:19neurons nerve cells rely very heavily on
01:05:22the regulation of calcium in order to
01:05:25generate those Action potentials to
01:05:26communicate with one another so it
01:05:28doesn't matter if it's a motor neuron a
01:05:29sensory neuron or a modulatory neuron
01:05:30they all generate Action potentials or
01:05:32something similar to it and calcium is
01:05:34important for that process calcium
01:05:36becomes dysregulated after traumatic
01:05:39brain injury in a number of different
01:05:40ways
01:05:41in particular in ways that impact the
01:05:44energy production systems of cells that
01:05:46are related to ATP adenosine
01:05:48triphosphate for those facionados out
01:05:50there that want to look it up you can
01:05:51simply look up calcium ATP and neurons
01:05:53and you can learn about that cycle
01:05:55creatine
01:05:57can be stored in muscles as we talked
01:05:58about before but creatine and in
01:06:00particular the phosphorylated form of
01:06:02creatine which is the readily available
01:06:04fuel source
01:06:07form of creatine can also be stored in
01:06:09brain tissue and is actually quite
01:06:11prominently stored in the forebrain the
01:06:13area where the real estate of of your
01:06:15brain just behind the forehead which is
01:06:16involved in planning and action and
01:06:18understanding context so it's very
01:06:20important for cognition
01:06:21it's important for personality too but
01:06:24it's important for a number of different
01:06:25aspects of life that have to do with
01:06:26making plans being able to focus very
01:06:28intensely on your work etc or on
01:06:30anything for that matter all functions
01:06:33that become heavily disrupted in people
01:06:34who have traumatic brain injury and
01:06:36concussion
01:06:38creatine's ability to communicate with
01:06:40the calcium in the ATP system was the
01:06:43motivation behind the study that is the
01:06:44authors hypothesize on the basis of
01:06:46pre-clinical data in animals
01:06:49that by increasing creatine stores
01:06:51within the brain not just in the muscle
01:06:53but in particular within the brain
01:06:55that
01:06:57the availability of creatine would allow
01:06:59for better cognitive function in general
01:07:01now they didn't look at cognition
01:07:02specifically in this paper but they did
01:07:04look at the other aspects that is that
01:07:06the bad stuff associated with TBI and
01:07:09they had people supplement with creatine
01:07:10at a level that is much higher than the
01:07:13typical level that people supplement
01:07:15with creatine Simply for Sports
01:07:17Performance so as I mentioned before
01:07:18most people if they supplement with
01:07:20creatine for sports performance they
01:07:22take creatine monohydrate
01:07:24typically five grams per day sometimes
01:07:2610 grams per day if they're about 100
01:07:28kilograms or or greater in body weight
01:07:30100 kilograms is 200 approximately 220.
01:07:33pounds so the dosage that was used for
01:07:36supplementing creatine in this study
01:07:39to address the potential impact of
01:07:41creatine on headache dizziness and
01:07:44fatigue was quite a bit higher than the
01:07:47dosages used simply for muscle
01:07:48performance in this study they had
01:07:50people take a dose of 0.4 grams of
01:07:54creatine monohydrate per kilogram of
01:07:57body weight so for somebody that weighs
01:07:59100 kilograms or 220 pounds that would
01:08:01be 40 grams of creatine per day if
01:08:05someone weighs half that much they would
01:08:06take 20 grams of creatine per day and
01:08:09they did that over a period of six
01:08:10months and we know that when you take
01:08:12creatine over and over day to day that
01:08:14there's a buildup of creatine stores
01:08:16both in the muscles and within the brain
01:08:17tissue now what they found as a
01:08:19consequence of this creatine
01:08:20Administration was really striking and I
01:08:22think quite exciting they found a very
01:08:25significant decrease in the frequency of
01:08:27headache in people that were
01:08:29supplementing with creatine as opposed
01:08:31to the controls now keep in mind that
01:08:33this is a pilot study but the effects
01:08:35are very dramatic they found a very
01:08:38statistically significant decrease
01:08:39increase in the frequency of headache in
01:08:42people that were taking creatine in fact
01:08:43if you look at the controls and you see
01:08:45that they're basically getting headache
01:08:47at a frequency of 90 percent or more
01:08:50after TBI the reduction in headache
01:08:52frequency is down to about 10 or 12
01:08:55percent in the people taking creatine so
01:08:57that's quite quite a dramatic effect and
01:08:59if you look at the other measures they
01:09:00took
01:09:01keep in mind again this is a pilot study
01:09:03so a limited number of subjects but
01:09:05again the results are very impressive
01:09:07what they found is that the number of
01:09:10people experiencing dizziness was
01:09:12significantly reduced in people
01:09:14supplementing with creatine as was the
01:09:16number of people experiencing fatigue
01:09:18and acute fatigue and chronic fatigue
01:09:20again not chronic fatigue syndrome per
01:09:22se but chronic fatigue which was in this
01:09:25study defined as a general sense of
01:09:26bodily weakness and even mental weakness
01:09:29mental weakness is a little bit hard to
01:09:31quantify but they were very careful to
01:09:33distinguish between cognitive and mental
01:09:35fatigue versus physical and somatic
01:09:37fatigue they acknowledge that both of
01:09:39those occur in TBI or post-tbi the
01:09:42headache is quite frequent basically the
01:09:44takeaway of the study is that for people
01:09:46experiencing headache dizziness and
01:09:48fatigue
01:09:49due to TBI and perhaps and I want to
01:09:51underline perhaps because it hasn't
01:09:53really been explored yet but perhaps
01:09:54headache dizziness and fatigue due to
01:09:57other conditions symptoms
01:10:00or causes of headache creatine
01:10:02monohydrate supplementation might be
01:10:05again might be an excellent candidate
01:10:07for people to try why do we say that
01:10:08well first of all creatine monohydrate
01:10:11is relatively inexpensive it's
01:10:13considered safe at the dosages used in
01:10:15this study and certainly for sports
01:10:18performance as well and
01:10:21there are very few other compounds that
01:10:24have been shown to have as significant
01:10:25an impact on headache over the long term
01:10:28as has creatine monohydrate in these
01:10:31studies of people with TBI it's also
01:10:33important to highlight the fact that
01:10:35many many people suffer from tbis I
01:10:37mentioned earlier and as now there are
01:10:40very few treatments for TBI you tend to
01:10:43get the basic advice coming back and
01:10:45again I think it's excellent advice you
01:10:47know get proper amounts of sleep get
01:10:49exercise but don't get another traumatic
01:10:50brain injury that's obvious but you'd be
01:10:53surprised how many people go right back
01:10:54to work because they have to and you
01:10:57know we have to be sympathetic to the
01:10:58fact that many people just can't stop
01:11:00working or go on disability
01:11:02so many people have to go back to work
01:11:03that could be sport or it could be other
01:11:05kind of work where they are then subject
01:11:07to perhaps getting more TBI maybe
01:11:09they're getting less rest as a
01:11:11consequence and stress obviously stress
01:11:12is a confounding issue for TBI but sleep
01:11:16exercise Sun nutrition
01:11:18all of those things proper social
01:11:20connection are what people are
01:11:21encouraged to do when they have TBI but
01:11:24there have been very few compounds in
01:11:25particular very few over-the-counter
01:11:27compounds that are known to be safe that
01:11:29have shown efficacy in dealing with TBI
01:11:31so I think that while this is a pilot
01:11:34study and we can consider it preliminary
01:11:36I think it's important enough and the
01:11:38effects were dramatic enough that people
01:11:40with headache and in particular people
01:11:42with TBI ought to consider supplementing
01:11:44with creatine in order to deal with
01:11:46their headaches and of course I eagerly
01:11:48await other studies exploring the role
01:11:51of this high dosage of creatine which is
01:11:53a relatively high dosage of creatine
01:11:55monohydrate for offsetting headache
01:11:57meanwhile I think there are a number of
01:11:58people out there
01:11:59suffering from headache who might
01:12:02consider using creatine monohydrate in
01:12:04an exploratory fashion and seeing
01:12:06whether or not it helps offset their
01:12:07headaches keep in mind of course anytime
01:12:09you're going to add or remove anything
01:12:10supplement or otherwise from your from
01:12:13your treatment your nutrition Etc I do
01:12:15suggest that you consult with your
01:12:16physician in particular if you have
01:12:17chronic headaches I don't say that to
01:12:19protect me I say that of course to
01:12:21protect you I'd like to take a brief
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01:12:59behavioral maybe even supplementation
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01:13:06of those metabolic factors hormones
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01:13:33and that's because apolipoprotein B
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01:13:56I'd like to discuss next I find
01:13:58extremely exciting why well what I'm
01:14:01about to describe is a compound or I
01:14:03should say a set of compounds that are
01:14:05available over the counter that have
01:14:08been shown to be very effective in
01:14:10reducing the frequency and intensity of
01:14:12headaches and not just one kind of
01:14:13headache but multiple types of headaches
01:14:15so what I'll describe has been shown to
01:14:17have significant effects in reducing the
01:14:19intensity or frequency of tension type
01:14:22headaches migraine type headaches as
01:14:25well as hormone type headaches that are
01:14:26related to the menstrual cycles that I
01:14:28described earlier now there are a lot of
01:14:30data centered around this General topic
01:14:32but I'm going to focus on three main
01:14:34papers but I haven't told you yet of
01:14:36course is what is the compound that I'm
01:14:38referring to what is this
01:14:39over-the-counter compound well it turns
01:14:41out this over-the-counter compound is
01:14:43not just available over the counter it's
01:14:45also available in food so it turns out
01:14:47that nutrition can have a very strong
01:14:49impact on the frequency and intensity of
01:14:51headache although supplementation with
01:14:53this particular compound can accomplish
01:14:55the same thing as well what I'm
01:14:57referring to here are omega-3 fatty
01:14:59acids many of you are probably familiar
01:15:01with omega-3 fatty acids these are fatty
01:15:04acids that come in the form of so-called
01:15:05EPA and DHA and omega-3 fatty acids are
01:15:09commonly distinguished from the
01:15:11so-called omega-6 fatty acids omega-6
01:15:13fatty acids come in a bunch of different
01:15:16foods and they of course can be
01:15:18supplemented as well omega-3 fatty acids
01:15:20come in a bunch of different foods and
01:15:21can be supplemented as well Common forms
01:15:23of omega-3 fatty acids or I should say
01:15:25common sources of omega-3 fatty acids in
01:15:28Foods include fatty ocean fish including
01:15:31salmon salmon skins sardines anchovies
01:15:34things of that sort
01:15:35common sources in supplement form are
01:15:38so-called fish oil
01:15:39capsules or liquid fish oil again
01:15:42omega-3 fatty acids and almost always
01:15:45when we're talking about omega-3 fatty
01:15:46acids we're talking about a combination
01:15:48of EPA and DHA but really it is the
01:15:52quantity of EPA
01:15:54omega-3 fatty acids that seems to be the
01:15:56most impactful for the sorts of Health
01:15:58metrics that we're going to talk about
01:15:59in a few minutes
01:16:00now with respect to omega-6 fatty acids
01:16:04the most typical food sources of omega-6
01:16:06fatty acids are seed oils I know
01:16:08nowadays seed oils have become quite
01:16:10controversial
01:16:11I've given my stance on this in a prior
01:16:14podcast but I'll just repeat it for
01:16:15those of you that haven't heard it I am
01:16:17not of the belief that all seed oils are
01:16:19bad that they're all inflammatory that
01:16:22they are killing us or making us sick
01:16:24that they are the major cause of
01:16:25metabolic dysfunction Etc however I
01:16:28think it is very clear and I learned
01:16:29this from Dr Lane Norton when he was a
01:16:31guest on this podcast and taught us all
01:16:32about nutrition in great depth I highly
01:16:35recommend that episode if you're
01:16:36interested in nutrition that people are
01:16:39consuming a lot more oil generally and a
01:16:41lot of those oils that people are
01:16:43consuming more of nowadays include a lot
01:16:46of the so-called omega-6 fatty acids and
01:16:49a lot of those oils are seed oils the
01:16:51particular omega-6 fatty acid that's
01:16:52going to be relevant for today's
01:16:54discussion is linoleic acid and that is
01:16:56common in a lot of seed oils so again
01:16:59I'm not going to tell you that seed oils
01:17:01are bad however it does seem to be the
01:17:03case that many people are consuming far
01:17:05too many seed oils and in doing so are
01:17:08consuming far too many calories and
01:17:09perhaps are consuming too much of the
01:17:11Omega six fatty acids relative to the
01:17:14omega-3 fatty acids now with that said I
01:17:17think there is General agreement among
01:17:19nutritionists and health professionals
01:17:21that we could all stand to get more
01:17:24omega-3 fatty acids perhaps for
01:17:26cardiovascular health although that's a
01:17:27little bit debated but certainly for
01:17:29immune system function
01:17:31for mood and for functioning of the
01:17:33brain and for the potent
01:17:35anti-inflammatory effects of Omega-3 so
01:17:37again Omega-3s can be sourced from food
01:17:39both animal based and plant-based you
01:17:41can simply go online and look up the
01:17:43various food-based sources but
01:17:46in thinking about headache and different
01:17:48treatments for headache there are some
01:17:49recent studies exploring how
01:17:51supplementing with omega-3 fatty acids
01:17:53and in one case how supplementing with
01:17:55omega-3 fatty acids and deliberately
01:17:57reducing the amount of linoleic acid the
01:18:00omega-6 fatty acids how that can impact
01:18:02headache so the first study I'd like to
01:18:04describe in reference to the role of
01:18:05omega-3 fatty acids and headache was
01:18:08published in 2018 and the title of the
01:18:10paper is long chain omega-3 fatty acids
01:18:12and headache in the U.S population there
01:18:14are a number of things that I really
01:18:15like about this study a few of those
01:18:17include the fact that they looked at an
01:18:19enormous number of people that is they
01:18:22included 12 317 men and women I like the
01:18:25fact that they included men and women in
01:18:27the study age 20 or older and that they
01:18:30broke down the population into
01:18:32categories that included age they
01:18:35certainly looked at race and ethnicity
01:18:37they looked at educational background
01:18:39they looked at body mass total energy
01:18:41intake which is really important if you
01:18:42think about it people are going to be
01:18:44eating and within the thing things that
01:18:47they eat they're going to be consuming
01:18:48some Omega-3s hopefully as well some
01:18:51omega-6s and if they're eating far more
01:18:52then they're going to get far more of
01:18:55likely going to get far more of both of
01:18:57those things than they would ordinarily
01:18:58if they were eating smaller amounts so
01:19:00they controlled for total caloric intake
01:19:02in a way that I find
01:19:04particularly useful for looking at these
01:19:06kind of data so the reason they explored
01:19:08Omega-3s is worth mentioning omega-3
01:19:10fatty acids are known to have an
01:19:12anti-inflammatory effect that
01:19:15anti-inflammatory effect is mediated
01:19:16through a couple of different Pathways
01:19:18we won't go into these in too much
01:19:19detail now but the omega-3 fatty acids
01:19:21keep in mind actually make up various
01:19:24parts of cells in the brain and body
01:19:26that's right the membrane that remember
01:19:29I talked before about how steroid
01:19:30hormones can go through the different
01:19:31membranes of the cells the outer
01:19:33membrane and the inner membrane a lot of
01:19:34those actual membranes the structural
01:19:36constituents of neurons and other cells
01:19:39are actually made up of or include
01:19:41certain fatty acid long-chain fatty
01:19:43acids and the omega-3 fatty acids are
01:19:45important for or the actual construction
01:19:48of those tissues as well as having
01:19:50anti-inflammatory effects through things
01:19:52like limiting prostaglandins and other
01:19:53things that can cause inflammation okay
01:19:55so there are a bunch of different ways
01:19:56that omega-3 fatty acids can be useful
01:19:58they refer in this study to an earlier
01:20:01study that looked at the so-called
01:20:03analgesic effect the pain relieving
01:20:05effect analgesic means pain relieving
01:20:06effect of omega-3 fatty acids in what
01:20:10had been a randomized controlled trial
01:20:12and in that previous paper what they
01:20:14found was that diets high in Omega-3s
01:20:17and low in omega-6s okay so high three
01:20:20low six and as compared to diets that
01:20:24were just reduced omega-6s they found a
01:20:28greater analgesic effect of increasing
01:20:30Omega-3s while also reducing omega-6
01:20:32fatty acids so in the context of the
01:20:34seed oil discussion although keeping in
01:20:36mind that omega-6s can come from other
01:20:37sources as well if omega-6s were just
01:20:40reduced on their own there wasn't as
01:20:43great in effect in terms of reducing
01:20:45pain and inflammation as there was when
01:20:47omega-3 fatty acids were deliberately
01:20:49increased and omega-6 fatty acids were
01:20:51reduced again in all of these studies
01:20:54because these are the ones in which they
01:20:56controlled things well as we should as
01:20:58we say they are holding constant the
01:21:01caloric intake so it's not just that
01:21:02you're removing fat eating less fat
01:21:04there's actually a removal of certain
01:21:06fats and fatty acids and a replacement
01:21:08of those with omega-3 fatty acids in one
01:21:10case in the other case it's just a
01:21:12reduction in omega-6s and you're using
01:21:14other food types and macronutrients to
01:21:16offset that that reduction in calories
01:21:18caused by reducing omega-6s the basic
01:21:21takeaway that they're relying on
01:21:22marching into the study is that
01:21:24increasing Omega-3s and reducing
01:21:26omega-6s seems to be beneficial for
01:21:28reducing pain and indeed in this study
01:21:30they find something quite similar which
01:21:32is that when you hold caloric intake
01:21:35constant and when you look at omega-6s
01:21:38whether or not you decrease omega-6
01:21:39fatty acids or not you find is that
01:21:42increasing omega-3 fatty acids
01:21:45in the diet so either consumed through
01:21:48food sources or by supplementation was
01:21:50associated with a lower prevalence of
01:21:52severe headache or migraine so severe
01:21:54tension type headache or migraine so
01:21:57this is promising and points to the fact
01:21:59that long chain omega-3 fatty acids are
01:22:01likely to have either a pain reducing
01:22:04and there's evidence for that and or an
01:22:07inflammation reducing effect that can
01:22:09significantly reduce the severity of
01:22:11headache in both tension type headache
01:22:13and in migraine so that's the first
01:22:15study the second study is a more recent
01:22:18study it was published in 2021 that used
01:22:21a I would say a more or less similar
01:22:24type of overall design is the one I'd
01:22:25refer to earlier the title of this paper
01:22:28is dietary alteration of what they call
01:22:30N3 but those are omega-3 and n6 omega-6
01:22:33sorry for this shift in nomenclature I
01:22:35didn't write the paper
01:22:37dietary alteration of
01:22:40omega-3 and omega-6 fatty acids for
01:22:42headache reductions in adults with
01:22:43migraine and this was a randomized
01:22:45control trial randomized control trials
01:22:47involve having people be in one
01:22:49condition where they do one thing and
01:22:50then they get swapped randomly into
01:22:52another condition so they serve as their
01:22:54own internal control and that controls
01:22:57for all sorts of things like differences
01:22:59in sex differences in age differences in
01:23:01health background in any number of other
01:23:03variables as best as one can
01:23:05in this study they had people either
01:23:07ingest a diet that had increased
01:23:11Omega-3s so increased EPA and DHA or
01:23:15increased
01:23:16EPA and DHA and reduced amounts of
01:23:20linoleic acid okay so that's going to
01:23:22reduce omega-6s
01:23:24or a control diet in which they had
01:23:27people taking well it's essentially the
01:23:29average intake of Omega-3s and omega-6s
01:23:31and you can probably already guess what
01:23:33the general results of the study are
01:23:35going to be the general results were
01:23:37that there were reductions in headaches
01:23:39okay the really cool thing is it was a
01:23:42massive reduction in headache okay this
01:23:43was they refer to it as a robust
01:23:45reduction in headache in particular for
01:23:48the subjects that increase their
01:23:50Omega-3s and reduce the amount of
01:23:52linoleic acid that they took the other
01:23:54thing that I really like about this
01:23:55study is that while they don't know the
01:23:57exact underlying mechanism for the
01:23:58effect they did spend some time
01:24:01delineating what it is that the omega-3
01:24:04and omega-6 fatty acids are likely doing
01:24:06to either offset or exacerbate headache
01:24:09now I didn't say that omega-6 fatty
01:24:11acids exacerbate headache but it does
01:24:13seem that people who ingest more
01:24:14linoleic acid and omega-6 are
01:24:17experiencing more inflammation and that
01:24:20is evident in a bunch of different
01:24:21conditions one for instance is or
01:24:23increases in things like cgrp cgrp is a
01:24:27molecule that's associated with the
01:24:28calcium signaling pathway it's involved
01:24:30in vasodilation the expansion of the
01:24:32blood vessels and capillaries and that's
01:24:34known
01:24:35as I mentioned earlier to exacerbate
01:24:37certain forms of headache okay there are
01:24:40also forms of headache that can be
01:24:41caused by vasoconstriction we'll talk
01:24:42about one very dramatic example perhaps
01:24:44as we get toward the end it's a very
01:24:46uncommon example but um it's a it's
01:24:48called Thunderclap headache and trust me
01:24:51you do not want Thunderclap headache um
01:24:53and so we'll talk about Thunderclap
01:24:54headache a little bit later that
01:24:55involves constriction of the blood
01:24:56vessels in any case
01:24:58in this paper they they didn't study
01:25:01mechanism directly but they're resting
01:25:03on this known analgesic anti-pain as
01:25:07well as known anti-inflammatory Pathways
01:25:09related to increasing omega-3 intake and
01:25:11simultaneously resting on the idea where
01:25:14I think there's I think we now can say
01:25:16conclusion that omega-6 fatty acids in
01:25:19particular linoleic acid
01:25:21can increase inflammation by way of
01:25:24increasing things like cgrp vasodilation
01:25:26and some other Pathways related to the
01:25:30so-called inflammatory cytokine Pathways
01:25:32and there's a whole discussion nowadays
01:25:34of What's called the inflammatorium so
01:25:36the basic takeaway is that if you are
01:25:38interested in reducing headache it may
01:25:41be beneficial at least according to
01:25:42these two studies and another one I'll
01:25:44talk about in a moment to increase
01:25:46amounts of omega-3 fatty acids and that
01:25:48can be done again through the ingestions
01:25:49of foods although based on the dosages
01:25:53that we'll talk about in a moment
01:25:55increasing omega-3 fatty acids by taking
01:25:57liquid form fish oil which is perhaps
01:25:59the most cost effective way to
01:26:01supplement Omega-3s or capsules which is
01:26:04perhaps the most efficient way to
01:26:05supplement Omega-3s relate to a level of
01:26:08one gram or more of EPA per day again
01:26:11that's the EPA form in particular so if
01:26:14you're for instance taking supplemental
01:26:16fish oil or you're getting your Omega-3s
01:26:18from food and you're getting what you
01:26:20determine to be 2 000 milligrams or two
01:26:23grams per day of Omega-3s keep in mind
01:26:26that's going to include EPA ndha and it
01:26:29does seem that getting above one gram
01:26:31per day of EPA omega-3 fatty acids
01:26:34either through food or supplements or
01:26:35both is going to be the critical
01:26:38threshold for reductions in the
01:26:40frequency and intensity of headaches
01:26:41that include both tension headaches and
01:26:43migraine headaches now some people will
01:26:45find actually that ingesting far more
01:26:48omega-3 fatty acids generally through
01:26:50supplementation but again can be
01:26:52accomplished through Foods as well
01:26:54can also be beneficial for other things
01:26:56such as mood and indeed there's a whole
01:26:58literature related to effects of
01:27:00ingesting one to three grams again three
01:27:03grams per day of EPA so that's going to
01:27:06require
01:27:07quite a high intake of Omega-3s in
01:27:09whatever form or supplement you decide
01:27:11to take those into your body but that
01:27:13that can improve mood and so forth the
01:27:15basic range that I was able to find in
01:27:18the meta-analysis so meta-analyzes are
01:27:20where a researcher will look at the
01:27:22results of a bunch of different studies
01:27:23focused on the same thing look at the
01:27:26different strength of those studies
01:27:27they'll do all sorts of cool statistical
01:27:29gymnastics like remove the most potent
01:27:32study the one that had the greatest
01:27:33effect and see whether or not they're
01:27:35still an effect of some treatment or for
01:27:37instance they will swap in and out
01:27:40different studies and different
01:27:41combinations to see whether or not any
01:27:43one study is really leading to the
01:27:45conclusion that a given treatment does
01:27:46something in any case in the
01:27:48meta-analysis of omega-3 fatty acids for
01:27:50the treatment of headache and that
01:27:51includes all the different kinds of
01:27:52headache
01:27:53they found
01:27:55in exploring a huge range of Omega-3
01:27:57supplementation ranging from 200
01:27:59milligrams all the way up to 2 000
01:28:01milligrams per day it really was at the
01:28:03one gram or higher dosage per day where
01:28:07the significant impact on reducing
01:28:09headache frequency and intensity was
01:28:10found and just very briefly earlier I
01:28:13mentioned that not only is omega-3 fatty
01:28:15acids supplementation been shown to be
01:28:17effective in reducing the frequency and
01:28:19intensity of headache in tension type
01:28:21and migraine type headache but it's also
01:28:23been shown to improve outcomes for
01:28:26premenstrual syndrome related headaches
01:28:29these are what we refer to earlier as
01:28:31hormone-based headaches again
01:28:33the low estrogen low progesterone
01:28:36associated with certain phases of the
01:28:38menstrual cycle as well as other phase
01:28:39of the menstrual cycle are often
01:28:41associated with headache in uh study
01:28:43entitled effective omega-3 fatty acids
01:28:45on premenstrual syndrome a systematic
01:28:47review and again meta-analysis what they
01:28:50found and here I'm paraphrasing the
01:28:51conclusion was that
01:28:53omega-3 fatty acids could yes
01:28:55effectively reduce the severity of PMS
01:28:58symptoms and one of the symptoms in
01:29:00particular that they found what that was
01:29:02reduced was the pain related symptoms
01:29:04associated with headache and they
01:29:06actually had some very nice hypotheses
01:29:08as to why that likely would be and in
01:29:11fact point out that in earlier studies
01:29:14omega-3 fatty acids have actually been
01:29:16considered as non-steroidal
01:29:18anti-inflammatory drugs in some cases
01:29:20and indeed there are prescription forms
01:29:23of omega-3 fatty acids and I highlight
01:29:25that not because I think people need to
01:29:26run out and get the prescription form of
01:29:28omega-3 fatty acids they're actually
01:29:29quite hard to obtain and quite expensive
01:29:32but because I think oftentimes when
01:29:35we're talking about something like
01:29:36omega-3 fatty acids
01:29:38the fact that they are available over
01:29:40the counter in a supplement or by liquid
01:29:42or available in food for that matter
01:29:43leads many people to conclude that oh
01:29:46you know this is supplementation this is
01:29:47something that
01:29:49um you know it's going to have
01:29:50relatively weak or minor impact on
01:29:52things like headache or other health
01:29:53metrics but let's just say that the fact
01:29:57that it exists as a prescription drug
01:29:59and its highest potency form at least in
01:30:02my opinion points to the potency of
01:30:05omega-3 fatty acids in dealing with
01:30:08analgesic effects that is reducing pain
01:30:10and anti-inflammation as well as some of
01:30:12the known cardiovascular improvements
01:30:14that are associated with increasing
01:30:16omega-3 fatty acid intake put simply
01:30:19Omega-3s are not just something that
01:30:20comes from food or supplements they are
01:30:22also being marketed as prescription
01:30:23drugs so I do think they need to be
01:30:25considered as quite potent and at least
01:30:27as far as these papers that again
01:30:29include meta-analyzes of many other
01:30:31papers and data sets indicate that
01:30:34supplementing with omega-3 fatty acids
01:30:36to a point where you're getting above
01:30:38one gram per day of EPA is not just
01:30:42going to be beneficial for treating and
01:30:43reducing the frequency and intensity of
01:30:45one particular type of headache but many
01:30:48types of headaches and when you combine
01:30:50hormonal headaches tension headaches and
01:30:51migraine headaches you account for more
01:30:53than 70 percent of the total types of
01:30:55headaches that are out there the effects
01:30:57of Omega-3s on cluster headaches and
01:30:59some of the other types of headaches at
01:31:00least to my knowledge have not been
01:31:01evaluated
01:31:02there's no reason to think that Omega-3s
01:31:05would not be beneficial for those types
01:31:07of headaches but at least as far as the
01:31:09data sets we talked about here are
01:31:11concerned it is clear omega-3 fatty
01:31:13acids are going to be a very potent way
01:31:16to reduce pain and to reduce
01:31:18inflammation in ways that can reduce the
01:31:21frequency and the intensity of different
01:31:24kinds of headache before we continue our
01:31:25discussion about many not commonly known
01:31:28and yet very potent treatments for
01:31:30different forms of headache I want to
01:31:32touch on a topic we mentioned a little
01:31:34bit earlier and also provide a treatment
01:31:36that is in a way to alleviate something
01:31:39and that's photophobia and Aura now keep
01:31:42in mind that earlier I referred to Aura
01:31:43as this sense that something's about to
01:31:46happen that is true and that meaning
01:31:48that is an accurate description of Aura
01:31:50but oftentimes people also come to
01:31:53understand Aura as the feeling that
01:31:55something surrounds a given object
01:31:57visually or even that people have a
01:32:00sense that something's around them so
01:32:02again this can be a little bit vague but
01:32:04this idea that aura is a sense of
01:32:06something about to happen or that
01:32:07visually or in an auditory way and or
01:32:09maybe even in kind of a sense that
01:32:12something is about to happen in a
01:32:14certain environment and the reason I'm
01:32:16making uh kind of Arc shapes with my
01:32:18hands for those of you that are just
01:32:19listening I'm making art shapes with my
01:32:20hands is that aura is often described as
01:32:23kind of a Halo or a um emanating out
01:32:25from from one's body or from something
01:32:27that they're looking at again nothing
01:32:29spiritual about this in the context of
01:32:31the discussion about migraine and
01:32:33headache but rather many people
01:32:35experience photophobia sometimes with
01:32:37aura sometimes no and I just want to
01:32:40touch on a couple of the mechanisms by
01:32:42which aurum photophobia occur and
01:32:45mentioned just briefly a pretty well
01:32:47established way that people can start to
01:32:50offset photophobia and again I mentioned
01:32:52that because many people experience
01:32:53photophobia in headache but there are
01:32:55also a number of people that experience
01:32:57photophobia even if they don't have
01:32:58intense headaches so photophobia is
01:33:00pretty common pretty debilitate it
01:33:03actually is one of the reasons why
01:33:04people feel not well and need to leave
01:33:06work or not go to school or or leave
01:33:09school these kinds of things or lay in
01:33:11bed all day or dim the lights not go
01:33:12outside again sunlight being so
01:33:15congruent with health you can imagine
01:33:17how photophobia can lead to all sorts of
01:33:19negative Downstream consequences okay so
01:33:22what is Aura and what is photophobia the
01:33:24exact origins of ARA aren't exactly
01:33:28clear but it is generally thought that
01:33:31what Aura represents is what's called
01:33:33spreading depression and this is not
01:33:35depression of one's mood although it can
01:33:38be associated with that this is
01:33:40depression of neuronal activity again
01:33:43neurons communicate with one another by
01:33:45generating electrical impulses that
01:33:47travel down the length of their of their
01:33:49so-called axons which are like little
01:33:50wires and then they dump
01:33:52neurotransmitter out at the so-called
01:33:53synapse and impact the electrical
01:33:55activity of other neurons
01:33:57depression is a electrical or I should
01:34:00say a chemical electrical
01:34:02chemoelectrical is the proper term
01:34:05phenomenon in which the excitability of
01:34:08neurons is reduced so again doesn't have
01:34:10anything to do with depression as a mood
01:34:12State per se rather it is a reduced
01:34:15excitability of neurons and it's been
01:34:18shown in some Imaging studies
01:34:20that aura is associated with a back to
01:34:24front so from the back of the brain to
01:34:25front spreading depression like a wave
01:34:28of lowering levels of electrical
01:34:31excitability and because this originates
01:34:33in the visual cortex which is in the
01:34:35back so that's the part of your brain
01:34:37that is making sense of visual images
01:34:38coming in through the eyes and relayed
01:34:40through other stations in the brain
01:34:42that people will start to see a kind of
01:34:45Halo of light or that they'll start to
01:34:47feel that the light around them is
01:34:50literally surrounding their body or some
01:34:52other object or body that they're
01:34:54looking at and then it spreads forward
01:34:56in the brain and that's when it tends to
01:34:59stretch over into other so-called
01:35:01sensory modalities sensory modalities
01:35:03being things like touch or hearing so
01:35:06people will get the sense that kind of
01:35:08seeing something in their periphery of
01:35:10their Vision then they'll start feeling
01:35:11something around them there's a sense
01:35:13that something's about to happen so is
01:35:15this spreading wave of depression goes
01:35:18from Back to Front people experience a
01:35:20number of these different semi-abstract
01:35:22sensory phenomena that we Call Aura okay
01:35:24so that's how Aura originates now
01:35:26photophobia is a little bit different
01:35:28photophobia We Now understand because of
01:35:31some beautiful work that was done at
01:35:33Cliff saper's Lab at Harvard Medical
01:35:35School and some other Laboratories
01:35:37showing that photophobia originates from
01:35:40a specific set of neurons in the eye we
01:35:43call these the intrinsically
01:35:44photosensitive melanops and ganglion
01:35:46cells which is really just a mouthful of
01:35:48nerd speak for neurons in the eye that
01:35:50connect to the brain these so-called
01:35:52ganglion cells
01:35:54that respond most robustly to bright
01:35:58blue light or other shortwavelength
01:36:00light so you've got short wavelength
01:36:02light that is blue and greens or short
01:36:04wavelengths and then long wavelet light
01:36:06which is red or you know it can even be
01:36:08out past red will be infrared we don't
01:36:10detect infrared consciously other
01:36:12species do like pit vipers can see in
01:36:14the infrared they can even heat sense so
01:36:16short wavelength light is going to be
01:36:18light that's that's bright
01:36:20blue green it's what's very common in
01:36:23fluorescent bulbs that are commonly used
01:36:25in household lighting and workplace
01:36:28lighting and other forms of artificial
01:36:30lighting it's also of course present in
01:36:32sunlight sunlight includes a huge range
01:36:34of wavelengths including long wavelength
01:36:36light of course you've seen that as the
01:36:38Reds and oranges in the sunset and so on
01:36:41those intrinsically photosensitive
01:36:43retinal ganglion cells in the eye
01:36:45respond best to bright green or blue
01:36:48light and they send connections to a
01:36:51bunch of different places in the brain
01:36:52including the so-called Central
01:36:54circadian clock superchiasmatic nucleus
01:36:56that sets your day night sleep wake
01:36:58rhythms this is why I encourage people
01:36:59to view sunlight in the morning to set
01:37:01this system in motion to avoid bright
01:37:03light exposure at night
01:37:05from artificial sources in order to not
01:37:08send wake-up signals from the eye to the
01:37:10brain and then on to the rest of the
01:37:11body but these intrinsically
01:37:13photosensitive retinal ganglion cells
01:37:15are also known to connect with other
01:37:17areas of the brain many other areas of
01:37:19the brain in fact and one of the
01:37:21important areas of the brain they
01:37:22connect to as it relates to photophobia
01:37:24is an area of a structure called the
01:37:26thalamus the thalamus is an egg-like
01:37:28structure that sits in the center of the
01:37:29brain and it serves as a kind of a
01:37:31switchboard like a sensory relay by
01:37:34which information coming from the eyes
01:37:36from the ears from The Touch system Etc
01:37:38are funneled into different compartments
01:37:40in the thalamus and then sent to
01:37:41different other areas of the brain so
01:37:43think of it kind of like an
01:37:44old-fashioned switchboard
01:37:46or
01:37:47um you could think of it uh sort of like
01:37:49a in an airport you go uh to a
01:37:51particular
01:37:52um wing of the airport then you go to a
01:37:54particular gate and so on you're getting
01:37:56funneled progressively through uh
01:37:58narrower narrower channels until you
01:37:59arrive at your particular plane much in
01:38:02the same way the thalamus has a bunch of
01:38:04different entry points
01:38:06so it's sensory information coming in
01:38:07from a bunch of different sources and
01:38:09those sources get routed into
01:38:10progressively narrower and narrower
01:38:12funnels to eventually arrive at the
01:38:14accurate place for their function so
01:38:17these intrinsically photosensitive
01:38:18gangling cells send connections to a
01:38:21small but important area of the thalamus
01:38:23called LP it's denoted L the letter and
01:38:26P with lateral posterior thalamus or
01:38:29that I should say it's the lateral
01:38:31posterior nucleus of the thalamus for
01:38:33uficionados out there and then the
01:38:36neurons in that location are going to
01:38:38respond that is they're going to be
01:38:39activated by bright blue light green
01:38:42light or any kind of bright light
01:38:44originating from artificial sources or
01:38:46from sunlight and the neurons there that
01:38:48respond to that have a very interesting
01:38:50pattern of connections they send
01:38:51connections up to the so-called sensory
01:38:54cortex so a bunch of different layers
01:38:56throughout the cortex that are not
01:38:58associated with visual perception that
01:39:00is they're not associated with
01:39:02understanding that there are shapes and
01:39:04Contours in the environment but rather
01:39:05to neurons that are involved in the
01:39:08detection of pressure pain and other
01:39:12forms of sensory information at the
01:39:14level of what the meninges we talked
01:39:16about the meninges earlier so again
01:39:18while the brain itself does not have a
01:39:21sensory system to detect pain the
01:39:25tissues around it do and the tissues
01:39:28around those
01:39:30tissues that is the stuff around the
01:39:31meninges themselves can respond to pain
01:39:34and intracranial pressure is also
01:39:36relayed through the meninges to our
01:39:39conscious awareness that there's pain so
01:39:40what does this mean for photophobia it
01:39:42means that
01:39:43bright blue light and green light and of
01:39:46course light from sunlight
01:39:47we'll activate these neurons in the eye
01:39:49these intrinsically photosensitive
01:39:51ganglion cells which then activate the
01:39:52lateral posterior neurons LP neurons and
01:39:55those LP neurons communicate with areas
01:39:57of the brain that are specifically tuned
01:39:59to different sensory phenomena and in
01:40:02particular pain at the level of the
01:40:04meninges and intracranial pressure what
01:40:07this means is that when we have headache
01:40:10or if we simply have photophobia on its
01:40:13own that bright light is actually the
01:40:15trigger for pain sensing and even the
01:40:19creation of pain at the level of the
01:40:20meninges and intracranial pressure what
01:40:22does this mean in terms of dealing with
01:40:24or treating photophobia well most people
01:40:26deal with photophobia by deciding to
01:40:28turn off or dim all the lights and
01:40:30simply getting under the covers or
01:40:31wearing a very um low brim hat and
01:40:34putting on sunglasses and they want to
01:40:36lie down
01:40:37and sometimes because uh migraine can be
01:40:40associated with nausea or even vomiting
01:40:41and it's severe instances rather but one
01:40:46very simple way to avoid activation of
01:40:48these retinal ganglion cells that would
01:40:49trigger photophobia is that if you are
01:40:52starting to feel like you have a
01:40:53migraine coming on or you have
01:40:54photophobia coming on to shift to using
01:40:57patterns of light that are in the longer
01:40:59wavelength domain what that means
01:41:02practically is Shifting to using very
01:41:05orange ideally dim but very orange and
01:41:08red light now this is not a call for
01:41:11people to go out and invest in expensive
01:41:13red light therapies admittedly there are
01:41:16some excellent case uses for red light
01:41:18therapy particularly for acne wound
01:41:21healing even for improving Vision
01:41:22especially in people beyond the age of
01:41:2440 for some hormone augmentation we
01:41:26talked all about that in the episode
01:41:28that I did on light and health again you
01:41:30can find that at hubermanlab.com
01:41:31everything time stamped what I'm talking
01:41:34about here would be simply having some
01:41:36red light bulbs on hand for any time
01:41:39that you need to remain awake but you're
01:41:41starting to experience photophobia these
01:41:43red light bulbs can be purchased very in
01:41:45expensively
01:41:46you know as party lights you can buy
01:41:49these online so there is no specific
01:41:51need to get any uh I would say red light
01:41:54that's designed specifically for
01:41:56photophobia or anything that sort you
01:41:57can find the cheapest um red light
01:42:00available out there and those will
01:42:02simply work the idea being that for many
01:42:04people who are experiencing photophobia
01:42:06they want to reduce that feeling of pain
01:42:08and pressure in their head experience
01:42:10through photophobia they also might want
01:42:11to stay awake get some work done and do
01:42:12things so operating under red light or I
01:42:15should say living working Etc under red
01:42:17light would allow you to stay awake not
01:42:19have to hide under the covers if you're
01:42:20experiencing photophobia in addition and
01:42:22I mentioned this at the beginning of the
01:42:24episode but many people find photophobia
01:42:26to be a entry point or a trigger to
01:42:30headache so what happens is they start
01:42:32to experience some Aura some onset of
01:42:34photophobia and then the photophobia
01:42:36itself leads to this feeling of malaise
01:42:38that then converts into headache and so
01:42:40while there are not a lot of clinical
01:42:42data on this just yet an emerging idea
01:42:45in the realm of headache treatment is
01:42:46the idea that if you can offset some of
01:42:48the early signs you can offset some of
01:42:50that photophobia and aura
01:42:53perhaps to the use of dim red lights or
01:42:55red lights as I've described a moment
01:42:57ago then you might be able to reduce the
01:42:59probability that you're going to have a
01:43:01migraine or other type of headache
01:43:03entirely so again no need for expensive
01:43:05red lights but you can find red lights
01:43:07very easily online and simply have them
01:43:10on hand or replace the current lights
01:43:11that you have on your nightstand or in
01:43:13whatever room you happen to be in with
01:43:15these red lights these red lights are
01:43:16also I should mention very useful in
01:43:18limiting the amount of cortisol a stress
01:43:20hormone that is very healthy for us to
01:43:22release at high levels early in the day
01:43:23in fact viewing sunlight will increase
01:43:25cortisol levels it's another reason why
01:43:28what I'm about to say is relevant to
01:43:30photophobia but if you want to keep
01:43:32cortisol levels low in the evening and
01:43:34at night and indeed you do and improve
01:43:36the transition to sleep and indeed your
01:43:37sleep overall reducing cortisol at
01:43:40evening time and at night time is
01:43:42extremely beneficial and red lights will
01:43:44help you accomplish that I talked about
01:43:45that in the episode on light and health
01:43:47so the point here is that if you suffer
01:43:49from photophobia with or without aura
01:43:51using red lights and not simply dimming
01:43:54ordinary artificial lights or feeling
01:43:56that you have to turn off all lights
01:43:57entirely is going to be one relatively
01:44:00inexpensive or I should say a very
01:44:03inexpensive in some cases because these
01:44:05red lights can be found very
01:44:06inexpensively online way to be able to
01:44:09continue with your daily activities at
01:44:11least in an indoor environment
01:44:12if you are suffering from photophobia so
01:44:15shifting back to ways to reduce the
01:44:16intensity and frequency of different
01:44:18kinds of headaches we haven't talked so
01:44:21much about tension headaches
01:44:22specifically so that's what I'd like to
01:44:23do now is you recall tension headaches
01:44:25are going to be muscular in origin again
01:44:28keeping in mind that everything's neural
01:44:29when it comes to pain everything's
01:44:31normal when it comes to everything
01:44:32frankly because every organ and tissue
01:44:34system in our body is ultimately
01:44:35controlled by our nervous system but
01:44:38tension headaches are often associated
01:44:40with tension of the muscles that are on
01:44:42the skull of the jaw of the neck and can
01:44:47be quite painful for many people and
01:44:49debilitating and the most common
01:44:50treatment for this that most people rely
01:44:52on that is is to take non-steroid
01:44:55anti-inflammatory so things like
01:44:57acetaminophen ibuprofen sometimes
01:44:59aspirin and things of that sort and
01:45:01oftentimes those can be helpful there
01:45:03are a couple things to keep in mind
01:45:04however the NSAIDs non-steroid
01:45:07anti-inflammatory drugs oftentimes will
01:45:09work very well at first but people
01:45:12quickly develop a tolerance to them
01:45:14meaning they're going to have to take
01:45:16more and more in order to get the same
01:45:17effect and oftentimes they can't take
01:45:20more and more because some of them are
01:45:21very hard on the liver and in addition
01:45:24to that some of them can offset some
01:45:26other things that you really want so for
01:45:27instance it's now known that non-steroid
01:45:29anti-inflammatory drugs can offset some
01:45:31of the benefits of exercise and that
01:45:32makes sense because a lot of the
01:45:33Adaptive benefits of exercise actually
01:45:35come from experiencing a lot of
01:45:37inflammation acute that means you
01:45:39actually want inflammation during a
01:45:40resistance training workout or even your
01:45:42endurance workout but then that
01:45:43inflammation triggers an adaptation
01:45:45event or series of adaptation events
01:45:47that leads to Greater strength greater
01:45:49speed more muscle
01:45:50more endurance whatever it is that you
01:45:52happen to be training for so reducing
01:45:54pain can be good of course but not if
01:45:56you have to take more and more of a
01:45:57given drug that it has side effects on
01:46:00the liver and can offset the effects of
01:46:02exercise and so forth the other issue
01:46:04with non-steroid anti-inflammatory drugs
01:46:06is that many of them simply do not work
01:46:08for many people or again they'll work
01:46:10the first time and the second time but
01:46:11then they stop working they also tend to
01:46:13lower body temperature I think most
01:46:15people are aware of this because many of
01:46:17these same drugs are used in order to
01:46:20reduce fever but if you are taking
01:46:22non-steroid anti-inflammatory drugs
01:46:24simply to reduce your headache and your
01:46:26lowing core body temperature that can
01:46:28have all sorts of Downstream issues
01:46:30related to sleep wake Cycles to
01:46:32metabolism to immune system function
01:46:34more generally and on and on for that
01:46:36reason
01:46:37there's been quite a lot of exploration
01:46:39of alternatives to non-steroid
01:46:42anti-inflammatory drugs for the
01:46:44treatment of headache and indeed pain
01:46:46generally but today we're talking about
01:46:48headache now as it relates to Tension
01:46:50Headache one of the more advanced kind
01:46:53of modern treatments that you sometimes
01:46:54hear about is Botox right Botox I think
01:46:57most people are familiar with as the
01:46:59thing that people get injected into
01:47:00their face around the eyes or around the
01:47:03lips or elsewhere in order to quote
01:47:05unquote reduce wrinkles it was
01:47:06discovered some years ago when Botox
01:47:08treatments were being done for cosmetic
01:47:10reasons that it could often be very
01:47:12effective for relieving headache if
01:47:14injected into the muscles and the way
01:47:16that it works is that of course Tension
01:47:19Headache involves a tension of the
01:47:20muscles
01:47:21a kind of a we'll call it clinching or
01:47:23cinching up with the muscles but we're
01:47:24really talking about is contraction of
01:47:26the muscles and that's controlled by
01:47:28neurons neurons which are neuromuscular
01:47:31so neuromuscular neurons that don't form
01:47:34synapses with or connections with other
01:47:36neurons they form synapses with muscle
01:47:38they release acetylcholine onto the
01:47:40muscle and that makes the muscle
01:47:41contract this is the way you move the
01:47:43limbs of your body this is also a way
01:47:45the muscles of your head contract and
01:47:47can give you tension type headaches
01:47:49Botox
01:47:51arises from or is rather botulinum
01:47:55neurotoxin botulinum neurotoxin is a
01:47:57toxin that's found in canned goods not
01:47:59all canned goods of course and what it
01:48:01does is it it prevents a certain step in
01:48:04the release of so-called
01:48:06neurotransmitter in the little packets
01:48:09that they live in which are called
01:48:10vesicles little little spheres of
01:48:13neurotransmitter live at the end of
01:48:14neuron nerve Terminals and are released
01:48:16onto the muscle make the muscle contract
01:48:18botulinum neurotoxin Cleaves a
01:48:21particular protein in there for you
01:48:22aficionados who want to look this up
01:48:23it's a really cool mechanism it Cleaves
01:48:25something called Snap 25. Snap 25 is
01:48:28involved in the fusion of those little
01:48:30spheres with the membrane of the neuron
01:48:32and releasing of the neurotransmitter so
01:48:34when botulinum neurotoxin is present at
01:48:37the nerve muscle interface those nerves
01:48:39cannot communicate with the muscle and
01:48:41as a consequence the muscles undergo
01:48:43kind of flaccid tone they just kind of
01:48:46relax there underneath the skin
01:48:48sure wrinkles are relieved but if Botox
01:48:51is injected into the muscles themselves
01:48:53it can provide long-lasting relief of
01:48:56certain types of headaches in particular
01:48:58tension type headaches so while it seems
01:49:00like a bit of an extreme treatment
01:49:01people who suffer very badly from
01:49:03tension type headaches due to hyper
01:49:05contraction of the muscles of the
01:49:07forehead or around the temples or around
01:49:10the Jaws or the or certain parts of the
01:49:12the neck and the MUSC muscles of the
01:49:14neck that encroach on the on the back of
01:49:15the skull
01:49:16or that actually connect to the back of
01:49:18the skull can achieve tremendous long
01:49:21lasting relief from these Botox
01:49:22injections sometimes for weeks or months
01:49:25or even longer people go in for periodic
01:49:27uh you know re-ups of Botox it actually
01:49:30is quite safe despite the fact that
01:49:32botulinum neurotoxin is quite dangerous
01:49:34it's given in very low Doses and given
01:49:36locally so those are the only muscles
01:49:37affected so that's how Botox is used to
01:49:39treat headaches and um it's a very
01:49:42effective treatment at that of course
01:49:43many people I imagine are interested in
01:49:46not just drug based treatments and not
01:49:49Botox type treatments
01:49:51for treating headache but other types of
01:49:53treatments for headache that are of the
01:49:55more so let's call them natural or um
01:49:58non-drug treatments and here we're
01:50:00starting to get into the realm of the
01:50:02kind of herbal and oil-based treatments
01:50:05for headache now I confess when I first
01:50:06started researching this area of
01:50:08headache and treatment for headaches
01:50:10that is
01:50:11um I found myself approaching it with a
01:50:14bit of trepidation because when I
01:50:15started to hear about essential oils and
01:50:17about herbal medications and things of
01:50:20that sort I thought okay well there'll
01:50:22probably be some effects I mean
01:50:23admittedly we've talked before on this
01:50:25podcast about things like apogenin
01:50:27epigenin is one of the core components
01:50:30of chamomile
01:50:31and chamomile is known to make people
01:50:33feel a little bit sleepy and can enhance
01:50:35sleep well apogenic and high
01:50:37concentration can indeed augment sleep
01:50:39we talk about this in our sleep tool kit
01:50:42by the way we don't just have episodes
01:50:43about sleep master or sleep perfect your
01:50:45sleep Etc but if you go to the
01:50:46hubermanlab.com website and you go to
01:50:48the menu and you click on newsletter you
01:50:50can scroll down you'll see that we have
01:50:51a tool kit for sleep this is completely
01:50:53zero cost to access you don't even have
01:50:54to sign up although if you'd like to
01:50:56sign up for future newsletters you can
01:50:58get those one of the key components of
01:51:00the toolkit for sleep in addition to
01:51:03behavioral tools and things that are not
01:51:04supplement based is apogenin which is
01:51:07this component from chamomile so the
01:51:09idea that certain herbal derivatives or
01:51:12herbs or Oils could be very useful for
01:51:16improving symptoms of whatever in this
01:51:18case
01:51:19improving sleep with apogenin is not
01:51:21unheard of and in fact the data
01:51:23continued to be released all the time
01:51:25that many of the things that we think of
01:51:26as herbal Etc can actually have quite
01:51:29potent effects and so
01:51:31um while I myself was approaching the
01:51:33discussion about essential oils and um
01:51:35or I should say oils right who's to say
01:51:37if they're essential or not oils and
01:51:40herbs in the treatment of headache I
01:51:42finished out my research on this
01:51:44literature feeling
01:51:46um quite I should say uh surprised and
01:51:50um and as if I need to really check
01:51:51myself a bit because what I found is
01:51:54that there are certain herbs and oils
01:51:55for instance that far outperform
01:51:58non-steroid and anti-inflammatory drugs
01:52:01for the treatment of headache that's
01:52:02right there are certain oils that are
01:52:03available over the counter that when
01:52:05looked at in many studies meta-analyzes
01:52:09and I'll tell you about one particular
01:52:10study and a meta-analysis in a moment
01:52:13they show that they can reduce the
01:52:15frequency and intensity of headache in a
01:52:18manner that far outpaces What You
01:52:20observe with non-steroid
01:52:21anti-inflammatory drugs with apparently
01:52:23none of the same issues associated with
01:52:25non-steroid anti-inflammatory drugs so I
01:52:27think it's really worth paying attention
01:52:29to the first of those studies I'd like
01:52:30to describe to you is one that has now
01:52:33become kind of a classic in the
01:52:34literature I should say at least for
01:52:36those that are interested in the
01:52:37atypical treatments for headache and the
01:52:39title of this paper is effective
01:52:41peppermint and eucalyptus oil
01:52:43preparations on neurophysiological and
01:52:45experimental
01:52:47alge's metric headache parameters okay
01:52:50what does that mean well this is an
01:52:52interesting study because rather than
01:52:53look at the effectiveness of peppermint
01:52:55and eucalyptus oil and other oils on
01:52:57headache what they did is because they
01:53:00want to look at the mechanisms
01:53:01underlying headache which I confess I
01:53:03love the fact that they want to
01:53:04understand the neurophysiology and not
01:53:07just get subjective ratings of headache
01:53:08although they did that too but they
01:53:09really want to understand
01:53:11how these oils can impact things like
01:53:13muscular tension or perception of pain
01:53:15what they did is they recreated headache
01:53:18in human subjects by using tightening
01:53:20cuffs of the of the head they cut off
01:53:23blood supply to certain areas of the
01:53:25head they basically induced headache and
01:53:27then they measured things like the EMG
01:53:29the muscle response at the level of
01:53:31electrophysiology in the muscle and of
01:53:34course subjective measures of how much
01:53:35people perceive to be in pain or not in
01:53:37pain I'll give you the broad Contour of
01:53:40the study because I want to make sure
01:53:41that it's the conclusions that come
01:53:42through most clearly and we will provide
01:53:44a link to the study in our show note
01:53:45captions so what they did is they had
01:53:48people use one of four different
01:53:51preparations say preparation one which
01:53:53includes some peppermint oil and some
01:53:56eucalyptus oil and all the details about
01:53:58the amount and the relative percentages
01:53:59are in the paper for you to peruse
01:54:01online through the link I mentioned
01:54:03before so they had four different groups
01:54:05they had one group
01:54:06apply peppermint oil but that peppermint
01:54:09oil also contained eucalyptus oil they
01:54:12had another group used just peppermint
01:54:13oil they had another group use just tiny
01:54:16traces of peppermint oil and smaller
01:54:19doses of eucalyptus oil and then they
01:54:21had a fourth group which was just using
01:54:24Placebo when I say using what they were
01:54:25doing is they were sponge applying the
01:54:28oil to the temples and forehead of
01:54:31people and then what they did is they
01:54:33used these different approaches to
01:54:36measure the activation of muscles to
01:54:39measure pain and they then induced head
01:54:43pain they induced headache so and they
01:54:45looked at the temporal muscles on the
01:54:46side they looked at forehead muscles
01:54:47things of that sort so they used three
01:54:49different types of pain stimuli they
01:54:51looked at people's sensitivity to
01:54:54experimentally induced Pain by either
01:54:56providing pressure so this was kind of a
01:55:00cuff around the forehead
01:55:01or thermal pain so they actually had
01:55:04them basically heat heat it up at the
01:55:07level of the skin and actually they
01:55:10brought the heat up pretty high to the
01:55:12point where people were rating the pain
01:55:14almost to the to the point of um
01:55:16excessive pain and pain limits so they
01:55:18obviously couldn't take them to the
01:55:19point of extreme pain and they had a
01:55:21constriction type condition in which
01:55:24they cut off blood circulation to the
01:55:26pericranial muscles using an inflatable
01:55:28collar around the cranium and they
01:55:30inflated that to pretty high pressure so
01:55:32kind of a brutal experiment to be
01:55:35involved in but look they're trying to
01:55:36mimic headache and I think by using
01:55:39these different approaches they're able
01:55:40to mimic the different aspects of
01:55:41headache and make sure and here's the
01:55:43key point that every person in the study
01:55:46is not just getting the same treatment
01:55:47for headache but is getting the same
01:55:49headache and that's something that I
01:55:50think gives this study power it's not
01:55:52the only way to do a study like this but
01:55:54it gives it a lot of power in trying to
01:55:55understand which types of interventions
01:55:57are going to assist in headache and
01:55:59maybe even specific dimensions of the
01:56:01pain and headache and basically what
01:56:03they found in the study is that of all
01:56:05the treatments they used the essential
01:56:07plant oil preparations that contained
01:56:09peppermint
01:56:11and I'll just mention as an aside and in
01:56:13other studies Menthol so these minty
01:56:16type uh essential minty type
01:56:19um what we think of as flavors but are
01:56:22really Aromas as well and as I'll point
01:56:24out the mechanism in a moment they have
01:56:26the effect of significantly reducing the
01:56:28intensity of the pain that is subjects
01:56:30could tolerate the pain far better and
01:56:32experienced less pain subjectively and
01:56:35the magnitude of the effects were really
01:56:36pretty impressive again I went into all
01:56:38this thinking essential oils okay that's
01:56:40like some really woo stuff
01:56:42um you know I don't know about that but
01:56:44it turns out that these essential oils
01:56:47at least the ones that contain
01:56:48peppermint oil with or without
01:56:50eucalyptus oil performed very well in
01:56:53reducing pain the key takeaway from the
01:56:55study is and here I'm paraphrasing from
01:56:57the study of that the combination of
01:56:58peppermint oil eucalyptus oil and these
01:57:01are basically in a ethanol suspension
01:57:03again people are not drinking these
01:57:05essential oils I want to be very clear
01:57:06they're applying these to the to the
01:57:08skin
01:57:09around the area that's in pain and
01:57:11particularly the temple and the
01:57:12foreheads
01:57:13increased cognitive performance I didn't
01:57:15talk about that but this is the ability
01:57:17to maintain cognitive functioning while
01:57:19in pain you know here we're talking
01:57:20about headache up until now just as kind
01:57:23of pain but that pain can be very
01:57:25debilitating for your ability to work
01:57:27and perform and do other things so this
01:57:29combination of peppermint oil and
01:57:30eucalyptus oil applied to the skin allow
01:57:33people to increase their cognitive
01:57:35performance while under pain and had a
01:57:37very muscle relaxing
01:57:39and mentally relaxing effect mental
01:57:41relaxation was of course measured
01:57:43subjectively but remember one of the
01:57:44things that led me to feature this study
01:57:47in this episode in particular is that
01:57:49they didn't just say oh my muscles feel
01:57:51more relaxed they actually saw that the
01:57:53muscles of the forehead and temples and
01:57:56some surrounding muscles were more
01:57:58relaxed when people had these oils on
01:58:00applied to their forehead and the
01:58:02temples not perhaps to the same degree
01:58:05that one would observe with botox or for
01:58:07the same extent or duration as one would
01:58:09experience with botox but much in the
01:58:11same way which then raises the question
01:58:13of what's going on here I mean is this
01:58:14all placebo effect well no because they
01:58:16compared to Placebo and they controlled
01:58:18for the odor of course of the oil that
01:58:21was applied so that everyone thought
01:58:22that they were getting
01:58:23essentially the same thing pun intended
01:58:26but in this case what they found is that
01:58:29if they applied the essential oil to the
01:58:33forehead and temples that people
01:58:36experience a more or less a cooling
01:58:38sensation or they could feel as if
01:58:39something was happening in the
01:58:40underlying muscle well what was
01:58:42happening we now know that Menthol
01:58:45peppermint and other things that smell
01:58:48that way and taste that way actually
01:58:50have an impact on the sensory neurons at
01:58:52the level of the skin and can actually
01:58:54inhibit certain Sensory neurons and can
01:58:57activate other Sensory neurons okay so
01:59:00in order to understand this we have to
01:59:02go back to what I said at the beginning
01:59:03of the episode which is that you have
01:59:04motor neurons these are neurons that
01:59:06constrict muscles or excuse me that
01:59:08cause contraction of muscles
01:59:10strict them they cause contraction of
01:59:12muscles you have Sensory neurons which
01:59:14sense different things light sound or
01:59:16touch and you have modulatory neurons
01:59:18Menthol and Eucalyptus are actually
01:59:21known to activate certain channels in
01:59:23the sensory neurons that respond not
01:59:26just a touch but also the sensation of
01:59:28cooling okay so when we think of Menthol
01:59:30and peppermint we think of kind of cool
01:59:33scents and flavors cool meaning cold
01:59:36and when we think of things like hot
01:59:38peppers capsaicin we think of anything
01:59:41that has a hot temperature we tend to
01:59:43think of spicy so spicy and hot go
01:59:45together and peppermint and menthol
01:59:48and cool go together much in the way
01:59:51that the gum commercials or the mint
01:59:53commercials would lead you to believe
01:59:55and in fact they're right so what's
01:59:57happening here is that the application
01:59:58of these oils is very likely activating
02:00:00channels in the sensory neurons
02:00:02including the trip channels but others
02:00:03as well that are leading to the analges
02:00:05effect by shutting down the heat and
02:00:09pain Pathways because heat and pain
02:00:11while they're not exactly the same in
02:00:13our nervous system they are funneled
02:00:15through common Pathways whereas Cooling
02:00:18and Pain Relief are funneled through
02:00:20alternate what we call parallel Pathways
02:00:22so the study on peppermint and
02:00:25eucalyptus oil preparations in reducing
02:00:28pain of headache and different aspects
02:00:31of pain due to headache I think are
02:00:33really important because they don't just
02:00:34illustrate the fact that yes indeed and
02:00:36you know going record saying it because
02:00:38that's what the data say and there are
02:00:40other papers to support this statement
02:00:41as well essential oils applied to the
02:00:43skin can reduce the symptoms of tension
02:00:45headache in a significant way and
02:00:47actually can lead to some offset of some
02:00:49of the cognitive
02:00:50defects seen with headaches so that's
02:00:52itself very impressive I must say
02:00:55surprising for me kind of put me in my
02:00:56place as somebody thought oh essential
02:00:58oils is going to be like okay but it's
02:01:00actually seemed to um really hold some
02:01:02Merit and when you compare the magnitude
02:01:04of the effect even though this was an
02:01:06enormous number of subjects you compare
02:01:08the magnet to the effect in a paper like
02:01:10this or similar papers on these
02:01:12essential oils to the impact of
02:01:14non-steroid anti-inflammatory drugs and
02:01:16they really hold their own and in some
02:01:17cases exceed the positive impact of
02:01:20anti-inflammatory drugs so for that
02:01:22reason I think we can look at peppermint
02:01:24oils and peppermint and Eucalyptus
02:01:26containing oils Menthol containing oils
02:01:28applied to the skin for the treatment of
02:01:30tension type headache as um among the
02:01:33more potent treatments available out
02:01:34there now another way to approach
02:01:36treatment of tension headache is
02:01:38something that many of you have probably
02:01:39heard about before
02:01:40and then I've talked a little bit about
02:01:42on this podcast in previous episodes and
02:01:44that's acupuncture we will do an entire
02:01:46episode all about acupuncture but much
02:01:48in the same way that essential oils I
02:01:51think for many people not all but for
02:01:52many people are considered kind of a woo
02:01:54biology or people think of it as a very
02:01:56alternative medicine keep in mind that
02:01:59as the underlying mechanisms of things
02:02:01like these peppermint oils are starting
02:02:03to be discovered or Omega-3s are
02:02:04starting to be discovered
02:02:05mechanistically they hold up very well
02:02:08there's a logic there there's an
02:02:09underlying understanding of not just why
02:02:12they should work but in many cases how
02:02:14they work in the same way acupuncture
02:02:17which of course has existed for
02:02:18thousands of years has been used very
02:02:21successfully to treat headache and other
02:02:22forms of pain so much so that many
02:02:25insurance companies will now pay for
02:02:28acupuncture as an insured practice not
02:02:30all but many will and in addition to
02:02:33that
02:02:33the scientific Community is starting to
02:02:35understand mechanistically how
02:02:37acupuncture works so I don't want to
02:02:38make this the major Focus for now
02:02:40but
02:02:42very briefly there's a laboratory at
02:02:44Harvard Medical School run by chufuma
02:02:47chufu is well known in the Neuroscience
02:02:49Community for doing excellent work in
02:02:51parsing the mechanisms of touch
02:02:54sensation and pain in particular so not
02:02:57just touch at the level of skin but pain
02:02:58and pain Pathways and in recent years
02:03:00his laboratory has started to do studies
02:03:02on how acupuncture works because indeed
02:03:05acupuncture has been known to work to
02:03:07alleviate pain for a long time but the
02:03:08underlying mechanisms haven't been clear
02:03:11what chufu's lab has published now in
02:03:13excellent journals like nature science
02:03:16and other journals is that the precise
02:03:19insertion sites of different needles
02:03:22lead to activation of sensory neurons
02:03:25and their Downstream Pathways in ways
02:03:27that can potently reduce inflammation
02:03:29and that can be used to potently reduce
02:03:32the activity of certain muscles
02:03:35for instance muscles in the forehead and
02:03:37temples so when you hear acupuncture can
02:03:40reduce pain I think some people think oh
02:03:41well if there's needles sticking out of
02:03:43your face first of all that must hurt
02:03:44and actually the needles are very fine
02:03:45needles and skilled acupuncturists can
02:03:47insert them without any pain or actually
02:03:49the person receiving it doesn't even
02:03:51usually recognize that the needles are
02:03:53in that's how quickly and efficiently
02:03:56they can put them in and people don't
02:03:57detect any pain but that has been shown
02:04:00to greatly reduce pain in particular
02:04:03headache related pain and back-related
02:04:05pain in some other forms of pain chufu's
02:04:08lab has shown that the specific needle
02:04:10insertion sites can activate the sensory
02:04:13Pathways and can deactivate the sensory
02:04:16motor pathways and now you're familiar
02:04:19with Sensory neurons motor neurons and
02:04:21modulatory neurons and can modulate the
02:04:24activity of the pain Pathways by way of
02:04:27impacting the activity of all sorts of
02:04:29different organs including organs that
02:04:31give rise to some of the inflammatory
02:04:33cytokines so basically what I'm saying
02:04:35here is that thanks to thousands of
02:04:37years of acupuncture and the maps of
02:04:39different insertion sites we now know or
02:04:42I should say people have long known and
02:04:44people in the west are starting to adopt
02:04:47the understanding that acupuncture yes
02:04:49indeed it really does work for relieving
02:04:51pain and Laboratories both in the United
02:04:53States such as chufus and elsewhere are
02:04:56starting to find the underlying
02:04:58mechanisms and those mechanisms include
02:05:00deactivation of the pain Pathways
02:05:03activation of some of the parallel
02:05:05Pathways that assist in shutting down
02:05:07pain or in relaxing the muscles that are
02:05:10causing tension type headache as well as
02:05:13activation of neural Pathways that
02:05:15impinge on organs that then cause or
02:05:18reduce the release of molecules into the
02:05:20body that give us the experience of pain
02:05:22so reduced inflammation and in many
02:05:24cases increasing anti-inflammatory
02:05:26Pathways so I just want to be sure to
02:05:29mention acupuncture and a little bit of
02:05:31mechanistic understanding of why
02:05:32acupuncture works because indeed
02:05:34acupuncture is shown to be quite
02:05:36effective for the treatment of tension
02:05:37type headache and to some extent
02:05:39migraine headache as well so we talked
02:05:41about omega-3 fatty acids we talked
02:05:43about essential oils we talked about
02:05:45acupuncture
02:05:46so this episode is starting to sound
02:05:48like alternative treatments to headache
02:05:50including migraine but I want to be very
02:05:52clear this is not about alternative
02:05:55treatments everything that I'm talking
02:05:57about here has a mechanistic basis and
02:06:00what we're talking about today are
02:06:01approaches to dealing with headache that
02:06:04yes are typically over-the-counter
02:06:06compounds or are grounded in nutrition
02:06:09or in the case of acupuncture behavioral
02:06:11practices
02:06:13but that are not necessarily meant as
02:06:16replacements for things like non-steroid
02:06:17inflammatory drugs or prescription drugs
02:06:19of course those things can still be
02:06:21taken many people derive benefit from
02:06:23them but the goal is always I believe I
02:06:26should hope for people to find ways that
02:06:29they can control their health outcomes
02:06:31and reduce things like headache using a
02:06:34minimum number of things that have other
02:06:36side effects and that of course can also
02:06:39include the use of essential oils in
02:06:41conjunction with things like non-steroid
02:06:42anti-inflammatory drugs or the use of
02:06:44red light to offset photophobia in
02:06:46conjunction with any number of different
02:06:48treatments either prescription or
02:06:50otherwise so I do want to make that
02:06:52clear and I especially want to make that
02:06:53clear as I transition to the next
02:06:55segment where I'm going to tell you
02:06:57about herbal treatments for migraine and
02:07:00this is based on what I consider a very
02:07:02comprehensive review of many randomized
02:07:05control studies indeed the title of the
02:07:07paper is herbal treatments for migraine
02:07:09a systematic review of randomized
02:07:11controlled studies and this was
02:07:12published in 2020 and this contains an
02:07:15immense amount of information so we will
02:07:17provide a link to it for those of you
02:07:18that really want to dive deep on this in
02:07:20this paper they focus on a number of
02:07:22different reviews and Analysis of data
02:07:24focused on compounds for the treatment
02:07:26of migraine ranging from and including
02:07:29things like Menthol and peppermint oil
02:07:31so we already covered that so I won't
02:07:33cover that again in detail but in this
02:07:35review they highlight the results I
02:07:37refer to before plus other results that
02:07:39show that Menthol and peppermint oil can
02:07:42be quite effective in the treatment of
02:07:44tension type headache and in this case
02:07:46migraine headache as well so that's
02:07:49interesting that Menthol and peppermint
02:07:50oils can be used not just to treat
02:07:53tension type headaches but
02:07:55migraine headaches as well and they look
02:07:57at an enormous number of other types of
02:08:00herbal and essential oil type treatments
02:08:02everything from coriander to Citron to
02:08:04damask Rose chamomile lavender a bunch
02:08:07of things so I'm not going to go through
02:08:09each and every one of these in a lot of
02:08:11detail what I've tended to do today and
02:08:13I'm going to do now is to highlight the
02:08:15most potent
02:08:16of these different treatments again
02:08:19Menthol peppermint oil being among the
02:08:21most potent in addition to that there's
02:08:24a particular pathway that's associated
02:08:25with headache and when I say that I mean
02:08:29the different types of headache which
02:08:31includes the activation of this thing
02:08:33that we call cgrp cgrp again is involved
02:08:36in this calcium regulation pathway and
02:08:37leads to vasodilation
02:08:40of the vessels and arteries and
02:08:43capillaries in a way that can create
02:08:44pain and this feeling of pressure inside
02:08:46the head which can be very uncomfortable
02:08:48of course
02:08:49now earlier in the episode I mentioned
02:08:52that I was going to touch on caffeine
02:08:54and so I'm going to do that now now the
02:08:56reason I mention caffeine is that
02:08:58there's a sort of lore out there that if
02:09:01you have a headache drinking a cup of
02:09:02coffee can eliminate that headache a few
02:09:05things about that point first of all if
02:09:07you are somebody who ingests caffeine
02:09:09every day and you do not ingest caffeine
02:09:12you will indeed get a headache and
02:09:15drinking caffeine will relieve that
02:09:17particular headache so it's absolutely
02:09:19true that caffeine can relieve the lack
02:09:22of caffeine induced headache that's sort
02:09:24of a duh but that leads actually to a
02:09:28very important question which is why
02:09:30would that be the case well it turns out
02:09:31that caffeine is both a vasodilator and
02:09:35a vasoconstrictor
02:09:37how does it do that well one of the main
02:09:40ways in which caffeine makes us more
02:09:41alert is that it occupies The receptors
02:09:44for something called adenosine adenosine
02:09:46is a molecule that builds up in the
02:09:48brain and body more and more the longer
02:09:50we've been awake it's one of the things
02:09:51that makes us feel sleepy
02:09:53so when we drink caffeine that caffeine
02:09:55occupies the adenosine receptor and the
02:09:58adenosine cannot have its normal effect
02:10:00of making us sleepy when that caffeine
02:10:02wears off the adenosine combine and we
02:10:03feel sleepy adenosine is a vasodilator
02:10:07so when we drink caffeine because it
02:10:10blocks the effects of adenosine there is
02:10:13a vasoconstriction associated with
02:10:15drinking caffeine so if you have a
02:10:18headache that is associated with
02:10:19excessive vasodilation and pressure in
02:10:21the head indeed drinking some caffeine
02:10:23can cause some vasoconstriction by
02:10:26preventing that adenosine pathway that
02:10:28would normally lead to vasoconstriction
02:10:30and you can get some relief from that
02:10:31headache however caffeine is also a
02:10:34vasodilator caffeine has the ability to
02:10:37impinge on the so-called no pathway the
02:10:39nitric oxide pathway which is a nerve to
02:10:43blood pathway that involves a few
02:10:44different enzymes that we won't get into
02:10:46right now but maybe in a future episode
02:10:48that causes dilation of the blood
02:10:50vessels and as a consequence drinking
02:10:52caffeine can also increase vasodilation
02:10:54so it's sort of a two-pronged effect now
02:10:56one of the ways in which you might think
02:10:58about this and perhaps utilize this is
02:11:00that if you are well rested or if it's
02:11:03early in the day and you've had some
02:11:05sleep the previous night adenosine
02:11:07levels are very likely to be low
02:11:09especially if you slept very well the
02:11:11night before
02:11:13under those conditions when you ingest
02:11:15caffeine you are not going to experience
02:11:17the vasoconstriction effects of caffeine
02:11:21that would ordinarily be there by
02:11:23inhibiting adenosine why because
02:11:25adenosine is not present at all and
02:11:28under those conditions drinking coffee
02:11:30ought to lead to some vasodilation not a
02:11:32lot but nonetheless vasodilation if
02:11:35however you haven't slept well or it's
02:11:37late in the day and you've been up for a
02:11:38long time drinking caffeine is likely to
02:11:40have more of a vasoconstriction effect
02:11:42and this is important because some of
02:11:44the treatments that you hear about that
02:11:45involve using caffeine to treat headache
02:11:47are as Extreme as okay if you have a
02:11:50headache at night drink a cup of coffee
02:11:51and then go to sleep I actually saw that
02:11:53in the literature which I couldn't quite
02:11:55believe because yes indeed some people
02:11:57can fall asleep after drinking caffeine
02:11:58but we know very well thanks to the
02:12:01beautiful work and science
02:12:02Communications of people like Dr Matthew
02:12:04Walker from University of California
02:12:05Berkeley and who's been a guest on this
02:12:07and many other podcasts that even if you
02:12:10can fall asleep after drinking caffeine
02:12:11ingesting caffeine within the 10 to 12
02:12:13hours prior to bedtime is simply not a
02:12:15good idea because of the ways it
02:12:16disrupts the architecture of sleep so
02:12:18what's the takeaway about caffeine and
02:12:20headache and vasodil relation you need
02:12:22to be very clear on whether or not
02:12:25caffeine tends to remove your headache
02:12:26or exacerbate it now this is going to
02:12:28depend on time of day and the amount of
02:12:30adenosine in your system as I mentioned
02:12:31before but also there seems to be a kind
02:12:33of bimodal distribution whereby some
02:12:35people when they drink caffeine it
02:12:37really improves their headache and so in
02:12:39some cases a very significant effects
02:12:41whereas other people when they drink
02:12:42caffeine it really exacerbates their
02:12:44headache and as at least as far as I
02:12:46could tell from the literature it's not
02:12:47easy to predict who those people are
02:12:49going to be what is reassuring however
02:12:52is it does not seem to be the case that
02:12:53if you're somebody who experiences
02:12:56relief from headaches by drinking
02:12:57caffeine that suddenly
02:12:58one day to the next you're going to
02:13:01experience a worsening of your headache
02:13:02and vice versa is also true so if you're
02:13:04somebody that drinks caffeine and your
02:13:06headaches get worse I don't think
02:13:08there's any reason to think that
02:13:09caffeine one day or from one day to the
02:13:11next rather is going to somehow
02:13:12alleviate your headache so you have to
02:13:13determine for yourself whether or not
02:13:15headaches are relieved or exacerbated by
02:13:17drinking caffeine and if you're
02:13:18wondering why it's so confusing it's
02:13:19because caffeine hits both the
02:13:21vasodilation and the vasoconstriction
02:13:22Pathways and there's nothing you or I or
02:13:25anyone else can do about it now the last
02:13:26thing I'd like to talk about in terms of
02:13:28relief for headaches is something that
02:13:30I'm guessing about probably 25 percent
02:13:33of you are familiar with and 75 percent
02:13:34of you are not which is curcumin
02:13:36curcumin is often also referred to as
02:13:39turmeric and turmeric is a root and
02:13:42curcumin is one of the key components of
02:13:44that root curcumin is known to have very
02:13:47potent anti-inflammatory properties
02:13:50I don't think that's debated at all in
02:13:52fact it's so potent as an
02:13:53anti-inflammatory that some people have
02:13:55cautioned against taking high levels of
02:13:58curcumin prior to for instance
02:13:59resistance training workouts or even
02:14:01cardiovascular workouts because it so
02:14:03prevents inflammation that it also can
02:14:06prevent the adaptation response because
02:14:08remember the inflammation that occurs
02:14:10during exercise both resistance and
02:14:12cardiovascular exercise is at least in
02:14:15part
02:14:16the trigger for the adaptation that it's
02:14:19going to lead to enhanced endurance
02:14:20enhanced strength hypertrophy Etc
02:14:22nonetheless curcumin has been explored
02:14:24in the context of treatment of migraine
02:14:26and it's one of the compounds that was
02:14:28analyzed in extensive detail in this
02:14:30wonderful review that I mentioned a
02:14:32little bit earlier what I like about
02:14:33this study is that they were able to
02:14:35explore the effects of curcumin as
02:14:38explored in previous research studies
02:14:40and compare those across a large range
02:14:43of different dosages and a large range
02:14:46of combinations with other things like
02:14:48coenzyme Q10 which we've talked about on
02:14:50this podcast before but I think for sake
02:14:52of this discussion just really focusing
02:14:54on what curcumin does alone or in
02:14:58conjunction with the omega-3 fatty acids
02:15:00is what turns out to be the most
02:15:01interesting first of all curcumin has
02:15:03been shown to be generally safe for most
02:15:05people at dosages as high as 8 000
02:15:09milligrams per day or eight grams per
02:15:11day now I want to be very clear I do not
02:15:13recommend that anyone take dosages of
02:15:16curcumin an AKA turmeric that are that
02:15:18high why well
02:15:20curcumin and turmeric not only are
02:15:23anti-inflammatory but they also can
02:15:24impinge on other Pathways in particular
02:15:26hormonal Pathways and in fact curcumin
02:15:29AKA turmeric can alter the synthesis of
02:15:34something called dihydrotestosterone
02:15:36dihydrotestosterone is involved in an
02:15:38enormous range of different bodily
02:15:39functions it's involved in libido it's
02:15:41involved in Men in beard growth and in
02:15:44the regulation of a number of different
02:15:46tissues both in the reproductive axis
02:15:48and outside the reproductive axis and
02:15:50curcumin is a potent inhibitor of DHT so
02:15:54I do want to caution that people who
02:15:55take high doses of curcumin and some
02:15:57people who are very sensitive to
02:15:58curcumin will even at low doses
02:16:01experience reductions in DHT that lead
02:16:04to things that they would not like such
02:16:05as sufficient reductions in libido
02:16:08however curcumin has been shown to be
02:16:11effective as an anti-inflammatory and
02:16:12has been shown to be very effective in
02:16:15treating different types of headache and
02:16:17particular migraine headache one of the
02:16:19ways in which curcumin does that is to
02:16:21inhibit this thing that I talked about a
02:16:23few minutes ago which is nitric oxide or
02:16:25no which causes vasodilation and in
02:16:28doing that can reduce the feeling that
02:16:31one has a lot of intracranial pressure
02:16:33okay so curcumin dosages come in
02:16:36enormous range as I mentioned before
02:16:38dosages that range anywhere from 80
02:16:40milligrams taken
02:16:4280 milligrams per day that is taken for
02:16:45eight weeks time that's been examined
02:16:46it's been explored at 80 milligram
02:16:48dosages taken alongside two and a half
02:16:51grams of omega-3 fatty acids or omega-3
02:16:55fatty acids alone
02:16:56and against Placebo and the general
02:16:59conclusion of these studies is that
02:17:01curcumin when taken it at dosages of
02:17:04about 80 milligrams although for those
02:17:06of you very sensitive to curcumin
02:17:07probably as low as 25 or even 50
02:17:10milligrams per day in conjunction with
02:17:12although not necessarily at the same
02:17:13time but taken daily alongside
02:17:17omega-3 fatty acids at two and a half
02:17:20grams per day led to significant
02:17:22improvements in migraine and other forms
02:17:26of headache meaning both the frequency
02:17:27and the intensity of the headaches that
02:17:29occurred was greatly reduced one
02:17:31important point about curcumin to keep
02:17:33in mind is that curcumin is known to
02:17:35inhibit something called cytochrome p450
02:17:38that's associated with an enzymatic
02:17:41pathway and some other things that
02:17:42relate to blood coagulation so for
02:17:45people that are taking medications that
02:17:47are anticoagulants to prevent clotting
02:17:49you do need to be very cautious about
02:17:51using curcumin and of course with
02:17:53curcumin or any other supplement you
02:17:55should always talk to your doctor prior
02:17:56to including it or removing it from your
02:17:59supplement regimen so as you can see
02:18:00there are a number of different things
02:18:02that in addition to prescription drugs
02:18:05and over-the-counter pain medications
02:18:07things like non-steroid
02:18:08anti-inflammatory drugs can really
02:18:10impact the different aspects of headache
02:18:13and different types of headache in some
02:18:15cases differentially now today we talked
02:18:18mainly about tension type and migraine
02:18:19type headaches because those are the
02:18:21most common forms of headache there are
02:18:23of course the cluster type headaches
02:18:24that are of neural origin talked about
02:18:26hormonal headaches and indeed some
02:18:28treatments such as Omega-3s which have
02:18:30been shown to be beneficial for
02:18:31offsetting the menstrual related
02:18:33headaches now in the context of the
02:18:35discussion about Omega-3s keep in mind
02:18:38that Omega-3s can be obtained from
02:18:40supplementation or from nutrition so you
02:18:42don't necessarily have to take omega-3
02:18:44capsules or liquid form Omega-3s if you
02:18:47want to use Omega-3s to Target different
02:18:49symptoms of headache but that probably
02:18:52is going to be the most efficient way to
02:18:53do it given that many foods do contain
02:18:56Omega threes but it's hard to get above
02:18:58that one gram dosage and in fact most of
02:19:02the studies that we talked about today
02:19:03involved getting two or even two and a
02:19:06half or in some cases on this podcast
02:19:08with previous guests such as Dr Rhonda
02:19:10Patrick she talked about the advantages
02:19:11of getting as high as three grams of
02:19:13Omega-3s per day which almost with
02:19:16certainty is going to require some
02:19:17external form of supplementation even
02:19:19for those of you that are making a point
02:19:21to eat fatty ocean fish with the skin on
02:19:24so I just want to make sure that I
02:19:25highlight that before we wrap up I can't
02:19:28help myself but to talk about something
02:19:30that I heard about on the news several
02:19:31years ago and it sounded too outrageous
02:19:33to be true but then was confirmed as
02:19:35accurate by one of my neurologist
02:19:37colleagues that's the fact that eating
02:19:39certain very spicy peppers can induce
02:19:42headache and in some cases can induce
02:19:45brain damage and bear with me here I'm
02:19:48not talking about your traditional
02:19:50jalapeno and I'm acknowledging the fact
02:19:52that certain people can tolerate far
02:19:55more spicy taste case then do others
02:19:58some people are very sensitive to spicy
02:20:00some people can tolerate very spicy food
02:20:02and that one can build up a tolerance to
02:20:04spicy food by ingesting progressively
02:20:06your spicy or excuse me spicy or and
02:20:08spicier Foods over time
02:20:10nonetheless there are these Pepper
02:20:12eating contests out there that um while
02:20:15not very common do exist and people
02:20:17challenge each other to eat peppers of
02:20:20um extreme spiciness and there's one in
02:20:22particular that's referred to as the
02:20:24Carolina Reaper by the way that's not a
02:20:25person as far as I know that's a pepper
02:20:28the Carolina Reaper which is known to
02:20:30have the most potent spice of any pepper
02:20:33and here's why you would not want to eat
02:20:34the Carolina Reaper a few years ago at
02:20:37one of these Pepper eating contests man
02:20:39ate a Carolina Reaper as part of the
02:20:42competition and suddenly experience
02:20:44what's called Thunderclap headache
02:20:45Thunderclap headache is a unique type of
02:20:48headache very different from all the
02:20:50other types of headaches it is not from
02:20:52the surface in so it's not tension
02:20:54headache it's not even the cluster type
02:20:56headache of the nerve activation of the
02:20:58trigeminal it's actually a hyper
02:21:01constriction of the vasculature in the
02:21:03brain caused by the ingestion of the
02:21:06pepper and inflammatory response and
02:21:08remember that heat and spicy go together
02:21:11in these neural Pathways and a bunch of
02:21:14different heat related and spice related
02:21:16Pathways get activated simultaneously
02:21:18when one ingests something of extreme
02:21:20spice and the blood vessels and indeed
02:21:23some of the smaller arteries feeding
02:21:26neural tissue shut down and he
02:21:28experienced this Thunderclap headache
02:21:29which is a brutal headache and sadly in
02:21:32his case um permanent brain damage so
02:21:34loss of neuronal tissue because neuronal
02:21:36tissue is very metabolically active you
02:21:37cut off the blood supply to that tissue
02:21:39Not only would you feel miserable maybe
02:21:42even pass out but lose vision and
02:21:45certain brain areas will actually die
02:21:46off in the absence of blood flow to
02:21:49those areas we know this more commonly
02:21:52as stroke so I don't want to strike fear
02:21:56in anybody about eating a you know a
02:21:58jalapeno or even a very spicy meal from
02:22:01time to time but if you're not somebody
02:22:02who's familiar with eating very spicy
02:22:05foods you certainly don't want to enter
02:22:06one of these competitions and just
02:22:09realize that the pathways from Menthol
02:22:12and cool or spicy and hot those aren't
02:22:15just subjective Pathways these are
02:22:16actually neural Pathways that again
02:22:18originate in our so-called nerds call it
02:22:21the sensory epithelium so our skin our
02:22:23our hearing our eyes and that feed that
02:22:27information into the body to make use of
02:22:30that information some case motor
02:22:31movement so sensory motor in other cases
02:22:34the information can be fed through nerve
02:22:36Pathways that goes to the vasculature
02:22:39and causes the vasculature to either
02:22:40dilate or constrict these very spicy
02:22:42peppers causing as I just mentioned
02:22:44extreme cerebro of of the head of
02:22:47vasoconstriction and brain damage again
02:22:49that's not going to be a common thing
02:22:51out there but nonetheless I encourage
02:22:54people to be very cautious about the
02:22:56Carolina Reaper so today we talked about
02:22:58headaches and first we highlighted the
02:23:01different types of headache making it
02:23:03clear that understanding which headache
02:23:05you might be experiencing
02:23:06can be very beneficial for understanding
02:23:08which sorts of treatments ought to be
02:23:11best and perhaps also best avoided in
02:23:14trying to alleviate those headaches or
02:23:16prevent them from happening at all we
02:23:18talked about tension headaches migraine
02:23:19headaches hormone-based headaches
02:23:21cluster headaches and traumatic brain
02:23:23injury related headaches we talked about
02:23:25different types of treatments ranging
02:23:26from creatine to omega-3 fatty acid
02:23:29supplementation some herbal and indeed
02:23:31some essential oil treatments as well as
02:23:34acupuncture all of which have been shown
02:23:36to have significant impact in reducing
02:23:38the frequency and intensity of headaches
02:23:40and in many cases reductions in the
02:23:42frequency and intensity of headaches
02:23:44that are at least as great as the
02:23:46results they're seen with non-steroid
02:23:48anti-inflammatory drugs again I want to
02:23:50highlight that none of these approaches
02:23:52are necessarily designed to be done on
02:23:54their own or in replacement of
02:23:56prescription drugs from your physician
02:23:57there are excellent prescription drugs
02:23:59out there that your physician can
02:24:00prescribe for you for the treatment of
02:24:02headache nonetheless I think many people
02:24:04who are listeners of this podcast are
02:24:06interested in the things that they can
02:24:07do in order to inoculate themselves or
02:24:10at least reduce the likelihood of
02:24:12experiencing headache especially for
02:24:14people who are experiencing chronic
02:24:16recurring headaches such as migraine or
02:24:19the other forms of headache which can be
02:24:20so debilitating thank you for joining me
02:24:22for today's discussion if you're
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02:25:16supplements while supplements aren't
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02:25:19derive tremendous benefit from them for
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02:25:23support and focus huberman Lab podcast
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02:26:29cost thank you once again for joining me
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02:26:33science and treatment of headaches and
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02:26:39[Music]
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