Dr. Painovich: There are several types of headaches. They can go from tension headaches to migraines, cluster headaches and headaches that we think are hormonally induced. The interesting thing about headaches is that from a Western medicine side, there are no real known causes of headaches. It’s an enigma. We know people have them. But we have not been able to figure out what is going on when people experience different types of headaches.

The good news is that there are a lot of alternatives, such as acupuncture and traditional Chinese medicine that can be quite good for not only eliminating headaches but also eliminating them completely.

Gail Edgell: Are there different treatment options available based on what doctors think cause a headache — if it’s coming from a food-based issue verses a hormone-based issue, for example?

Dr. Painovich: From a Western-medicine standpoint, I don’t know if it looks at that specific of a cause. I do know that certain types of foods can trigger headaches. Let’s talk about the different types of headaches, what causes them, and go from there. It’s such a broad topic.

Tension headaches, which are the headaches that you feel in the neck, shoulders and back, are the most common. Those are usually due to tight muscles in your shoulders, neck, scalp and jaw. Those are usually tolerable for most people and can be relieved with painkillers. But if somebody happens to have these on a daily basis, it can certainly interfere with his or her quality of life. We do not know the causal factor. But we think that it’s just those tight muscles, that inflammation that just presses on the nerves enough to cause some pain in those particular areas. Western-medicine practitioners will tell you to take a pain-reliever and do some relaxation exercises, just to try and reduce that tension in the body.

When you start to talk about migraine headaches and cluster headaches, migraines are the most common — three times more common in women. Cluster headaches, which are much less frequent, are found in the male population. Doctors think that migraines definitely have to do with the constricting and dilating of blood vessels in the head. But it is believed that people who suffer from migraine headaches tend to have more sensitive nervous systems, meaning that they are more easily triggered by foods or environmental stressors. When those things are triggered, it causes this whole kind of neurochemical reaction in the brain. Currently, what the research shows — this is the most common theory, and just a theory — is that when the nervous system gets triggered, it causes the arteries in the brain to constrict. When they constrict, they cause a large amount of serotonin to be released. Whether people know it or not, serotonin can be associated with a lot of other things such as depression, anxiety and some pain syndromes outside of headaches.

The body gets this big surge of serotonin. But the body has a system of checks and balances. This large amount of serotonin causes all these other neurotransmitters to get released, to go up there and say, “Oh, these arteries can’t be constricted. We need to let these arteries relax.” These neurochemicals cause a very fast and acute dilation of arteries in the brain. That dilation causes the swelling of these arteries, which then press on the nerves. That is what causes the migraine pain to occur. Researchers have done studies that look at levels of serotonin right before a migraine hits that show those levels can be very high. Those same levels during or after a migraine are very low. They think it’s that whole reaction that happens, these big surges and high levels to low levels, that cause the over-dilation in the brain and the arteries that cause the pain in the head.

Some premenopausal and menopausal women say, “I definitely have migraines that are associated with the start of the period or the end of the period.” That is probably due to the fluctuation of high levels of estrogen, higher levels going to lower levels. This is the same with progesterone. They think that if that is really what is causing the migraines, the migraines should actually ease as they go into menopause or are through menopause. Whether that happens or not is a whole other issue.

Gail Edgell: Getting back to migraines and cluster headaches, what is the typical form of testing? Do doctors typically prescribe synthetic medications? And if we move into a more naturopathic approach, are we actually looking at things like food allergies or environmental toxins?

Dr. Painovich: Again, from a Western-medicine standpoint, they try to put people on preventive medication, things that will decrease that sympathetic tone or that vulnerability of the nervous system. It may prevent fewer occurrences. But they also give them medication for acute occurrences because, typically, that doesn’t stop the headache from coming on. Unfortunately, these medications tend to have some unwanted side-effects.

From a Chinese-medicine standpoint, we don’t look at levels of serotonin and those sorts of things. We break it down very specifically to where the headache is. Is it in the back of the head, the top of the head, or the side of the head? When does it happen? We are looking for patterns of disharmony. We are looking for that root cause of what is causing these headaches to occur.

We rarely treat symptomatically; we look at what is going on from the root standpoint. If we figure this out, the headaches should go away, not only temporarily but for a lifetime.

We always take a holistic approach. We will certainly look at the foods and environmental toxins that you are taking in. But we also talk about exercise and life stressors. We look at everything. When we meet and consult with patients, we certainly touch on all of those things. Then we specifically get into the way that we treat. I use acupuncture and herbs to treat these headaches.

There have been several studies that have shown that acupuncture is one of the best treatment modalities. We’ve found that it is not only effective in stopping the discomfort but in reducing time away from work, family and such. When you look at the cost-effectiveness and quality of life, you find that acupuncture is one of the most cost-effective treatments that you can do for headaches. It doesn’t surprise me. When we look at a deeper level of studies that have been done on acupuncture, we know two things for sure. One is that it reduces stress and that sympathetic tone of the body. If that is calmer, people are not as susceptible to triggers. The other thing we know is that it definitely reduces or stabilizes serotoninlevels. The two big things that practitioners of Western medicine think cause these migraine headaches are two things that are directly affected in a positive way through acupuncture.

Acupuncture also releases opiates — endorphins and things like that that help reduce pain — into the system. When you take that all together, it’s really quite easy to see why acupuncture works so well in helping get rid of these chronic headache problems that people suffer.

Gail Edgell: Just to sum it up, there are three types of headaches: tension headaches, migraines, cluster headaches and hormonal headaches (PMS or menopausal related). Some things people can do to lessen their frequency and severity include relaxation — perhaps yoga or meditation — exercise and examining stress levels, food allergies and environmental toxins that may trigger them. People should start looking at all of these. And if they cannot resolve the headaches on their own, they should start looking at acupuncture, which is one of the best means of treating this ailment. Did I miss anything?

Dr. Painovich: I don’t think so. It comes down to maintaining a healthy lifestyle. If that doesn’t do it, seek out a professional such as an acupuncturist to get you to that next level of increased quality of life.

Note: This article is an edited transcript of an audio interview. Changes have been made.