In this episode, I discuss the causes and treatments of different types of headaches, including tension headaches, migraines, sinus and cluster headaches, as well as menstrual and other hormone-based headaches. I describe how to distinguish between the different headache types and how to select the right treatment, including prescription-based and non-prescription-based treatments, behavioral and nutrition-based approaches. I also explain the evidence and mechanisms supporting the use of omega-3 fatty acids, high dose creatine, peppermint oil, turmeric, acupuncture and more. Additionally, I touch on traumatic brain injury, the causes of photophobia, aura, and the link between spicy foods and thunderclap headaches. By the end of this episode, listeners and viewers will have a comprehensive understanding of headaches, their types and the best way to prevent and stop them.

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Articles
Prevention of traumatic headache, dizziness and fatigue with creatine administration. A pilot study: https://bit.ly/3Y8lKLU
Long-chain omega-3 fatty acids and headache in the U.S. population: https://bit.ly/3X5lRXw
Dietary alteration of n-3 and n-6 fatty acids for headache reduction in adults with migraine: randomized controlled trial: https://bit.ly/3Y4SXaZ
Effect of omega-3 fatty acids on premenstrual syndrome: A systematic review and meta-analysis: https://bit.ly/40uX5Tu
Effect of Peppermint and Eucalyptus Oil Preparations on Neurophysiological and Experimental Algesimetric Headache Parameters: https://bit.ly/3wZegiu
Herbal treatments for migraine: A systematic review of randomised-controlled studies: https://bit.ly/40uXbuk

Timestamps
00:00:00 Headache
00:03:51 Sponsors: Thesis, LMNT, Maui Nui, Momentous
00:07:47 Headache Sources: Muscle Tension; Blood Flow & Meninges
00:14:06 Headache Sources: Neurons; Inflammation & Sinus Headache 
00:23:21 3 Neuron Types, Pain, Tension Headaches
00:31:05 Tension Headaches
00:33:25 AG1 (Athletic Greens)
00:34:29 Migraine Headaches, Aura, Photophobia 
00:43:10 Cluster Headaches
00:47:47 Hormone-Based Headaches, Menstrual Cycle & Menopause
00:53:38 Traumatic Brain Injury (TBI) & Headache, Baseline Health
01:02:08 Tool: Headache Treatment, Creatine Monohydrate & TBI
01:12:22 InsideTracker
01:13:55 Headache Treatment, Omega-3 & Omega-6 Fatty Acids (Linolic Acid)
01:22:14 Tool: Omega-3 Supplementation, Omega-6 Fatty Acids & Inflammation
01:28:11 Hormone Headache Treatment & Omega-3s
01:31:24 Tool: Aura, Photophobia & Offsetting with Red Light 
01:44:15 Tool: Tension Headache & Botox Treatment
01:49:43 Tool: Alternative Headache Treatments, Peppermint Oil, Menthol
02:01:35 Tool: Tension Headaches Treatment & Acupuncture
02:05:41 Tool: Migraine & Herbal Treatment, Caffeine Timing
02:13:26 Tool: Migraine Treatments & Curcumin (Turmeric) 
02:18:00 Carolina Reaper Pepper & Thunderclap Headache
02:24:21 Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Sponsors, Social Media, Momentous, Neural Network Newsletter

Title Card Photo Credit: Mike Blabac - https://www.blabacphoto.com

The Huberman Lab podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

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.

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 we'll review all the different types of headaches and what the underlying biology of each and every 1 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, or 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 1 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.

As you'll soon learn today, each and every 1 of the treatments for each and every 1 of the different kinds of headaches is grounded in a 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 1 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 0 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.

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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, 1 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 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 in 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 involved in the other types of headaches as well.

Okay, so I just wanna highlight muscular issues as 1 particular source of the ache in headaches.

The other tissue that can be prominently involved in generating the ache of a headache are the so-called meninges.

Now the meninges, in addition to being a fun word to say, are 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

The brain is actually encased in a very thick, very durable sack or casing that's wrapped around it, tight like Saran wrap.

It actually has a name, which is dura, D-U-R-A.

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 a very sharp razor blade.

So the brain is actually sitting in a very fibrous like sack that you simply could not open up with your fingertips under any conditions.

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, if you've ever felt, for instance, the sail of a sailboat, you might think, oh, it's just this big flapping 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 sack is 1 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 1 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, a little skin flap has to 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 tissue 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 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 1 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, N-O-C-I, 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 2 sources of pain, that is the ache and headache.

And there are 2 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.

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 1 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, or I should say the relatively more minor cluster headaches are extremely painful and the severe ones are exceedingly painful.

Cluster headaches arise from deep, or 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 3 branches tri.

Okay, so there's a branch that essentially extends to the eye.

There's also a branch that extends to the mandible, right?

And there's a branch that extends more or less 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 1 side.

Oftentimes there's lacrimation, which is tearing up.

Another common symptom of this type of headache, that is the cluster headache, is that the pupils 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 1 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 stuff around the brain and as it relates to the vasculature.

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, this reduces inflammation and inflammation is bad.

And I suppose in some cases, and when inflammation is really widespread across the brain or 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 1 form of signaling in the body, which of course includes the brain.

Inflammation of a tissue is 1 way in which a set of cells, so these could be for instance, 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 at hubermanlab.com, and it'll take you to specific episodes and timestamps for the topics you're interested in.

So for sake of this discussion about headache, inflammation is going to be the case when 1 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.

And indeed, if you were to get a BB or a splinter into a particular, 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, or 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 1 big piece of solid bone or 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 have them on either sides of your nose.

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.

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 1 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 in that it sends out a very broad signal that's very clear something is wrong here and needs to be dealt with.

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 extent of inflammation by putting in different scar tissues.

Indeed, a lot of the things that we think of as kind of gross pussy, 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 experienced as pain mechanisms in the other 3 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 ache in headache, we have neural origins of the ache in headache, and we have inflammation-based origins of the ache and 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, and this is an 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 pinprick 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 3 to 5 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 1 of those times when if I had a highlighter pen that could go out across the microphones and speakers, leading to your ears, I would use it here.

Because what I'm about to tell you is perhaps 1 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 in 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 some make glutamate and on and on.

The key distinction among different types of neurons, that is the 3 types of neurons that I believe everybody, scientists or 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.

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 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 heartbeats or you move your limbs, you lift your eyelids or your eyebrows rather,

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.

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 experienced that as pleasurable.

Whereas if you stroke in the direction opposite to the way the hairs lay down, we experienced that as not pleasurable.

So these sensory neurons respond in some cases, for instance, within the auditory system, they respond to sound waves in 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.

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How to Stop Headaches Using Science-Based Approaches | Huberman Lab Podcast