Patricia came to me panicked and frightened over a recent event. She and her family just came back from a vacation in Canada. As they were at cruising altitude, she suddenly developed a bloody nose. It wasn’t a simple drip-drip. Her nose was gushing and she was “throwing clots for about 25 minutes”. She was afraid to fly back home. Now that she was home she had a headache for the last 2days. Did she ever have problems with flying? No. Did she ever have nosebleeds? No. Did she have a cold, where she was blowing her nose excessively? No. Did her allergies recently act up (nasal tissue tend to be friable and delicate, susceptible to nosebleeds in allergic patients)? No. What happened recently? Two weeks ago, she “caught a table.” She had immediate back pain and saw a chiropractor. The chiropractor “treated” her and she felt better. On physical exam, her back was still in SPASM. She had a throbbing headache, sinus congestion and infection as well. I started her on antibiotics, treated her headache and back spasm, and gave her instructions on nasal care. She responded and has not been back for this problem. (I still see her other family members, and that is how I know she responded). In this case, the chronic low grade spasm kept her blood pressure wired, the sympathetic nervous system hyperactive. When she reached high altitude, the atmospheric pressure decreased, and the delicate nasal tissue ruptured. As long as she stays on land in the next week, she will be fine. Over time the nasal tissues will heal, her blood pressure will stabilize and she should be able to fly again without any problems.
Total visits: 1

The approach to headache treatment is very simple: find the cause and treat the cause.

If it is caused by -

high blood pressure - treat the high blood pressure; you will want to make sure that the HBP is
not caused by kidney disease, hormone secreting tumor, etc. (so your GP or internist should
do that work-up before calling it familial essential hypertension and putting you on pills).

caffeine withdrawl - put yourself back on a slower wean by using decaffeinated coffee or
regular tea first.

sleep deprivation - get some sleep; this is especially true for new moms.

tumors, aneurysms are other less common causes that need to be ruled out.

"migraines" are a more complicated type of headache; simply labeling a headache "migraine" does not help in establishing the cause.

any headache associated with clicking jaw, neck pain, back pain are generally long standing physical strains that are traumatically induced; a simplistic approach of taking pills to prevent an attack (prophylaxis) or to stop one (abortive) does not address the cause. the whole body needs to be treated in order to get sustained, long term recovery and to be eventually free of pills, tests, pain, and yes, even us doctors.

Headaches should never, ever, ever, be treated by chiropractic 'cracking' of the neck or back. Never. Never. Ever. I've seen too many people pay dearly for these mistakes. Never.

Here is another case of headaches from what I call "sympathetic overdrive." This is one of my most difficult and most interesting cases. Very frequently, older women with chronic, out, they get automatic cardiovascular and neurologic work-up. The problem happens when all testing is negative. Where do they go? How else would the find someone like me? If early, for them, it would have to be pure luck. I tell Lynn all the time how lucky she was to have found a doctor who was caring and intellectually honest enough to send her to me. She agrees.