More on Headaches

By Dr. A. R. Scopelliti

Nov

15

Over the years I have written several articles on headaches.  This is because there are so many types and causes of head pain that there is much to write about.  Headaches remain one of the top three reasons why people go to the doctor.  The most common types of headaches are tension headaches and migraine headaches.  Tension headaches are typically a constant squeezing-like pain around the head whereas a migraine headache has a throbbing or pulsating component.  Many people believe the term migraine headache is used simply to describe a very severe headache.  This is not the case.  Migraines are a specific group of headaches which have a vascular cause and thus have a throbbing component.  Compounding diagnosis, headaches of the same type can have many different causes.  In my office we address many migraine causes as well as tension headaches which are caused by brain based inabilities to perform appropriate eye movements.  This becomes confusing for many patients as once you mention the eyes as a cause of headaches you inherently think to see an optometrist.  In reality, optometrists are interested in the focusing ability of the eyes and in diseases of the eyes.  Movement of the eyes to targets however is brain based and not typically assessed by eye doctors.  This is an extremely overlooked cause of headaches as few practitioners have appropriate diagnostic equipment to evaluate brain based eye movements.  Additionally, many headaches are perpetuated through poor eating habits and deficient nutritional needs.  This can easily be addressed by changing poor dietary habits in favor of better eating habits and thus augmenting nutrition.  It is most unfortunate however that the vast majority of headaches are managed through inappropriate drug therapies, most all of which do not fix the underlying cause of headaches but rather are typically an opiate based drug prescribed to deal with symptoms.  Recent studies are uncovering more and more deficits associated with these-type drugs which can be extremely addictive and require increasing dosage to maintain any level of symptom control.  If you suffer from headaches you would be well served to contact my office to schedule an appointment for a complete neurologic examination.  For many, it is their last headache consult.

Vestibular Rehabilitation Therapy

By Dr. A. R. Scopelliti

Oct

6

So what is vestibular rehabilitation therapy, a.k.a.VRT?  Think about it like this.  Suppose you just had shoulder surgery.  Would you be all better, or would you now need to do physical therapy to rehabilitate your shoulder back to normal function?  Without rehab such as this, I can tell you that you will never regain normal use of your shoulder.  Well the same is rue of the vestibular labyrinth.  Whenever you have any affliction that causes any type of dizziness or vertigo, without vestibular rehabilitation therapy exercises, it is highly unlikely that you will just return to normal function.

Is There a Difference Between Physical Therapy and Vestibular Rehabilitation Therapy?

Yes.  Physical therapy involves exercise therapy primarily for the trunk and limbs.  This can oftentimes be useful for individuals with increased fall risk and imbalance.   However, it should not be confused with vestibular rehabilitation therapy which concerns itself with rehabilitation of the vestibular labyrinth, brain and oculomotor system.

How Does Vestibular Rehabilitation Therapy Work?

Just like physical therapy makes muscles grow stronger and more coordinated, vestibular rehabilitation therapy is a method of habituating neurons of the central nervous system, (primarily the brain), and the vestibular system so that neurologic function  may be enhanced thus improving the function of the balance systems. Because neurons respond and grow very differently than does muscle tissue however, vestibular rehabilitation therapy must be done very specific to your needs.  This is to say that a canned approach will not work.  Two individuals with the same exact problem may respond very differently to vestibular rehabilitation therapy depending on the extent of involvement of their disorder, their overall health going into treatment, and their level of stamina in their ability to perform the exercises in the first place. If this is not taken into consideration in the therapy plan, the treatment is destined to fail and will in all likelihood even worsen the patients status.  I see this all of the time in my own practice as it is a common occurrence and reason for referral to my office in the first place.

High Blood Pressure

By Dr. A. R. Scopelliti

Jul

20

High blood pressure affects about 1 in 4 American adults and is one of the most common worldwide diseases afflicting humans.  It increases the risk of heart disease and stroke for those afflicted, so it’s important to know how to lower high blood pressure. High blood pressure, aka hypertension risk factors include obesity, drinking too much alcohol, smoking, and family history of hypertension.  Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease.

Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg, (however, unusually low readings should be evaluated for clinical significance as well).  Prehypertension is a new category emphasizing that patients with prehypertension are at risk for progression to hypertension and that lifestyle modifications are important preventive strategies.  Home blood pressure predicts cardiovascular events much better than do office readings and can be a useful clinical tool. Anyone with hypertension should be monitoring their own BP at home.  BP kits are available everywhere, and they are inexpensive.  If your BP readings suddenly become low, you should tell your doctor to titrate downwards your medication so that you do not become syncopal, (passing out).  The following are the ranges of BP:

Normal – Systolic, (top number) lower than 120, diastolic, (bottom number) lower than 80.

Prehypertension – Systolic 120-139, diastolic 80-99.

Stage 1 hypertension- Systolic 140-159, diastolic 90-99.

Stage 2 hypertension- Systolic equal to or more than 160, diastolic equal to or more than 100

Recommendations to lower blood pressure and thus decrease cardiovascular disease risk include the following:

  • Lose weight if overweight. Even a few extra pounds will raise blood pressure.
  • Google DASH (Dietary Approaches to Stop Hypertension) for a reasonable diet, which is rich in fruits and vegetables.
  • Limit alcohol intake to no more than 1-2 drinks/day.
  • Increase aerobic activity (30-45 min most days of the week).
  • Reduce sodium intake, learn to read nutritional information labels on products you purchase.
  • Maintain adequate intake of dietary potassium, calcium and magnesium for general health.
  • Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.

“Mystery Disorders”

By Dr. A. R. Scopelliti

Jun

28

So why is it that one can go to ten different specialists, get no diagnosis or effective treatment , and that same individual can then come to see me and get better in a few days?  Am I just very lucky?  Is it the power of suggestion?  Well, I can tell you, that’s not it.

Here is why.  Most specialists do what they do very well.  They excel in and have vast studies preparing for their particular area of expertise.  However, most human suffering is not always textbook.  That is to say that when a doctor studies disorders, they do not always match up with what we might see in our offices.  Further, most doctors tend to be trained such that they are examining you with a goal of matching up your symptoms with illnesses that are referenceable in a medical textbook.  Many disorders can be diagnosed in this manner; however, the vast majority of human suffering is not from these “named” diseases.  It is from “shades of grey” symptoms that do not typically match up well with any disorder, yet are real symptoms for the patient.  Since the doctor cannot find any disease that matches your conditions symptoms, you are simply told to “learn to live with it”, or worse, “it’s all in your head.”  Few doctors examine patients cumulatively just trying to get a grasp of what might be realistically happening with that person rather than just trying to find the matching diagnosis code to send to the insurance carrier.  Well when you think about this, you can see how easy it is to have no idea of what may be happening to explain your symptoms.  It is easy to see how all of the individuals with disorders that fall into the “shades of grey” area are just going to be brushed off as being odd or unrealistic problems.

The reason why my office has so much success in this area, is because when I examine patients, I do not have a predisposed opinion of what disease I am trying to rule out.  I look at them for what they are, a human being with symptoms, and I use logic to rationalize what neurophysiology is not working properly, and more importantly, what could be done to fix it.  My office has had great success treating patients with difficult disorders in this regard.  Because of our success, we routinely see patients who come from other states and spend a week with me so that they may get better.

So if you have been told to “learn to live with it”, or have been going from doctor to doctor without answers, you are my best patient.  We always offer a complementary consultation if you prefer one prior to examination as we understand that you may have many questions simply out of years of frustration in dealing with the medical system.

More On Headaches

By Dr. A. R. Scopelliti

Apr

22

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Headaches comprise the top three reasons why one goes to the doctor. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea. What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative. As a chiropractic neurologist, I have been successfully helping patients rid themselves of headaches, oftentimes in as little as one treatment.  Research has demonstrated the value of manipulative therapy for a multitude of disorders including headaches. A report released in 2001 by researchers at the Duke University Evidence Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication. As a neurologist, we have many diagnostic capabilities at our disposal, as well as adjunctive therapies, which have proven to work very well for migraineurs as well as headache sufferers who have yet to be diagnosed. Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems. The other ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern. Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. Many find themselves in fluorescent lighting and/or in front of a computer monitor all day.  Many are on the telephone much of the day, which is very stressful on the muscles of the head, neck and shoulder. These scenarios are fuel for headaches. So what can you do? If you spend a large amount of time in one fixed position, such as in front of a computer, take a break and stretch every 30 minutes to one hour. Exercise may help relieve the pain associated with primary headaches, however, this will often aggravate headaches of migraineurs. As migraine headaches are vascular headaches, they should always be evaluated prior to entertaining any course of self-treatment. Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches. Naturally, I would recommend all headache sufferers to come see us for an evaluation, as most will be helped in a short amount of time without requiring drug therapies, which can often have deleterious side effects and consequences.  You will be referred for these types of therapies if felt to be warranted to be used as an alternative course of care, although this is certainly not the norm but rather the minority.  The vast majority of our headache patients share a common conclusion; they invariably wish that they had come in to see us sooner and avoided the years of unnecessary suffering.

Headaches

By Dr. A. R. Scopelliti

Feb

26

The topic of headaches is vast as there are many causes as well as types of headaches, causing most doctors to shudder at the mere presentation of a headache patient.  Nonetheless, there remains hope for many with proper diagnosis and treatment.  Lets start by discussing the most common and least harmful type, stress headache.  This is often associated with tightness, which is band like around the head and often into the neck. These are often alleviated with stress reduction and increase in exercise.  The more chronic type would be best managed with treatment.  Headaches that have a throbbing component are typically migrainous headaches.  Migraine sufferers typically know when they are getting a headache as they get an aura, (seeing wavy lines, stars, etc.) just prior to the headache.  As this is a serious medical condition, individuals with these types of headaches should always seek care. Many will respond favorably to non-drug treatments.  Those who do not would be candidates for drug therapies.  Similarly, individuals often have headaches associated with high blood pressure.  You should have your blood pressure checked routinely when visiting a doctor of any type.  If you do not frequent your doctor, most shopping centers now have free pressure monitors that you can use.  Units for purchase are also readily available and inexpensive, especially in consideration of the preponderance of high blood pressure and the costs of managing it compared to prevention.  HBP will typically respond well to weight loss and exercise, however, if you already have HBP, you should work with a doctor regarding an appropriate exercise regimen as overexertion with HBP can be equally as dangerous.  Many individuals with severe headaches assume inappropriately that their headache must be the result of a tumor, although in realty, the vast majority of severe headaches are not related to tumors, which will rarely cause headache pain if at all.  Although there are many other types of headaches, these are the most common.  Our office has a very high success rate treating these types of headaches without necessitating the use of drug therapies. There is also much more detailed information on headaches available on my website which is listed below.