Entries by dmiddaugh

Common Causes For Tension Headaches & Migraines


Hey, everyone, welcome to the Stay Healthy El Paso Podcast. I'm your host, Dr. David Middaugh specialist physical therapists over at El Paso Manual Physical Therapy, and today we're going to talk about the top eight reasons for tension headaches and migraines. Now, if you've ever suffered from a headache or migraine, you may have had symptoms like pounding pressure on the front of your head, like on the forehead area, sometimes on the top of the head. It can often appear also on the back of the head, you can get those symptoms that just feels tight at the base of the neck at the base of the skull. And it can radiate from there, onto the top of the head or onto the side of the head, over the ears, and over in the temporal area between your ears and eyes.

Sometimes it can even feel like a pain deep behind the eyeball. Sometimes it's one sided, sometimes both. And there are different types of headaches and there are differences between headaches and migraines, which I won't get into much here on this podcast episode, just because it really is a scientific medical diagnosis and there are slightly different reasons for each one happening.

But for the purposes of giving you the top eight, the top eight reasons for tension headaches, that's what we're going to do today. And migraines, I'm not going to get into the differences. If you've got head pain, then this is going to be helpful for you whether you label it a tension headache or a migraine, this is still going to be helpful information for you.

Just real quick, some of the minor differences. Migraines tend to have some light sensitivity, noise sensitivity, there's more sensory sensitivity versus a tension headache, which is not really associated with sensory as much as far as like light sensitivity or sound sensitivity. It's more like at tension was just like the name describes, pressure or tension that happens in the head. But I think that they all have root reasons for happening. So that's why I'm lumping them together in this podcast episode.

I'm going to go into the top eight reasons for tension headaches and migraines next.

The number one reason is muscle weakness.

Now there are tons of muscles that come off the neck and go to the shoulders. There’re tons of muscles in the front of the neck that help with swallowing, movement of your head, looking up and down, and all around. But there are some deep muscles to all those other muscles, the throat muscles, the movement muscles, we call them the deep neck flexors and those oftentimes are weak. And they're weak for a variety of reasons.

It could be other factors that we'll talk about, but overall, we find people that have frequent tension headaches and migraines, people that are suffering from those problems that we help here in the clinic. They have some overall weakness and then some severe weakness in just a couple of those muscle groups. And when we strengthen those muscles, oftentimes, well, pretty much all the time whenever we see clients, their headache symptoms, their migraine symptoms begin to diminish, and eventually they get under control to where they're not having to take a pain medication every day or whenever they get a migraine or headache to deal with it.

The second most common reason for tension headaches and migraines is neck stiffness.

This is kind of related to the strength issue that I was talking about just a second ago. But if you take a moment to turn your head in each direction, all the way like you're looking over your shoulder, so turn all the way to the right turn all the way to the left, as far as you can go and just assess and feel or look with your eyes how far you can go and then think about how your neck feels as well. If it feels stiffer to one side versus the other, than you've likely got a neck stiffness problem.

Now I'm looking at joints whenever I'm looking at a patient's neck in regards to a headache, or migraine, and whenever I find stiff joints, almost always, there are nerves that are being mildly compressed, there are muscles that are spasming just a bit to hold that joint to take some pressure off that joints and protect it, the ones that are stuck. And that's what's causing the stiffness.

It's a combination of the joints being not as mobile as it should be, and then the muscles around there protecting, and then the nerves getting aggravated as a result of that joint not moving and the muscle not moving. There is some sort of neck joint stiffness, muscle stiffness, that's contributing to that headache and migraine problem.

The third reason is poor posture.

Now, this can be related to a desk job or not, today in our American culture, we've got screens everywhere. We're probably attached to screens, whether it's a mobile device, a phone, a tablet, a computer, a TV, movie screen, there are all kinds of screens around us all the time. And as a result of that, we're fixated on a screen for a while.

So we might not have the best posture. And that carries over into our everyday conversations with other people. The way we sit and have a meal, it just the posture becomes our norm or default. And if it's not very good, it can promote the neck, muscle weakness, upper body weakness that I was talking about in those joints, and muscles getting stiff as well.

Posture has a role in it. But usually if we fix the stiffness, and if we fix the strength, the posture tends to improve. And truth be told, worrying about your posture constantly is not a good idea. It's better to worry about it just a few moments throughout the day. Typically, when you're in the worst posture, like maybe when you go sit in front of the computer, or if there's a time maybe if you're using your phone or reading books. People that read a lot that might be to really focus on the posture versus worrying about it all day.

Because some people that come into the clinic here, they're hyper aware of their posture and trying to fix it and, the reality is that it's just not practical to fix posture constantly all day long, and just it can get obsessive and bothersome for some people. So, yes, it is a contributing factor, but I wouldn't make it the main thing that anybody fixes to relieve a tension headache, or migraine problem.

The fourth reason and it's related to the posture is bifocals and reading glasses.

If you're over the age that you need bifocals or reading glasses. And in case you don't know what bifocals are, they're glasses that have an extra lens in the bottom that's different from the normal lens that serves as a reading glasses so that you can see the two lenses and people will put on the bifocals and the reading lenses on the bottom, or they'll just get the reading glasses that tend to be smaller and tend to sit a little lower on the nose bridge.

Sometimes they slip down, or they just aren't as big as normal glasses. So they have to look down. Well think about the posture. If you pull up a book or a screen, people tend to do this, you tend to tip their nose up to stick their chin out to view, whatever they're looking at through the glasses, the reading glasses or the bifocals, and it puts their head and neck in not the best posture.

Now, that's fine if you do that for brief moments if you're just reading something real quick. But if you're sitting there reading a book, you're reading chapters, or you're reading some newspaper articles, or you're browsing the web, and you're just you're there for 10 minutes or more, and your head and neck is in this position trying to look through the bifocals or reading glasses. It is killing your posture.

You got to think about the position, the posture that you're in that makes sure that your glasses are on right. And I always encourage my clients that are heavily dependent on reading glasses, to get glasses that are different full size for reading. So, go to the eye doctor spend the money if you need to. It's typically not that expensive anyway. And you might even be able to find some that work for you at a department store like a Walmart or a place where you buy reading glasses that are full size.

You can just try out different ones and get the ones that fits you best. And keep those glasses handy so that you can have something whatever you're reading at the right level, you're not having to tip your head or adjust your head and neck posture. So be careful when choosing bifocals or reading glasses. And honestly, I would rather you not get the bifocals just get reading glasses unless you find that it just fits your personal situation the best but go with the big full reading glasses lenses not the bifocals that are small or the reading glasses that are small.

Reason number five is excessive computer use.

Now this this can be related to the glasses thing, that I was just talking about the bifocals and reading glasses, but even if you don't use bifocals, or reading glasses, using the computer a lot can lead to tension headaches and migraines.

And the reason is this, if the text on your screen or whatever you're doing, because it may not be text, maybe other things you're looking at, if you're having to focus and kind of strain your eyes just a bit to look at whatever's on your screen, then it requires extra energy from your eyes and your brain to really look in and understand everything that you're looking at and interpret what you're looking at.

And just look at your screen right now, if you're looking at this video on a computer screen, and there's text around you, how small is the font on the text, and if you had to read it, say go down and look at the description. This video might be smaller text, if you have to really focus to scan the text and read the text. And you do that for hours on end or even just an hour.

It takes a lot of energy from your eyes and what many people don’t realize is your eyes are part of your nervous system. It's an extension of your brain. It's an extension of nerves. In the medical field, eyeballs are classified as nerve tissue. Kind of weird, right? Because you can see your nerves that way. But it tires out and exhausts the tissue and when you exhaust nerve tissue, it can affect other tissues nearby. And of course, right behind your eyeballs is your brain.

So if you've spent a while straining to read text, or look at small things on a screen, you bet it's going to tire your brain out and it's going to probably develop a migraine more likely, or even a tension headache. Especially if your head's not the best posture, and you're using reading glasses or bifocals, like I just described. So think about making the text on your screen bigger or use zoom features on your computer screen or mobile device, whatever you're using.

I use Kindle a lot, so I'm looking at a Kindle device or Kindle app on a mobile device, you can modify the text size on those things, and work to find out those features and learn how to use those features so that you're not having to strain when you read, you can just scan and go through the texts a lot easier.

Reason number six is not getting enough sleep, or rest.

Your nervous system requires sleep and rest just like the rest of your body. What many people don't realize is the nervous system, the brain, the nerves, the eyeballs, all those nerve tissues are some of the highest energy demand tissues in the body. Did you know that the nervous system is only about 2% of your entire body weight, just 2%. In other words, for a 200 pound person like me, that's four pounds of tissue. It's not that much. Yet, It requires 25% of the oxygen that I breathe in at any given time. That's hugely disproportion!

So, if you're not getting enough rest to allow those tissues to recover and regenerate and be healthy, it can strain the nervous system and create aches and pains in different areas, it can create sub optimal use of the tissues, the nerves that connect to the muscles may not operate as good as they can. That can also contribute to the neck weakness, and eventually the joint stiffness as well. So, it is incredibly important that you get enough rest and sleep.

Now I'm a type of person that does not require a full eight hours of rest, in fact, I get uncomfortable in bed if I'm there that long. I’m more of like the six to seven-hour type. And I function very well off that. I think that's my normal amount of sleep and rest that I need. And there's even times where I'm physically tired. So if I've been exercising for a while, like a couple days in a row, then my body's physically tired, but mentally I am rested. There’re times where I will just lie in bed, I've slept my six, seven hours, but I can feel my body, my, the rest of my joints and muscles need to rest.

I'll just lay in bed for 30 minutes to an hour. And I will I'll try to not tax my nervous system as well I won't be on the screen, I'll just be there thinking to myself or, or even just trying to not think just trying to meditate or pray for a minute so that I can rest my body. So, it is important to get rest as well as sleep.

Reason number seven is chronic dehydration.

If you're not a lover of water, you just don't like to drink water very much. You tend to drink more other types of drinks, maybe coffee, teas, sodas, juices and you're not getting just pure water on a regular basis, then likely you could be chronically dehydrated, and not even feel it, that might just be your norm.

But if you're suffering from a tension headache or a migraine, try up in your water intake. A good rule of thumb is if you ever buy bottled water, or you enjoy bottled water even if you aren't a bottle water fan, but you can have a refillable water bottle and drink five of those in a day. Just make it a point to drink five bottles of water about 16 to 20 ounces a day. So you're looking at 80 to 100 ounces in one day.

And if it's a bit of a chore to drink that much water, then what you might do is fill up your water bottle or get five bottles and put them on your counter or on your desk or somewhere where you're going to run into them often. And make sure you hammer those down throughout the day or if you if you get to the end of the day and you have not finished your water pounded down chug it down and make sure you get all that water in.

You'll be surprised the difference in the headache and intention problem that the migraine problem that you've got it tends to reduce a bit, just give it a try. Now, yes, you'll have to visit the bathroom a bit more frequently. As long as you don't have any other issues stopping you from doing that, then it's okay just allow yourself to do that your bladder will eventually adjust to the metal out of the chair that you're drinking. And of course, if you're drinking 7, 8, 9, 10 bottles of water a day, you're going to go way more frequently. But five tends to be pretty manageable, and your bladder can adjust to that and it's not a huge deal for most people.

Some people have some bladder issues and I get that, but you have to start to weigh what's worse right now for you the tension headache, the migraine, or the bladder problem. But give that a shot. It can give you tons of relief, especially if you're suffering from a tension headache or a migraine on a regular basis. This can allow you to get off a pain medication that you've been relying on that's potentially harming your other organs, your liver, your kidneys, your brain tissue. You want to get off those medications if you can.

The final reason number eight, for two tension headaches and migraines, is not enough exercise.

If you have a desktop, especially if you tend to be sedentary, maybe you don't have a desktop, but your just not exercising on a regular basis. That's okay. There’re seasons of life where you might not exercise regularly. But if you've got a tension headache and migraine problem, it is important to get out and do some consistent exercise.

It doesn't have to be every day. But if you even just plan on doing every other day, three to four times a week, gets your heart rate up, get a little bit of a sweat going on, and allow yourself to feel tired a bit. It doesn't have to be exhausting, just a bit tired, you might go for a walk a longer walk than you're used to.

Or you may be a gym goer and you'd like to go to the gym and do exercise in the gym or play some sort of activity with family or friends get do some sport or something that just gets your heart rate going. I've got small children and I'll just rough house with the children and play with them the way they like to play, chase them around the house. And I'll literally look at the clock and I'll say okay, It's, it's 5pm I'm going to play with them for a solid 30 minutes or even 45 or an hour if we can, and that's pretty tiring. It's pretty exhausting.

If we just keep going bring the energy, get your heart rate up, be okay with getting all sweaty, just plan on taking a shower afterwards. And that can be your form of exercise. I love going to the gym as well. I'll go to the gym for 45 minutes to an hour or a few, a few days a week. And that can make a big difference and it helps with getting rest and sleep.

Because if you haven't been getting enough rest and sleep, haven't been exercising on top of that, chances are your body gets thrown off its rhythms, it cycles. There are hormones that regulate all that. But if you begin to get some sort of consistent exercise routine, you bet your body tells you I need to rest, and you go lie down and sleep and you fall asleep pretty quickly most of the time.

So, make it a point to get some sort of regular exercise that fits your current fitness level and your schedule. It doesn’t have to be a long time, don't think that you have to go spend hours in the gym, it could be as simple as a 15 to 20-minute walk, you might just do briskly to get your heart rate up and get a bit of a sweat going. You could be indoors or outdoors. It just depends on your personal situation, but get some consistent exercise built into your schedule.

Thanks so much for listening to the top eight reasons for tension headaches and migraines. I hope that this podcast was helpful for you. If you think that you have a tension headache and migraine problem that is getting worse, and you can't really get it under control. And maybe you've already tried to fix some of these issues that I've talked about, and you're just not getting the traction that you're looking for the problems not getting that much better. Or worse yet, maybe this problem is spreading into your shoulders, or arm or even all the way down into your hand.

We often find people that have tension headaches and migraines, they get nerve radiation into their shoulder, it can decrease the function of their shoulder muscles and cause shoulder problems like rotator cuff issues. It can also send pain, numbness, tingling into the elbow area all the way down into the hand. And oftentimes people think that they're getting carpal tunnel problems in addition to their headache and migraine problem, and it radiates from the neck. We'll look at their neck problem and we'll find that it's, it's all that that's kind of the root issue, other headache migraine problem, as well as the problem that's going to their shoulder, elbow and hand.

So, if you think that it's that bad for you, then I strongly encourage you to talk to a specialist physical therapist. Here, at El Paso Manual Physical Therapy, we handle this type of problem all the time. If you're looking to talk to us specifically, the best thing to do is call us at 915-503-1314 or visit our website www.EPmanualphysicaltherapy.com and begin to talk with us.

If you call us just tell us that you heard about us on our podcast here. And tell us about your migraine problem, your headache problem, we'd love to hear all about it. My staff will take the time to talk to you about it and make sure that this is the best fit for you. If you go to our website, hit the cost and availability tab at the top of the website. Fill in the form and leave us your details, and my staff will call you back so that they can talk to you about your headache and migraine problem.

And if it's a good fit for you to work with us, if we think this is the type of problem that we can help you out and have success so you can get rid of this issue and quit taking pain medications avoid getting injections.

A lot of people go get injections in their neck for severe tension headache and migraine problems. And in real bad cases, they'll look to get a surgery to fix some neck issue that could be contributing to the migraine problem are the headache problem.

We want to help people avoid that situation because they are very fixable issues, headaches and migraines. We help people with that all the time. So my staff will talk with you about all that and let you know what the next best step is for you in how to fix this problem.

I hope this podcast was helpful for you. Please subscribe to our podcast here. We love subscribers and if you found this was helpful, share it with somebody else that you think could use this information and please give us a five star rating on whatever podcast platform you're listening to this on. We love those ratings. It helps us get more visible so we can get this information out to the people that might be suffering with a headache or migraine problem. Thanks so much and have a great day.

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What You Should Know About Degenerative Disc Disease


Welcome to the Stay Healthy El Paso Podcast. My name is Dr. David Middaugh, I'm a specialist physical therapist over at El Paso Manual Physical Therapy, and today we're going to be talking about degenerative disc disease and what to do about it.

The reality is that most people don't really know what it is or what it means. And a lot of people in the medical field don't even really know what it is and what it means either. They just know how to diagnose it and help patients that they have it. They will often do an MRI or an X-ray, or some other imaging study, and tell patients that they have degenerative disc disease. Or otherwise known as DDD for short.

Aside from medications and surgery, there isn't a whole lot of other treatment for this. But the good news is that we have a lot of great help that we can give patients that is natural, and they can really have long lasting benefits for the patient, and definite benefits as long as they can keep up a few things.

I'm going to tell you exactly what it's about and what to do about it through this podcast today.

The cool thing about this problem is that it can get better naturally, without having to rely on medications, injections, or surgery. And we help people do this all the time.

Now, there are a lot of facets to a degenerative disc disease problem. It's kind of an accumulation of several different little causes that all come together to form degenerative disc disease. I'm going to go through all that with you, so that you can have a better understanding of what it is and what to do about it.

First off, let me tell you about the signs and symptoms of this. That way you can see if this is what you have or not. And most people with a degenerative disc disease are 50 and up. It tends to affect people later in life. And it's a combination of arthritis, bone spurs, disc problems, shrinking disc height, and pinched nerves all coming together at the same time.

Now the process of accumulating all these problems happens gradually over time. So it's not like it all happens all of a sudden, it's slowly over years and that's why this tends to affect people later in life.

One of the biggest complaints of this is back pain, stiffness, especially in the morning when waking up, they have stiffness when getting up and moving around. It commonly takes people 20 minutes, 30 minutes, sometimes even up to 60 minutes to free the back up and get to a working place, where it's not that bad, and they can move around.

Oftentimes, the back pain gets worse whenever they're lifting something heavy or carrying something for a long period of time. Even just standing for long periods of time can affect the problem and make it worse. Many times, people with degenerative disc disease get the sensation of their back gives out, or they just all of a sudden get a bunch of back pain and are kind of out of commission for at least a few hours, sometimes as long as a few days. In worst cases, it can take weeks or even months to get better from a flare up like that.

They would have overdone it somehow, typically they would have walked too much, or stood too much or picked up some heavy stuff. Oftentimes when we get patients here in the clinic, they're doing housework and they just overdid it. Or they went on a trip and were on their feet too much. And when they returned from their trip, or finished with their housework, their yard work, then they paid for it as well. They often say I knew I was going to do all that stuff and would have to pay for it the next day.

But as the degenerative disc disease gets worse, the length of time of the flare ups tends to get longer and longer and longer. Usually when they are in their 50s, they say, “Well, you know what I can deal with the flare up that lasts just a day or two, I take some pain medication, and I'm good. I can get on with my life. There's always that low level of back pain, but nothing that stops me from being able to work and take care of my home and my family and do everything that I need to do.

But as the years go by, it worsens and worsens and what was a one or two day flare up, now turns into a five to seven day flare up, and they are out for a while, they are moving a lot less. They're usually getting less healthy on other fronts, because they can't exercise as much as they like to, they can't walk as much as they like to. They're just not as active as they were in younger years. Because the back pain is just debilitating them slowly over time.

And if it's bad enough and goes on long enough, people often experience losses of balance, they begin to feel like they need to hold on to walls to walk around or furniture people, they need to have a hold of somebody's arm, just to make sure that their balance is okay. And this tends to happen because if the problem goes on long enough, it can begin to affect the nerves that come out of the low back, that go into the legs and provide the nerve supply to the muscles of the legs.

It also helps with the balance systems within the legs. So if that begins to get affected over time, then you start to have some balance issues and that sets you up for some other potential problems, falls, fractures, those kinds of things. The people that go get x rays or MRIs, or other imaging studies are often told that they have decreased disc height. The discs that are between the bones of the spine are shorter than they should be. They also find bone spurs on the vertebrae on the bones in the spine. And they'll often find disc herniations as well.

There are parts of the disc that might be bulging out. And oftentimes there might be stenosis, as well as. Stenosis is where there's a narrowing of the spaces for the nerves to travel through the spine. And sometimes they'll say that they've got a pinched nerve sensation. And sometimes off the imaging, they'll tell the patient that they've got a pinched nerve in an area of the spine, and the patients often feel it, they'll feel that back pain or that radiating pain.

Oftentimes, it can feel like sciatica, where there's pain going down the leg from the back. In rare cases, there isn't much back pain, maybe a low level of it, but the pain going down into the legs is much more severe and stops people from being able to do what they want to do. But when they do the imaging studies on their lower back, they'll find that they've got this degenerative disc disease like we're talking about.

Some other findings that will be on the imaging will be arthritis, osteoarthritis, and then they'll talk about facettes arthropathy which just means the facettes, so arth arthropathy. arth means joint, pathi means disease. So there's some joint disease in the facettes. It's usually arthritis that they're talking about.

If you have had an X-ray or an MRI that talks about all this stuff that I'm discussing, it can be overwhelming, and you hear all these big medical terms. I wouldn't get too concerned about it. It's just a lot of medical jargon. The reality is we've had people in here that have some terrible looking MRIs and x rays, and through our treatments here as specialist, we can actually get them to balance better, to walk better, to have less back pain and be able to live a life without constantly worrying or thinking or stopping or adjusting their schedule to their back problem.

We help people do that all the time, even with severe degenerative disc disease, that the most common treatments. People with degenerative disc disease get recommended is of course pain medications. They will start some sort of oral pain medication. They might also do injections where they stick pain medication into the spine using a needle. And then in some cases, doctors might recommend surgery to open up the holes for nerves and put space in more discs they can replace discs now these days.

They look to do that, and the surgery is dependent on age and strength and other health factors that that the surgeons have to take into consideration. But what you have to realize with surgery is, once they go in and do that, they can't really undo it and there's risks with surgeries, infection, the surgery not even working oftentimes with degenerative disc disease. There are so many components to this.

Like I described that when a surgeon goes in there fixing one of those components, usually maybe two, if they can wing it, but to fix arthritis, the disc problem the pinched nerve, the stenosis, all these issues that I talked about, it's really challenging to fix with surgery.

The other recommendations that are out there are weight loss sometimes. If the individual with a disc problem is a little bigger and could stand to lose some weight that can help. Oftentimes, it does help to some degree. But what needs to be addressed even in people that are heavier is the strength. Because we get people in here all the time that are not obese or not heavy, they really don't need to lose any weight, but they're still dealing with a degenerative disc problem.

And what we find the root is oftentimes is a muscle imbalance, the way that they're moving, some strength issue, some joint that is stuck, some muscles that are stuck as well. And that's something that needs to be checked hands on in the clinic, and talked about with the patient, and a plan needs to be formed so that we can have a process to fix this degenerative disc problem gradually over time, for the long term.

That's exactly what we do here at El Paso Manual Physical Therapy.

Thanks for listening to this podcast, I hope that it was helpful for you. If you'd like to learn more about how we might help you in your back problem, you can visit our website at www.EPmanualPT.com or you can just google El Paso Manual Physical Therapy, that tends to work pretty well as well.

You'll find more helpful videos in our blog, or you can look into the podcast. We have tons of videos on YouTube as well, just hit subscribe to our YouTube channel, you can follow us on Facebook.

And if you want to get direct help, if you're interested in hiring us, and you're in the El Paso area, and you want us to take a look at you and see if it's possible for us to help you directly, then give us a call at 915-503-1314 so that we might begin to help you out. Thanks, and have a wonderful day. Thanks for listening to the stay healthier pestle podcast. Bye.

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