Mind Wandering & Happiness.

In a recent study entitled "A wandering Mind is an Unhappy Mind" Harvard researcher Mathew Killingsworth set out to detirmine the biggest influences on happiness.

To investigate this Killingsworth developed an iphone app called Track Your Happiness. The app contacts people at random times throughout the day and asks:

1. A happiness question: How do you feel right now?(On a scale from bad to good)
2. An activity question: What are you doing?
3. A mind wandering question: Are you thinking about something other than what you are currently doing? 

The results from 2200 respondents were as follows.
- Approximately 47% of the time, people's minds are wandering.
- People are substantially less happy when their minds wonder than when their minds are on the task at hand. This is true even in the midst of a seemingly boring task, such as commuting to work. 
- When minds wander, people often think of unpleasant things, which makes them enormously less happy. Even when people have pleasant thoughts they are still less happy than if their mind is not wandering.

Tip for the Month: Begin to get a sense of how often your mind wanders, and how this impacts your mood. If your mind is wondering, are you able to bring your mind back to the task at hand? What if anything, changes?

Knee Osteoarthritis
Osteoarthritis of the knee is a major cause of disability among adults. Treatment is focused on symptom management, with nonpharmacologic therapies being the preferred first line of treatment. Many arthritis sufferers incorrectly think that because the change is deep in the bone that treatment will not be effective.

Authur Selfe & Tayloe in 2008 conducted a review of the best current research.Ten trials representing 1456 participants met the inclusion criteria and were analyzed. The treatment groups received an average of 12 acupuncture  sessions over a 5 to 20 week period.

In 8 of the 10 studies, the acupuncture group experienced statistically significant pain reduction in comparison with the control group. The acupuncture groups had better outcomes when compared to medicines like diclofenac without any of these medicines dangerous side effects. These studies which fit with my clinical experience show that  even if you have significant changes on your knee  x-ray a viable drug free treatment option is available that can decrease your pain and increase your quality of life.

If you or a loved one has knee arthritis book in for a session to see if we can get you pain-free and moving again.

Headaches & Migraines Part 4 - Natural Ways to Prevent Headaches/Migraines

NATURAL WAYS TO PREVENT HEADACHE/MIGRAINE

1 - Get Your Neck Checked

As we have stated recent research has shown that migraine and headache conditions share a common cause ie. the central sensitisation of the lower brain stem. One potential major contributing factor in a sensitised lower brain stem is the upper three spinal nerve roots in the neck and their ability to refer pain to the head. Manual therapy can effectively can effectively reduce the irritation of the upper cervical vertebra and surrounding structures. You able to ascertain whether the neck is a factor in headaches by careful palpation of the upper three cervical vertebra. If your headache/migraine symptoms are able to be reproduced on palpation it is a very good indicator that treatment of this region will lead to a significant reduction in your headaches.

Dean Watson in his second  PhD study has measured the activity of the brainstem in migraineurs during treatment of the upper three spinal joints. He demonstrated that reproduction that reproduction and resolution of patients' migraine pain desensitised the brainstem. This is the first major peice of research showing a precise link of neck disorders to migraine. (Watson DH, Drumond PD. Cervical Referral of Head Pain in Migraineurs; Effects on the Nociceptive Blink Reflex, Headache 2014:54;1035-1045(full)) For more on the Watson Approach to Headache go to www.watsonheadache.com

Having trained with Dean Watson I am well placed to assess whether your neck is a contributing factor your headache/migraine.

2 -Keep a Headache Log

A good way to start is to figure out your triggers is to keep a detailed record of every headache/migraine for a few months.

Time and date headache started

Time and date headache finished

Where you were when headache started

Severity (use a scale of 1 to 10, with 1 being the least and 10 the most severe)

Location of the pain

Type of pain(pressing, throbbing, piercing etc.)

Other symptoms(nausea, vomiting)

Hours of sleep the night before headache

What I ate before headache(with emphasis on the common triggers mentioned earlier)

Medications taken and effect of medications

Activities before headache occurred (for example increased computer use)

How stressed did I feel over the last few days( use scale 1 to 10, with 1 being less stressed and 10 being maximally stressed.

Writing a log helps you start to identify patterns which can be very powerful in motivating you to change your lifestyle to alter your triggers.

3 -Eliminate Food Triggers

The headache diary and the list of foods in the trigger section will assist in finding your food triggers and avoiding them. As a general rule the less processed food you eat and the more vegetables you eat the less migraines you will have. Remember that low blood sugar can cause headaches so don't skip meals. If you are hungry don't go for sugary snacks or high sugar fruits as this will temporarily spike your blood sugar which then crashes back below normal possibly leading to a headache.

4- Book in for  Acupuncture

Acupuncture works by improving the quality of blood supply to damaged nerves. As we discussed earlier the migraine/headache is caused by hypersensitivity of the nerves in the brainstem. The reason nerves stop functioning correctly is a compromised blood supply. The blood supplies the nervous system with what is needs to function, including all its nutrients, white blood cells and oxygen. When the blood supply is blocked this leads to a compromised nerve conduction which leads to a hypersensitive nerve. Acupuncture's main function is to unblock this blood stagnation. Acupuncture helps the body get back to neurological homeostasis and the vascular system to normality.

The systematic review into Acupuncture by the Cochran review was conducted looking at 11 studies including 2,317 participants with tension headaches and 22 studies with 4,419 migraine sufferers. The study found cases acupuncture was more effective than routine medical care. This is very significant as the subjects received better outcomes without the risk of side effects from the medications. This shows acupuncture is a great way to break the medication cycle.,

Acupuncture as well as treating headaches directly is also very successful at treating some of the major triggers of headache and migraine.

Insomnia -A review of randomized Acupuncture trials into insomnia was conducted by Cao & Pan in 2009 which included 46 trial with 3,811 patients. The results showed Acupuncture appeared effective in the treatment of insomnia. I have found my own results in the clinic back this up.

Hormonal Problems- Acupuncture and Chinese Herbal medicine have a long history of treating problems with menstruation. A study published in Jan 2012 in the Canadian Medical Associated Journal had 500 menstrual migraine subjects receive acupuncture for four weeks. Four weeks after the trial the number of migraines had halved.

Stress – The stress response of the body in triggered  in the area of the brain called the HPA. When put under stress this axis release peptides and proteins called CRH which in turn launch the production of a group of hormones such as cortisol. Cortisol levels are now at the forefront of research into stress. In chronic stress, the cortisol levels are elevated and never come back down to baseline, so people end up with insomnia, anxiety or depression because of the constant ramping up of this system. The journal of Endocrinology researches led by Ladan Eshkevari looked at cortisol levels in Rats and found that Acupuncture reduced the cortisol levels dialing down the heightened stress response and returning it to normal levels.

Sinus Congestion – As discussed earlier most so called sinus headaches are really a migraine that may have been triggered by sinus congestion. Chronic rhinitis or post nasal drip as well as been a migraine trigger is cause disruption. A  study(Hua J Acunct. Tuina 2010) of 85 patients with chronic rhinitis found 61 people had total recovery, 21with marked improvement with 3 people with no effect. This showed a remarkable 96% improvement rate. The key factor in this study was the subjects underwent 15 sessions of acupuncture in a 15 day period. A key to acupuncture is to have multiple sessions per week initially as this clinically obtains the best results.

Get Some Exercise

There is evidence that exercise can be as effective as a leading migraine prevention tablets in preventing migraine attacks. In a 2011 study published in the  journal Cephalagia (Varkey et al) researches compared a program of exercise against topiramate( a market leading migraine prevention tablet) for  migraine prevention. The exercise group performed exercise 40 min per week and this led to a reduction of migraine of 0.93 days per month compared to 0.97 days per month on the Topirate. This shows that the exercise was just as effective in reducing the migraine as the medication. Of course the exercise subjects also did not have to deal with any potential side effects that comes along with the medication. Here at Freedom Physio & Acupuncture we are a he believer in the overall benefits of regular exercise, We focus on helping you find an exercise regime that you enjoy and most importantly fits with your lifestyle.

Botox

Botox is injected directly into the muscles of the forehead, neck ad shoulders, it does not pose the same risk of systemic side effects as orally ingested medications do. Botox effects last around 12 weeks and has been shown to be useful. Obviously this is a quite invasive treatment so I recommend the other natural treatments to be tried before this.

Try Some Natural Supplements

Butterbur- A perrenial shrub that has shown promising results as a migraine prophylactic. In one study butterbur at 75 mg twice a day reduced migraine frequency by 48 percent compared with 26 percent for the placebo.

Riboflavin -Riboflavin or vitamin B2 has shown effectiveness in reducing migraines. In a 1998 study by Schoenen, Jacquy and Lenarts 59 percent of those taking 400mg of riboflavin daily improved by at 50 percent in headache days compared to 15 percent of those on placebo.

Magnesium - Studies have shown migraine sufferers have a lower levels of mineral magnesium. Dr Jay Cohen has written a book called the Magnesium Solution for Migraine Headaches. I have found in my work with  multiple muscular- skeletal conditions magnesium supplementation can help.

Headache & Migraines Part 3 - What Triggers a Migraine

WHAT TRIGGERS A MIGRAINE?

The most frustrating thing about Migraines is their unpredictability. Most sufferers are obviously desperate to find what their triggers are because they think this will help stop the problem.  The problem is these triggers seem to keep changing. One day it will be red wine then the next week you can drink a glass of wine without a problem. You can happily eat  almonds one month then the next month they seem to trigger migraines. Theoretically it should be easy you keep a diary pinpointing  the trigger for each migraine and try to avoid these triggers. The problems is this approach sometimes works and sometimes doesn't. Plus if you read the list of possible trigger foods you start to wonder if you can eat anything at all.

The reason why the triggers seem to change is that it is never one thing that triggers a migraine. What actually happens is every migraine sufferer has a number of triggers. Each trigger acts as a  brick in the wall and when the wall reaches your specified height you will trigger a migraine. Obviously the more susceptible to migraines the lower the  wall has to be before a migraine is triggered. The plan then is to try and figure out what your bricks are and try to prevent your wall getting high enough to cause a trigger.

BRICKS IN THE WALL

Family History 

There is a strong genetics component to migraines and it is obviously the one you obviously cannot control.

Neck Vertebra 

It is agreed that many that many headache sufferers experience neck symptoms. Joints of the upper neck are positioned right next to the lower brainstem. Abnormal signals from the neck lead to increased sensitivity of the brainstem.  I will discuss how research has shown physiotherapy can identify and treat this cause of headache.

Sinus Congestion 

An acute sinus infection or allergic sinusitis can trigger a migraine. Sinus problems are most likely over diagnosed as a trigger for headaches but it can be significant. Now we are coming into spring I am beginning to treat a lot of hay fever sufferers. Acupuncture has been found to be very effective at treating allergic sinusitis and sufferers of chronic sinus infections so this trigger can be treated.

Hormones  

The hormonal shifts that occur just prior to and during menstruation have long been linked to migraines. Some women only have migraines around the time of menstruation. Many women also experience worsening of their migraine symptoms with birth control pills as do post menopausal women on hormone replacement therapy. The interesting thing with this trigger is the hormone levels of women who suffer from menstrual migraine when tested are within normal limits. This indicates a normal signal to the brain leads to a migraine indicating there is a problem elsewhere in the system.

Even though the hormone level itself is not the problem in  my experience if a women is experiencing significant premenstrual symptoms it is worth addressing these with Acupuncture. This will reduce stress and increase dopamine production and lead to less headaches. 

Bright Light 

Light particularly coming in at an oblique angle, like sun through a side window of a car or strobe lighting.

Food Triggers

Caffeine – Caffeine particularity in the afternoon can trigger a migraine. Many people can tolerate a coffee in the morning but continued coffee throughout the day can become a trigger. Ironically some sufferers find when a migraine is coming on caffeine can help prevent onset. There is no clear understanding of why this is at this stage.

Alcohol – Alcohol is one of the strongest triggers of headache. Obviously some  migraine sufferers can get away with one or two drinks but others one sip can be a trigger.

MSG – Can be a major trigger for some people. Also known as glutamic acid, glutamate.

Chocolate – Less of a trigger than some think as a migraine can cause a chocolate craving which leads it be be blamed more than it probably should be.

Processed Meats – salami, pepperoni, ham and any other meat you don't have to cook. It is thou=ght the nitrates in the meat are the trigger.

Cheese – normally aged cheeses.

Milk – particularly low fat milk which have a higher concentration of milk sugars.

Nuts – Almost any type of nut can act as a trigger

Citrus – Grapefruit, oranges, lemons particularly on an empty stomach

Banana – Any sweet fruit eaten to satisfy hunger can be a trigger. The advice is to only eat sweet fruit after  meals not too satisfy huger.

Artificial Sweeteners – particularly aspartame & saccharin.

 Lifestyle Triggers

Stress  - It is clear stress emotional or physical significantly raises the migraine risk level. Stress management plays a big part in controlling your headaches. Stress commonly adds tension to your neck which we have already discussed as a major headache trigger.

Sleep – Any sleep disruption can be a trigger. The most common are insomnia, too late a night on Friday night, new born baby or flying into a different time zone. Oversleeping can also trigger a migraine is some.

Poor Posture -Poor posture particularly at a work station leads to tension in the neck which as stated earlier is a major cause of tension headaches.

Hunger – Skipping or delaying meals is a well documented headache trigger. The drop in blood sugar is thought to be the trigger. Make sure when you feel hungry you do not eat a sweet food to satisfy the hunger as this will cause the headache to escalate.

Dehydration – An obvious trigger that every headache sufferer knows about. Carry a water bottle with you and if you sweat a lot with exercise take an electrolyte replacement drink.

Frequent use of Migraine medication – Ironically each time you take a medication to abort a migraine you are increasing your likelihood of triggering a migraine when the medicine wears off. This is called a rebound headache.

Medications – Asthma inhalers, No Doz, Nitroglycerine for heart disease, acne medication. Obviously if you have been prescribed these medication you can discuss with your GP if there are alternatives or if you can safely withdraw and check to see if the medicine is in fact a trigger.

Depression – Commonly a significant increase in headache can be  a sign of depression. If the depression is not treated it is unlikely the headaches will improve.

The next blog entry will look at the all important question of what can you do about preventing the wall building up to a level that you are susceptible to a headache or migraine.

Headaches & Migraines Part 2 - 4 Stages of Migraine

This blog entry will explain the basic progression of a migraine to help you understand the stages which migraine sufferers go through.

Prodome

The first sign of a migraine  is called a prodome and occurs four to forty-eight hours before the pain starts and is commonly experienced as fatigue. It can also present as change in mood, food cravings, dizziness and changes to bowels and urination.

Aura

Secondly the aura which is visual disturbances that some migraine sufferers experience. This is due to wave spreading depression in brain function leading to the slow spread of the aura symptoms.

Headache

The pain in the head originates from the lower brain stem which sits at the base of the brain, forming the juncture between the brain and the spinal cord. Pain sensitive nerve endings from the meninges (which is the outer layer of the brain send messages to the brain stem which then sends it along to pain centers of the brain and lead to the headache.)

Postdone

Post migraine is called postdone which is commonly experienced as fatigue or brain fog. These symptoms can last up to a day.

Migraine diagnosis is officially made with a strict criteria but as I stated earlier the more we learn the more it seems that a headache and a migraine are really on the same continuum. An example of this is one study showed 90 percent of supposed sinus headaches were actually migraines.

In the next blog we will look at what triggers a migraine and start to look at the question are these triggers really the cause of a migraine or is something else going on underneath this process.

Headaches and Migraines Part 1

Headaches and Migraines Part 1

This blog is aiming to give some information on current research and thinking on the management of headaches and migraines.

No major study has been undertaken in Australia on the prevalence of headaches but a best estimate based on US figures estimates there is up to three million migraine sufferers and seven million tension type headache sufferers in Australia. The direct costs to Australia would be well over a billion dollars per year.

Headaches and Migraines have long been classified as separate conditions but  current research shows that fundamentally a headache and migraine have the same root cause. As I will explain more fully as we progress on this blog the root cause of both headaches and migraines is a sensitized lower brain stem.

While I understand a migraine can feel a lot different to a headache it is actually similar concept to that of low back disk injury. You can have low back disk injury that can cause mild pain in a small area in the back or it can cause severe pain that spreads pain from the back all the way down your leg. Both cases are due to the same cause but the symptoms can be greater or  worse depending on the severity of the nerve irritation.

The premise for my approach is that headache and migraine are both due to a  sensitised brainstem.

The brainstem due to its position at the base of the head acts as a filter of information from the body as it passes into the brain. If the brainstem becomes sensitised the information that is passed onto the brain is made to seem more significant than it really is. This leads to normal information being wrongly perceived as a threat to the body. The brains response to this is to produce pain. Western medicine is in consensus with the brainstem theory as the most commonly used anti-migraine drugs which are called “tripans”( imigram, naratripan, relpax, zomig) prevent headache by desensitizing the  lower brain stem. Unfortunately the effect of these drugs is only temporary as the medicine does not treat the root cause of the sensitivity and like most medication the more of it you take the less effective it is.

The fact that migraines and headaches have the same root makes sense when you see that most tension type headache sufferers occasionally experience a more severe headache with similarities to a migraine just as most migraine sufferers will often experience a lesser headache resembling a tesion type headache. 

In the next entry I will explain the basic progression of how a migraine develops and in later entries I will look at how the lower brainstem becomes sensitized.

The Freedom Blog and you

At Freedom, we put in the time and effort to give – 
what is the best treatment for ‘You’

We don’t take a ‘One size fits all’ approach to how we care for you. 

Instead, all our treatments are selected and applied using a method of selective analysis tailored to give you the best outcomes.  We constantly strive to be at the forefront offering the latest in medical complementary treatment options for a multitude of ailments and wellbeing as well as rehabilitative therapies for illness/accident recovery.

This blog will highlight my thoughts on new treatments and things that will benefit you as a patient of Freedom Physio.

-Michael