Main

Does stress at work or at home cause my headaches?
Research studies show that the areas of the brain that form emotions are also the areas that light up on fMRI scans in patients with migraines, but do not light up for patients without migraines. We are sure that feeling stressed plays a large part in contributing to headaches, but we have not yet found out exactly what types of stress are the worst culprits in causing headaches. And most importantly, none of us headache experts are able to prove that one method is successful for all patients to reduce stress and prevent headaches that occur after stressful events. We teach many stress reduction methods, and discuss the evidence, pro and con, with patients that these methods will reduce the headaches for this particular patient, but may not have a strong chance of reducing headaches for a different patient. We are starting stress reduction classes for our patients with severe headaches because we have found that the number of medication tablets can usually be reduced if a patient learns how to thoroughly de-stress their lives. For some patients who have been to many neurologists and had a long list of medications for headache that have not worked, stress reduction allows the patient to feel that they can control their headaches instead of feeling that their headache pain controls their lives.

Does the food I eat cause my headaches?
Although we were taught in traditional medical textbooks that chocolate causes headaches, a famous headache researcher found that chocolate caused no more headaches than sugar pills. Some foods that are strong triggers for one patient, may be weak triggers for another. We assess triggers by using headache calendars for each patient. This allows us to come up with a plan so the patient avoid their food triggers but not all the foods they like.

I treat ADD/ADHD. I see parents come in to the office and say they don't want their kids on stimulants, but they want me to do something to help their families. Their kid is running around too much, disrespectful, can’t focus, can’t finish homework, loses the homework, can't organize school things, or complete other tasks. They want me to do something to fix it. I can give stimulants or non-stimulant ADD/ADHD medications. But none of these meds fix the problem the mom originally came in for. They miss the point of the visit. The parents are not satisfied, and the kid feels blamed and over-medicated. Often the kids don’t want to take their medications, especially the pre-teens and teens. The kids may be right.

People ask me all the time about alternatives. Do they work? Does staying away from sugar, milk, wheat, tomatoes, etc make any difference or are these diets a waste of time? We don't know - that's what has to be admitted.
What about better parenting? stricter parenting? Therapy? Does that work?

What about articles that ADD kids are geniuses in disguise? Is that true?
Would anxiety or bipolar fit the behavior better, and would treatment for these conditions work to change the basis of the problem?
Can schools change to educate ADHD kids in better ways?
These questions are in terrific controversy by different neurologists. My goal is to discuss with the patient and the family the pros and cons of the different sides on each question, so the family as a whole can decide how they prefer treatment to be done.

Do hormonal changes dictate my headache pattern?
The good news is that we are certain from research studies that hormonal changes affect headache severity. The bad news is that some of the oral contraceptives that we prescribe to increase the estrogen level in headache patients have not helped the patient, while for other patients the synthetic hormones are miraculous in stopping their headaches. We do not know why our estrogen synthetically produced from pharmaceutical companies does not work half as effectively as our natural estrogen. However, with many patients we can treat their hormonal headache with a combination of natural hormone stabilizers, migraine medications used in a mini-prophylaxis before the menstrual period, and synthetic hormones and make a tremendous improvement in their hormonally produced migraines.

Do sinus problems cause my headaches?
Headaches located over the cheeks and near the nose are often misdiagnosed as arising only from the sinuses, when they are actually migraines occurring over the face. Many times patients report that they went to their internist or ENT and were told that they do not have an active sinus infection causing the pain over the face. We have had excellent success in treating these headaches that mimic sinus headaches, but are actually migraines, with migraine specific medications called triptans. For many patients they have both chronic sinus problems and migraines, and each one makes the other one more severe.

I often have a stiff neck or painful tightness over my neck and shoulders. Can this be causing my headaches?
Almost 90% of my patients report neck and shoulder problems along with headaches, so my team concentrates on stress reduction exercises for tight muscles, physical therapy techniques on the neck and shoulder, and teaching simple exercise regimens. I prescribe muscle relaxers in the initial stages of treatment, but patients usually do not like these medications as they make them drowsy. I gradually reduce the muscle relaxer medications as the patient learns physical techniques for loosening tight muscles.