Welcome to the huberman live podcast where we
discuss science and science based tools for everyday life.
I'm Andrew huberman. And I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today we are discussing headaches. Headaches are something that everybody will suffer at some point in their lifetime, of course, some people suffer from headaches far more, often than others. And for many people headaches can be incredibly. Debilitating limiting their ability to work.
Work to socialize to sleep, to exercise, essentially to live life in any kind of normal way as well. Soon, discuss. There are many different kinds of headache. We have migraine headaches, tension, headaches, cluster headaches. Today, I will review all the different types of headaches and what the underlying biology of each and every one of those types of headaches is, as well as fortunately, the many excellent treatments that exist for the different types of headache. In fact, what will soon discuss is that by understanding which type of
Take you have and a little bit about the underlying biology of each different type of headache. It becomes quite straightforward to select the best treatment options for you to. For instance, provide relief from frequent and recurring tension, headaches, cluster, headaches, even sinus headaches. The sorts of headaches that are associated with sinus infections and colds, where the sinuses get clogged up and you experience headache. So while today's episode focuses on all aspects and types of headaches, it will have tremendous relevance for everybody. So for those of you that
Is headache. Every once in a while, we're only when you're sick or have a sinus headache or for those of you that suffer from debilitating migraines, today's conversation actually has a bit of optimism woven into it. Meaning, there are excellent treatments for each and every one of the different types of headaches. And I was quite impressed and excited to learn. When researching this episode that the treatments for headache range from of course, prescription drug treatments and over-the-counter medications of the sort of type that most of us have heard about ibuprofen.
Benefit and so forth. So called an anti-inflammatory drugs. But it turns out there are many natural treatments for headaches that when compared to those over the counter drugs and even some prescription drugs appear to be easily as effective. And in many cases, more effective than the typical drug treatments, many of which can carry side effects. That is the drug treatment scary side effects. Whereas the natural treatments appear to not carry side effects. Now, of course, anytime we have a discussion about natural treatments, they're
Likely to be some eye rolls out there and people thinking, oh, you know, this is going to be a bunch of woo science. Well, far from it as you'll soon learn today each and every one of the treatments for each and every one of the different kinds of headaches is grounded in a solid biological understanding of why that particular treatment ought to work and does work. So for instance you'll learn that some headache arises because of muscular pain, other headache arises because of excessive vasodilation the arteries and blood vessels get bigger and wider and so there's a pressure in a swell.
Within the cranium and that people experience as a headache. And it turns out that many of them, more natural treatments out there can address either the muscular pain issue or the vasodilation issue, or other issues and underlying mechanisms for headache. So again, while headaches are very intrusive irritating and in some cases, debilitating there is certainly light at the end of this tunnel. Meaning by the end of today's episode each and every one of you will have an array of excellent treatment options that you can choose.
Ooze from in order to address and provide relief from any of the different types of headache. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is thesis thesis makes custom nootropics. And as many of you know, I'm not a fan of the word nootropics because nootropics means
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Are the huberman Lab podcast has. Now partnered with Momentis supplements to find the supplements, we discuss on the huberman Lab podcast you can go to live momentous. Spelled ous live, momentous.com huberman and I should just mention that the library of those supplements is constantly expanding again. That's live momentous.com / huberman. Let's talk about headaches and as we are soon, going to learn, there are different types of headaches and different types of headaches. Arise from changes in different types of tissues in the head area and indeed in
Neck area as well. Now, one of the key things to understand is that if you want relief from a headache, you need to understand which tissue is mainly involved in creating that type of headache. So, for instance, many people suffer from what are called, tension headaches, tension headaches are little bit of a misnomer because many people might think, oh, tension. I'm under a lot of tension and stress. And therefore, I get tension headaches and indeed, stress can cause tension headaches, but tension, headaches are really the sort of headache that you feel around.
The top part of the head, not the very top, but sort of where you would put a headband. So above the eyes and around the head, it doesn't have to be experience all the way around the head, but the main underlying reason that is the tissue system. That mainly underlies tension headaches is the muscular system. There are a lot of muscles on the skull, Believe It or Not, of course, on the neck and they allow you to move your neck and head. There are a lot of muscles that lie, parallel to the skull and oftentimes those muscles will undergo excessive.
Of constriction. Now, there are of course, muscles in the jaw that can also lead to headache and jaw, ache, and things of that sort and neck, aches and headaches. So what we're really pointing out here is that the muscles are a key player in the formation of different types of headache, Tension Headache, in particular, but of course, muscles and muscle tension can be involved in the other types of headaches as well. Okay, so I just want to highlight muscular issues as one particular source of the ache in headaches, the other tissue that
that can be prominently involved in generating the ache of a headache, the so-called meninges. Now the meninges, in addition to being a fun word to say or a bunch of tissues that line, the outside of the brain and reside between the brain and the skull. So you might think okay between the brain and the skull there's probably just a little bit of fluid and the brain is right up next to the skull but turns out that's not the case. The brain is actually encased in a very thick, very durable Sack or casing. That's wrapped around.
Tight, like Saran wrap, it actually has a name which is dura. Di you are a and so you can remember Dura durable and having done some surgeries many surgeries before on brains of different types. Ranging from Human even though I'm not a neurosurgeon as a clinician ranging from Human to other types of species. What you find is that the dura is exceedingly durable, getting through this thing really requires an a very sharp razor blade. So the brain is actually sitting in a very fibrous
Like Sac that you simply could not open up with your fingertips, under any conditions, it's really durable. The meninges are in that general area and also encasing the brain and the meninges provide an additional buffer between the brain and the dura and the skull. So again you don't want to think about the brain is just sitting right next to the skull. It's close by, but they're a bunch of other thin fibrous tissues, many of which are very thin and fragile and others of which touches the dura that are very, very
Strong because they're very fibrous almost like a. If you've ever felt for instance, the sale of a sailboat you might think oh it's just this big flapping sheet in the wind. It is anything but a sheet in the wind. It is a very very strong and durable material. Now the proximity of the dura and the meninges to the brain, and the fact that everything is wrapped very tightly together, and the fact that there's a lot of vasculature, so that would be arteries blood, vessels and capillaries are all in that area on the top of the brain, and throughout the brain. The fact that all of that is in very close proximity.
Symmetry and wrapped really tight in this very durable, sack is one of the reasons why when blood vessels or arteries or both become dilated, they open their creates a pressure between the brain and those tissues. And because there isn't much distance between the tissues like the dura and the meninges and the skull. There's also pressure that allows for the brain to literally sneak up or I should say it. Give the impression that your brain is
Standing up against your skull. So the point here is that while muscular tension can give rise to a headache, the other thing that can give rise to a headache as so-called vasodilation the expansion or the widening of the arteries, blood, vessels and capillaries. And one of the reasons why that gives rise to a headache is because they're simply not a lot of space for that expansion to go, it doesn't allow anything except for the brain to push up against that very durable tissue and that very durable tissue to push up against the skull. And even though the brain itself,
Elf doesn't have pain receptors. That's right. The brain itself doesn't have pain receptors. That is why a neurosurgeon can take off a piece of skull and can probe around in the brain, with an electrode in the person is completely unaware and in order to get through the skull of course a little skin flap has to remove be removed from the skull and that requires a little bit of topical anesthetic. But really you don't need any anesthetic to go into the brain itself because there aren't pain receptors on the brain itself. However, the tissue surrounding the brain such as the dura, the meninges and
The vasculature that then reaches up, believe it or not into the skull. The vasculature doesn't actually stop right beneath the skull to actually blood vessels. It get into the skull and they're actually portals by which blood can move within the skull itself. Well, what that means is that since all of the tissues are very close by and very compact with respect to one another, any increase in the size of the portals that allow movement of blood there. And the fact that there are what are called nociceptors, noci, nociceptor, 's.
These are essentially pain receptors because of the presence of pain receptors in the tissues around the brain. When there is an increase in the size of those vascular portals, the arteries. Capillaries and vessels. We experienced that as intense, pain and pressure and fortunately, there are excellent treatments for dealing with that, intense, pain and pressure. But keep in mind that the intense pain and pressure, that is the consequence of vasodilation. That is the widening of these different, vascular portal.
Is very different than the type of pain that arises from muscular tension. As is the case with Tension Headache. Okay? So now we have two sources of pain. That is the ache in headache and there are two more that we need to think about in trying to better understand the different types of headaches that will discuss. And in terms of trying to understand which are going to be the best treatments for the different types of headaches. And those are neural and inflammatory responses. So let's talk about the neural type first. There is a type of headache that many people, unfortunately, suffer from
We'll get into this in a bunch more detail in a moment. Those are called cluster headaches. Cluster headaches are headaches, that arise not from the surface. People don't experience them as kind of a tightening of the forehead in the neck and the jaw, but rather it feels as if the headache is coming from deep within the head and in particular, from behind the orbit of one or the other eyes and sometimes both eyes. For those of you that have ever experienced cluster headaches, they are extremely painful. Even the more where I should say, the relatively more minor,
Strategies are extremely painful. In the severe ones are exceedingly painful cluster headaches, arise from Deep or this, we get the Sensation that they are rising from deep within our head as opposed from the surface inward because they are neural in origin and there's a particular nerve pathway called the trigeminal nerve that often is the origin of these cluster headaches, that people experience behind the eye. The trigeminal is the name, suggests has three branches try. Okay, so there's a branch that
essentially extends to the eye. There's also a branch that extends to the mandible right to the to the lip. And there's a branch that extends more or less to the to the nasal area. And so this trigeminal nerve becomes inflamed, or in other ways is hyperactivated in some cases and that causes the Deep pain below the eye because it is that first branch of the trigeminal nerve which is the ophthalmic branch, which tends to be activated first. So people start feeling
If there's a pain behind there, I in particular on one side, oftentimes there's lacrimation which is tearing up. There can be some nasal discharge another common symptom of this type of headache. That is the cluster headache. Is that the pupils sometimes will become very small, the pupils of the eyes and they won't dilate even in darkness. So there are a bunch of things that are going on on one or both sides of the face. That seemed to arise from deep within the head or it's almost as if it's coming from the brain outward and that's because it's neural and origin. Okay so we've got
Muscular origins of headaches. We've got meningeal origins of headaches. That is the stuff around the brain and as it relates to the vasculature and we have neural origins of headaches. And of course there's inflammation. Origins of headaches. Now, inflammation is a term that gets thrown around a lot these days people are talking about. You know, this reduces inflammation, inflammation is bad. And, and I suppose in some cases and when inflammation is really widespread across the brain or body, it's bad. But I don't think any of us should think about inflammation.
Or say as bad. What I mean is inflammation is just one form of signaling in the body, which, of course, includes the brain inflammation of a tissue is one way in which a set of cells. So these could be for instance, cells of the immune system and we cover this in a detailed episode. All about the immune system. If you'd like to check that out, you go to huberman live.com. Just put into our search function immune system. And you can find that episode. By the way, all of our episodes are searchable by keyword, a human lab.com, and it'll take you to specific episodes. And
And time stamps for the topics you're interested in. So, for sake of this discussion about headache, inflammation is going to be the case when one particular tissue in and around the head area is releasing molecules cytokines, which sometimes are called inflammatory cytokines. But there are also non inflammatory or anti-inflammatory, cytokines, but inflammatory molecules that are signaling to the rest of the body. Hey, there's something going on here. There's either some intrusive object and indeed, if you
To get, you know, a bb or a splinter into a particular, you know, skin area. There be a lot of inflammation so it could be the introduction of a foreign physical object into an area that will cause inflammation. It can be the presence of some sort of local toxin in that area. It could be a more systemic inflammation, nonetheless, inflammation in the neck and head area where frankly anywhere within the sinus area. So this would include the mouth, the nose around the eyes, because the sinuses many of us think of sinuses is just our nose but
Ashley. If I were to show you a skull a human skull or any other kind of skull you'd be. Very, hopefully intrigued to learn that the skull is just not one big piece of solid bone or a, you know, a top with a jaw below. It, it actually has all these small what are called, fenestrations little holes and canals that run through the skull and through the depth of the skull like little tubes. You've got them down here on your mandible, you've got them above your lips, you have them on either sides of your nose. Those are the sinuses. The sinuses allow the
I said, two different fluids through the skull because the skull, even though it's bone, it's not a dead tissue, right? In a live person or animal. The skull is a very active living tissue. Indeed all bone is active living tissue and it needs to be nourished with blood. It needs to be nourished with cerebral spinal fluid, in the case of the skull, it needs to be nourished with all sorts of important things. So those sinuses often times can become clogged as in the case with sinus headache which we'll talk about in a little bit but more generally any time there's inflammation.
Nation of one given area of the body. So it could be a shoulder, it could be the neck, it could be the mouth, it could be the nose or in the case of headache, it could be any portion of the head or neck. What happens is inflammation while it's a very efficient signal, it's much like the siren on an ambulance or a police car and that it sends out a very broad signal, that's very clear. Something is wrong here and needs to be dealt with. It's not very specific, so it's very robust but it's not very specific.
So for instance, if there's a little bacterial infection, or a little viral infection, the inflammation response to that site of infection tends to be far more widespread than the actual site of infection. It's a little bit different when you have a foreign object there like a splinter, or some other foreign object that tends to be a bit more localized. And the immune system is always trying to limit the extent of inflammation by putting in different scar tissues. Indeed, a lot of the things that we think of, as kind of gross pussy, you know, pustules and boils and things like that. I know it's a gross topic.
Our ways in which our body tries to restrict the amount of inflammation, but the face area and the head itself are so heavily infused with blood vessels. And there's a constant perfusion as we say of blood and cerebrospinal, fluid, and other things through this, incredibly metabolically, active tissue, that we call our brain and our eyes. Those are by far the most metabolically active tissue is our entire body. Even if we're running, hundreds of miles and ultramarathons, your brain is still far more metabolically demanding than all the
Of your body combined, no matter what the conditions because of that, there tends to be a generalization, or a spreading out of any inflammatory response and that inflammatory response, then can trigger the pain. Mechanisms are what we experience as pain mechanisms in the other three types of tissues that we talked about. So, for instance, if you have a systemic infection or you're experiencing inflammation of any kind, and it has anything to do with our encroaches, on the face or head area that can easily and almost always,
It spills over into activation of nerve cells can give rise to neural, based headache or to the meninges and can give rise to a meningioma headaches and of course to the muscles and to muscular type headaches. So we've got muscular origins of the ache in headache. We have meningocele origins of the Aiken headache. We have a neural origins of the Aiken headache and we have inflammation based origins of the ache in headache and that pertains to all the different types of headaches that we're going to talk about and it's important to keep in mind that there are these
Foreign sources of the ache and headache and that sometimes they exist alone and sometimes they exist in combination. However, this is an important however all pain or I should say all experience of pain as a perception is going to be neural in origin when we experience pain, whether or not to pin prick or a cut stub, our toe we trip and fall or a headache. It is natural in origin. It is the nervous system and nerve cells that are going to carry.
That signal, that we perceive as pain. So, as we talk about the different sources of pain and different types of headache, we will also talk about, of course, I think what most people are interested in today's discussion, the different treatments for the different types of headache and why each of those different treatments work. But by understanding a little bit about how pain arises in the nervous system and certainly by understanding the different types of headaches? You know, what is a tension headache, I gave you some impression that it's running around your head like a headband in many cases versus cluster headache, which
It's deep below the eye often it feels as if it's emerging from deep in the brain versus migraine, which we'll get into in a moment by understanding the different types of headaches. You should be able to quickly. Pinpoint, what type of headache? You have? What types of tissues are likely involved and therefore, what types of treatments are going to most quickly and most completely relieved that type of headache. Okay. So for the next three to five minutes and I promise no more, I'm going to explain how pain arises at the level of nerve cells and
and suppose this is one of those times when if I had a highlighter pen that could go out and across the the microphones and speakers leading to your ears, I would use it here because what I'm about to tell you is perhaps one of the most important things to understand about your nervous system that is your brain and you, which is that while you have trillions of neurons and we hear that you have trillions and different types of neurons in your brain. And they come in different shapes and sizes, and do different things. And some make dopamine and something serotonin, and some make glutamate and on and on.
The key distinction, among different types of neurons. That is the three types of neurons that I believe, everybody scientists are, no everybody should understand exist are some neurons nerve cells, are what we call motor neurons, in the sense that they control the contraction of muscles. Sometimes for walking, other neurons, control the movements of your fingers scientist called those digits. Other ones your toes, they also control the beating of your heart.
Although that's a slightly different mechanism and slightly different type of tissue than is involved in generating motor movements of your limbs. These are neurons that we call motor neurons because their goal or their purpose. I should say, they don't really know what their their goal or purpose is. But what they do is they make sure that muscles contract so that certain things happen in your body like your heartbeats or you move your limbs, you lift your eyelids or your eyebrows rather,
And so on and so forth. Other types of neurons are what we call Sensory neurons. They communicate the same way that motor neurons do that is they fire, what we call Action, potentials, which are just electrical signals. They release neurotransmitters like any other neuron, but they respond to certain events in the environment or the environment within the body. But they are not responsible for generating muscular contractions. So we call these Sensory neurons, some Sensory neurons sense, light touch
Other Sensory neurons sent firm touch other Sensory neurons sent Spain. Other Sensory neurons sense. Light brushing on the skin. In fact, you have sensory neurons believe it or not that respond specifically to the light brushing of a hand across your skin, any region of your body. And if that particular region of your body happens to have hair on it and you stroke the skin in the direction that the hair is laid down. We experience that as pleasurable, whereas, if you stroke in the direction opposite to the way, the
There's lay down. We experienced that as not pleasurable, so these Sensory neurons respond in some cases, for instance, within the auditory system, they respond to sound waves and you're either respond to photons of light, sometimes photons of light of particular wavelengths that we think of as red green blue and so on Sensory neurons don't move muscles, they respond to things in the environment and they exist within us. So we have Sensory neurons that sense for instance, pressure within our head or pressure within our gut. How full or empty our gutters
Pain within our tissues like our liver or or any kind of other internal organ. So we've got motor neuron Sensory neurons. And then the last kind of neuron is what we call module ettore neurons. These are the ones that adjust the relationship between the sensory neurons in the motor neurons to determine whether or not we do anything in response to a sensory input that is whether or not if a sensory neuron fires sends an electrical potential whether or not it will generate a motor.
Inch. Let me give you a very simple example. This. So, for those of you listening, I'll just explain what I'm doing. And for those of you watching, you'll be able to see I'm holding my hand out in front of me. If I were to touch the top of my hand with my fingertip, I can deliberately override that is, I can modulate that more typical reflex, which is that when something touches us, if we're not aware of where it's coming from, we typically move away. From that thing, that touches this is a very natural response, but we can decide we're not going to move away. We can decide to stay still or we can decide to move.
Toward the thing that touches us but typically if you were to walk up to somebody and you were to touch them, they'd either turn toward you on the side that you touch them or they'd step away, it's rare that they going to step into you, but you could decide that you were not going to move away or you could step into the direction of touch. And that's because you have modulatory neurons that can adjust the conversation in a very context, dependent way as to whether or not the sensory neuron will cause motor neurons to contract or not. Okay, so we've got motor neurons Sensory neurons. And
Angela Tory neurons. And you're probably thinking by now, why are we talking about this? I thought we were talking about headache. I thought we would talk about treatments for headache, but this turns out to be very important because you could imagine. And in a moment, I'll explain how let's say, you have tension, headaches. You're somebody that has the classic symptoms of tension, headache. Let me tell you what those are. These are headaches. Again, that occurred more or less on the kind of a headband like fashion or they tend to start there and exist around the head. These are very common. We can arise from a number of different sources.
Rise from sleep deprivation, they can rise from excessive. Use of caffeine intake will talk about why that is they can arise from stress. They can arise from very low level viral infections or bacterial infections. But we experience these as just as headaches or you've been thinking too hard or working too hard or life has been stressful. They're often also associated with jaw pain and jaw, tightness and neck. Tightness. So tension, headaches, everything you'd imagine muscular tension could cause. Well, if you want to treat tension headache, you could imagine.
That because all headache is neural that you'd want to go after some sort of neural mechanism to treat them. But of course, we now know that there are three types of neurons. There are motor neurons Sensory neurons and module ettore neurons. So we have choices we can say, okay do we want to turn off the muscles in the head jaw and neck that are hyper contracted. For instance you want to take a muscle relaxer or relaxed intent or would you want to try and change the sensory?
Put itself, maybe don't change the way the muscles are behaving, but shut off the sensory part of it. Your ability to sense it. There are certainly ways you can do that. Or would you want to adjust the module ettore neurons? Would you want to make it such that you have the headache but you don't perceive the headache. That is you cut off communication between the sensor and the motor. So that the muscles relax, turns out there are treatments and approaches for each and every one of those each and every one of those has different advantages and disadvantages. But as you
Quickly. See, we are going to have different types of headaches and different approaches to treating headache. But if you keep in the back of your mind, that you have neurons, that contract muscles to create movement or tension of muscles. Remember you can turn off those neurons and allow those muscles to relax. You have Sensory neurons that sense input and actually sense the pain and you have modulatory neurons which can allow you to adjust the relationship between the sensory neurons in the motor neurons. And of course, some of you are probably screaming at me by now, saying, wait, why would you ever want to deal with the motor neurons or
Or or the module Tory neurons. Once you want to just go straight to the source and just cut off the pain. Ah well the problem there is that many painkillers have other issues as well. In particular they can be sedative many of them can be habit-forming or even addictive and for many people not all but many people they don't want to take drugs whether or not they're over the counter or prescription drugs or even more natural supplement based type treatments and they would rather use for instance a behavioral approach in which
They can modulate, they can deliberately turn off the communication between Sensory neurons and motor neurons, and turns out those approaches exist as well. Okay? So at this point, I promise you that I'm not going to give you any more of a biology lesson in terms of pain, sensing and headaches as a more conceptual phenomenon instead. What I'd like to do next is talk about the different types of headaches. And I think this is something that's very important, and not often discussed, except for those people out there that unfortunately suffer repeatedly from certain kinds of headaches like migraine.
Nor cluster or tension headache. But I think for most people out there who experienced headache and again, that is everybody at some point experiences headache rather than just think of headache. As one thing understanding the major types of headache and how they differ from and are similar to one. Another will really help you identify what the best source of treatments for those are. So I'd like to talk about what the different types of headache are now. The first type of headache, we're going to discuss is the tension type headache again, tension type headaches. Tend to start.
Off. Not always but tend to start off as more or less a Halo or a headband around the forehead, in the area, above the eyes, often also include the jaw, the neck muscles and can extend even into the upper back. Again, this can be caused by some low level of infection, but more often than not tension type headaches are going to come on because of some chronic psychological stress, usually combined, with lack of sleep, usually combined with lifestyle issues. And of course,
And without getting into a long discussion about it, anytime you have lack of sleep, you're going to have excessive stress. Anytime you have excessive stress, you're going to have to make sure your offsetting that by getting proper sleep. Most people don't when they're under excessive stress, by the way, we have excellent tools or grounded and excellent science available to you at zero cost. If you are experienced, chronic stress or even short-term stress, we have a master stress episode of human law. Podcast again, just go to huberman live.com and all that time, stamped for you. Tension type headaches,
Begin in a more less a headband pattern but can really extend to other tissues as well. Not so often in the face but really the head and and often will start to climb up toward the top of the head. They are not always in this Halo pattern, sometimes they can be localized to one area such as the, you know, the back of the head or the front of the head or one side of the head, more than others. And that's often the case, because of tension within muscles of the neck that tend to bias the ache towards one side of the head. I'd like to take a quick
Break and acknowledge one of our sponsors. Athletic greens, athletic greens. Now called a G1 is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking athletic green since 2012 so I'm delighted that they're sponsoring the podcast. The reason I started taking athletic Greens in the reason I still take athletic greens once or usually twice a day, is that it gets to be in the probiotics that I need for gut health. Our gut is very important, it's populated by gut microbiota that communicate with the
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Green's while you're on the road, in the car, on the plane that cetera and they'll give you a year supply of vitamin D3 K to again, that's athletic greens.com huberman to get the five free travel packs. And the year supply of vitamin D3 K to the other type of headache. That unfortunately is very common is migraine headaches. Migraine headaches are defined generally as disorders of recurring attacks of headaches. So people who get migraines often. Get them in a recurring fashion. Some people get them very often other people get them less often,
And but migraines are very debilitating. The numbers that is the prevalence of migraine is still pretty debated. One thing that we know for sure is that female suffer from migraine headaches at a rate at least threefold higher than do males. And surprisingly this does not seem to have any direct hormonal origin because we're also going to talk about hormonal headaches. That is headaches that relate to a dip in estrogen and progesterone and particular phase.
The menstrual cycle, that is the ovulatory cycle. So there's a bit of a mystery here and the Mystery is, why is it that migraine headaches occur at such greater frequency in females even independently of the menstrual cycle? So when you control for changes in hormones, that still appears to be the case and overall migraines are very common. Now the numbers on migraine and just how common migraine is, are extremely wide. This was a little bit frustrating. For me, in researching this episode, you will find for instance, that 17 percent of women suffer
Suffer from migraines. You will also hear that six percent of males, suffer from migraines. You will also hear that 43 43 percent of females suffer from migraine. That is recurring headaches that qualifies migraine headaches and that 17 percent of men suffer from migraine headaches on a recurring basis, which is again, the definition of a migraine headache or one of the key definitions. So all we can say, for sure is that many, many millions of people, maybe even billions of people suffer from migraine
Headaches. It's kind of a staggering thing to contemplate but we know it's extremely common and we know that it's more prevalent in females in any of the studies that you will find in terms of that compare, the overall prevalence of headache, it's going to be higher substantially higher in females and males does not seem to be related to the ovulatory. Menstrual cycle. There are some interesting facts related to that that I'll just touch on for a moment pregnancy. For whatever reason seems to be protective against migraine headaches, that is
Women who suffer from recurring migraines before they get pregnant when they get pregnant and often after they give birth, they experience fewer migraine headaches. So there may be something hormonal, it may be something else. What do we know for sure? We know that headache, that is the ache in headache is neural. So whether or not the origins are hormonal, or whether or not the origins are inflammation or gut microbiome or some other feature of the body brain axis at this point.
All we know is that neural pain or the experience of pain at the neural level is the final common pathway and it's more prevalent in females. So as I mentioned migraines tend to be recurring so some people get them once a week. Some people get the once a month, some people get them far more frequently that they can be extremely debilitating. Oftentimes people experience migraine because it is a recurring phenomenon. Will know when a migraine is coming on. They'll say, my migraine is coming on the test. Sense it coming. There's this notion of aura.
Talk about Aura in a little bit. Some people think of or adjust as visual aura or the sense of kind of a haloing of light, with a sense that there's something outside the body, the actual definition of Aura is that it's the experience that something is about to happen. It's this kind of feeling of anticipation. It's not deja vu. Deja vu is different and very interesting in its own right, but different, it's this feeling that something's about to happen and the fact that aura is such a prominent feature of migraine headaches, or at least that people feel that the headache is
On long before they feel the actual ache of the headache and the other debilitating symptoms suggest that migraine has something of deep neural origin. That it arises from deep within the nervous system, spinal cord, and brain. And that it's not something like a tension headache that is going from outside in, you know, the constriction of the muscles in the jaw and head. So migraine headaches are very different than tension headaches, even in terms of how they come on or they're on set. The other feature of migraine headaches, I think is important to note is that
At dilation of the vessels, remember the vasodilation. So the widening of those pipes that we call arteries vessels, and capillaries is a very prominent feature of migraine and fortunately, that allows for a very particular types of treatment and ways of dealing with the pain, specific to migraine headaches. The other feature that's common in migraine headaches, a so-called photophobia. Many of you are probably familiar with photophobia you've ever been sleep-deprived, simply if you're sleep deprived.
And you go outside in the morning, the light is going to seem very, very bright much brighter than where you two have had a really good night sleep. And that's because during sleep there, all sorts of reset mechanisms in the brain. There's the washing out of metabolic debris and things in the brain. The so-called glymphatic washout, That's essential. There's also an adjustment of the neural tissue of the eyes, which has many of you've heard me say before, actually, two pieces of rain that have been extruded from the cranial Vault. So your eyes. Yes, indeed are two pieces of brain. The only two pieces of rain outside the cranial Vault, and within your eyes, you have neurons in.
Seems that adjust the, the sort of sensitivity of your eyes to light and of your brain to light. And when you are sleep deprived, or when you have a low-level viral infection or a cold or a flu of any kind, you tend to experience light as a brighter than it actually is when you're rested, or you're in the healthy state. So photophobia is something that's very, very common in migraine and often, the photophobia is a prominent feature of the experience that a migraine is coming on. People start saying, oh, you know what
Just too bright in here and normally they'd be able to tolerate that level of sunlight or indoor lighting with no problem. So there are two aspects of migraine that I think are particularly important to understand for sake of of the treatment and that's the dilation of vessel. So we if we want to treat migraine we're gonna have to think about things that can constrict blood vessels in the brain area. But we also need to think about photophobia not photophobia just as a symptom of migraine but that maybe by adjusting our sensitivity to light we can actually
Lee short-circuit, some of the onset and subsequent pathology of the migraine that is. If we can prevent photophobia partially, or completely can actually offset a lot of the ache of the migraine, that would otherwise occur. So that's an exciting Avenue for addressing migraine headaches will get into photophobia and how to deal with that will also talk about or a little bit more in a few minutes. But for the time being we talked about tension headaches, we not talk about migraine headaches again, keep in mind knowing what kind
Headache. You have is essential. It's, I would say indispensable for selecting the best treatment. Many people out. There will simply get a headache and decide. Oh, I'm gonna pop a couple of aspirin. Okay, what does aspirin do? And aspirins and anti-inflammatory. It also has pronounced effects on the vasodilation and vasoconstriction system. It actually allows more blood to flow through those arteries vessels and capillaries. A lot of people actually use baby aspirin or small amounts of aspirin, as a way to offset cardiovascular disease.
That's another discussion. But what do we know we know that in migraine? There's a hyper dilation of the blood vessels, a hyper dilation of the very little portals that exist in the brain and around the brain. And that are going to cause the pain, they're going to activate those Sensory, neurons, those nociceptors that will, then give us the experience of extreme headache and migraine. So taking an aspirin or something like it for migraine. In some cases, the worst possible Choice again. So knowing what kind of headache you were experiencing is going to be essential here. The other thing that you'll sometimes
Here, is that drinking a cup of coffee or getting caffeine through? T is a great way to deal with headache. Why would that be? Well, it turns out that coffee can cause either vasoconstriction or vasodilation depending on when you take it and we'll get into the use of caffeine as a treatment for headache. Because indeed, it can be a very potent treatment for headache but you absolutely need to know what kind of headache you are experiencing. Because in some cases, drinking caffeine, whether it's in tea or coffee can.
Solutely alleviate the pain of a headache especially if you catch that onset of a migraine or attention type headache early on. But in some cases, it can make it far far worse again, knowing which type of headache you're experiencing and how the different treatments work is key. Okay, so we have tension, type headaches, migraine type headaches. I think you're starting to get the picture. They have different underlying biology's. The next type of headache is cluster headaches. Cluster headaches are the ones I mentioned earlier that arise from deep within the head. They feel as if they're coming.
The inside out. And they tend to be on one side or the other, what scientists and clinicians called unilateral and tends to originate behind the eye and sometimes the nose region sometimes in the mouth region, as well, feels kind of patchy. But as if it's coming from the inside out. And again, that's because of that trigeminal nerve, for those of you listening and not watching this on YouTube, I've got three fingers as if I'm putting up three fingers in them. I've got one pointed toward my eye, one pointed towards my nose region, and one towards my upper lip, the trigeminal nerve is an
Easy one to remember and it will completely explain cluster headaches and what to do about cluster headaches and ammonia. If you remember that the herpes 1 virus and not herpes to not genital herpes, but herpes one virus. Is the one that gives cold sores on the mouth herpes 1 virus. By the way, is exceedingly common up to 90% of people. Many children. In fact have these again, this is not a sexually transmitted herpes, although it can be, of course, transmitted through kissing and sexual contact, but that's not the only origin of it, okay? Can be passed by skin contact.
To mucosal contact, so mucosal mucosal so that would be kissing mucosal lining or even skin to mucosal lining. So that's why it's so common. And the reason why cold sores develop on the mouth for people that have herpes 1 is because the virus actually lives on the trigeminal nerve. And yes, it is true, that sometimes the virus will inflame the nerve in the inflammation, will occur at the level of the iso people do, unfortunately, sometimes get herpes of the eye, it actually can be quite dangerous. If you have an infection of the eye,
Herpes infection of the eye. You should see an ophthalmologist or the nose region. They can experience pain in the mucosal tissue of the nose. More often than not, the most inflammation is occurring on the branch that innervates the lip or the region close to the lip. And that's why a cold sore develops their, an immune response. They're signaling that there's inflammation due to the herpes virus which lives on that, neuron for a very long time neurons. Don't turn over and the lifespan so it can live on there for the extent of of the person's life. However, most people
Hopefully treat their HSV-1, but if they don't the sort of frequency and the severity of infections tends to taper off with time, we'll have an entire discussion about viruses and herpes in particular and a future episode. But the thing to keep in mind here is that this very nerve is the one that gets inflamed in these cluster type headaches. Now, cluster type headaches are associated with a bunch of very uncomfortable symptoms. Again, they tend to be unilateral, they tend to be
In very deep and they tend to be excruciatingly painful, excruciating, painful they can last anywhere from 30 minutes to three hours. Some people experience these in sleep, in fact, this is one of the cases where men experience a headache, more than females men experience, cluster type headaches that have a sudden onset during sleep at five times the frequency than do females, the origins of that aren't exactly clear, they do seem to have something to do with the biological clock mechanisms that so called circadian mechanisms. So if you are
Man, or woman for that matter. And you're waking up in the middle of the night with a unilateral headache. And it seems like it's deep within your within your head or it's starting there and it's on one side and localized to the eye and maybe these other regions the trigeminal is involved. In, you may be suffering from cluster type headache and you should talk to your physician. The other symptom that's quite common in cluster type headache is a droopy eyelid, which should make sense because the trigeminal innervates, the eye region. And there are other nerves that control the eyelid. But they're in that General region and they can be impacted. The other thing is something called meiosis, which is that
You can't dilate the pupil I mention this before. So there's your pupils might get really really small and they won't dilate and the other thing is lacrimation tearing and then nasal discharge all because of a neural inflammation problem. Why do I tell you with such detail about cluster headaches? Well, if you are somebody that's experiencing the kind of pain that is consistent with cluster headache, taking a standard anti-inflammatory or doing something that is going to adjust the vile. The scuse me. The dilation or constriction of blood vessels, may have an indirect impact.
I'm cluster headache but is unlikely to relieve cluster headache. Either acutely meaning right away or in preventing cluster headaches you have to deal with this as a neural issue and we'll talk about some of the main causes of inflammation and activation of these cluster type headaches at the level of the trigeminal nerve in a little bit because fortunately there are some excellent treatments, the next type of headache that is quite common are hormonal headaches. Now the phrase hormonal headache, should already qu2. The fact that it's far too General.
ERM because there's so many different hormones, testosterone, estrogen, thyroid hormone, growth hormone, and on, and on, and on, and they all have many different functions in the brain and body every single hormone. And in particular, the so-called steroid hormones, steroids again, not just limited to things that people take for Sports. In fact, a steroid hormones refers to estrogen testosterone of the sort that we all make that men and women make naturally. And the steroid hormones can impact gene expression, they can are
Of course, what turns, on the growth of the, of the breast, tissue of the testicular tissue of the hair growth and on, and on, and that's all because of gene expression. If you're really going to change the identity and function of a cell long-term, right? You're going to literally change the breast tissue or change the penile tissue or change. The ovarian tissue in some sort of consistent way across the Life Span. You can bet that there are changes in gene expression and those changes in gene expression occur because these steroid hormones have this incredible ability sort of like the X-Men of hormones to pass through.
The outer membrane of a cell which we call the extra cellular membrane and into the so-called nuclear membrane that can go into the area where genes are made and turn on and off different genes. However they multitask in their life that is these steroid hormones like estrogen and particular and testosterone. In particular can also bind to the surface of cells and impact all sorts of things at the level of the cells that have nothing to do with changes in gene expression. And that second mechanism of binding to the surface of cells is one of the ways in which estrogen can
All different aspects of headache. Now, that doesn't necessarily mean the estrogen gives you headaches. In fact, it's just the opposite. It turns out that low estrogen and another hormone low progesterone, combined to give rise to a headache because of the ways that low estrogen and low progesterone impact, vasodilation, and vasoconstriction, and the inflammatory response will talk about how to deal with hormone based headaches particular hormone.
Umm has headaches that occur because of low estrogen and progesterone in a moment. But the key thing to know is something that we covered in the fertility episode, I did a very long, very detailed episode on fertility, so I'm not going going to go into this in significant detail. Now, you can refer to that episode for probably more detail than you ever wanted, but also a lot of tools as it relates to fertility in both males and females. But right now I'm just going to give you a course overview of that in about 60 to 120 seconds. So that you'll understand when
Hormonal headaches are most likely to take place. Keep in mind that that hormonal headaches are most likely to take place when estrogen and progesterone our lowest. So, if you understand that during the follicular stage of the ovulatory, / menstrual cycle, okay? So, menstrual cycle is about 28 days on average, not everyone, but it's about 20 days on average and the first, half of that, estrogen starts creeping up up, up up, up, up, up, up up. And as we learn in endocrinology estrogen Prime's progesterone. So estrogen will then
Peak and then start to fall low. The low low low low, low low pretty quickly. Right about the time that the egg ovulates an egg is released and will essentially be ready for fertilization. If the egg is fertilized, a whole bunch of other things happen, as it relates to pregnancy, if not what ends up happening. Is that during the luteal phase, which is the second half of the menstrual cycle. There's been a buildup of the lining of the uterus because of an increase in progesterone. So estrogen goes up during the follicular phase.
Then it goes down, and then progesterone goes up, up up up up, which is important for generating, that thick lining of the uterus to allow the fertilized egg, if it's fertilized to implant. And if it's not fertilized, all of that gets released from the body, in this bleeding process that we call menstruation if menstruation occurs and day. One of the menstrual cycle is considered the first day in which bleeding occurs, well, then what that means is that estrogen is already low. Because remember estrogen was low, at the start of the follicular phase in, went up, up up up, then.
It comes down right, at the time of ovulation, and progesterone goes up, up up, up, up during the luteal phase. In fact, it's more than a thousand fold increase in progesterone, but if there's no fertilization of the egg progesterone starts coming down, down, down, down down, what does that mean? That means, that on the first two about the fourth or fifth day of the menstrual cycle. First, being the first day of bleeding until about the fourth or fifth day of the menstrual cycle, both estrogen and progesterone are very, very low. And it is at that time at the very
Beginning of the menstrual cycle. So about the first week of the menstrual cycle, the many women are very prone to hormonal headaches, hormonal headaches, not because estrogens High. That's a common misconception, rather because estrogen and progesterone are both low. And now that you understand the Contour or the under underlying reasons for hormonal headache. You can start to ask well, what happens when estrogen is low? Well, estrogen has strong impact on the vasodilation vasoconstriction system as does progesterone will talk about
bout that a little bit later. But now that you know what hormonal headache is at least this one particular type of hormonal headache which is very, very common given the number of women that are menstruating and the fact that low estrogen low progesterone is the cause of the hormonal headache. And the fact that, of course, there are women who are no longer menstruating, so they're either in perimenopause and menstruation is becoming more infrequent or they're in menopause and it has ceased entirely. Well, now you understand what the origin of the hormonal headache is. And so all we need to know is what do
Sturgeon and progesterone normally do to, in order to prevent headache. And thereby, you'll know exactly how to offset that is prevent or treat hormonal headache. In that first week of the menstrual period. The last type of headache that I'd like to discuss is headache. Associated with head hits? That is traumatic, brain injury. Although, I definitely want to underscore the fact that even people who do not have traumatic brain injury can experience headaches as the consequence of hitting their head. So the line between traumatic brain,
Jury and lower level. Brain injury is one that still seeks definition. In fact, this is one of the major goals of the clinical field as it relates to concussion. You know. It's also what comes up a lot during the discussion about football, you know, these days you'll see players hit really hard and depending on whether or not they're laying there for 5 seconds. 30 seconds or 3 minutes. You know, the crowd and the people watching on television and everywhere else are all speculating as to whether or not. The person should be allowed to play. And to be quite direct. There really is.
No way to assess the extent of brain damage. After the consequence of hitting one's head, we're having one's head hit. Because first of all, almost all of the best ways to detect traumatic brain injury, except the most severe. Ones tend to require a lot of very large equipment, like MRI and functional MRI, and CT scans, none of which are available on the side of the field or in the locker room. But also because many many, if not, most of the effects of traumatic brain
We are going to occur, not in the immediate minutes or even hours after the injury, but several hours days or even weeks after that injury. This is a discussion that we should hold off for a longer full episode on traumatic. Brain injury. Keeping in mind, of course, that football is this very Salient example of traumatic, brain, injury and concussion as is boxing as is even soccer with heading of the ball, Believe It or Not repeated low-level impact to the forehead and other parts of the head can give rise to over time.
Out of brain injury without the need for any kind of full-blown concussion or being quote, unquote knocked out. But sports-related concussion actually occupies. Just a tiny fraction of the majority of traumatic brain injury and concussion. Most traumatic brain injury and concussion and low-level brain injury that can accumulate over time to become traumatic. For sake of daily living. That is lowered. Cognition disruption. In mood, sleep etcetera is actually the consequence of things other than Sports. So, for instance, bicycle accidents,
Playground accidents, construction accidents. And this is often forgotten. And for some reason, all the sports and in particular football, tend to grab all the attention, as it relates to concussion. Keep in mind that while that for certain people is a path to living for most people traumatic. Brain injury is going to occur in a car accident, construction, work, or other types of work for which people generally don't have many options in terms of the type of work that they're doing. So they are prone to concussions and head injuries simply by virtue of
Of their work without any, you know, millions of dollars contracts or the opportunity to necessarily some cases they do. But necessarily to do other things and certainly car accidents, or bike bicycle, accidents are not voluntary events. So the point being traumatic brain injury and headache related to traumatic. Brain injury extends far beyond the realm of sports. And in fact, if you were to look at the numbers, what you find is that more than 90% of traumatic brain injury. So people coming into the hospital or clinic or people claiming that they've got consistent headaches, they're not sleeping well.
Well, their mood is off, they're feeling more irritable after having hit their head, even once is not the consequence of sports, it's going to be the consequence of accidents, either on at the workplace or in terms of a bicycle or other sorts of Transportation based accident like a car accident. With that in mind, any kind of head hit, certainly involves a concussion or traumatic brain injury. Often leads to headaches either infrequent but severe headaches or chronic low-level headaches or a feeling there's kind of a stuffiness or a
Almost to the head. There can be a lot of different Origins to that. A common origin is going to be actual swelling of the not necessary. The brain tissue directly, but if you recall our discussion about the meninges, which include the dura and the other tissues, that surround the brain, there are three layers that we call the meninges. The dura, just being one of them. And there's a very little space between those, the brain, the meninges, that surround it, and the skull, it's called, the subarachnoid space. Very cool, my arachnoid like spider. Well, if there's even a slight bit of swelling,
In the brain or even distant brain tissue. So, for instance, even if the there's Whiplash. So there's swelling of the tissue muscular tissue and neural tissue in the neck area that can constrict. The flow of things like cerebral, spinal fluid, blood flow, and indeed, mucus, and other other things that are essential, we all heal here, mucus and we think Illness, but mucus is a vital vital substance within the body. For a lot of important reasons in health as well as in sickness. Well, if there's less of that liquid and other fluids and
Guess being delivered to that space will then it can clog up. So sort of the plumbing is clogged up or that it's caught at the level of the site of hit or injury, because there's some local swelling and inflammation there. So there are many different mechanisms that can underlie headache associated with head hits or traumatic brain injury. Now, fortunately there are some recent data pointing to some, what I would call non-obvious treatments for headache in traumatic. Brain injury, keeping in mind that any time we're talking about,
An injury or disease or health for that matter, mental health and physical health. We have to highlight a fact that's going to come up again and again in every single episode of this podcast. And I think it's not being overly redundant to do so, which is that
Regular sufficient amounts of deep sleep. Each night are going to be important for all aspects of mental health, physical, health, and performance, and have been shown over, and over again, to reduce the frequency of headache and, to reduce the time to repair after traumatic brain injury and can improve cognition, and on, and on and on. So sleep is essential for all the normal things, that encourage healthy activity of the different tissues that are involved in brain and body to occur. So sleep. Deprivation, of course, is going to limit those, but I do want to point out that
Sleep sunlight. And I've talked about this almost Ed nauseam on this podcast but regular circadian cycle is getting sunlight in your eyes early in the day, and in the evening as well. And as much as possible throughout the day without burning your skin, and limiting your exposure to artificial lights at night and on, and on all of, which is covered in the light for health episode of the human Lab podcast, the master, your sleep episode of The huberman Lab podcast and in the perfect, your sleep episode huberman. Lab podcast, you can find all that a human lab.com getting light and avoiding light.
At the proper times of the 24-hour cycle is also going to favor all the pathways ranging from gut-brain access to the inflammatory. Anti inflammatory, Pathways neural Pathways Etc. That of course, if you do that, you're going to improve and offset any kind of detriment caused by traumatic, brain injury, is it treating traumatic? Brain injury directly? No, but is not getting sufficient sleep. Not getting sunlight at the right times of day and getting too much artificial light at night, going to make any impact of traumatic brain injury, including headache, far worse? Yes, there are
Only a ton of data to support that statement as well and then of course nutrition and exercise are also important so we can list out sleep son, proper nutrition exercise and I would put proper social connection, whatever. That means to you healthy, social connections, include romantic friendship, familial and relationship to self those five things. Sleep, exercise, Sun nutrition, and social connection are all critical for maintaining baselines of health, and raising your bass lines of health. And I mentioned that, I kind of segment this out now because
Because I think that any time we're about to start discussing pointed treatments, that is things that you can take or do to reduce headache or things that you can take her, do to improve anything within mental health, physical, health, and performance. We have to remember that the foundation of mental health, physical health, and performance is only set at its highest level by tending to those other things. And that nothing really surpasses. Any of those things or put differently, there's no replacement for any of those things in the form of a pill, a powder, even a behavioral practice there are things you can do to offset.
Getting less than ideal sleep. Things that you can use like bright artificial lights during the day to try and partially offset, lack of sunlight, but really there is no exercise pill. There is no sunlight device, although some bright lights are very bright. There's no replacement for actual sunlight, there's no replacement for actual sleep. There's no replacement for actual nutrition and I do feel. It's an important conversation to have as we head into the next segment. Which is what can you take or do to reduce headache? And in order to address this, we're going to start first.
First with the headaches associated with head hits and traumatic brain injury, because it turns out there's a surprising and very useful approach to doing that. But this same approach also can help offset and treat headache in other conditions as well. Meaning not just for headaches caused by traumatic, brain injury, but also headaches caused by sudden onset, Tension Headache, or migraine headache or even perhaps again, perhaps cluster type headaches. So the first substance that I'd like to highlight that
And shown to significantly reduce the intensity and, or frequency of headaches is creatine. Now, creatine, as many of you know, is something that people supplement intake. Most often creatine is discussed in the context of muscle performance, not just for people who weight lift, but for people to do endurance exercise, and it's often been said that five to 10 grams per day of creatine monohydrate depending on how much you weigh 5 to 10 grams per day of creatine monohydrate can increase. Creatine, phosphate stores.
In muscles can bring more water into muscles. Can make you stronger, get increased power output and that is all true. As all completely true, we discuss this in the huberman, lab podcast with dr. Andy Galpin, when he was a guest on the humor and lab podcasts or standard series, and we discussed this extensively in an upcoming episode from dr. Andy Galpin in his special six-part guest Series, where he is a guest on the huberman Lab podcast, but we're really, he's the one doing the majority of the teaching that series covers everything from strength hypertrophy in
Rinse. And there's an episode on supplementation where we go deep into the discussion about creatine. Now, in that discussion. And again now we highlight the fact that creatine While most often discussed online and in the media as a supplement for sports performance, for the reasons, I just mentioned actually has four more data behind it that is laboratory studies exploring the role of creatine in the clinical setting so I'd like to highlight a paper from that literature now that will make very clear as to why creatine is interesting. And in fact, very
effective for treating headache and particular headache caused by head hits or traumatic brain injury. The title of the paper is prevention of traumatic headache, dizziness and fatigue with creatine Administration. Now keep in mind, this is a pilot study. It was performed in humans. So when you hear that words, preclinical that is, if you hear there was a preclinical study on blank, that means almost always that the study was performed on animal models. Mice, rats primates, Etc. I clinical trial is something that's carried out on humans and I pilot study means that the study was carried.
Out on humans but on a fairly small cohort of very fairly small group or limited number of subjects nonetheless. If the data are robust as it is, in this case of this paper, I think it's worth paying attention to. So in this study, what they looked at was creatine Administration. So what they did is they had people ingest, a certain amount of creatine. I'll tell you in a moment in fluid, should be taking in water and milk with, or without food, doesn't really matter. What time of day, they had people take creatine, why would they have people take creatine after traumatic brain injury? And
And in particular for people that are suffering from headache, dizziness fatigue, Etc. The reason is that neurons nerve cells rely very heavily on the regulation of calcium in order to generate those Action, potentials to communicate with one another. So, it doesn't matter if it's a motor neuron, a sensory neuron or module Toreador, en they all generate Action, potentials, or something similar to it. And calcium is important for that process. Calcium becomes dysregulated after traumatic brain injury in a number of different ways.
In particular in ways that impact the energy production systems of cells that are related to ATP adenosine, triphosphate for those physician Otto's out there that want to look it up. You can simply look up, calcium, ATP, and neurons. And you can learn about that cycle. Creatine can be stored in muscles as we talked about before, but creatine. And in particular, the phosphorylated form of creatine, which is the readily available fuel source, form of creatine can also be stored in brain tissue, and it is actually quite
Stored in the forebrain, the area where the real estate of your brain just behind the forehead, which is involved in planning, and action, and understanding context. So, it's very important for cognition. It's important for personality to what's important for a number of different aspects of life that have to do with making plans, being able to focus very intensely on your work, etc, or on anything, for that matter. All functions that become heavily disrupted in people who have traumatic brain injury and concussion creatine's ability to communicate with the calcium.
In the ATP system was the motivation behind the study that is the author's hypothesize on the basis of preclinical data in animals that by increasing creatine stores within the brain, not just in the muscle. But in particular within the brain that the availability of creatine would allow for better cognitive function in general. Now, they didn't look at cognition specifically in this paper but they did look at the other aspects that is that the bad stuff associated with TBI and they had people supplement with creatine at a
That is much higher than the typical level that people supplement with creatine Simply for Sports Performance. So, as I mentioned before, most people, if they supplement with creatine for sports performance, they take creatine monohydrate typically 5 grams per day, sometimes 10 grams per day, if they're about 100 kilograms or were greater in body weight. After kg is 200, approximately 220 pounds. So the dosage that was used for supplementing creatine in this study to address the potential impact.
Of creatine on headache. Dizziness and fatigue was quite a bit higher than the dosage is used. Simply for muscle performance in this study. They had people take a dose of 0.4 grams of creatine monohydrate per kilogram of body weight. So for somebody, that weighs 100 kg or 220 pounds, that will be 40 grams of creatine per day. I have some ways half that much, they would take 20 grams of creatine per day. And they did that over a period of six months. And we know
That when you take creatine over and over day-to-day, that there's a buildup of creatine stores both in the muscles and within the brain tissue. Now, what they found as a consequence of this creatine Administration was really striking and I think quite exciting, they found a very significant decrease in the frequency of headache and people that were supplementing with creatine as opposed to the controls. Now keep in mind that this is a pilot study but the effects are very dramatic. They found a very statistically significant decrease in the frequency of headache.
In people that were taking creatine. In fact, if you look at the controls and you see that they're basically getting headache at a frequency of 90% or more after TBI, the reduction in headache frequency is down to about 10 or 12 percent in the people taking creatine. So that's quite quite a dramatic effect and if you look at the other measures they took, keep in mind. Again, this is a pilot study so a limited number of subjects but again the results are very impressive. What they found is that the number of people experiencing
Venus was significantly reduced in people supplementing with creatine as was the number of people experiencing fatigue and of acute, fatigue and chronic fatigue again, not chronic fatigue syndrome per se, but chronic fatigue, which was in this study defined as a general sense of bodily weakness and even mental weakness. Mental weakness is a little bit hard to quantify, but they were very careful to distinguish between cognitive and mental, fatigue versus physical and somatic fatigue. They acknowledge that both of those occur in TBI or post,
TBI, that headache is quite frequent. Basically the takeaway of this study is that for people experiencing headache. Dizziness and fatigue due to TBI and perhaps and I want to underline perhaps because it hasn't really been explored yet. But perhaps headache, dizziness and fatigue due to other conditions symptoms or causes of headache. Creatine monohydrate supplementation might be. Again, might be an excellent candidate for people to try. Why do we say that? Well, first of all creatine monohydrate is relatively
Inexpensive it's considered safe at the dosages used in this study and certainly for sports performance as well. And there are very few other compounds that have been shown to have as significant an impact on headache over the long term, as has creatine monohydrate in these studies of people with TBI, it's also important to highlight the fact that many, many people suffer from TBI as I mentioned earlier, and as now, there are very few trees.
Treatments for TBI, you tend to get the basic advice coming back. And I again I think it's excellent advice, you know, get proper amounts of sleep, get exercise but don't get another traumatic brain injury, that's obvious, but you'd be surprised how many people go right back to work because they have to and you know, we have to be sympathetic to the fact that many people just can't stop working or go on disability. So many people have to go back to work. That could be sport or could be other kind of work where they are then subject to perhaps getting more TBI. Maybe they're getting less rest as a consequence and
Obviously stresses confounding issue for TBI but sleep exercise, Sun nutrition, all of those things. Proper social connection are. What people are encouraged to do when they have TBI. But there have been very few compounds in particular, very few over-the-counter compounds that are known to be safe that have shown efficacy in dealing with TBI. So, I think that while this is a pilot study and we can consider it preliminary, I think it's important enough in the effects were dramatic enough that people with headache and a
killer people with TBI, ought to consider supplementing with creatine in order to deal with their headaches. And of course I eagerly, await other studies exploring. The role of this high dosage of creatine, which is a relatively high, dosage of creatine monohydrate for offsetting headache. Meanwhile, I think there are a number of people out there suffering from headache, who might consider using creatine monohydrate in an exploratory fashion and seeing whether it helps offset their headaches. Keep in mind, of course, anytime you're going to add or remove anything,
Enter otherwise from your, from your treatment, your nutrition Etc. I do suggest that you consult with your physician in particular, if you have chronic headaches, I don't say that to protect me. I say that, of course, to protect you. I'd like to take a brief break and thank our sponsor inside tracker, inside tracker is a personalized nutrition platform. The analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals. I've long been a believer in getting regular blood work done for the simple reason that many of the factors that impact your immediate and long-term
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Those numbers into the ranges that are appropriate and indeed optimal for you inside trackers, ultimate plan. Also. Now includes a measure of April lipoprotein. Be April lipoprotein, be sometimes also called apob has emerged in recent years as among the most important measures to evaluate your overall levels of cardiovascular health and health overall. And that's because April lipoprotein be levels are predictive of cardiovascular function disease and things that
scalar function and disease can impinge on including brain, Health and Longevity. If you'd like to try inside tracker, you can visit inside tracker, dot, coms, huberman, and get 20% off any of inside trackers plans. That's inside tracker.com huberman to get 20% off what I'd like to discuss next. I find extremely exciting. Why well what I'm about to describe is a compound or I should say a set of compounds that are available over the counter that have been shown to be very effective in reducing the frequency and
City of headaches and not just one kind of headache but multiple types of headaches. So what I'll describe has been shown to have significant effects in reducing the intensity or frequency of tension, type headaches, migraine type headaches as well as hormone type headaches that are related to the menstrual cycles that I described earlier. Now there are a lot of data centered around this General topic, but I'm going to focus on three main papers but I haven't told you yet. Of course, is what is the compound that I'm referring to what is this over-the-counter compound, but it turns out this
Over-the-counter compound is not just available over-the-counter. It's also available in food. So it turns out that nutrition can have a very strong impact on the frequency and intensity of headache. Although supplementation with this particular, compound can accomplish the same thing as well. What I'm referring to here are a mega Three fatty acids, many of you are probably familiar with omega-3 fatty acids. These are fatty acids that come in the form of so-called EPA and DHA. And omega-3 fatty acids are commonly distinguished from the so-called
Mega 6 fatty acids, Omega 6 fatty acids come in, a bunch of different foods, and they, of course, can be supplemented as well. Omega-3 fatty acids coming in a bunch of different foods and can be supplemented as well. Common forms of omega-3 fatty acids. Why should take common sources of omega-3? Fatty acids in Foods include fatty ocean, fish, including salmon, salmon, skin sardines, anchovies, things of that sort common sources in supplement form are so-called fish oil capsules or liquid fish.
Oil again, omega-3 fatty acids, and almost always when we're talking about omega-3 fatty acids, we're talking about a combination of EPA and DHA, but really it is the quantity of EPA omega-3 fatty acids. That seems to be the most impactful for the sorts of Health metrics that we're going to talk about in a few minutes. Now, with respect to Omega 6 fatty acids, the most typical food sources of omega 6. Fatty acids are seed oils. I know nowadays seed oils have become quite controversial.
I've given my stance on this, in a prior podcast, but I'll just repeat it. For those of you that haven't heard it, I am not of the belief that all seed oils are bad, but they're all inflammatory that they are killing us, or making a sick that they are the major cause of metabolic dysfunction etcetera. However, I think it is very clear and I learned this from dr. Lane Norton, when he was a guest on this podcast and taught us all about nutrition in great depth, I highly recommend that episode. If you're interested in nutrition that people are consuming a lot more oil generally and
A lot of those oils that people are consuming more of nowadays. Include a lot of the so-called omega-6 fatty acids, and a lot of those oils are seed, oils. The particular omega-6 fatty acid, that's going to be relevant for, today's discussion is linoleic acid, and that is common in a lot of seed oils. So again, I'm not going to tell you that seed oils are bad. However, it does seem to be the case that many people are consuming far too many seed oils and in doing so are consuming far too many calories and perhaps are consuming too much of the
Mega 6 fatty acids, relative to the omega-3 fatty acids. Now with that said, I think there is General agreement among nutritionists and health professionals that we could all stand to get more omega-3 fatty acids, perhaps for cardiovascular health of all. That's a little bit debated but certainly for immune system function for mood and for functioning of the brain, and for the potent, anti-inflammatory effects of Omega-3. So again, Omega-3s can be sourced from food, both animal-based and plant-based
You can simply go online and look up the various food based sources. But in thinking about headache and different treatments for headache, there are some recent studies exploring. How supplementing with omega-3 fatty acids and in one case, how supplementing with a mega Three fatty acids and deliberately reducing the amount of linoleic acid, the omega-6 fatty acids, how that can impact headache. So, the first study I'd like to describe in reference to the role of omega-3. Fatty acids in headache was published in 2018 and the title of the paper is long chain.
I
got three fatty acids and headache in the u.s. population. There are number of things. I really like about this study, a few of those include fact that they looked at an enormous. Number of people that is the included 12,300 17, men and women alike to factor, the included men and women in the study age, 20 or older and that they broke down the population into categories. That included age. They certainly looked at race and ethnicity. They looked at educational background, they looked at body mass total energy intake.
Which is really important. If you think about it, people are going to be eating and within the things that they eat, they're going to be consuming some Omega-3s, hopefully as well, some omega sixes, and if they're eating far more than they're going to get far more of likely going to get far more of both of those things, then they would ordinarily if they were eating smaller amount. So, they controlled for total, caloric intake in a way that I find particularly useful for looking at these kind of data. So, the reason they explored Omega-3s is worth mentioning omega-3 fatty acids are known to have
Of it, an anti-inflammatory effect that anti-inflammatory effect is mediated through a couple of different Pathways. We won't go into these in too much detail now, but the omega-3 fatty acids, keep in mind actually make up various parts of cells in the brain and body. That's right. The membrane that remember I talked before about steroid, hormones can go through the different membranes of the cells, the outer membrane, and the inner membrane, a lot of those actual membranes. The structural constituents of neurons and other cells are actually made up of or include.
A certain fatty acid, long chain fatty acids, and the omega-3 fatty acids are important for the actual construction of those tissues, as well as having anti-inflammatory effects through things, like, limiting prostaglandins, and other things that can cause inflammation, okay? So there are a bunch of different ways that omega-3 fatty acids can be useful. They refer in this study to an earlier study, that looked at the so-called analgesic effect, the pain, relieving effect, analgesic means pain. Relieving effect of omega-3 fatty acids in what had been a
- controlled trial. And in that previous paper, what they found was that diets high in Omega-3s and low in Omega sixes, okay? So high three, low six and as compared to diets that were just reduced Omega sixes, they found a greater analgesic effect of increasing Omega-3s. While also reducing omega-6 fatty acids. So in the context of the seed oil discussion, although keeping in mind that omega-6 is can come from other sources as well, if Omega sixes were just reduced on their own,
There wasn't as great, an effect, in terms of reducing pain and inflammation, as there was, when Omega 3 fatty acids, were deliberately increased, and omega-6 fatty acids were reduced again, in all of these studies. Because these are the ones in which they controlled things. Well, as we should, as we say, they are holding constant, the caloric intake. So it's not just that, you're removing fat, eating less fat. There's actually a removal of certain fats and fatty acids in a replacement of those with omega-3 fatty acids and one case in the other
It's just a reduction in Omega sixes and you're using other food types and macronutrients to offset that reduction in calories. Caused by reducing Omega sixes. The basic takeaway that they're relying on marching into the study is that increasing Omega-3s, and reducing Omega sixes seems to be beneficial for reducing pain. And indeed, in this study, they find something quite similar, which is that when you hold caloric intake, constant, and when you look at Omega sixes, whether or not you, decrease omega-6 fatty acids or not,
You find is that increasing, omega-3 fatty acids in the diet. So either consume through food sources, or by supplementation was associated with a lower prevalence of severe headache, or migraine. So severe tension type headache or migraine. So this is promising and points to the fact that long chain. Omega-3 fatty acids are likely to have either a pain reducing and there's evidence for that and or inflammation reducing effect that can significantly reduce the severity.
E of headache in both tension type headache and migraine. So that's the first study. The second study is a more recent study was published in 2021 that used a I would say a more or less similar. Type of overall design is the one I'd refer to earlier the title of this paper is dietary alteration of what they call M3 but those are Omega 3 and N 6. Omega 6. Sorry for this shift in nomenclature. I didn't write the paper dietary alteration of
Omega-3 and omega-6 fatty acids for headache reductions in adults, with migraine, and this was a randomized control trial randomized, control trials. Involve having people being one condition where they do one thing and then they get swapped randomly into another condition. So they serve as their own internal control and that controls, for all sorts of things like differences in sex, differences, in age differences in health background in any number of other variables. Asbestos one can in this study they had people either ingest a diet that
It had increased Omega-3s, so increased EPA and DHA or increased EPA and DHA and reduced amounts of linoleic acid, okay? So that's going to reduce Omega sixes or a control diet, in which they had people, taking boats, essentially, the average intake of Omega-3s and omega-6s and you can probably already guess what? The general results of the study are going to be the general results. Were that there were reductions in headaches?
Okay. The really cool thing is, is it was a massive reduction in headache. Okay. This was they refer to it as a robust reduction in headache, in particular for the subjects that increase their Omega-3s and reduce the amount of linoleic acid that they took the other thing that I really like about this study is that while they don't know the exact underlying mechanism for the effect, they did spend some time.
Delineating. What it is that the omega-3 and omega-6 fatty acids are likely doing to either offset or exacerbate headache. Now, I didn't say that omega-6 fatty acids, exacerbate headache, but it does seem that people who ingest more linoleic acid in omega-6 or experiencing more inflammation and that is evident in a bunch of different conditions. One for instance is are increases in things like CG R PC. G RP is a molecule that's associated with the calcium. Signaling pathway is involved in vasodilation the
Mansion of the blood vessels and capillaries and that's known. As I mentioned earlier, to exacerbate, certain forms of headache. Okay, there are also forms of headache that can be caused by vasoconstriction. Will talk about one very dramatic example. Perhaps as we get toward the end it's a very uncommon example but it's called Thunderclap headache and trust me you do not want Thunderclap headache and so we'll talk about Thunderclap headache. Little bit later that involves constriction of the blood vessels. In any case,
In this paper, they, they didn't study mechanism directly, but they're resting on this known analgesic anti-pain, as well as known anti inflammatory Pathways related to increasing omega-3 intake, and simultaneously resting on the idea where I think there's I think we now can say, conclusion, that omega-6 fatty acids in particular linoleic acid can increase inflammation by way of increasing things. Like see grp vasodilation and some other pathways
Ways related to the so-called inflammatory cytokine Pathways and there's a whole discussion nowadays. What's called the inflammatory? Mm. So the basic takeaway is that if you are interested in reducing headache, it may be beneficial at least according to these two studies. And another one I'll talk about in a moment to increase amounts of omega-3, fatty acids, and that can be done again through the ingestion of foods. Although, based on the dosages that we'll talk about in a moment increasing. Omega-3 fatty acids by taking liquid form fish oil,
Perhaps the most cost-effective way to supplement, Omega-3s or capsules, which is perhaps the most efficient way to supplement, Omega-3s really, to a level of 1 gram or more of EPA per day. Again, that's the EPA form in particular. So if you're for instance, taking supplemental fish oil or you're getting your Omega-3s from food and you're getting what you determined to be 2,000 milligrams or two grams per day of Omega-3s, keep in mind, that's going to include EPA and DHA.
And it does seem the getting above one gram per day of EPA. Omega-3 fatty acids, either through food or supplements or both is going to be the critical threshold for reductions in the frequency and intensity of headaches that include both tension headaches and migraine headaches. Now some people will find actually that ingesting far more omega-3 fatty acids generally through supplementation but again can be accomplished through Foods as well. Can also be beneficial for other things, such as mood and indeed there's a whole
You're related to effects of ingesting 123 grams again, 3 grams per day of EPA. So that's going to require quite a high intake of Omega-3s in whatever form or supplement you decide to take those into your body, but that can improve mood and so forth. The basic range that I was able to find in the meta-analysis. Oh meta-analyses. Are where a researcher will? Look at the results of a bunch of different studies focused on the same thing. Look at the different strengths of those studies, they'll do all sorts of
Cool statistical. Gymnastics. Like, remove the most potent study, the one that had the greatest effect and see whether or not, there's still an effect of some treatment or, for instance, they will swap in and out different studies and different combinations to see whether or not anyone study is really leading to the conclusion that a given treatment does something. In any case, in the meta-analyses of omega-3 fatty acids, for the treatment of headache and that includes all the different kinds of headache, they found in exploring a huge range of Omega-3 supplementation range.
From 200 mg all the way up to 2,000 milligrams per day. It really was at the one gram or higher dosage per day where the significant impact on reducing headache frequency and intensity was found and just very briefly earlier, I mentioned that not only as omega-3 fatty acid, supplementation been shown to be effective in reducing the frequency and intensity of headache, intention type and migraine type headache, but it's also been shown to improve outcomes for premenstrual syndrome related.
Headaches, these are what we refer to earlier, as hormone based headaches. Again, the low estrogen low progesterone associated with certain phases of the menstrual cycle, as well as other phase of the menstrual cycle are often associated with headache, in a study entitled effective, omega-3 fatty acids on premenstrual syndrome, a systematic review and again, meta-analysis, what they found in here, I'm paraphrasing. The conclusion was that omega-3 fatty acids could, yes, effectively reduce the severity of PMS.
X. And one of the symptoms in particular that they found with that was reduced, was the pain related symptoms associated with headache. And they actually had some very nice hypotheses as to why that likely would be. And, in fact, point out that in earlier, studies omega-3 fatty acids have actually been considered as non-steroidal anti-inflammatory, drugs, in some cases, and indeed, there are prescription forms of omega-3, fatty acids. And I highlight that not because I think people need to run out and get the prescription form of. Oh.
Omega-3 fatty acids are actually quite hard to obtain and quite expensive, but because I think often times when we're talking about something like omega-3 fatty acids, the fact that they are available over the counter in a supplement or by liquid or available in food for that matter. Leads many people to conclude that, oh, you know, this is supplementation. This is something that you know, it's going to have relatively weak or minor impact on things like head ache or other health metrics. But let's just say that the fact that it exists as a
Scription drug and its highest potency form least, in my opinion points, to the potency of omega-3 fatty acids in dealing with analgesic effects. That is reducing pain and anti-inflammation as well as some of the known cardiovascular improvements that are associated with increasing omega-3, fatty acid intake, put simply Omega-3s are not just something that comes from food or supplements. They are also being marketed as prescription drugs. So I do think they need to be considered as quite potent. And at least as far as these papers,
is that again, include meta-analyses, of many other papers, and datasets indicate that supplementing with omega-3 fatty acids to a point where you're getting above 1 gram per day of EPA is not just going to be beneficial for treating and reducing the frequency, and intensity of one particular type of headache, but many types of headaches, and when you combined hormonal headaches, tension, headaches and migraine headaches, you account for More than 70% of the total types of headaches that are out there, the effects of Omega-3s on,
A takes in some of the other types of headaches, least, to my knowledge have not been evaluated. There's no reason to think that Omega-3s would not be beneficial for those types of headaches, but at least as far as the datasets, we talked about here are concerned, it is clear. Omega-3 fatty acids are going to be a very potent way to reduce pain and to reduce inflammation in ways that can reduce the frequency and the intensity of different kinds of headache. Before we continue our discussion about many not commonly
Known and yet very potent treatments for different forms of headache. I want to touch on a topic. We mentioned a little bit earlier and also provide a treatment that is it a way to alleviate something and that's a photophobia and Aura. Now, keep in mind that earlier, I referred to Aura as this sense that something's about to happen. That is true. And that meaning, that is an accurate description Aura. But oftentimes people also come to understand Aura as the feeling that something surrounds a given object visually or
That people have a sense that something's around them so in this can be a little bit vague but this idea that aura is a sense of something about to happen or that visually or in an auditory way in or maybe even in kind of a sense that something is about to happen in a certain environment and the reason I'm making kind of Arc shapes with my hands, for those of you, they're just listening and making art shapes with my hands. Is that aura is often described as kind of a Halo, or a emanating out from from one's body or from something that they're looking at.
That again, nothing spiritual about this in the context of the discussion about migraine and headache. But rather many people experience photophobia sometimes with are sometimes know and I just want to touch on a couple of the mechanisms by which or and photophobia occur. And mention just briefly a pretty well-established way that people can start to offset photophobia. And again, I mention that because many people experience photophobia and headache, but there are also a number of people that experience photophobia, even if they don't,
Of intense headache. So photophobia is pretty common, pretty debilitating it, actually. It's one of the reasons why people feel not well and need to leave work or not. Go to school or, or leave school. These kinds of things or lay in bed all day, or dim the lights. Not go outside. Again, sunlight being so congruent with health, you can imagine how photophobia can lead to all sorts of - Downstream consequences. Okay. So what is Aura and what is photophobia the exact origins of ära aren't exactly clear.
But it is generally thought that what Aura represents is what's called spreading depression and this is not depression of one's mood although it can be associated with that. This is depression of neuronal activity again neurons communicate with one another by generating electrical impulses that travel down the length of their of their so-called axons which are like little wires and then they dumped neurotransmitter out at the so-called synapse and impact the electrical activity of other neurons depression.
Is a electrical or I should say a chemical-electrical chemo. Electrical is the proper term phenomenon in which the excitability of neurons is reduced. So again doesn't have anything to do with depression as a mood State per se rather, it is a reduced excitability of neurons and it's been shown in some Imaging studies that aura is associated with a back to front. So from the back of the brain to front spreading depression like a wave.
Of lowering levels of electrical excitability. And because this originates in the visual cortex, which is in the back. So that's the part of your brain. That is making sense of visual images coming in through the eyes and relayed through other stations in the brain that people will start to see a kind of Halo of light or that they'll start to feel that the light around them is literally surrounding their body or some other object or body that they're looking at and then it spreads forward in the brain and that's when
Tends to stretch over into other so-called sensory, modalities sensory, modalities being things like touch or hearing. So people will get the sense that kind of seeing something in their periphery of their Vision. Then they'll start feeling something around them. There's a sense that something's about to happen. So is this spreading wave of depression, goes from Back to Front. People experience a number of these different semi-abstract sensory phenomena that we Call Aura, okay, so that's how or originates. Now, photophobia is a little
bit different. Photophobia We Now understand because of some beautiful work that was done at Cliff's a lab at Harvard. Medical School and some other Laboratories showing that photophobia originates from a specific set of neurons. In the eye, we call these the intrinsically photosensitive, melanopsin ganglion cells, which is really just a mouthful of nerd. Speak for neurons in the eye that connect to the brain. These so-called ganglion cells that respond most robustly too bright.
Blue
light or other short, wavelength light. So you got short wavelength light that is blue and greens are short wavelengths and then long wavelength light, which is red or it can even be out. Password will be infrared. We don't detect infrared consciously. Other species do like pit vipers can see in the infrared. They can even heat sense. So short wavelength light is going to be light. That's that's bright blue green. It's what's very common in fluorescent bulbs that are commonly used in household lighting and workplace.
Ting and other forms of artificial lighting. It's also of course, present in sunlight sunlight includes a huge range of wavelengths, including long, wavelength light, of course, you've seen that as the Reds and oranges in the sunset. And so, on those intrinsically, photosensitive retinal ganglion cells in the eye respond, best to bright, green, or blue light and they send connections to a bunch of different places in the brain, including the so-called sir Central circadian clock. Suprachiasmatic nucleus that sets your day night. Sleep-wake rhythm
This is why I encourage people to view sunlight in the morning to set the system in motion to avoid bright light exposure at night, from artificial sources. In order to not, send wake up signals from the eye to the brain and then on to the rest of the body, but these insurance is actually photosensitive. Retinal ganglion. Cells are also known to connect with other areas of the brain. Many other areas of the brain, in fact, and one of the important areas of the brain that connect to, as it relates to photophobia is an area of a structure called the thalamus. The thalamus is an egg like
Lecture that sits in the center of the brain and it serves as a, kind of a switchboard and like, a sensory relay by, which information coming from the eyes from the ears from The Touch system Etc. Are funneled into different compartments in the thalamus and then sent to different other areas of the brain. So, think of it, kind of an old-fashioned switchboard or you could think of it sort of like a in an airport, you go to a particular wing of the airport then you go to a particular gate and so on, you're getting funneled, progressively through narrow.
Our channels until you arrive at your particular plane much in the same way the thalamus has a bunch of different entry points. So it's sensory information coming in from a bunch of different sources and those sources get routed into progressively narrower and narrower funnels to eventually arrive at the accurate place for their function. So these intrinsically photosensitive ganglion cells. Send connections to a small but important area of the thalamus called LP. It's denoted L the letter and P would lateral posterior thalamus.
Me or the I should say. It's the lateral posterior. Nucleus of the thalamus for you, if a scene Otto's out there and then the neurons in that location are going to respond. That is there going to be activated by bright, blue light, green light, or any kind of bright light originating from artificial sources, or from sunlight. And the neurons there that respond to that have a very interesting pattern of connections. They send connections up to the so called sensory cortex. So a bunch of different layers throughout the cortex that are not.
Associated with visual perception that is, they're not associated with understanding that there are shapes and Contours in the environment. But rather to neurons that are involved in the detection of pressure, pain and other forms of sensory information at the level of what the meninges we talked about the meninges earlier. So again, while the brain itself does not have a sensory system to detect pain. The tissues around it do and the tissue.
Is around those tissues. That is the stuff around the meninges themselves can respond to pain and intracranial pressure is also relayed through the meninges to our conscious awareness that there's pain. So what does this mean for photophobia, it means that bright blue light and green light. And of course, light from sunlight, will activate these neurons in the eye, these intrinsically, photosensitive ganglion cells, which then activate the lateral posterior neurons, LP neurons. And those LP neurons communicate with areas of the brain that are
Perfectly tuned to different sensory phenomenon and in particular pain at the level of the meninges and intracranial pressure. What this means is that when we have headache or if we simply have photophobia on its own, that bright light is actually the trigger for pain sensing and even the creation of pain at the level of the meninges and intracranial pressure, what does this mean in terms of dealing with or treating photophobia? Well, most people deal with photophobia by deciding to
turn off or dim all the lights and simply getting under the covers or wearing a very low brimmed hat and putting on sunglasses and they want to lie down and sometimes because migraine can be associated with nausea or even vomiting and it's a fear cage instances rather. But one very simple way to avoid activation of these retinal ganglion cells, that would trigger photophobia is that, if you are starting to feel like you have a migraine coming on, or you have photophobia coming on to shift to using patterns of light that
The
longer wavelength domain. What that means practically is Shifting to using very orange, ideally dim, but very orange and red light. Now, this is not a call for people to go out and invest in expensive, red light therapies admittedly. There are some excellent case uses for red light therapy particular for acne wound healing, even for improving Vision, especially in people beyond the age of 44, some hormone augmentation. We talked all about that in the
That I did on light and health. Again, you can find that at huberman lab.com, everything time-stamped. What I'm talking about here would be simply having some red light, bulbs, on hand, for any time that you need to remain awake, but you're starting to experience photophobia these red light bulbs can be purchased very inexpensively. You know, as party lights, you can buy these online. So there is no specific need to get any, I would say, red light, that's designed specifically for photophobia or anything of that sort, you can find the
Red light available out there and those will simply work. The idea being that for many people who are experiencing photophobia, they want to reduce that feeling of pain and pressure in their head experience through. Photophobia they also might want to stay awake, get some work done and do things. So operating at a red light or I should say living working, Etc, under red light would allow you to stay awake. Not have to hide under the covers if you're experiencing photophobia in addition and I mentioned this at the beginning of the episode, but many people find photophobia to be a entry,
A point or a trigger to headache. So what happens is they start to experience some Aura and some onset of photophobia and then the photophobia itself leads to this feeling of malaise that then converts into headache. And so, while there are not a lot of clinical data on this, just yet an emerging idea in the realm of headache treatment is the idea that if you can offset some of the early signs, you can offset some of that photophobia Andorra, perhaps the use of dim red lights, or red lights as I've described a moment ago then,
Might
be able to reduce the probability that you're going to have a migraine or other type of headache entirely. So again, no need for expensive red lights but you can find red lights, very easily online and simply we have them on hand to replace the current lights that you have on your nightstand or in or, in whatever room you happen to be on with these red lights. These red lights are also. I should mention very useful in limiting the amount of cortisol a stress hormone that is very healthy for us to release at high levels early in the day. In fact, viewing sunlight will increase of cortisol levels is another reason why?
What I'm about to say is relevant to photophobia, but if you want to keep cortisol levels low in the evening and at night and indeed you do and improve the transition to sleep and indeed your sleepover all producing cortisol at evening. Time in a nighttime is extremely beneficial and red lights will help you accomplish that. I talked about that in the episode on light and health. So the point here is that if you suffer from photophobia with or without Aura, using red lights and not simply dimming ordinary, artificial lights or feeling that you have to turn off all lights and
Lee is going to be one relatively inexpensive or I should say it very inexpensive in some cases because these red lights can be found very inexpensively online. Way to be able to continue with your daily activities, at least in an indoor environment if you are suffering from photophobia. So shifting back to ways to reduce the intensity and frequency of different kinds of headaches. We haven't talked so much about tension headaches, specifically. So that's what I'd like to do. Now, as you recall tension, headaches are going to be muscular and origin again.
Keeping in mind that everything is normal when it comes to pain, everything is normal when it comes to everything. Frankly because every organ and tissue system in our body is ultimately controlled by our nervous system. But tension, headaches are often associated with tension of the muscles that are on the skull of the jaw of the neck and can be quite painful for many people and debilitating in the most common treatment for this that most people rely on that is is to take non-steroidal anti-inflammatory. So things like acetaminophen ibuprofen.
Finn, sometimes, aspirin, and things of that sort, and often times those can be helpful there, a couple things to keep in mind. However, the NSAIDs non-steroidal anti-inflammatory, drugs, often times will work very well at first, but people quickly, develop a tolerance to them, meaning they're going to have to take more and more in order to get the same effect. And often times, they can't take more and more because some of them are very hard on the liver. And in addition to that, some of them can offset some other things that you really want. So, for instance, it's now
Known that non-steroidal anti-inflammatory. Drugs can offset some of the benefits of exercise and that makes sense. Because a lot of the Adaptive benefits of exercise actually come from experiencing a lot of inflammation. Acutely, that means you actually want inflammation during a resistance training workout or even your endurance workout, but then, that inflammation triggers an adaptation event or series of adaptation of events that leads to Greater strength, greater speed, more muscle, more endurance, whatever it is that you happen to be training for so reducing pain, can be good, of course, but not, if you have to take more and more of a given drug,
That it has side effects on the liver and can offset the effects of exercise and so forth. The other issue with non-steroidal anti-inflammatory drugs is that many of them simply do not work for many people or again, they will work the first time in the second time, but then they stopped working. They also tend to lower body temperature, I think most people are aware of this, because many of these same drugs are used in order to reduce fever. But if you are taking non-steroidal anti-inflammatory drugs simply to reduce your headache and you're lowering core body temperature that can have all
All sorts of Downstream issues related to sleep-wake Cycles, to metabolism, to immune system function, more generally and on. And on for that reason, there's been a quite a lot of exploration of alternatives to non-steroidal anti-inflammatory drugs for the treatment of headache and indeed pain generally, but today, we're talking about headache. Now as it relates to Tension, Headache, one of the more advanced, kind of modern treatments that you sometimes hear about is Botox, right? Botox, I think most people are familiar with
As the thing that people get injected into their face around the eyes or around the lips or elsewhere in order to quote unquote reduce wrinkles. It was discovered some years ago when Botox treatments were being done. For cosmetic reasons that it could often be very effective for relieving headache. If injected into the muscles and the way that it works is that, of course, Tension Headache, involves a tension of the muscles, kind of a, we'll call it clenching, or cinching up in the muscles. But we're really talking about is contraction of the muscles and that's controlled by
Neurons neurons which are neuromuscular so neuromuscular neurons. Don't form synapses with or connections with other neurons. They form synapses with muscle, they release, acetylcholine on to the muscle in that makes the muscle contract. This is the way you move the limbs of your body. This is also a the muscles of your head contract and can give you tension, type headaches, Botox arises from, or is rather botulinum neurotoxin botulinum. Neurotoxin is a toxin that's found.
In canned goods. Not all canned goods, of course. And what it does is it prevents a certain step in the release of so-called neurotransmitter in the little packets that they live in, which are called vesicles little little spheres of neurotransmitter live at the end of neuron nerve Terminals and a released onto the muscle. Make the muscle contract botulinum neurotoxin Cleves, a particular protein in there for you. If it's, you not is want to look this up. It's a really cool mechanism. It Cleaves something called, Snap 25, snap 25.
Is involved in the fusion of those little spheres with the membrane of the neuron and releasing of the neurotransmitter. So, when botulinum neurotoxin is present at the nerve muscle interface, those nerves cannot communicate with the muscle. And as a consequence, the muscles undergo kind of flaccid tone. They just kind of relax there underneath the skin. Sure, wrinkles are relieved. But if Botox is injected into the muscles themselves, it can provide long-lasting relief of certain types of headaches, in particular tension,
Headaches. So while it seems like a bit of an extreme treatment people who suffer very badly, from tension, type headaches, due to hyper contraction of the muscles of the forehead or around the temples, around the Jaws, or the or certain parts of the, the neck, and the musk muscles of the neck that encroach on the, on the back of the skull, or that actually connect to the back of the skull can achieve tremendous, long lasting relief, from these Botox injections, sometimes, for weeks, or months, or even longer people, go in for periodic, you know, real,
UPS of Botox, it actually is quite safe to despite the fact that botulinum neurotoxin is quite dangerous. It's given in very low Doses and given locally. So those are the only muscles affected so that's how Botox is used to treat headaches and it's a very effective treatment at that. Of course many people I imagine are interested in not just drug based treatments and not Botox type treatments for treating headache. But other types of treatments for headache that are of the more sort of let's call them natural or
Non-drug treatments. And here we're starting to get into the realm of the herbal and oil based treatments for headache. Now, I confess when I first started researching this area of headache and treatment for headaches that is, I found myself approaching it with a bit of trepidation because when I started to hear about essential oils and about herbal medications and things of that sort, I thought okay well they'll probably be some effects. I mean admittedly we've talked before on this podcast about things like apigenin apigenin is
One of the core components of chamomile and chamomile is known to make people feel a little bit sleepy and can enhance sleep well, apigenin and high concentration can indeed augment sleep. We talked about this in our sleep toolkit. By the way, we don't just have episodes about sleep. Masters sleep. Perfect, your sleep etcetera. But if you go to the huberman lab.com website, and you go to the menu and you click on newsletter, you can scroll down, you'll see that we have a tool kit for sleep is completely zero cost to access. You don't even have to sign up. Although if you like to sign up for future newsletters, you can get those
One of the key components of the toolkit for sleep, in addition to behavioral tools and things that are not supplement based is apigenin, which is this component from camomile. So the idea that certain herbal derivatives were herbs or Oils could be very useful for improving symptoms of whatever. In this case improving, sleep with apigenin is not unheard of. And in fact, the data continue to be released all the time that many of the things that we think of, as herbal Etc,
I actually have quite potent effects. And so while I myself, it was approaching the discussion about essential oils and I should say, or Oils, right? Who's to say, if there are essential or not oils and herbs in the treatment of headache? I finished out my research on this literature feeling quite, I should say surprised. And, and as if I need to really check myself a bit because what I found is that there are certain herbs and oils for instance that far out.
Non-steroidal anti-inflammatory drugs for the treatment of headache. That's right. There are certain oils that are available over-the-counter that when looked at in many studies meta-analyses and I'll tell you about one particular study and a minute analyses. And the moment they show that they can reduce the frequency and intensity of headache in a manner that far outpaces What You observe with non-steroidal, anti-inflammatory drugs with apparently, none of the same issues associated with non-steroidal anti-inflammatory drugs. So I think it's really
Worth paying attention to the first of those studies. I'd like to describe to you is one that has now become kind of a classic in the literature I should say at least for those that are interested in the a typical treatments for headache. And the title of this paper is effective peppermint and eucalyptus oil preparations on neurophysiological and experimental algiz metric, headache parameters. Okay, what does that mean? Well, this is an interesting study because rather than look at the effectiveness of peppermint and eucalyptus oil and other oils on headache,
Did is because they want to look at the mechanisms underlying headache which I confess. I love the fact that they want to understand the neurophysiology and not just get subjective ratings of headache. Although they did that too. But it really want to understand how these oils can impact, things like muscular tension or perception of pain. What they did is they recreated headache in human subjects by using tightening, cuffs of the of the head, they cut off blood supply, to certain areas of the head, they basically induced headache and then they measure
Things like the EMG, the muscle response at the level of electrophysiology in the muscle. And of course, subjective measures of how much people perceive to be in pain or not in pain. I'll give you the broad Contour the study because I want to make sure that it's the conclusions that come through most clearly and we will provide a link to the study in our show, no captions. So what they did is they had people use one of four different preparations. Say preparation one, which includes some peppermint oil, and some eucalyptus oil and all the details about the
Mount in the relative percentages are in the paper for you to peruse online through the link I mentioned before. So they had four different groups, they had one group apply peppermint oil but that peppermint oil also contained eucalyptus oil. They had another group used, just peppermint oil. Had another group use, just tiny traces of peppermint oil and smaller doses of eucalyptus oil. And then they had a fourth group, which was just using Placebo. And I say, using what they were doing is they were sponge applying
The oil to the temples and forehead of people. And then what they did is, they use these different approaches to measure the activation of muscles to measure pain and they then induced head paint. They induced headache. So and they looked at the temporal muscles on the side. They look at forehead muscles, things of that sort. So they use three different types of pain stimuli. They looked at people's sensitivity to experimental e induced Pain by either providing
So this was kind of a cough around the forehead or thermal pane. So they actually had them basically heat that heated up at the level of the skin and actually they brought the heat up pretty high to the point where people were raiding, the pain almost to the point of excessive pain and pain limit so obviously couldn't take them to the point of extreme pain and they had a constriction type condition in which they cut off. Blood circulation to the pericranium muscles using an
Relatable collar around the cranium, and then inflated that to pretty high pressure. So, kind of a brutal experiment to be involved in. But look, they're trying to mimic headache. And I think by using these different approaches, they're able to mimic the different aspects of headache and make sure. And here's the key point that every person in the study is not just getting the same treatment for headache, but is getting the same headache and that's something that I think gives this study power. It's not the only way to do a study like this, but it gives it a lot of power and trying to understand which types of interventions are going.
Cysts in headache and maybe even specific dimensions of the pain and headache. And it basically what they found in this study is that of all the treatments, they used the essential plant oil preparations that contained peppermint, and I'll just mention as an aside and in other studies Menthol. So these minty type essential minty type what we think of as flavors, but are really a Roma's as well. And as I'll point out the mechanism in a moment, they have the effect of significantly reducing the intensity.
Density of the pain that is subjects. Could tolerate the pain far better and experienced less pain subjectively and the magnitude of the effects were really pretty impressive. Again, I went into all this thinking essential oils. Okay. That's like some really woo stuff. You know, I don't know about that. But it turns out that these essential oils, at least the ones that contain peppermint oil with or without eucalyptus oil perform very well in reducing pain. The key take away from the study is and here I'm paraphrasing from the study of that the
In a peppermint oil, eucalyptus oil. And these are basically in a ethanol suspension again, people are not drinking these essential oils. I want to be very clear. They're applying these to the, to the skin around the area. That's in pain and particularly the temple and the foreheads increased cognitive performance. I didn't talk about that, but this is the ability to maintain cognitive functioning while in pain. You know, here we're talking about headache up until now just as kind of pain but that pain can be very debilitating for your ability to work and perform and do other.
Oh things. So this combination of peppermint oil and eucalyptus oil applied to the skin. Allow people to increase their cognitive performance, while under pain and had a very muscle relaxing and mentally relaxing effect. Mental relaxation was, of course, measured subjectively. But remember, one of the things that led me to feature this study, in this episode in particular, is that they didn't just say, oh my muscles feel more relaxed. They actually saw that the muscles of the forehead and temples and some surrounding muscles were more.
Next when people had these oils on applied to their forehead and the temples not perhaps to the same degree, that one would observe with botox, or for the same extent or duration as one would experience with botox, but much in the same way, which then raises the question of what's going on here. I mean, is this all placebo effect will know because they compared to Placebo and they controlled for the odor, of course of the oil that was applied so that everyone thought that they were getting essentially the same thing pun intended. But in this case,
what they found is that if they applied the essential oil to the forehead and temples that people experience a more less a cooling sensation or they could feel as if something was happening in the underlying muscle. Well, what was happening? We now know that Menthol peppermint and other things, that smell that way and taste. That way actually have an impact on the sensory neurons, at the level of the skin and can actually inhibit certain sensory neurons and can activate
Other Sensory neurons. Okay, so in order to understand this, we have to go back to what I said at the beginning of the episode, which is that you have motor neurons, these are neurons that constrict muscles or excuse me that cause contraction of muscles. They don't constrict them. They cause contraction of muscles, you have Sensory neurons which sends different things, light sound, or touch, and you have modulatory neurons Menthol and Eucalyptus are actually known to activate certain channels in the sensory neurons. That respond, not just a touch but also the
Ian of cooling. Okay, so when we think of Menthol and peppermint, we think of kind of cool sense and flavors, cool, meaning cold. And when we think of things like hot peppers, capsaicin we think of anything that has a hot temperature. We tend to think of spicy so spicy and hot go together and peppermint and Menthol and cool go together much in the way that the gum commercials are the mint c'mere commercials would lead you to believe. And in fact, they're right. So, what's happening here is that
Application of these oils is very likely activating channels in the sensory neurons, including the trip channels, but others as well that are leading to the analgesic effect by shutting down the heat and pain. Pathways because heat and pain. While they're not exactly the same in our nervous system they are funneled through common Pathways where has Cooling and Pain Relief are funneled through alternate what we call parallel Pathways. So this study on peppermint and eucalyptus oil preparations in reducing
The pain of headache and different aspects of pain due to headache. I think a really important because they don't just illustrate the fact that yes, indeed, I'll go on record saying it because that's what the data say. And there are other papers to support this statement as well. Essential oils applied to the skin, can reduce the symptoms of tension headache, in a significant way and actually can lead to some offset of some of the cognitive defects seen with headaches. So that's itself, very impressive. I must say, but surprising for me, kind of put me in my place that somebody thought, oh,
Oils is going to be like, okay, but is actually seem to really hold some Merit and when you compare the magnitude of the effect even though this was an enormous number of subjects, you compare the magnet to the effect in a paper like this or similar papers on these essential oils to the impact of non-steroidal, anti-inflammatory drugs and they really hold their own and in some cases exceed the positive impact of anti-inflammatory drugs. So for that reason, I think we can look at peppermint oils and peppermint eucalyptus containing oils Menthol containing oil.
Has applied to the skin for the treatment of tension type headache. As among the more potent treatments available out there. Now, another way to approach treatment of tension headache is something that many of you have probably heard about before and then I've talked a little bit about on this podcast in previous episodes and that's acupuncture. We will do an entire episode all about acupuncture but much in the same way that essential oils. I think for many people not all but for many people are considered kind of Wu biology or people think of it as a very alternative medicine, keep
Mind that as the underlying mechanisms of things. Like these peppermint oils are starting to be discovered or a mega threes or starting to be discovered mechanistically. They hold up very well. There's a logic there, there's an underlying understanding of not just why they should work. But in many cases how they work in the same way, acupuncture, which of course, has existed for thousands of years has been used, very successfully to treat headache, and other forms of pain so much so that many insurance companies will now pay,
Or acupuncture, as an insured practice, not all but many will, and in addition to that, the scientific Community is starting to understand mechanistically how acupuncture works. So I don't want to make this the major Focus for now, but very briefly. There's a laboratory at Harvard, Medical School run by cheuku. Mossi, cheuku is well, known in the Neuroscience Community for doing excellent. Work in parsing the mechanisms of touch sensation and pain in particular. So not just touch it. The level of
But pain and pain Pathways. And in recent years, his laboratory has started to do studies on how acupuncture works because indeed acupuncture has been known to work to alleviate pain for a long time but the underlying mechanisms haven't been clear, what chufas lab has published now in excellent journals like nature science and other journals is that the precise insertion sites, have different needles lead to activation of sensory neurons and their Downstream Pathways in ways that can
potently reduce inflammation and that can be used to potently reduce the activity of certain muscles. For instance, muscles in the forehead and temples. So when you hear acupuncture can reduce pain, I think some people think oh well thirds needle sticking out of your face. First of all that was hurting and actually the needles are very fine needles and skilled acupuncturist can insert them without any pain or actually the person receiving it doesn't even usually recognize that the needles are in. That's how quickly and efficiently they can put them in and people don't detect any pain.
But that has been shown to greatly reduce pain, and particular headache, related, pain and back related pain, and some other forms of pain. Chew food is lab has shown that the specific needle, insertion sites can activate the sensory Pathways and can deactivate the sensory motor pathways, and now, you're familiar with Sensory neurons motor neurons and modulatory neurons and can modulate the activity of the pain Pathways by way of impacting. The
Activity of all sorts of different organs, including organs that give rise to some of the inflammatory cytokine. So basically what I'm saying here is that thanks to thousands of years of acupuncture and the maps of different insertion sites. We now know or I should say people have long known and people in the west are starting to adopt the understanding that acupuncture. Yes indeed it really does work for relieving pain and Laboratories both in the United States just to Foose and elsewhere are starting to find the underlying mechanisms.
Those
mechanisms include deactivation of the pain Pathways activation of some of the parallel Pathways that assist in shutting down pain or in relaxing, the muscles that are causing tension type headache as well as activation of neural Pathways that impinge on organs that then cause or reduce the release of molecules into the body that give us the experience of pain. So reduced inflammation and in many cases, increasing anti inflammatory Pathways. So, I just want to
Be sure to mention acupuncture, and a little bit of mechanistic understanding of why acupuncture works, because indeed acupuncture is shown to be quite effective for the treatment of tension, type headache, and to some extent migraine headache as well. So we talked about omega-3 fatty acids, we talked about essential oils, we talked about acupuncture, so this episode is starting to sound like alternative treatments to headache, including migraine. But I want to be very clear. This is not about alternative treatments, everything that I'm talking about here has a mechanism.
Take basis. And what we're talking about today are approaches to dealing with headache. That yes are typically over-the-counter compounds or are grounded in nutrition or in the case of acupuncture behavioral practices. But that are not necessarily meant as replacements for things like, non-steroidal anti-inflammatory, drugs or prescription drugs. Of course those things can still be taken many people drive benefit from them, but the goal is always, I believe I should hope for people.
To find ways that they can control their health outcomes and reduce things like headache using a minimum number of things that have other side effects. And that, of course, can also include the use of essential oils in conjunction with things like, non-steroidal anti-inflammatory, drugs, or the use of red light to offset. Photophobia in conjunction with any number of different treatments, either prescription or otherwise. So, I do want to make that clear and I especially want to make that clear as I transition to the next segment where I'm going to tell you about herbal.
It's for migraine. And this is based on what I consider a very comprehensive review. Of many randomized control studies. Indeed, the title of the paper is herbal treatments for migraine a systematic review of randomized, controlled studies. And this was published in 2020 and this contains an immense amount of information, so we will provide a link to it. For those of you that really want to dive deep on this, in this paper, they focus on a number of different reviews and Analysis of data focused on compounds for the treatment of migraine ranging from
And including things like Menthol and peppermint oil. So we already covered that. So, I won't cover that again in detail. But in this review, they highlight the results are referred to before plus other results, that show, that Menthol and peppermint oil can be quite effective in the treatment of tension type headache. And in this case, migraine headache as well. So that's interesting that Menthol and peppermint oils can be used not just to treat tension, type headaches, but migraine headaches as well. And they look at an enormous number of
Other types of herbal and essential oil, type treatments. Everything from coriander to Citron to damask, Rose chamomile, lavender, a bunch of things. So I'm not going to go through each and every one of these in a lot of detail. But I've tended to do today, and I'm going to do now is to highlight the most potent of these different treatments. Again Menthol peppermint oil being among the most potent in addition to that there's a particular pathway that's associated with headache and
When I say that, I mean the different types of headache, which includes the activation of this thing that we call CG R PC. Grp again is involved in this calcium regulation, pathway and leads to vasodilation of the vessels and arteries and capillaries in a way that can create pain. And this feeling of pressure inside the head, which can be very uncomfortable. Of course, now earlier in the episode, I mentioned that I was going to touch on caffeine and so I'm going to do that now. Now, the reason I mention caffeine is that there's
I sort of lure out there that if you have a headache drinking a cup of coffee can eliminate that headache. A few things about that point. First of all, if you are somebody who ingest caffeine every day and you do not ingest caffeine, you will indeed get a headache and drinking caffeine will relieve that particular headache. So it's absolutely true. That caffeine can relieve the lack of caffeine induced headache. That's sort of a duh, but that leads actually to a very important
Don't question. Which is why would that be the case? Well, it turns out that caffeine is both a vasodilator and a vasoconstrictor. How does it do that? Well, one of the main ways in which caffeine makes us more alert, is that it occupies The receptors for something called adenosine adenosine is a molecule that builds up in the brain and body more and more the longer we've been awake. It's one of the things that makes us feel sleepy. So when we drink caffeine, that caffeine occupies, the adenosine receptor and the
Anything cannot have its normal effect of making a sleepy when that caffeine wears off the adenosine combined. And we feel sleepy adenosine is a vasodilator. So when we drink caffeine because it blocks the effects of adenosine, there is a vasoconstriction associated with drinking caffeine. So if you have a headache, that is associated with excessive vasodilation and pressure in the head, indeed drinking some caffeine can cause some vasoconstriction by preventing that adenosine.
Way that would normally lead to vasoconstriction and you can get some relief from that headache. However, caffeine is also a vasodilator caffeine has the ability to impinge on the so-called no pathway. The nitric oxide pathway, which is a nerve to blood pathway. That involves a few different enzymes that we won't get into right now. But maybe in a future episode, that causes dilation of the blood vessels. And as a consequence drinking, caffeine can also increase vasodilation, so, it's sort of a two-pronged effect. Now, one of the ways in which you might
Think about this in perhaps utilize this is that if you are well rested or if it's early in the day and you've had some sleep previous night, adenosine levels are very likely to be low, especially if you slept very well. The night before under those conditions, when you ingest caffeine, you are not going to experience the vasoconstriction effects of caffeine that would ordinarily be there by inhibiting adenosine. Why? Because adenosine is not present at all and under those
Those conditions drinking coffee ought to lead to some vasodilation, not a lot, but nonetheless vasodilation, if however, you haven't slept well or it's late in the day and you've been up for a long time, drinking caffeine is likely to have more of a vasoconstriction effect. And this is important, because some of the treatments that you hear about that involve, using caffeine to treat headache are as Extreme as okay. If you have a headache at night, drink a cup of coffee, and then go to sleep. I actually saw that in the literature, which I couldn't quite believe, because yes, indeed some people can fall asleep after
Caffeine. But we know very well, thanks to the beautiful work and science Communications of people like dr. Matthew Walker from University of California Berkeley, and who's been a guest on this? And many other podcast that even if you can fall asleep, after drinking caffeine ingesting caffeine within the 10 to 12 hours prior to bedtime is simply not a good idea because of the ways. It disrupts the architecture of sleep. So what's the takeaway about caffeine and headache and vasodilation? You need to be very clear on whether or not caffeine tends to remove your headache or exacerbate. It. Now this is
Going to depend on time of day and the amount of adenosine your system as I mentioned before. But also there seems to be a kind of bimodal distribution whereby some people when they drink caffeine it really improves their headache. That's a in some cases, a very significant effects. Whereas other people when they drink caffeine it really exacerbates their headache. And as least, as far as I could tell from the literature it's not easy to predict who those people are going to be, what is reassuring? However, is it does not seem to be the case that if you're somebody who experiences relief from headaches by drinking caffeine that suddenly
One day to the next, you're going to experience a worsening of your headache and vice versa is also true. So if you're somebody that drinks caffeine in your headaches, get worse, I don't think there's any reason to think that caffeine one day or from one day, to the next rather is going to somehow alleviate your headache. So you have to determine for yourself with a not headaches are relieved, or exacerbated by drinking caffeine. And if you're wondering, why it's so confusing, it's because caffeine hits. Both the vasodilation and the vasoconstriction Pathways and there's nothing you or I, or anyone else can do about it. Now, the last thing I'd like to talk about in terms,
Of relief, for headaches is something that I'm guessing about, probably, 25% of you are familiar with and 75% of you are not, which is curcumin. Curcumin is often also referred to as turmeric and turmeric is a root. And curcumin is one of the key components of that route, curcumin is known to have very potent anti-inflammatory properties. I don't think that's debated at all. In fact, it's so potent as an anti-inflammatory, that some people have cautioned against taking high levels of Kirk.
Prior to, for instance, resistance training workouts or even cardiovascular workouts, because it so prevents inflammation that it also can prevent the adaptation response. Because remember the inflammation that occurs during exercise, both resistance, and cardiovascular exercise is at least in part the trigger for the adaptation that it's going to lead to enhanced endurance enhanced strength, hypertrophy, Etc. Nonetheless, curcumin has been explored in the context of treatment of migraine and it's one of the compounds that was
I analyzed in extensive detail in this wonderful review, that I mentioned a little bit earlier. What I like about this study is that they were able to explore the effects of curcumin as explored in previous research, studies, and compare those across a large range of different dosages and a large range of combinations with other things like coenzyme, Q10, which we've talked about on this podcast before but I think for sake of this discussion just really focusing on what curcumin does alone or
Conjunction with the omega-3 fatty acids, is what turns out to be the most interesting. First of all curcumin has been shown to be generally safe for most people at dosages, as high as eight thousand milligrams per day or eight grams per day. Now, I want to be very clear, I do not recommend that. Anyone take dosages of curcumin, AK tumeric. That are that high. Why? Well, curcumin and turmeric not only are anti-inflammatory but they also can impinge on other Pathways in particular. Hormonal pathways
And in fact, curcumin AK, turmeric can alter the synthesis of something called dihydrotestosterone. Dihydrotestosterone is involved in an enormous range of different bodily functions. It's involved in libido. It's involved in men and beard growth. And in the regulation of of number of different issues both in the reproductive access and outside the reproductive axis, and curcumin is a potent inhibitor of DHT. So I do want to caution that people who take high doses of curcumin and some people who are very sensitive
It of curcumin will even at low doses experience reductions in DHT that lead to things that they would not like such as sufficient reductions and libido. However curcumin has been shown to be effective as an anti-inflammatory and has been shown to be very effective in treating different types of headache and particular migraine headache. One of the ways in which curcumin does that is to inhibit. This thing that I talked about a few minutes ago which is nitric oxide or no, which causes vasodilation
And in doing that can reduce the feeling that one has a lot of intracranial pressure. Okay, so, curcumin dosages come in an enormous range. As I mentioned before dosages, that range anywhere from 80 mg taken, 80 milligrams per day that is taken for eight weeks time. That's been examined. It's been explored at 80 milligram dosage has taken alongside two and a half grams of omega-3, fatty acids, or omega-3 fatty acids alone.
And against Placebo. And the general, conclusion of these studies is that curcumin when taken it at dosages of about 80 mg. Although, for those of you very sensitive to curcumin, probably as low as 25 or even 50 milligrams per day in conjunction with. Although not necessarily at the same time, but taken daily, alongside omega-3 fatty acids at two, and a half grams per day, led to significant improvements in migraine and other forms of headache.
Meaning both the frequency and the intensity of the headaches that occurred was greatly reduced. One important point about curcumin to keep in mind is that curcumin is known to inhibit something called cytochrome p450, that's associated with an enzymatic pathway and some other things that relate to blood coagulation. So for people that are taking medications that are anticoagulants to prevent clotting, you do need to be very cautious about using curcumin. And of course with curcumin or any other supplement, you should always talk to your doctor.
Prior to including it or removing it from your supplement regimen. So as you can see there are a number of different things that in addition to prescription drugs and over-the-counter pain medications. Things like non-steroidal anti-inflammatory, drugs can really impact the different aspects of headache and different types of headache and some cases differentially. Now, today we talked mainly about tension, type in migraine type headaches because those are the most common forms of headache. There are, of course, the cluster type headaches that are of neural origin, talk about,
No headaches and indeed some treatments such as Omega-3s which have been shown to be beneficial for offsetting the menstrual related headaches. Now in the context of the discussion about Omega-3s keep in mind that Omega-3s can be obtained from supplementation or from nutrition. So you don't necessarily have to take omega 3 capsules or liquid form Omega 3s. If you want to use omega-3 is to Target different symptoms of headache, but that probably is going to be the most efficient way to do it, given that many foods do contain
And Omega-3s. But it's hard to get above that one, gram dosage. And in fact, most of the studies that we talked about today, involved getting two, or even two and a half or in some cases on this podcast with previous guests such as dr. Rhonda Patrick, she talked about the advantages of getting as high as 3 grams of Omega-3s per day which almost with certainty is going to require some external form of supplementation. Even for those of you that are making a point to eat fatty ocean fish with the skin on. So I just want to make sure that I highlight that.
Wrap up, I can't help myself, but to talk about something that I heard about on the news, several years ago and it sounded too outrageous to be true, but then was confirmed as accurate by one of my neurologist colleagues. And that's the fact that eating certain very spicy peppers, can induce headache and in some cases can induce brain damage and bear with me here. I'm not talking about your traditional jalapeno and I'm acknowledging. The fact that certain people can tolerate far more spicy
Taste than do others. Some people are very sensitive to spicy, some people can tolerate very spicy food and that one can build up a tolerance to spicy food by ingesting, progressively your spicier, excuse me, spicier and spicier Foods over time. Nonetheless, there are these Pepper eating contests out there that while not very common, do exist and people challenge each other to eat peppers of extreme spiciness. And there's one in particular that's referred to as the Carolina Reaper. By the way that's not a person as far as I know.
That's a pepper, the Carolina Reaper, which is known to have the most potent spice of any pepper. And here's why you would not want to eat the Carolina Reaper a few years ago, at one of these Pepper eating contests, man, ate a Carolina Reaper, as part of the competition and suddenly experience what's called Thunderclap headache? Thunderclap headache is a unique type of headache. Very different from all the other types of headache. It is not from the surface in, so it's not tension headache. It's not even the cluster.
Type headache of the nerve activation of the trigeminal. It's actually a hyper constriction of the vasculature in the brain caused by the ingestion of the pepper and inflammatory response. And remember that heat and spicy go together in these neural Pathways and a bunch of different heat-related and spice related Pathways get activated simultaneously. When one ingest, something of extreme spice and the blood vessels and indeed some of the smaller arteries feeding neural.
Shut down and he experienced this Thunderclap headache, which is a brutal headache and sadly. In his case permanent brain damage. A loss of neuronal tissue because neuronal tissue is very metabolically active. You cut off the blood supply to that tissue. Not only would you feel miserable? Maybe even pass out but lose vision and certain brain areas will actually die off in the absence of blood flow to those areas. We know this more commonly as stroke so I don't want to strike fear in.
Anybody about eating, you know, a jalapeno or even a very spicy meal from time to time, but if you're not somebody who's familiar with eating very spicy foods, you certainly don't want to enter one of these competitions and just realize that the pathways from Menthol and cool or spicy and hot those aren't just subjective Pathways. These are actually neural Pathways that again originate in our so called nerds call it the sensory epithelium. So our skin are hearing our eyes and that
Feed that information into the body to make use of that information some case motor movement. So sensory motor in other cases, the information can be fed through nerve Pathways that goes to the vasculature and causes the vasculature to either dilate or construct. These very spicy peppers causing. As I just mentioned, extreme cerebro of the head vasoconstriction and brain damage. Again, that's not going to be a common thing out there. But nonetheless, I encourage people to be very cautious about the
Allina, Reaper. So today, we talked about headaches and first, we highlighted the different types of headache, making it clear that understanding, which headache, you might be experiencing, can be very beneficial for understanding, which sorts of treatments ought to be best. And perhaps also best avoided in trying to alleviate those headaches or prevent them from happening at all. We talked about tension, headaches, migraine headaches, hormone based headaches, cluster headaches and traumatic brain injury related, headaches, we talked about different types of treatments ranging.
Ring from creatine to omega-3 fatty acid supplementation, some herbal and indeed some essential oil treatments as well as acupuncture. All of which have been shown to have significant impact in reducing the frequency and intensity of headaches and in many cases reductions in the frequency and intensity of headaches that are at least as great as the results that are seen with non-steroidal anti-inflammatory. Drugs again, I want to highlight that none of these approaches are necessarily designed to be done on their own, or in replacement of
Option drugs from your physician. There are excellent prescription drugs out there that your physician can prescribe for you for the treatment of headache. Nonetheless, I think many people who are listeners at this podcast. Are interested in the things that they can do in order to inoculate themselves or at least reduce the likelihood of experiencing headache. Especially for people who are experiencing chronic, recurring headaches such as migraine or the other forms of headache which can be so debilitating. Thank you for joining me for today's discussion, if you're learning from, and, or enjoying this podcast, please.
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