June is migraine and headache awareness month! According to the World Health Organization about half of the world’s adult population has had a headache at least once in the past year. Prolonged use of electronic devices has greatly contributed to this problem. For many people, these headaches are infrequent and do not often affect daily life. But what about when your headache occurs frequently or is so severe it prevents you from going about your day to day activities? Some types of headaches are more easily treated and managed than others.
There are two types of headaches: primary and secondary. Primary headaches occur without an underlying disease and include migraines and tension-type headaches. Secondary headaches can be associated with serious disease, requiring emergency care, or can be referred from other structures of the body such as the cervical spine (neck).
Headaches symptoms that may constitute a medical emergency are: vomiting, seizures, fever, muscle pain, night sweat, weight loss, and neurologic symptoms such as blurred vision. If you are experiencing any of these symptoms, if your headache worsens, or your symptoms change it is recommended that you seek medical attention. Any headache that is unusual for you and does not resolve itself in a reasonable time should be brought to your primary care physician’s attention.
Migraines: Migraines are a primary form of headache that typically lasts from four to seventy two hours, can range from moderate to severe pain, and typically are located on only one side of the head. Often they can be accompanied by an aura, nausea or vomiting, sensitivity to sound, or light sensitivity. Migraines can be aggravated by routine physical activity such as going up stairs. This type of headache is thought to occur in the central nervous system.
Tension-type: Tension-type headaches are the most common primary headache disorder and can last anywhere from thirty minutes to seven days. These can often have a pressing or tightening quality that occurs on both sides of the head. Typically, there is no nausea, vomiting, or aggravation with physical activity, however, light or sound sensitivity can occur. This type of headache is thought to occur in the central nervous system but can have a hereditary component and is usually associated with muscle tender points. Tension – type headaches can be treated with relaxation techniques such as Progressive Muscle Relaxation (PMR), medications, and physical therapy.
The most common secondary headache that is not related to a serious medical condition is a cervicogenic headache (originating from the neck).
Cervicogenic Headache: The length of time a cervicogenic headache can last varies. Here the pain is on one side and usually starts in the neck. This type of headache is aggravated or preceded by head postures or movements of the neck. Due to the nerves of the neck and face sharing common connections, pain signals sent from one region can lead to discomfort in the other. Physical therapy can be an effective treatment to help relieve symptoms. For example: posture, exercise, ergonomics, massage, manual techniques, traction, trigger point, and acupressure.
A cervicogenic headache can be caused by an accident or trauma or can stem from neck movement or sustained postures. Sustained postures could mean sitting in front of a computer at work or looking down at your phone. Changing these postures throughout the day could help reduce symptoms. Changing postures could mean bringing your phone closer to you using pillows or another supportive surface when reading or checking social media. If you are someone who works at a desk, it could involve taking breaks or getting a standing desk. However your life requires you to move, there are some simple and effective exercises you can perform throughout the day to help cervicogenic headache symptoms.
Progressive Muscle Relaxation: PMR is an effective method for reducing tension throughout the body. With this method you first tense a muscle group, such as at the neck or shoulder, and then relax the muscles noting the difference between the two. This helps reduce both stress and tension. For more information or to learn how to do PMR, refer to podcast at: https://www.psychologies.co.uk/try-progressive-muscle-relaxation
Manage your stress level: While stressors vary from person to person, one method for managing stress is with exercise. Any form of exercise can help reduce stress, but a cost free method is aerobic exercise such as walking or running. A less time consuming method could be to perform deep breathing exercises throughout the day.
Heat or cold: When feeling sore or stiff, applying a hot or cold pack or taking a hot shower can help ease a tension headache.
Posture: Some tips for posture are to make sure your head is over your shoulders rather than sitting forward and making sure you are sitting or standing up straight with your shoulders back.
Over the counter medications: Talk to your doctor or pharmacist for additional information.
Posture: See tips listed under tension headaches.
Ergonomics: If your job or hobbies require you to sit for extended periods it may be beneficial to change positions throughout the day or consider getting a standing desk. Also, limit time on electronic devices. When sitting make sure the monitor is at eye level, your legs are able to fit under your desk, and you are close to the keyboard and monitor. If you are working with a laptop or phone, avoid putting it on your lap. Instead, bring your laptop closer to you by putting pillows on your lap or using an ergonomic desktop. See photo below.
Exercise: Some exercises to help relieve symptoms are chin tucks, shoulder blade pinches, and back extension. These exercises can be performed multiple times throughout the day in sitting or standing.
Physical Therapy: Physical therapy may include massage, manual techniques, stretching, traction/ decompression and exercise. A physical therapist can assess your posture and provide strategies specific to you.
Over the counter medications: While medication may not cure cervicogenic headaches, they may help relieve pain. Talk to your doctor or pharmacist for additional information.
Visit your doctor regularly and listen to your body.
Dr. Chua is a neurologist and headache specialist at Geisinger Health System in Northeast Pennsylvania. In addition to caring for people with headache and facial pain disorders, Dr. Chua also serves as: Director of Headache Medicine at Geisinger, Clinical Director of Neurology at Geisinger Wyoming Valley, faculty at Thomas Jefferson University’s Advanced Headache Diagnosis and Management Post-Graduate Certificate Program, and Treasurer and Executive Board Member of the Association of Migraine Disorders. In her spare time, she enjoys going on adventures with her husband and toddler, learning new skills (she is now certified in battlefield acupuncture), and buying great books she will never have time to read!
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
This column is dedicated to the memory of John R. O’Brien, Esq., who recently passed due to medical complications associated with multiple sclerosis (MS). John was a source of joy and inspiration for those fortunate to have known him. Twenty years ago, John hesitantly agreed to contribute to my column on MS with two requirements: one, if the column would be valuable to those affected by MS and two, he would remain anonymous. When speaking with his dedicated wife, Sally, it became very apparent that any discussion of John’s life would be diminished if it was defined by the disease because he was committed to turning his “DISABILITY INTO AN ABILITY!”
With the help of his loving wife, family, friends, and devices such as an electric scooter and adaptive car, John not only lived but thrived! He was a skilled lawyer, a respected member of the Bar, and an active member of the community. John served on the executive committee of the Lackawanna Bar Association. In addition, the Lackawanna Pro Bono honored him recently. He also taught business law and healthcare law and coached Prep’s mock trial team.
John shared his thoughts with me about the challenges of redefining life… from Golf Club Champion to living with a physically disabling disease. Anyone who knew him would agree that he succeeded in doing so through his keen intellect and sharp wit and humor…his heart and brain overcompensated for his body! In addition to reading books in Latin and Greek, he had his crossword puzzles published in The New York Times and Los Angeles Times. In September 2023, John conducted an interview with presidential historian Doris Kearns Goodwin before a full house at the Scranton Cultural Center. Ms. Goodwin later reported that John was the most knowledgeable, effective and enjoyable interviewer she’s encountered.
John’s absence will be deeply felt and his legacy will continue to shape our community for years to come!
Multiple Sclerosis is a chronic disease. While it may lay dormant and stable for a period of time, living a healthy lifestyle will make a positive contribution toward how you and your family live with Multiple Sclerosis. Studies show that a life of family, love, and support are essential to maintain a positive attitude with a chronic illness. This combined with a healthy diet and proper exercise can contribute greatly toward taking control and living a relatively normal life with MS.
As I have mentioned in many other columns, studies show that people with good attitudes and great faith live longer than others. This is especially helpful when living with chronic disease like Multiple Sclerosis. The Cleveland Clinic offers some suggestions how to maintain a positive attitude:
Many sources, including the Cleveland Clinic suggest that exercise, when performed properly, can have a positive impact on Multiple Sclerosis symptoms both physically and psychologically. However, because you have a chronic illness, you should consult with you family physician and physical therapist before beginning an exercise program. They will advise you on the proper type and amount of exercise.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
This column is dedicated to the memory of John R. O’Brien, Esq., who recently passed due to medical complications associated with multiple sclerosis (MS). John was a source of joy and inspiration for those fortunate to have known him. Twenty years ago, John hesitantly agreed to contribute to my column on MS with two requirements: one, if the column would be valuable to those affected by MS and two, he would remain anonymous. When speaking with his dedicated wife, Sally, it became very apparent that any discussion of John’s life would be diminished if it was defined by the disease because he was committed to turning his “DISABILITY INTO AN ABILITY!”
With the help of his loving wife, family, friends, and devices such as an electric scooter and adaptive car, John not only lived but thrived! He was a skilled lawyer, a respected member of the Bar, and an active member of the community. John served on the executive committee of the Lackawanna Bar Association and was recently honored by the Lackawanna Pro Bono. He also taught business law and healthcare law and coached Prep’s mock trial team.
John shared his thoughts with me about the challenges of redefining life… from Golf Club Champion to living with a physically disabling disease. Anyone who knew him would agree that he succeeded in doing so through his keen intellect and sharp wit and humor…his heart and brain overcompensated for his body! In addition to reading books in Latin and Greek, he had his crossword puzzles published in The New York Times and Los Angeles Times. In September 2023, John conducted an interview with presidential historian Doris Kearns Goodwin before a full house at the Scranton Cultural Center. Ms. Goodwin later reported that John was the most knowledgeable, effective and enjoyable interviewer she’s encountered.
John’s absence will be deeply felt and his legacy will continue to shape our community for years to come!
According to the National Multiple Sclerosis Society, Multiple Sclerosis affects approximately 400,000 people in the United States. Multiple Sclerosis is second only to trauma as the most common cause of neurological disability for those in early to middle adulthood. MS is almost three times as common in women. Multiple Sclerosis is very uncommon before adolescence or after 50. However, the risk increases from teen years to age 50.
Multiple sclerosis is considered to be an autoimmune disease. The immune system of the body does not work properly when it fails to attack and protect the body against substances foreign to the body such as bacteria. Instead, the system allows the body to attack normal tissues and create diseases such as MS, rheumatoid arthritis and lupus.
In MS, the immune system attacks the brain and spinal cord of the central nervous system. Each nerve has an outer covering of a fatty material (myelin) for insulation to improve the transmission and conductivity of impulses or messages to and from the brain. The damage to the myelin of the nervous system interrupts the ability of messages to travel to and from the brain, through the spinal cord and to other areas of the body such as the muscles in the arms and legs. Due to this “short circuiting” the brain becomes unable to send or receive messages. In multiple sclerosis, scar tissue or plaques (sclerosis) replaces the fatty myelin in “multiple” areas. This is also called demyelination.
The symptoms associated with MS vary greatly from person to person. The amount, frequency and speed of the demyelination process vary greatly and are directly related to the loss of strength and function in daily activities. Some people are independent and ambulatory with mild and infrequent episodes of weakness and disability and live a relatively normal life. Others suffer from frequent and aggressive episodes that significantly weaken and disable. Some common symptoms in the early stages include: muscle weakness, loss of coordination, blurred vision, pain in the eyes, double vision. Some common symptoms as the disease progresses are: muscle stiffness with muscle spasms, pain, difficulty controlling urination, difficulty thinking clearly.
The diagnosis of MS can be very difficulty in the early stages because the symptoms are often vague and temporary. Also, MS symptoms are very similar to other neurological problems. A neurologist will run several tests to rule out other possible problems. However, an MRI showing demyelination of the nerves is a primary confirmation.
Treatment for MS depends upon many factors and requires consultation with your physician. Some medications can control the frequency and severity of MS symptoms such as pain, weakness, and spasticity. Also, some drugs can slow the progression of certain types of MS. Additional treatments for MS include: diet, exercise, physical therapy, support groups, and counseling for the MS patient and their family. Part II of Multiple Sclerosis will discuss these options in further detail next week.
Visit your doctor regularly and listen to your body.
EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog
EVERY SUNDAY in "The Sunday Times" - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy - NEXT WEEK: PART II OF II - MULTIPLE SCLEROSIS
This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy in Scranton and Clarks Summit. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Mackarey's articles, visit our exercise forum!
