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Gersten Alt. Med.

The Many Faces of Headaches

In the last issue we began a discussion about headaches, focusing mainly on migraine and tension headaches. We’ll continue by exploring dangerous headaches like epidural hematoma and brain tumor. More than 95% of headaches are not the dangerous kind. For every 4,000 children with a headache, one has a tumor. That’s .0025% of children’s headaches.

Dangerous headaches usually start suddenly and are severe. These usually occur after age 50 and may be associated with neurological symptoms such as weakness, numbness, and paralysis. Headaches that include marked weight loss and changes in one’s mental state( like sleepiness, hallucinations, or a dramatic change in memory and cognition) can be dangerous.

Head trauma can also cause a dangerous headache if the trauma has caused an epidural hematoma. That’s a bleed between the inside of the skull and the dura (the outer covering of the brain). With an epidural hemorrhage, the individual may briefly lose consciousness after head trauma, regain consciousness, and then lapse back into unconsciousness. This kind of headache is a true emergency, but it’s an emergency with a clear treatment and usually a good outcome. Of all the headache sufferers, dangerous ones are rare, but they are important to know about. If you think you or a loved one might be having a dangerous headache, call your physician or go to an emergency room ASAP.

Is it possible to have migraine headaches and a dangerous kind of headache? Yes. If a person with migraines suddenly develops a new kind of severe headache, s/he will notice that the new headache feels different—and it doesn’t feel like a migraine.

Sinus Headaches

Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling. Our sinuses ordinarily easily drain. In sinusitis and sinus infections, drainage from the sinuses is blocked, leading to increased pressure within one or more sinuses. There are four sinuses on the left and right side. Sinuses are cavities within the skull. The main sinus infections are caused by bacteria, so treatment will involve an antibiotic (either pharmaceutical or natural, such as colloidal silver). It is not widely accepted by medicine that sinuses can also be infected with yeast overgrowth. However, any mucous membrane can develop a yeast infection. Yeast infections do not respond to antibiotics. Like the digestive tract, most of our mucous membranes normally have friendly bacteria. Antibiotic treatment often kills bacteria throughout our mucous membranes and digestive tract. When friendly bacteria are killed, the way is paved for yeast to overgrow.

Sinus headaches can be caused by bacterial or yeast infections and also noninfectious inflammation, which can be caused by allergies. Treatment involves: 1) antibiotic or antifungal treatment, 2) determining if seasonal allergies or food allergies are the culprit, and 3) opening up the passages that drain the sinuses. Decongestant medication (like pseudoephedrine) helps shrink swollen sinuses and opens the drainage pathway. Over the last 5 or 6 years, an Ayurvedic product called a “neti pot” has grown in popularity as a way to help heal sinuses.

If you’re not sure if your headache is caused by a sinus problem, you can tap gently on the sinuses. If you have sinusitis, you’ll feel some discomfort when tapping on a blocked sinus. The largest sinuses are the

frontal sinuses, which are in the forehead area. There are also sinuses in the cheekbone areas, a pair between the eyes, and lastly a pair behind the eyes.

Cluster Headaches

Cluster headaches may occur up to three times a day, during a “cluster period.” A person can go months or even years without a cluster headache, but then have a cluster of them which can last two weeks to three months. The pain is located behind one eye or in the region of the eye, without changing sides and is often associated with eye drainage (on one side) and nasal congestion. The pain can be burning or piercing, constant or throbbing. The pain of cluster headaches is severe, and usually is regarded as more painful than a migraine headache. The pain is not relieved by lying down or avoiding bright lights.

A recent survey of people with cluster headache examined the benefits of alternative therapies, including acupuncture, chiropractic, therapeutic touch, and homeopathy. Fewer than 10% found these modalities to be helpful. That’s information from the Mayo Clinic. However, many have found that major lifestyle changes alleviated or cured their cluster headaches. In addition, there are numerous reports of people whose doctor treated their headache with antifungal drugs with excellent results.

Temporal Arteritis

Some people have a headache in the temple area. If they gently press the affected area, they’ll feel it throbbing. The temporal artery runs horizontally across the temple, just beneath the skin. Patients and doctors alike may think the headache is a tension headache at first, unless they specifically think of temporal arteritis (inflammation of the temporal artery). Women experience temporal arteritis twice as often as men. The age of onset is 50–60. This condition of inflamed blood vessels has been found in association with lupus (systemic lupus erythematosus) and RA (rheumatoid arthritis), two inflammatory autoimmune diseases. The conventional treatment of Lupus and RA is powerful drugs like steroids. The alternative therapy of earthing is my first thought when dealing with any inflammatory condition.

Localized Sources:


Any part of your head can be a source of headaches. TMJ (temporomandibular joint syndrome) is one example. TMJ involves trauma, inflammation, or malformation of the jaw, jaw joint or surrounding muscles.

Middle Ear Pressure

Middle ear infections cause pain in a similar way to sinus headaches. If the drainage of the middle ear is blocked (due to an inflamed eustachian tube), pressure builds up in the middle ear, causing pain. Most of the time, with a localized problem like the middle ear, you’ll know where the source of the problem is, but not necessarily what to do about it. Treatment includes a decongestant medication to open the eustachian tubes, and an antibiotic if the middle ear problem is caused by a bacteria. Many middle ear problems do not involve an infection.


Dental pain is another localized problem that can spread. When dental cavities progress too far, the nerve to that tooth becomes exposed. Those nerves are very sensitive to oral bacteria and can quickly become inflamed. Dental pain will start in the tooth, but can quickly involve one side of your face.

Trigeminal Neuralgia

Once a nerve gets inflamed and is on the way to dying, the major nerves of your face, including the trigeminal nerve, can also get inflamed. Dental problems, if left untreated, can cause trigeminal neuralgia, which is very painful. It affects the side of the face where the dental problem is. A person can develop trigeminal nerve pain for non-dental reasons.

Most of the American population (around 90%) carries one of the herpes viruses, mainly HSV1. We usually acquire HSV1 before age 10. HSV1, HSV2 (herpes simplex II), and Varicella Zoster Virus (VSV) quietly live in nerves, especially in ganglia (a mass of nerve tissue). These viruses can exist for decades without a problem, but can be reactivated by emotional stress, physical stress, chronic illness, colds or the flu, injury to the lips, mouth, or skin, a weakened immune system, menstruation or pregnancy. During a viral reactivation, a herpes virus travels down from the trigeminal ganglion to the trigeminal nerve, causing sudden, very sharp, bursts of pain, that feel like electrical shocks.

A herpes-related headache is not a common cause of headache. Herpes 1 and 2 have become as taboo to talk about as HIV/AIDS once was, and are usually written about as lifetime sentences. You’ll want to treat the inflammation and the infection. While there are a number of antiviral drugs, they often have significant side effects, including extreme intestinal upset. The best treatment for viruses, including herpes, is IV ozone.

When evaluating headaches, your doctor will probably want to consider TMJ, middle ear infection, sinus infection, dental pain, or trigeminal neuralgia as possible causes. This article, and the last one, have reviewed quite a number of kinds of headaches. They are almost always too difficult for the individual to self-diagnose, and the difficulty is compounded by the fact that a person can have two or more different kinds of headaches.

Next month, we’ll conclude this series on headaches with TBI­—Traumatic Brain Injury.

David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063.,