Transcript

Ayla Wolf  00:00

I mean, I had a patient who was essentially, to make it short, taking ibuprofen every single day. And once I explained to her that taking ibuprofen for more than 15 days a month can actually cause rebound headaches, she finally went off of it, and her daily headaches went away just by not taking a pain killer every day. Yeah, and so I think a lot of people don't recognize, even if they're only taking 200 to 400 milligrams of ibuprofen a day, if you're doing that more than 15 days a month, it can actually be causing rebound headaches.

Sophia Bouwens  00:36

Welcome to the life after impact podcast, where we do a deep dive into all things concussion and brain injury related. We talk about all the different symptoms that can follow brain injury, different testing methods, conventional and functional, different types of specialists out there, and different therapies available. I'm Sophia Bowens. I'm here with Dr Ayla Wolf and we will be your guide to living your best life after impact. Hi, Sophia, how are you doing? I'm doing well. How are you today? I am good. I'm

Ayla Wolf  01:09

excited to be here recording our second podcast in our series.

Sophia Bouwens  01:13

Oh, Ayla, I'm so excited for this episode. I know that we're gonna have so much to dive into. There's gonna be a series of them.

Ayla Wolf  01:20

Yeah, headaches are the most common symptom that people report following a concussion, and yet, what I have seen clinically, and I'm sure you have too and many providers, is that the headaches people experience after a concussion are often much more difficult to treat than other types of headaches.

Sophia Bouwens  01:40

They are. It's really confusing as a provider and as a sufferer of brain injury, the headache complexity is really tricky. I really appreciated your chapter that outlines so much in your book about the different types of headaches and how their distinctions can be really important for getting correct diagnosis. So I think I would love to start just by diving into the different types of headaches that people can have after a head injury. What do you say?

Ayla Wolf  02:11

That sounds good. And in my book, Concussion Breakthrough, my goal in writing it was really to develop a troubleshooting guide for people to help them figure out, okay, I tried this thing, and I'm still not any better. You know what's what's next? And so again, being practitioners of acupuncture and Chinese medicine, typically, what that means is that by the time people come to me, they've already had symptoms for a long time, because most people don't seek out acupuncture as a first line of therapy, right? Although they should, yes, they should. Because, man, when people do, they seem to get better really quickly. So when people do it right away, I do think it can make a big difference. However, a lot of the people that come to see me have already tried many, many things, and they're still symptomatic, and so we have to do a lot of deep troubleshooting to try to figure that out,

Sophia Bouwens  03:08

and they've already seen probably one or two or more other providers, and they've had kind of hit or miss effectiveness with their treatments. Why do you think that is do you think that the diagnosis is difficult, or do you think that it's just a stubborn condition to treat, or do you have thoughts on that component?

Ayla Wolf  03:27

There are a number of things that I think go wrong. So the way that I've kind of designed it in the book is I classified headaches into a couple of different categories, and one of the categories is cervicogenic headaches, meaning a headache that arises from some kind of pathology in the neck. And so oftentimes, when a lot of the people that I see have concussions and whiplash and from like, say, motor vehicle accidents or slips and falls on the ice where they slipped and hit their head and also injured their neck. Some people can have headaches as a direct result of their neck injury, and the nerves that get irritated in the back of the neck can then cause these headaches that just kind of radiate even all the way up into the front of the head and behind the eyes. Damage to the neck alone can cause a lot of the same symptoms that concussion can cause so things like nausea and dizziness and even changes in balance, even changes in depth perception. And so that's where it can get confusing, is that a lot of the same symptoms of a traumatic neck injury can kind of look like concussion symptoms. Usually people, I think often, can have a combination of both, right? They've got their concussion symptoms, and then they have these neck injury symptoms, and sometimes people are diagnosed with the neck injury and the concussion gets missed, and there's all this focus on the neck and then in other cases, the concussion gets diagnosed and the neck injury kind of gets diminished or not. Attention to and so then that gets missed, and it's so important that both of them are recognized and tested and diagnosed correctly and treated correctly.

Sophia Bouwens  05:09

I'm excited to dive into that conversation more. I have some patients I have to share about some experiences with that in particular, and I want to get your expertise with that as well. So cervicogenic, and then there's also a different type, tension type headache.

Ayla Wolf  05:25

Yeah, some people can have just a bad tension headache after a concussion that feels a lot like a squeezing pressure sensation, and that can also be caused from a number of different things. When people get a concussion, there can be congestion within the glymphatic system, which is the lymphatic system in the brain. And so if you think about a lymphatic congestion that creates a sense of pressure, and so that lymphatic congestion alone within the brain can create these types of chronic pressure headaches, and oftentimes those feel intractable. I always ask people, do your headaches ever fully go away? And that's a really important question, because when people's headaches do fully go away, to me, that is like a thumbs up, yay. This is gonna be easier to treat.  Then the people who say, No, I have a headache 100% of the time, it just varies in its level of intensity. And so the people that often say that their headache is there all the time, and that there is always a sense of pressure, and the sense that there's just too much inside the head kind of wanting to come out, is how some people describe it. And so that's where I often think that there's usually an underlying component of either dysautonomia that's interfering with normal blood flow to different parts of the brain and normal blood vessel motility, as well as potentially this congestion within the glymphatic system that needs to be addressed as well.

Sophia Bouwens  06:56

And the glymphatic system, or the lymph system, is really our detoxification component, right? And so we have the tension type, which we'll dive into more. But the other types we have, we're going to do total episodes on, are these migraine and this migraine-like headache presentation.

Ayla Wolf  07:13

Yes, that's another area where I think a lot of people are struggling, it's that they get a concussion, and then they get diagnosed as having migraines, because their post traumatic headache very closely resembles a migraine, and then they're being placed on migraine medications. And a recent study came out that said that 87% of people with post traumatic headaches were dissatisfied with their current therapies.

Sophia Bouwens  07:41

That's a 13% success rate.

Ayla Wolf  07:43

Yeah, that's not good.

Sophia Bouwens  07:45

no!

Ayla Wolf  07:45

And that means that basically means that we all need to do a better job.

Sophia Bouwens  07:49

Absolutely. So let's dive into kind of what these different types are, because knowing the distinctions between them can lead to the correct diagnosis and the correct therapies.  Because I'm assuming you don't do the same thing for all types?

Ayla Wolf  08:02

No, I think that's where you know, having the Chinese medicine perspective, it comes in handy, because we talk about this difference between a constant sense of pressure in the head and in Chinese medicine, we talk about that. We call it dampness, right? This idea that there's too much fluid, or something wrong with the fluid metabolism in the body,

Sophia Bouwens  08:25

that murky water, that filter is not working well, exactly.

Ayla Wolf  08:25

So it's almost like, again, going back to the fish tank analogy, if your filter is not working and you haven't cleaned the water, all of a sudden the fish poop is just everywhere. These fish are swimming in their own poop, right? It's gross, and our glymphatic system in the brain is literally meant to take out all of the metabolic waste in the brain. And then we forget, though, that once that is removed from the brain, it has to also be removed from the body, which means we do need our liver to filter everything out, and we need our kidneys to filter everything out and flush it out. Part of the problem in medicine is that we rely so heavily on blood work. And when it comes to organ function, disease within organs show up last in blood work. And so by the time your labs start to say, Hey, there, you know, you've got an indicator light flashing, it's kind of like the damage is already there. It's already been done. And that's where, you know, having more of a natural, holistic approach to health and longevity isn't about let's wait for something to get so bad, and that is now, you know, red flag on a lab, right? And the truth is, is we live in such a toxic environment that everybody has an excessive amount of burden now on their liver and their kidneys, and especially, you know, with all of the wildfire smoke that's been happening in the US and in Canada, air pollution. I mean, it was so frustrating when I was practicing in Bend Oregon, where. Where every summer there would be horrible wildfire smoke, and it would just linger in the air to the point where even I would feel asthmatic for like a week or two in the summertime. But my patients that had all been recovering from their brain injuries the second that smoke landed in town, everybody's oxygen saturations got worse. Their symptoms got worse. Like the nervous system is so sensitive to oxygen and the lack of oxygen and air quality and pollution. And I would literally see, physically see the effects of that wildfire smoke. And if you think about houses being burned down, and how much toxins are being released when actual structures are being burnt down, and then that all ends up in the atmosphere. And like even in Minnesota, less the last two summers, we were getting all of the smoke from Canada filtering down.

Sophia Bouwens  10:53

It was gloomy outside for weeks on and haze in the background.

Ayla Wolf  10:58

Yeah. So it doesn't matter if you live on a, you know, desert island, like we're all breathing the same air on the planet, and it's toxic air, sadly. 

Sophia Bouwens  11:06

I've had the privilage of being able to travel the world in the past year, going to Egypt and going to Nicaragua, and living in the United States and seeing everywhere has this haze,

Ayla Wolf  11:16

yeah, and even the discussion about micro plastics and forever chemicals and all of the things that we are exposed to that, you know, even just all these conversations around Parkinson's, you know, being, in a sense, a man-made disease based on chemical exposure to these different chemicals in our environment.

Sophia Bouwens  11:33

disruptors to our nervous system.

Ayla Wolf  11:35

Yeah. So that's why, you know, we have to really promote liver and kidney health, because those are our filters. They are, those are our big, important filters.

Sophia Bouwens  11:48

They help so much. But let's start with cervicogenic headache. So if, if you're seeing a patient in your clinic and they come in with, what symptoms, do you start thinking more cervicogenic versus the other types? Do you want to talk about the distinction of cervicogenic headache?

Ayla Wolf  12:03

Well there's often a lot that you can glean from somebody's, you know, from doing a basic intake, right, and saying, you know, what was the mechanism of your injury? Did you have immediate neck pain afterwards? We do a lot of functional range of motion testing as well. And there was a great study that also came up, I think, in 2024 that said that after a concussion, people that did not complain about neck pain when you evaluated them and did certain orthopedic tests and palpation, they were finding that these people, in fact, did have pain when they were being, you know, palpated and evaluated appropriately, and then also they had a loss of joint position, sense of that cervical spine. And so we do a lot of functional tests where we've got the glasses that people wear, it's got a laser right in the middle, and then you have them close their eyes, and you turn their head, and they're supposed to bring the laser back to the center with their eyes closed. And so all they're using is the kind of receptors in their neck to tell them how far and how fast they're moving. And so we can do these functional tests to say, How is someone's joint position sense, and are they having errors in that joint position sense, meaning that their receptors in their neck are not accurately telling their brain how far or how fast or in what direction their head is moving, and that can create a lot of tension and a lot of problems with the neck and how people move. And I also just in looking at somebody's gait, how they walk down the hall, some people don't realize how much tension they have, but when you look at them, they're walking almost like they're trying to balance a pineapple on top of their head, rigid, yeah. And that can sometimes be because they have dizziness or vertigo, and they're actually afraid to move their head because they're afraid to trigger that.

Sophia Bouwens  13:58

And one thing I learned from you that really blew my world apart was that our neck alone can make us dizzy. If those little receptors in those joints don't feed forward into the central nervous system, we can get a lot of miscommunication and where ahead and where our body is in space. So these proprioceptors, or these joint receptors in the joints of the neck alone can drive a lot of dizziness, and that dizziness can make our system really stressed out, because our brain and our nervous system doesn't like to not know where we are in space or not trust it. So we have a lot of feeding into that system from the neck that can drive concussion like symptoms, is that? Right?

Ayla Wolf  14:44

Yeah, I mean, everything is connected, and we have to look at everything holistically, as opposed to even trying to separate head from neck, because they all communicate with each other constantly.

Sophia Bouwens  14:59

I have a patient I've been working with for a while. He's doing much. Better than he was when I first saw him, but they were treating his concussion mainly in the beginning, and really, if, after working with him, realizing that His neck was a lot more involved in his symptoms, right, it was causing a lot of dizziness, I had him do a vestibular evaluation with another partner, and they confirmed for me that it was more than neck that was feeding bad information into the nervous system, making him more dizzy. So we've started working on that joint perception more, and his tension has come down a ton, and his headaches have gotten better. He was having these like kind of ticks come up from his tension and the neck that was driving a lot more symptoms that he thought was just his concussion, his inability to concentrate or focus or hyper fixate on different things made it difficult for him to see the bigger picture and cut back a little bit once we started working the neck, not just the cognitive components, he had a really big turnaround. What might you do differently for a patient with a cervicogenic headache from maybe the other types.

Ayla Wolf  16:04

Well a lot of it has to do. Again, as an acupuncturist, we have this incredible tool which can help to improve the joint position sense of the neck by doing acupuncture points along the spine the cervical Jia Ji points is what we call them. And not only do those help to improve the joint position sense in the cervical spine, but they also help to increase blood flow to the brain as well. And by doing that, you can improve a lot of even cognitive symptoms and autonomic nervous system functions by getting more blood flow into the brain stem. And I think that that's where you know being able to understand the importance of the neck in all of the different pathology and in improving blood flow to the brain, acupuncture just is such a great tool for that.

Sophia Bouwens  16:54

It really is. How might a cervicogenic headache mimic or be different from attention type headache?

Ayla Wolf  17:01

a lot of times the cervicogenic headaches, because you've got irritated nerves coming from the back of the head. The headache will often start in the back of the head, and it might refer into the front of the head. So a lot of people can literally trace a line from the back right to kind of their eyebrow or their eyeball. And so sometimes the cervicogenic headaches can be a unilateral throbbing headache depending on kind of which nerves are irritated, or they can just be an intense pressure in the back of the head, or at least, like I said, a headache that starts in the back of the head. Whereas, when people experience tension headaches, a lot of times they describe it as their head being in a vice, or this bilateral squeezing that can either be the entire head, or it can be the temples the forehead. A lot of people with post traumatic headaches, in that one paper, where they were actually trying to classify the different types of headaches that people had, they said that 65% of people had bilateral headaches, and of those, 70% of those headaches were in the front. Okay. And so a huge percentage of people with post traumatic headaches, based on the research, seemed to really complain about a lot of frontal and temporal headaches. And a lot of people do kind of point right to their eyes and their forehead and their temples when they're describing those headaches. Again, because I see so many different people with concussions, I also have seen that different eye movement pathology can trigger headaches, and when people have problems with convergence or convergence insufficiencies or convergent spasms. Those things can often also cause occipital headaches too. And so we have to be able to look at it from, you know, a comprehensive neurological exam, to also point us in the right direction to say, either, oh, look, there's a lot of findings involving the neck, or maybe there's a lot of findings involving the autonomic nervous system, and perhaps this dysautonomia is what's driving the headaches. Perhaps there is a lot of this congestion within the glymphatic system that's creating this backlog of waste that's causing increased pressure that causes headaches.

Sophia Bouwens  19:15

And that will be more the tension, like headache that you see glymphatic system talk a little bit about that.

Ayla Wolf  19:22

Within our brain, we've got what we call the glymphatic system, which was originally found in rats, and then eventually they realized that we have this as well. And this was really first discovered back in, I think 2015 when this one researcher came out with a very famous paper called The Garbage Truck of the Brain. And so we have to realize that our the work on the glymphatic system is very new, and that when it comes to what is inside our heads, we often think about neurons, but the reality is that there are even more glial cells than there are neurons.

Sophia Bouwens  20:01

More cells for detoxification and clearing out waste.

Ayla Wolf  20:05

And specifically, there are these interesting cells called astrocytes. And the astrocytes have what are called end feet that clamp onto the blood vessels. And blood vessels when we often think about blood pumping through our body as Oh, it's our heart's job to pump blood, but that's only half the story. The heart only pumps blood through a portion of our blood vessels, and then the rest of the blood gets pumped through as the smaller and smaller vessels through a process called vasomotion. And what can happen with a traumatic event like a concussion, is that people can lose healthy vaso motion of their blood vessels, and all of a sudden there's congestion and stagnation. And then on top of that, you've got the astrocytes who they have end feet. And the end feet clamp around the blood vessels. And within those end feet there are these like tunnels that actually funnel through all of the waste.

Sophia Bouwens  21:05

Sounds like little aliens in your brain.

Ayla Wolf  21:08

And there was some interesting research that found that military personnel that had blast injuries and experienced traumatic brain injuries from sound waves basically causing the concussion, those sound waves could literally blow the astrocytes off of the blood vessels.

Sophia Bouwens  21:25

Oh, my goodness.

Ayla Wolf  21:26

And cause what's called astrocyte scarring.  So there's, there's a lot going on there within our brains that we don't know, right, but that come that basically can create a scenario where we have a loss of vaso motion. We've got issues with blood flow. We've got problems with the glymphatic system, being able to get metabolic waste out of the brain. All of that, like I said, can cause a lot of pressure, build up, a lot of tension, headaches, throbbing headaches, and even dizziness and nausea and brain fog.

Sophia Bouwens  21:58

And what might you do for a patient with those kinds of glymphatic like symptoms, or what might you guide them to look at or think about?

Ayla Wolf  22:08

Well, that's where being a Chinese medicine practitioner comes in handy, because going back to this idea of pattern differentiation and seeing that there is this accumulation of metabolic waste, and that there is an inability to clear it out. That means that we need to up regulate the glymphatic system. We need to up regulate the water metabolism, the waterways in the body, and we can do that through different herbs. So do you have you ever used one of those loofahs in the shower? Yes, yeah, love them. So those loofahs are actually part of the Chinese medicine repertoire. And Si Gua Luo is the name of the herb, and it actually acts as almost a detergent that takes these large solutes that are in the brain and breaks them down and clears them out.

Sophia Bouwens  22:58

That's amazing. I love Chinese medicine because there's all these weird hacks like we use to clean our body, but it's actually like an herb that we can use to clean the inside too.

Ayla Wolf  23:08

So I use different herbal formulas that help to basically break down these larger solutes that need to get cleared out of the body, and then kind of up regulate these clearance pathways and up regulate glymphatic function and lymphatic function and kidney function to start flushing all of that out,

Sophia Bouwens  23:26

I can't talk about this detoxification flushing out without stressing the importance of hydration in my own recovery and with my patients, I'm a big water pusher, because I have found that ample hydration really helps with this process of, like, keeping things clear, helping with energy production and usage, and also this detoxification. When I was doing a deeper dive into the amount of water we need, just wondering, like, okay, we're 70% water. Our brain uses a ton of it. How much water do I need to be taking in? There's a lot of different numbers out there, but finding in general, what surprised me was the amount of water everyone should be drinking. The average person should drink 100 ounces of water a day as kind of a minimum. That number seemed really daunting to me, because sometimes I would lose my need for water, like I wouldn't get thirsty, and I actually found out that's a symptom of chronic dehydration. So if you're in this chronic dehydration state, you don't really get thirsty, but you can have all this toxic buildup in your system that leads to symptoms, brain fog, headaches, a number of other ones,

Ayla Wolf  24:41

and of course, many of the other things that people love to drink, like coffee, can promote dehydration because it's diuretic.

Sophia Bouwens  24:50

Or they go to sodas which are full of sugar, which need more water to detox and clear a system.

Ayla Wolf  24:56

and not to point fingers. But I will say that in general, my population of elderly people are the worst, and they all give me the same reason for not drinking enough water, which is that they don't want to have to get up and go to the bathroom.

Sophia Bouwens  25:11

Yes!

Ayla Wolf  25:12

and so that's why they choose to actually not drink water. But then they're dehydrated, and everything gets worse.

Sophia Bouwens  25:18

well, and I found so that this water schedule, 100 ounces of water, I put people on it. I have them take a 20 ounce water bottle and drink five a day, because 100 ounces and I break it down into a schedule. Every three hours you drink 20 ounces, you drink, first by 9am second by noon, third by 3/4, by six and the fifth by nine. The first week or so, I finally we will pee all the time, because what's happening is your body is finally dumping all the build up and detox all the things that wasn't able to process before, because now it finally has a place to put it, to get rid of it. So you do pee a lot more, especially if you're dehydrated, because the body's working to filter it all this toxic waste, but after about seven to 10 days, you go back to peeing as much as you would normally when you weren't drinking 100 ounces of water. Your body adapts to having that water in it and uses it for energy and uses it for function of cells. You get better concentration, better sleep. I've had patients lose weight just by doing this, having blood sugars come in to balance more. Like, there's a lot of symptoms that get better when you just drink a lot of water. So a lot of elderly patients, or I have a lot of patients who will say, like, I just don't want to go to the bathroom that much. Or I have I started, but I had to pee so much. Like, actually, it's a really good thing. Keep with it, and you'll be better off in the long term, your body will regulate. You won't need to go to the bathroom quite as much because it is inconvenient to have to go frequently.

Ayla Wolf  26:49

And frequent urination can also be a sign of autonomic dysregulation and a sign of stress on the kidneys. And I have found, like with some of the herbal formulas that we have that support kidney function, that once I put people on those formulas, then all of a sudden their frequent urination improves as well.

Sophia Bouwens  27:06

Gets better, and tension in muscles gets better too, because they're not tight and dry like ropes anymore. They're moistened and they're able to be flexible. I just think that the water and the hydration and the detoxification conversation is really, really needed for that Absolutely. What about the other types? You'd break it down into migraine and then migraine-like headache. Now there's a lot we can dive into with that, but want to break it down kind of acutely for us.

Ayla Wolf  27:37

so our whole next podcast is going to be on this topic in particular, but to put it kind of quickly as an overview, what is often happening is that people will get a concussion, and they will develop a post traumatic headache that is throbbing in quality. And they also often have photophobia and phonophobia, so light and sound sensitivity and nausea and so all of these symptoms look like a migraine, but in reality, a lot of these people don't actually meet the criteria for true migraines. So what can happen is that they get misdiagnosed as having migraines and put on migraine medication that isn't helping them, and then potentially can create rebound headaches. And so we're gonna talk about that in our next episode and really break that down and help people figure out if maybe what they're having is indeed a true migraine, or if it's more of these migraine like post traumatic headaches, that need to be treated differently.

Sophia Bouwens  28:40

Okay so let's do a quick review between cervicogenic tension and migraine headache symptoms. Again. What would you break down you do this really nicely in your book, and you have a great tool in there too to really tease it out. But for our listeners who aren't going to necessarily right away dive into that, what would be big takeaways for communicating with your providers accurately about these types of symptoms, to get the correct diagnosis between a cervicogenic tension and a migraine and post traumatic headache?

Ayla Wolf  29:15

One of the most important things in order to get the right diagnosis and to get good care is to be able to very accurately describe your symptoms, and that was one of the things that I really wanted to help people do in the book and in the podcast, is by giving people the tools to be able to accurately describe their symptoms, the communication tools, then we can hopefully avoid people getting misdiagnosed or getting these kind of confusing diagnoses. And I also would find too that some people would feel like they weren't getting better, but because I had asked the right questions, we could actually see that certain types of their headaches were improving, even if other ones weren't, which would then allow me to kind of stick and move with what's changing and change up my treatment plan in order to continue to make further progress. So some of the descriptors that we need to have when talking about headaches are these things like the difference between a pressure and a squeezing sensation that is kind of classic to a tension headache, compared to a throbbing or pulsing quality, which could be coming from a cervicogenic headache, and in that case, it's usually starting in the back of the head and potentially radiating upwards and into the top of the head or the front of the head, or even maybe the side of the head. So having that throbbing, pulsing quality could happen in a cervicogenic headache, but it's likely coming from the back of the head first, or the back of the neck, or it could happen in a migraine headache, because a classic migraine is a unilateral, one sided, throbbing, pulsing headache, at least at the start of migraines, that's how they present. And then with post traumatic headaches, they're more often bilateral. Many people say that they're on both sides of the head when they're having a migraine-like headache that is a combination of this pulsing, throbbing quality with the light sensitivity, the sound sensitivity, like I said, it's more usually both sides of the head, and so that's where things can get confusing, is that a lot of these headaches do resemble each other, but they have these kind of subtle differentiating features that you then can also do further tests to really try to get to the bottom of it. If somebody has a true migraine, when they take migraine abortives, they typically get some level of relief. And many people with post traumatic headaches that are being diagnosed with migraines will take an abortive migraine medication, and they won't get that much relief from it. So there are little things that we can kind of look at that give us these red flags to say, Is this what's really going on? And then there's this whole other category of neuropathic pain, which we'll do a whole other podcast on. And people that have concussions and brain injuries can often develop neuropathic pain where they also describe things like electrical buzzing or electrical sensations in the scalp or the head, or these like lightning bolts of pain, or sometimes they'll actually feel a sense of water kind of dripping down their head, like this weird twinging, yeah, and it can feel hot, or it can feel cold. And so the neuropathic pain is also this. It's kind of own category of pain that can include a lot of different sensations that are maybe I don't want, I don't know if separate is the right word, separate from these other headaches, but what I find is that people can come in and they can have kind of this constant low level pressure, tension type headache, and then they can also have moments where they have these intense throbbing headaches, and then they can also have these little Zinger type sensations that are more of the neuropathic pain. And so people can actually come in with kind of a number of these different headaches all happening simultaneously. And that's where it's very helpful for people to be able to have the tools and the communication, the language, to describe all of that. Because typically when I start working with somebody, some aspect gets better first. And some people, even if they still have these chronic tension headaches, they might not even realize, Oh, I'm no longer having those sharp stabbing zingers anymore. Because lot of times when pain goes away, you forget you had it in the first place, for sure. And so a lot of people can feel very dejected and depressed and thinking that they're not getting better. But then you start going through their chart and saying, Well, what about this pain, or what about that type of headache? And then all of a sudden they realize, oh, that's actually gotten better. I forgot. I used to have that all the time.

Sophia Bouwens  33:54

If it's not knocking on the door, I don't I don't hear it anymore. Yeah, I find that a lot too, with patients.

Ayla Wolf  34:01

And so for that reason, I developed this post traumatic headache communication tool that we have on the life after impact website that people can go to, and all they have to do is just sign in with their email address, and then they'll get taken to a landing page where they can download that PDF, and it serves as a way for them to, very quickly, just check a bunch of boxes and kind of fill in some sections and then bring it with them to their medical appointments, as a way of saying, you know, to their other health care providers. Here are the types of headaches I'm having. Here's what I'm doing about it. Here's what has worked, here's what's not working. And it's just a very concise way to help people communicate their experience.

Sophia Bouwens  34:44

And that is a big takeaway I have after reading your chapter, is just being able to communicate it correctly is really important, because we don't have that much time with our providers, and we're trying to capture what's happened in our life in like five or 10 minutes with somebody, right and trying to hope that. Get we say it all correctly and that they hear it the right way to know what's in their arsenal to give us for resources or tools, and so that tool is so valuable for patients to kind of guide that conversation and capture that language correctly, to know what their providers might pay attention to more. And that will help get the right diagnosis, which will help get the right treatment and more relief.

Ayla Wolf  35:24

Absolutely, the longer I've been in practice, the more I realize that communication is everything. And so often, when people come to see me and they're describing their experience, I ask them the same question, maybe in three or four different ways, because when people have concussions, they can also the part of the part of what can be lost is their ability to tune into their own experience. And I certainly feel like that was my case with my concussions, is that I was so focused on just trying to get through my day that I didn't even have good self awareness of the symptoms I was having, and so to have somebody else be able to really pull that out and help you to recognize what it is that you're dealing with and to communicate it in a really clear, precise way, is so important in being able to get the right diagnosis, get the right treatments, be able to monitor whether those treatments are working or not. I've never understood, you know, I have so many people that have come to me and they've been on a medication for like, you know, seven or eight years, and when I asked them, well, the original thing that they put you on this medication for you still have so clearly, it's not doing anything if eight years have gone by and you still have the same symptoms. So why are we on this? Right? I mean, and it's funny, because being an herbalist, I think for a lot of people, herbs are so foreign and strange that they are like, if I don't notice miraculous things happening in two weeks, I'm quitting, I'm quitting your therapy. I'm over it, right? And yet, when it comes to pharmaceuticals, there's this weird kind of buy in, where people are willing to be on them for a very long time, even if they're still symptomatic and they're not working. And yeah, because it's taxing your liver. I mean, everything we put in our body taxes our liver, and so if something's not doing the job, let's not burden the liver and the kidneys even more by taking something that's not working.

Sophia Bouwens  37:20

Which will cause maybe more headaches down the road. Exactly. Dive into that too in another episode. Okay, this is really robust and really great information. This tool that you have is really incredible, and I hope it will guide patients. One example from my own experience is I get a lot of patients who refer to me from providers with diagnosis like they already have, like migraines, right? So I in my evaluation, I take in their chart review, and then I do my evaluation with them. But it's more it's a little bit quicker at the neuroscience center than it is in private practice because of the capacity I have there. So oftentimes I'm relying on those referral diagnoses. I had a patient come with me with a referral diagnosis of migraine, and was treating her migraine like headaches. With some success, it would go away and it would get better, but I was really just focused in on the migraine component. And after reading your chapter, I really started thinking more clearly about maybe this isn't migraine, maybe it's cervicogenic, because I could start to see this patient in that description. And so I treated more cervically, and headaches completely went away. And one type of them, because they had two types, right? They had the cervicogenic type. And this migraine like one, the migraine like ones, would respond to migraine medications, but the cervicogenic ones didn't. When I started treating the neck, the cervicogenic ones went away. Still got a few migraines, but not nearly as many, and didn't need as much medication. So that was helpful for me, because I was able to read the information to the provider to get them on board, and some new tools for that patient too, just understanding where their headaches are coming from and why they might be having them so that they can make decisions in their daily life, that might help alleviate that too. So that's it's really key, and really, I really hope a lot of our listeners glean from that.

Ayla Wolf  39:12

I love it. So my book hasn't even published yet, but it's already helping. It's already helping people!

Sophia Bouwens  39:16

Is there anything else you think that our audience should kind of know or tune into before we wrap this up and dive into more headache discussions in the next episode.

Ayla Wolf  39:27

Yeah, I think that listening to the next couple episodes should also help people who still have questions, specifically on this question of, Am I having a true migraine or a quote migraine like headache that may not be responding well to migraine medication, and then also exploring this idea of the neuropathic pain better. And so I think that if people are suffering from post traumatic headaches, definitely tune into our next couple of episodes where we get into even more detail about these things, as well as the medication overuse headache factor. After, I mean, I had a patient who was essentially to make it short, taking ibuprofen every single day. And once I explained to her that taking ibuprofen for more than 15 days a month can actually cause rebound headaches, she finally went off of it, and her daily headaches went away just by not taking a painkiller every day. Yeah, and so I think a lot of people don't recognize, even if they're only taking two to 400 milligrams of ibuprofen a day, if you're doing that more than 15 days a month, it can actually be causing rebound headaches. And you know, those kinds of warnings aren't very clearly stated on the bottle. People assume, if this is over the counter, it must be safe. But the reality is that these medications can be problematic, even if there's something you can just buy, you know, over the counter.

Sophia Bouwens  40:50

And no one teaches us all this in school, or there's no Academy, really, where you go to learn all this, then you get a brain injury, and you're even more confused and just in the midst of everything. So having the ability to understand it and communicate it and really know what risk factors are out there, as far as if you're taking ibuprofen every day, or other things you might be doing that could be adding insults to injury unknowingly.

Ayla Wolf  41:18

So on that topic, I did write a blog post about medication overuse headaches at the lifeafterimpact.com website. So if people do want that information right away or in writing, it's it's there in the blog and then also at the on the home page on the bottom, that's where people can sign up for the post traumatic headache journal. It's on the bottom of the home page as well as on the resource page at the moment. So if people go to life after impact.com all of that information and resources are there for them.

Sophia Bouwens  41:51

And our next episode is gonna dive into migraine, migraine like headache and medication overuse as well. Then we'll dive into neuropathic pain in another episode, and if you're not understanding that post traumatic headache is really confusing, by the end of that, we even have an episode, we'll talk about our research study on post traumatic headache and some of our findings there, excellent.

Ayla Wolf  42:14

Well, thank you for tuning in, and we hope you'll join us for our next several episodes, all still kind of diving into this topic on post traumatic headaches, and then we'll also get into some of the therapies that are out there, non pharmaceutical therapies that people can try to help get out of pain.

Sophia Bouwens  42:30

Yes, so stay tuned. Thank you.

Ayla Wolf  42:38

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