11__transcript.txt

welcome to the huberman Lab 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 to socialize to sleep to exercise
essentially to live life in any kind of
normal way as we'll 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 we'll
soon discuss is that by understanding
which type of headache 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 experience
headache every once in a while where
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 acetaminophen and so
forth so-called 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 treatments
carry side effects whereas the natural
treatments appear to not carry side
effects now of course anytime we have a
discussion about natural treatments
there are 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 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 and
a swelling within the cranium that
people experience as a headache and it
turns out that many of the 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 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
smart drugs and as a neuroscientist I
can tell you there is no neural circuit
in the brain for being smart thesis
understands this and has designed
different nootropics in order to bring
your brain into specific States for
specific types of work so for instance
for Creative work or to engage with more
Focus or to give you more energy for
cognitive or physical work so with
thesis they'll design custom nootropics
for you that will allow you more focus
better task switching more creativity
and so on and they'll be sure to include
only the ingredients that you want and
not the ingredients that you don't I've
been using thesis for more than a year
now and I can confidently say that their
neutropics have been a total game
changer for me I like the clarity
formula prior to Long bouts of cognitive
work or the Energy Formula prior to
physical workouts if you'd like to try
your own personalized nootropic starter
kit go online to takethesis.com huberman
you'll take a brief three-minute quiz
and thesis will send you four different
formulas to try on your first month
again that's takethesis.com huberman and
use the code Huber minute checkout for
10 off your first box today's episode is
also brought To Us by element element is
an electrolyte drink that has everything
you need and nothing you don't that
means the exact ratios of electrolytes
are an element and those are sodium
magnesium and potassium but it has no
sugar I've talked many times before on
this podcast about the key role of
hydration and electrolytes for nerve
cell function neuron function as well as
the function of all the cells and all
the tissues and organ systems of the
body
if we have sodium magnesium and
potassium present in the proper ratios
all of those cells function properly and
all our bodily systems can be optimized
if the electrolytes are not present and
if hydration is low we simply can't
think as well as we would otherwise our
mood is off hormone systems go off our
ability to get into physical action to
engage in endurance and strength and all
sorts of other things is diminished so
with element you can make sure that
you're staying on top of your hydration
and that you're getting the proper
ratios of electrolytes if you'd like to
try element you can go to drink element
that's lmnt.com huberman and you'll get
a free element sample pack with your
purchase they're all delicious so again
if you want to try element you can go to
element.com huberman today's episode is
also brought To Us by Maui Nui which I
can confidently say is the most nutrient
dense and delicious red meat available
Maui Nui spent nearly a decade building
a USDA certified wild harvesting system
to help balance invasive deer
populations on the island of Maui I've
talked before more on this podcast and
we've had guests on this podcast that
have emphasized the critical role of
getting quality protein not just for
muscle repair and protein synthesis but
also for repair of all tissues including
brain tissue on a day-to-day basis and
the general rule of thumb for that is
one gram of quality protein per pound of
body weight per day with Maui Nui meats
you can accomplish that very easily and
you can do that without ingesting in
excess of calories which is also
critical for immediate and long-term
health I should say that Maui Nui meats
are not only extremely high quality but
they are also delicious I particularly
like they're jerky so they're venison
jerky I also have had Maui Nui venison
in various recipes including ground
venison some venison steaks and I love
the taste of the venison it's lean but
it doesn't taste overly lean or dry at
all it's incredibly delicious so if
you'd like to try Maui Nui venison go to
mauinuyvenison.com huberman to get 20
off your first order again that's Maui
News venison.com
to get 20 off your first order the
huberman Lab podcast is now partnered
with momentous 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
livemomentis.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 the 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 now tension headaches
are a 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
experienced 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
amounts of constriction
now there are of course muscles and 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
evolved 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 can be prominently involved
in generating the ache of a headache or
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 it turns out that's not
the case the brain is actually encased
in a very thick very durable Sac or
casing that's wrapped around it tight
like Saran wrap it actually has a name
which is dura d-u-r-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 as just sitting right next to the
skull it's close by but there are a
bunch of other thin fibrous tissues many
of which are very thin and fragile and
others of which such as the dura that
are very very strong because they're
very fibrous almost like a uh if you've
ever felt for instance the sale of a 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 and wrapped really
tight in this very durable sac
is one of the reasons why when blood
vessels or arteries or both become
dilated they open there 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 give the impression that your
brain is expanding up against your skull
so the point here is that while muscular
tension can give rise to headache the
other thing that can give rise to
headache is 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 headache is because there's
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 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 and the person is
completely unaware and in order to get
through the skull of course that 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 tissues 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 it 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 nociceptors
These are essentially pain receptors
because of the presence of pain
receptors in the tissues around the
brain
when there's an increase in the size of
those vascular portals the arteries
capillaries and vessels
we experience 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 portals
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 we'll
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
but 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 and 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
cluster headaches are extremely painful
and the severe ones are exceedingly
painful
cluster headaches arise from Deep where
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 as 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 uh 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 hyper
activated 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 as if there's a
pain behind their eye 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 pupil
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 seem 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 in origin
Okay so we've got muscular origins of
headaches we've got meningeal
origins of headaches that is the 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 I suppose in some cases and
when inflammation is really widespread
across the brainer body it's bad but I
don't think any of us should think about
inflammation per se 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 uh 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
hubermanlab.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
hubermanlab.com and it'll take you to
specific episodes 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 were to get you know a bb or a
splinter into a particular uh you know
skin area there'd 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
as just our nose but actually 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 um on either sides of your
nose those are the sinuses the sinuses
allow the passage of 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 oftentimes can
become clogged as is in the case with
sinus headache which we'll talk about in
a little bit but more generally anytime
there's inflammation 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
the 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 the extent of
inflammation by putting in different
scar tissues indeed a lot of the things
that we think of as kind of gross
you know pustules and boils and things
like that I know it's a gross topic are
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 cerebral spinal 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 tissues in
our entire body even if we're running
hundreds of miles in Ultra marathons
your brain is still far more
metabolically demanding than all the
muscles 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 or
what we've 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 or
encroaches on the face or head area that
can easily and almost always
spills over into activation of nerve
cells can give rise to neural based
headache or to the meninges and can give
rise to meningeal 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
meningeal origins of the achin headache
we have neural origins of the aching
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 different sources of the
ache and headache and that sometimes
they exist alone and sometimes they
exist in combination however this isn't
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 it's a
pin prick or a cut stub our toe we trip
and fall or a headache it is neural 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 starts
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 relieve 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 I 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 some make serotonin and so
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 scientists
call 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 heart
beats 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 sense firm touch other sensory
neurons sense pain 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 hairs lay
down
we experience that as pleasurable
whereas if you stroke in the direction
opposite to the the way the hairs lay
down we experience that as not
pleasurable so these Sensory neurons
respond in some cases for instance
within the auditory system they respond
to sound waves and your eye they 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 gut is
pain within our tissues like our liver
or or any kind of other internal organ
so we've got motor neurons Sensory
neurons and then the last kind of neuron
is what we call modulatory neurons these
are the ones that adjust the
relationship between the sensory neurons
and 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 it electrical potential whether or
not it will generate a motor change let
me give you a very simple example of
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're
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 neuron
Sensory neurons and modulatory neurons
and you're probably thinking by now why
are we talking about this I thought we
were talking about headache I thought
we're going to 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
occur more or less on on the in a kind
of a headband like fashion or they tend
to start there
and exist around that these are very
common they can arise from a number of
different sources rise from sleep
deprivation they can rise from excessive
use of caffeine intake we'll 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
where 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 can 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 modulatory 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 relaxedant
or would you want to try and change the
sensory input 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
modulatory 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 can 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 and 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 the modulatory
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 uh 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 or cluster or
tension headache but I think for most
people out there who experience 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 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 you're offsetting
that by getting proper sleep most people
don't when they're under excessive
stress by the way we have excellent
tools we're grounded in 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 the human Lab podcast
again just go to hubermanlab.com and all
that's time stamped for you tension type
headaches
begin in a more or less a headband
pattern but can really extend to other
tissues as well not so often in the face
but really the head 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 ag-1
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 and the reason I still
take athletic greens once or usually
twice a day is that it gets to be the
probiotics that I need for gut health
our gut is very important it's populated
by gut microbiota that communicate with
the brain in the immune system and
basically all the biological systems of
our body to strongly impact our
immediate and long-term health
and those probiotics and athletic greens
are optimal and vital for microbiotic
health in addition athletic greens
contains a number of adaptogens vitamins
and minerals that make sure that all of
my foundational nutritional needs are
met and it tastes great if you'd like to
try athletic greens you can go to
athleticgreens.com huberman and they'll
give you five free travel packs that
make it really easy to mix up athletic
greens while you're on the road in the
car on the plane Etc and they'll give
you a year's supply of vitamin d3k2
again that's athleticgreens.com huberman
to get the five free travel packs and
the year supply of vitamin D3 K2 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 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
females 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 a particular phase of 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 of
women 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 qualify as 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 you know 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 them 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 kind of sense
it coming
there's this notion of Aura and we'll
talk about Aura in a little bit some
people think of Aura just as visual aura
or the sense of kind of a haloing of
light with the 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 coming
on long before they feel the actual ache
of the headache and the other
debilitating symptoms suggests 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 their onset the
other feature of migraine headaches that
I think is important to note is that
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 very particular types of treatment
and ways of dealing with this pain
specific to migraine headaches the other
feature that's common in migraine
headaches is so-called photophobia many
of you are probably familiar with
photophobia if 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 were you to have had
a really good night's sleep and that's
because during sleep there are all sorts
of reset mechanisms in the brain there's
the washing out of metabolic debris and
things in the brain the so-called
lymphatic washout That's essential
there's also an adjustment of the neural
tissue of the eyes which as many of you
have 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 brain outside the cranial
Vault and within your eyes you have
neurons and mechanisms 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 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 will start saying oh you know
it's just too bright in here and
normally they'd be able to tolerate that
level of sunlight or of 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 vessels so we
if we want to treat migraine we're going
to 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 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 we'll get into photophobia and
how to deal with that we'll also talk
about Aura a little bit more in a few
minutes but for the time being we've
talked about tension headaches we've now
talked about migraine headaches again
keep in mind knowing what kind of
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 going to pop a couple of aspirin
okay what does aspirin do aspirin's 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
you're going to activate those Sensory
neurons those non-iceceptors 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 are experiencing is
going to be essential here the other
thing that you'll sometimes hear is that
drinking a cup of coffee or getting
caffeine through tea 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 absolutely
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 biologies
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 from the inside out and they tend
to be on one side or the other what
scientists and clinicians call
unilateral and tends to originate behind
the eye and sometimes the nose region
sometimes in the mouth region as well it
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 and I'm 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 in a moment if you
remember that the herpes one virus and
not herpes two not genital herpes but
herpes one virus is the one that gives
cold sores on the mouth
herpes one virus by the way is
exceedingly common up to 90 percent 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 it can be passed by skin
contact and mucosal contact
um so mucosomucosal so that would be
kissing mucosa lying or even skin to
mucosal Linings that's why it's so
common and the reason why cold sores
develop on the mouth for people that
have herpes one is because the virus
actually lives on the trigeminal nerve
and yes it is true that sometimes the
virus will inflame the nerve and the
inflammation will occur at the level of
the eye so people do unfortunately
sometimes get herpes of the eye it
actually can be quite dangerous if you
have an infection of the eye of a herpes
infection in 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 the branch that innervates the lip
or the region close to the lip and
that's why a cold sword develops there
an immune response there 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
in 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 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 in 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 begin very deep
and they tend to be excruciatingly
painful excruciatingly 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 the
so-called circadian mechanisms so if you
are a 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
um 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 mentioned this before so those 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
vial the excuse me the dilation or
constriction of blood vessels may have
an indirect impact on 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 cue you to the
fact that it's far too General a term
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 the
steroid hormones refers to estrogen
testosterone of the sort that we all
make that men and women
make naturally and those 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
lifespan 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 extracellular membrane and into the
so-called nuclear membrane they 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 in
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
control
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 combine
to give rise to headache because of the
ways that low estrogen and low
progesterone impact vasodilation
and vasoconstriction and the
inflammatory response we'll talk about
how to deal with hormone-based headaches
a particular hormone was 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 hormonal
headaches are most likely to take place
when estrogen and progesterone are
lowest
so if you understand that during the
follicular stage of the ovulatory slash
menstrual cycle okay so menstrual cycle
is about 28 days on average not in
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 up and as we learn in
endocrinology estrogen primes
progesterone so estrogen will then Peak
and then start to fall
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 ludial
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 and went
up up 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 to 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 that
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 a
strong impact on the vasodilation
vasoconstriction system as does
progesterone we'll talk about 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 deceased entirely well
now you understand what the origin of
the hormonal headache is and so all we
need to know is what do estrogen and
progesterone normally do 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 injury 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 five seconds 30 seconds
or three minutes you know the crowd and
the uh 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 or
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 injury 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 traumatic 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 and mood
sleep Etc
is actually the consequence of things
other than Sports so for instance
bicycle accidents playground accidents
construction accidents and this is often
forgotten for some reason all the sports
in particular football tend to grab all
the attention as it relates to
concussion keep in mind that while for
certain people is a path to a 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 their work without
any you know millions of dollars
contracts or the opportunities
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 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 percent of traumatic brain
injury so people coming into the
hospital or clinic are people claiming
that they've got consistent headaches
they're not sleeping 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 fullness 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 necessarily 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 they're actually
three layers that we call the meninges
the durages 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 right
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 hear 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 mucus being
delivered to that space well 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
anytime we're talking about injury or
disease or health for that matter mental
health or 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 ad nauseam on this podcast but
regular circadian Cycles 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
huberman Lab podcast the master sleep
episode The huberman Lab podcast and in
the perfect your sleep episode The
huberman Lab podcast you can find all
that at hubermanlab.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
certainly a ton of data to support that
state statement as well and then of
course nutrition and exercise are also
important so we can list out sleep Sun
proper nutrition exercise and I would
put a 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 baselines of
health and I mentioned that I can
segment this out now because I think
that anytime 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 or
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 the 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 no replace basement
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 with the
headaches associated with head hits and
traumatic brain injury because 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 has been
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
and take
most often creatine is discussed in the
context of muscle performance not just
for people who weightlift but for people
who do endurance exercise and it's often
been said that 5 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 that is all
completely true we discussed this in the
huberman lab podcast with Dr Andy Galpin
when he was a guest on the Hebrew and
Lab podcast 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 Hebrew Lab podcast but
where really he's the one doing the
majority of the teaching that series
covers everything from strength
hypertrophy endurance 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 far 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 the
words pre-clinical that is if you hear
there was a pre-clinical study on blank
that means almost always that the study
was performed on animal models mice rats
primates Etc
a clinical trial is something that's
carried out on humans and a pilot study
means that the study was carried out on
humans but on a fairly small cohort a
very fairly small group uh 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 so it could be taken in water
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 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 a modulatory neuron
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 facionados 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 is actually quite
prominently stored in the forebrain the
area where the real estate of 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 too but
it'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
authors hypothesize on the basis of
pre-clinical 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 level 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 five grams per day sometimes
10 grams per day if they're about 100
kilograms or or greater in body weight
100 kilograms 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
dosages 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 kilograms or 220 pounds that would
be 40 grams of creatine per day if
someone weighs 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 in 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
increase 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 percent 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 dizziness was
significantly reduced in people
supplementing with creatine as was the
number of people experiencing fatigue
and 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 the
headache is quite frequent basically the
takeaway of the 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 tbis I
mentioned earlier and as now there are
very few treatments for TBI you tend to
get the basic advice coming back and
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 it 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 stress obviously stress
is a 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 and the
effects were dramatic enough that people
with headache and in particular 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 or not it helps offset their
headaches keep in mind of course anytime
you're going to add or remove anything
supplement or 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 that 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 Health can only be
analyzed from a quality blood test the
problem with a lot of blood and DNA
tests out there however is that you get
data back about metabolic factors lipids
and hormones and so forth but you don't
know what to do with those data inside
tracker solves that problem and makes it
very easy for you to understand what
sorts of nutritional
behavioral maybe even supplementation
based interventions you might want to
take on in order to adjust the numbers
of those metabolic factors hormones
lipids and other things that impact your
immediate and long-term Health to bring
those numbers into the ranges that are
appropriate and indeed optimal for you
inside tracker's ultimate plan also now
includes a measure of April lipoprotein
b apolipoprotein b sometimes also called
APO B 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 apolipoprotein B
levels are predictive of cardiovascular
function disease and things that
cardiovascular function and disease can
impinge on including brain Health and
Longevity if you'd like to try inside
tracker you can visit insidetracker.com
huberman and get 20 off any of inside
tracker's 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 intensity 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 well 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 omega-3 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 omega-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
come in a bunch of different foods and
can be supplemented as well Common forms
of omega-3 fatty acids or I should say
common sources of omega-3 fatty acids in
Foods include fatty ocean fish including
salmon salmon skins 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 that they're all inflammatory that
they are killing us or making us sick
that they are the major cause of
metabolic dysfunction Etc 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
Omega six 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 although 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
omega-3 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 and headache was
published in 2018 and the title of the
paper is long chain omega-3 fatty acids
and headache in the U.S population there
are a number of things that I really
like about this study a few of those
include the fact that they looked at an
enormous number of people that is they
included 12 317 men and women I like the
fact that they 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 thing things that
they eat they're going to be consuming
some Omega-3s hopefully as well some
omega-6s and if they're eating far more
then they're going to get far more of
likely going to get far more of both of
those things than they would ordinarily
if they were eating smaller amounts 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 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 how 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
certain fatty acid long-chain fatty
acids and the omega-3 fatty acids are
important for or 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 randomized controlled trial
and in that previous paper what they
found was that diets high in Omega-3s
and low in omega-6s okay so high three
low six and as compared to diets that
were just reduced omega-6s 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-6s can come from other
sources as well if omega-6s were just
reduced on their own there wasn't as
great in 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 and a replacement
of those with omega-3 fatty acids in one
case in the other case it's just a
reduction in omega-6s and you're using
other food types and macronutrients to
offset that that reduction in calories
caused by reducing omega-6s the basic
takeaway that they're relying on
marching into the study is that
increasing Omega-3s and reducing
omega-6s 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-6s
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 consumed 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 an
inflammation reducing effect that can
significantly reduce the severity of
headache in both tension type headache
and in migraine so that's the first
study the second study is a more recent
study it 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
N3 but those are omega-3 and n6 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 be in 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 as best as one can
in this study they had people either
ingest a diet that 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-6s
or a control diet in which they had
people taking well it's 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 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 and omega-6 are
experiencing more inflammation and that
is evident in a bunch of different
conditions one for instance is or
increases in things like cgrp cgrp is a
molecule that's associated with the
calcium signaling pathway it's involved
in vasodilation the expansion 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 we'll talk
about one very dramatic example perhaps
as we get toward the end it's a very
uncommon example but um it's a it's
called Thunderclap headache and trust me
you do not want Thunderclap headache um
and so we'll talk about Thunderclap
headache a 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 cgrp vasodilation
and some other Pathways related to the
so-called inflammatory cytokine Pathways
and there's a whole discussion nowadays
of What's called the inflammatorium 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 ingestions
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 which is perhaps
the most cost effective way to
supplement Omega-3s or capsules which is
perhaps the most efficient way to
supplement Omega-3s relate to a level of
one 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
determine to be 2 000 milligrams or two
grams per day of Omega-3s keep in mind
that's going to include EPA ndha and it
does seem that 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
literature related to effects of
ingesting one to three grams again three
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
that can improve mood and so forth the
basic range that I was able to find in
the meta-analysis so meta-analyzes are
where a researcher will look at the
results of a bunch of different studies
focused on the same thing look at the
different strength 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 they're
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 any
one study is really leading to the
conclusion that a given treatment does
something in any case in the
meta-analysis 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 ranging from 200
milligrams 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 is omega-3 fatty
acids supplementation been shown to be
effective in reducing the frequency and
intensity of headache in tension 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 uh study
entitled effective omega-3 fatty acids
on premenstrual syndrome a systematic
review and again meta-analysis what they
found and here I'm paraphrasing the
conclusion was that
omega-3 fatty acids could yes
effectively reduce the severity of PMS
symptoms and one of the symptoms in
particular that they found what 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
omega-3 fatty acids they're actually
quite hard to obtain and quite expensive
but because I think oftentimes 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
um you know it's going to have
relatively weak or minor impact on
things like headache or other health
metrics but let's just say that the fact
that it exists as a prescription drug
and its highest potency form at 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 that again
include meta-analyzes of many other
papers and data sets indicate that
supplementing with omega-3 fatty acids
to a point where you're getting above
one 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 combine
hormonal headaches tension headaches and
migraine headaches you account for more
than 70 percent of the total types of
headaches that are out there the effects
of Omega-3s on cluster headaches and
some of the other types of headaches at
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
data sets 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 in a way to alleviate something
and that's 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 of Aura
but oftentimes people also come to
understand Aura as the feeling that
something surrounds a given object
visually or even that people have a
sense that something's around them so
again 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 and or
maybe even in kind of a sense that
something is about to happen in a
certain environment and the reason I'm
making uh kind of Arc shapes with my
hands for those of you that are just
listening I'm making art shapes with my
hands is that aura is often described as
kind of a Halo or a um emanating out
from from one's body or from something
that they're looking at again nothing
spiritual about this in the context of
the discussion about migraine and
headache but rather many people
experience photophobia sometimes with
aura sometimes no and I just want to
touch on a couple of the mechanisms by
which aurum photophobia occur and
mentioned just briefly a pretty well
established way that people can start to
offset photophobia and again I mentioned
that because many people experience
photophobia in headache but there are
also a number of people that experience
photophobia even if they don't have
intense headaches so photophobia is
pretty common pretty debilitate it
actually is 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
negative Downstream consequences okay so
what is Aura and what is photophobia the
exact origins of ARA 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 dump
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
chemoelectrical 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 it 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 Aura originates now
photophobia is a little bit different
photophobia We Now understand because of
some beautiful work that was done at
Cliff saper's 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 melanops and 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 to bright
blue light or other shortwavelength
light so you've got short wavelength
light that is blue and greens or short
wavelengths and then long wavelet light
which is red or you know it can even be
out past red 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
lighting 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 Central
circadian clock superchiasmatic nucleus
that sets your day night sleep wake
rhythms this is why I encourage people
to view sunlight in the morning to set
this 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 intrinsically
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 they
connect to as it relates to photophobia
is an area of a structure called the
thalamus the thalamus is an egg-like
structure that sits in the center of the
brain and it serves as a kind of a
switchboard 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 like an
old-fashioned switchboard
or
um you could think of it uh sort of like
a in an airport you go uh to a
particular
um wing of the airport then you go to a
particular gate and so on you're getting
funneled progressively through uh
narrower narrower 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
gangling cells send connections to a
small but important area of the thalamus
called LP it's denoted L the letter and
P with lateral posterior thalamus or
that I should say it's the lateral
posterior nucleus of the thalamus for
uficionados out there and then the
neurons in that location are going to
respond that is they're 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 tissues
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
we'll 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 specifically tuned
to different sensory phenomena 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 um low brim hat and
putting on sunglasses and they want to
lie down
and sometimes because uh migraine can be
associated with nausea or even vomiting
and it's severe 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 are in 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 particularly for acne wound
healing even for improving Vision
especially in people beyond the age of
40 for some hormone augmentation we
talked all about that in the episode
that I did on light and health again you
can find that at hubermanlab.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 in
expensively
you know as party lights you can buy
these online so there is no specific
need to get any uh I would say red light
that's designed specifically for
photophobia or anything that sort you
can find the cheapest um 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 under 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 point or a trigger to
headache so what happens is they start
to experience some Aura 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 and aura
perhaps to the use of dim red lights or
red lights as I've described a moment
ago then you 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 have them
on hand or replace the current lights
that you have on your nightstand or in
whatever room you happen to be in 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
cortisol levels it's 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
sleep overall reducing cortisol at
evening time and at night time 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
entirely is going to be one relatively
inexpensive or I should say a 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 is you recall tension headaches
are going to be muscular in origin again
keeping in mind that everything's neural
when it comes to pain everything's
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 and the most common
treatment for this that most people rely
on that is is to take non-steroid
anti-inflammatory so things like
acetaminophen ibuprofen sometimes
aspirin and things of that sort and
oftentimes those can be helpful there
are a couple things to keep in mind
however the NSAIDs non-steroid
anti-inflammatory drugs oftentimes 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 oftentimes 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-steroid
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 acute 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 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-steroid anti-inflammatory drugs
is that many of them simply do not work
for many people or again they'll work
the first time and the second time but
then they stop 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-steroid anti-inflammatory drugs
simply to reduce your headache and your
lowing core body temperature that can
have 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 quite a lot of exploration
of alternatives to non-steroid
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
a kind of a we'll call it clinching or
cinching up with 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 that don't form
synapses with or connections with other
neurons they form synapses with muscle
they release acetylcholine onto the
muscle and that makes the muscle
contract this is the way you move the
limbs of your body this is also a way
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 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 are released
onto the muscle make the muscle contract
botulinum neurotoxin Cleaves a
particular protein in there for you
aficionados who 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 type 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 or around
the Jaws or the or certain parts of the
the neck and the MUSC 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
uh you know re-ups of Botox it actually
is quite safe 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 um 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 so let's call them natural or um
non-drug treatments and here we're
starting to get into the realm of the
kind of 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
um 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 there'll
probably be some effects I mean
admittedly we've talked before on this
podcast about things like apogenin
epigenin 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 apogenic and high
concentration can indeed augment sleep
we talk about this in our sleep tool kit
by the way we don't just have episodes
about sleep master or sleep perfect your
sleep Etc but if you go to the
hubermanlab.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 this is completely
zero cost to access you don't even have
to sign up although if you'd 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 apogenin which is
this component from chamomile so the
idea that certain herbal derivatives or
herbs or Oils could be very useful for
improving symptoms of whatever in this
case
improving sleep with apogenin is not
unheard of and in fact the data
continued to be released all the time
that many of the things that we think of
as herbal Etc can actually have quite
potent effects and so
um while I myself was approaching the
discussion about essential oils and um
or I should say oils right who's to say
if they're essential or not oils and
herbs in the treatment of headache I
finished out my research on this
literature feeling
um quite I should say uh surprised and
um 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 outperform
non-steroid and 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-analyzes
and I'll tell you about one particular
study and a meta-analysis in a moment
they show that they can reduce the
frequency and intensity of headache in a
manner that far outpaces What You
observe with non-steroid
anti-inflammatory drugs with apparently
none of the same issues associated with
non-steroid 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
atypical treatments for headache and the
title of this paper is effective
peppermint and eucalyptus oil
preparations on neurophysiological and
experimental
alge's 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 what they 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 they
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 measured 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 of
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 note
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 amount and 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 they 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 when 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
used these different approaches to
measure the activation of muscles to
measure pain and they then induced head
pain they induced headache so and they
looked at the temporal muscles on the
side they looked at forehead muscles
things of that sort so they used three
different types of pain stimuli they
looked at people's sensitivity to
experimentally induced Pain by either
providing pressure so this was kind of a
cuff around the forehead
or thermal pain so they actually had
them basically heat heat it up at the
level of the skin and actually they
brought the heat up pretty high to the
point where people were rating the pain
almost to the to the point of um
excessive pain and pain limits so they
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
pericranial muscles using an inflatable
collar around the cranium and they
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 in trying to
understand which types of interventions
are going to assist in headache and
maybe even specific dimensions of the
pain and headache and basically what
they found in the 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 uh essential minty type
um what we think of as flavors but are
really Aromas as well and as I'll point
out the mechanism in a moment they have
the effect of significantly reducing the
intensity 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
um 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 performed very well in
reducing pain the key takeaway from the
study is and here I'm paraphrasing from
the study of that the combination of
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 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
relaxed 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 well no 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 or 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
strict them they cause contraction of
muscles you have Sensory neurons which
sense 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 sensation of
cooling okay so when we think of Menthol
and peppermint we think of kind of cool
scents 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 or the mint
commercials would lead you to believe
and in fact they're right so what's
happening here is that the 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 analges
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 whereas Cooling
and Pain Relief are funneled through
alternate what we call parallel Pathways
so the study on peppermint and
eucalyptus oil preparations in reducing
pain of headache and different aspects
of pain due to headache I think are
really important because they don't just
illustrate the fact that yes indeed and
you know going 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
surprising for me kind of put me in my
place as somebody thought oh essential
oils is going to be like okay but it's
actually seemed to um 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-steroid 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 and Eucalyptus
containing oils Menthol containing oils
applied to the skin for the treatment of
tension type headache as um 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 a woo
biology or people think of it as a very
alternative medicine keep in mind that
as the underlying mechanisms of things
like these peppermint oils are starting
to be discovered or Omega-3s are
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 for
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 chufuma
chufu 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 at the level of skin 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 chufu's lab has published now in
excellent journals like nature science
and other journals is that the precise
insertion sites of 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 if there's needles sticking out of
your face first of all that must hurt
and actually the needles are very fine
needles and skilled acupuncturists 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 in particular
headache related pain and back-related
pain in some other forms of pain chufu's
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
cytokines 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 such as chufus and elsewhere are
starting to find the underlying
mechanisms and 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 mechanistic 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-steroid
inflammatory drugs or prescription drugs
of course those things can still be
taken many people derive 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-steroid
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 treatments 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 I
refer 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 what 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 cgrp cgrp 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 a sort of lore 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 ingests 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 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
adenosine cannot have its normal effect
of making us sleepy when that caffeine
wears off the adenosine combine 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 pathway 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 and perhaps utilize this is
that if you are well rested or if it's
early in the day and you've had some
sleep the 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 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 drinking 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 podcasts 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 vasodil relation 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 in 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 and so in
some cases a very significant effects
whereas other people when they drink
caffeine it really exacerbates their
headache and as at 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 and 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 whether or 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 percent
of you are familiar with and 75 percent
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 root 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
curcumin 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
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 in
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 8 000
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 an AKA turmeric 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
AKA 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 in beard growth and in
the regulation of a number of different
tissues both in the reproductive axis
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 to
curcumin will even at low doses
experience reductions in DHT that lead
to things that they would not like such
as sufficient reductions in 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
enormous range as I mentioned before
dosages that range anywhere from 80
milligrams taken
80 milligrams per day that is taken for
eight weeks time that's been examined
it's been explored at 80 milligram
dosages 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 milligrams 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-steroid
anti-inflammatory drugs can really
impact the different aspects of headache
and different types of headache in some
cases differentially now today we talked
mainly about tension type and 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 talked about
hormonal 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-3s 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
Omega threes 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 three 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 before we 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 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 case then 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 spicy or excuse me spicy or and
spicier Foods over time
nonetheless there are these Pepper
eating contests out there that um while
not very common do exist and people
challenge each other to eat peppers of
um 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 headaches 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 ingests something of extreme
spice and the blood vessels and indeed
some of the smaller arteries feeding
neural tissue shut down and he
experienced this Thunderclap headache
which is a brutal headache and sadly in
his case um permanent brain damage so
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 a 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 our
our 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 constrict these very spicy
peppers causing as I just mentioned
extreme cerebro of of the head of
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
Carolina 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
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 they're seen with non-steroid
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
prescription 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 of 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 subscribe to our YouTube
channel that's the best zero cost way to
support us in addition please subscribe
to the podcast on Spotify and apple and
on both Spotify and apple you can leave
us up to a five-star review if you have
questions for me or comments about the
podcast or guests that you'd like me to
include on the huberman Lab podcast
please put all of that in the comments
section on YouTube I do read all the
comments in addition please check out
the sponsors mentioned at the beginning
and throughout today's episode that's
the best way to support this podcast if
you're not already following us on
social media we are huberman lab on
Instagram Twitter Facebook and Linkedin
and on both Instagram and Twitter I
cover science and science related tools
some of which overlap with the content
of the huberman Lab podcast but much of
which is distinct from the content of
the huberman Lab podcast so again it's
huberman lab on Instagram Twitter
Facebook and Linkedin during today's
episode and on many previous episodes of
The huberman Lab podcast we discuss
supplements while supplements aren't
necessary for everybody many people
derive tremendous benefit from them for
things like improving sleep hormone
support and focus huberman Lab podcast
has partnered with momentous supplements
because momentous supplements are of the
very highest quality and they include
single ingredient formulations this is
very important as I pointed out in the
episode about a rational approach to
supplementation single ingredient
formulations allow you to develop the
most biologically effective and
cost-effective approach to
supplementation in addition momentous
ships internationally which is important
because I realize that many of you
reside outside of the United States if
you'd like to see the supplements
described on this and other episodes of
The huberman Lab podcast you can go to
live momentous spelled ous live
momentous.com huberman
if you haven't already subscribed to the
huberman Lab podcast neural network
newsletter it's a monthly newsletter
that's completely zero cost it includes
summaries of podcast episodes and it
includes tool kits for everything from
improving your sleep to deliberate cold
exposure and heat exposure for health
and performance Focus dopamine
regulation and much more in order to
sign up for the huberman Lab podcast
neural network newsletter you simply go
to hubermanlab.com go to the menu scroll
down to newsletter and you provide your
email we do not share your email with
anybody and again it is completely zero
cost thank you once again for joining me
for today's discussion all about the
science and treatment of headaches and
last but certainly not least thank you
for your interest in science
[Music]