Tips to Prevent Tension Headaches with Andrew Bang, DC

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Ever feel like there's a tight band wrapped around your head that's squeezing so tight your skull might explode? That's a tension headache, and it's the most common cause of cranium pain. These types of headaches can come and go quickly, or they might linger for weeks, but there are ways to end or prevent the aching, and we're going to share them with you today.

Our guide to relief is chiropractor Andrew Bang, a frequent guest on the podcast. He's one of the many experts at Cleveland Clinic who visit us weekly to address your health concerns. So let's learn more about what causes tension headaches and how we might be able to stop them.

Dr. Bang, thank you so much for joining us again. Make sure you get your guest card punched. I think you might be eligible for a free t-shirt or something by now.

Dr. Andrew Bang:

Do you think I could exchange that for a gas card?

John Horton:

Yeah.

Dr. Andrew Bang:

Gas prices are crazy right now.

John Horton:

We'll have to look and see what we've got in the cupboard there, but we'll see what we can do.

Dr. Andrew Bang:

All right. Good. Aw, thanks, man.

John Horton:

So you're with us here today to talk about tension headaches, that pain in the skull that we've all probably dealt with at one time or another.

Dr. Andrew Bang:

Yeah.

John Horton:

To be honest, it just hurts thinking about it.

Dr. Andrew Bang:

Oh, yeah. Totally. I mean, I see these all the time in my office. In fact, tension headaches are the most common headache that anyone will experience. It's most classified as a tight band. Think of it like a crown around your head or a baseball cap around your head, and we're all getting ready for the opening of baseball season. So think of that tight band, like a baseball cap around your head, and it wraps down into the neck and shoulders a lot of times. They're awful. They really disrupt your life, and they can come on to anybody.

John Horton:

Yeah. Well, that's why you always adjust that cap. So that way, it doesn't do that, so you don't force it on yourself.

Dr. Andrew Bang:

That's right. That's right, yeah. There's lots of things you can do to force it on yourself and a lot of things you can do to not even experience them.

John Horton:

Now, I know that these tension headaches often seem to come out of nowhere, but I'm guessing that they're not so random.

Dr. Andrew Bang:

Yeah.

John Horton:

What are some of the most common triggers that kind of bring them on?

Dr. Andrew Bang:

Well, there's four major groups of triggers that happen. Emotional stress is a huge one, and this can be anything from mental fatigue — you've just been working a long day, really stressful news at home or working or personal life that brings tension into it.

John Horton:

Yeah. I've been there a few times.

Dr. Andrew Bang:

Yeah. I think we've all experienced that.

There's the environmental factor. This could be like you haven't had your morning cup of coffee, or you're trying to go off coffee for a cleanse or something like that. Or sometimes, even after you have a lot of alcohol, and you're coming off of that, that will bring on tension headaches. Even things you are more in control of, like your sleep. You're not planning ahead. And so, you're not getting enough sleep. Those are bringing on tension headaches.

And then there's the really most common one, is muscular tightness. This could be like you're doing a lot of overhead work, or if you're stuck in one position for a super long time, like a long drive, or you're grinding out a paper for work or for school, and you're just stuck in one place, and the muscles are constantly firing. You're not giving them a break. That can bring on tension headaches and tension throughout that area.

John Horton:

Yeah. That makes total sense. And I have to say, after hearing all of that, I get the sense that folks can limit their chances of getting a tension headache if they do certain things.

Dr. Andrew Bang:

Oh, for sure.

John Horton:

Yeah. So let's start with some things that folks can do just to kind of maybe limit their chances of getting these tension headaches or, I guess, maybe even stop them in the moment.

Dr. Andrew Bang:

Yeah.

John Horton:

Yeah. So where do you think we should start here?

Dr. Andrew Bang:

Let's start with what we do the most. So let's start with something basic, like sleep, because we talked about lack of sleep, but also position of sleep. I'm a chiropractor by nature. I'm physical. Think of physical medicine, anything that involves muscles, joints, movement. That's what I'm really specialized. So let's focus on those things. I can give the most tips for that.

John Horton:

All right. Good place to start.

Dr. Andrew Bang:

Good place. Instead of just thinking about the quantity of hours, which is really important, making sure you're getting roughly eight. Some people, it's plus or minus an hour, but we got to get close to that.

Let's talk about positioning. So a big one is stomach sleeping. That can put a ton of tension on your neck because you got to turn left or right. Most of us who stomach sleep still use a pillow. So now, your head is cranked backward and to the side for a long period of time, put a lot of tension on one side of the neck versus the other. That can bring on the tension headache.

So when you research what's the optimal sleeping positions, one of them is sleeping on your low back with something under your knees and the right size of pillow. Right? You're trying to fill the space, not do two or three pillows where your neck is now flexed forward too much.

And then the next position we talk about is sleeping on your side. And when you sleep on your side, you're trying to avoid the fetal position, where you're super curled up like a C.

John Horton:

Which I think is what we all naturally do.

Dr. Andrew Bang:

For sure. I mean, I look at my own kids when I tuck them in at night or go check on them. They're all over the place.

John Horton:

Yeah.

Dr. Andrew Bang:

But as adults, we get a little bit more in control of sleep. They've done some cool research studies on that, because if you think, "Oh, I can't change how I sleep," well, you can. It does take some work. But if you consistently reposition yourself whenever you're conscious, like you got to wake up, use the restroom or right as you're going to sleep, you putting yourself in that position will start to train your body that's a normal sleep position you want to be in.

So when you're on your back, we which we said is good, and then on your side is good. Just when you lie down, imagine yourself down if you were trying to be neutral in your spine. It has an S curve. So we don't want to be perfectly straight. But you got to think of you don't want your chin resting on your chest when you're sleeping on your side. Right? You don't want your knees totally curled up into your chest either. So you want to bring your knees down, so your legs are almost straight. So that makes your nice, normal low back curve, and then your head kind of ... oftentimes, I sleep on my side. So I oftentimes lift up my head. I'm looking straight ahead of myself, then lay it on this side of my pillow, so it's aligned.

John Horton:

All right. Well, I know I'm a back sleeper. So it sounds like I'm in a good spot, one pillow. I'm finally doing something right. So most of the time, I always find out what I'm doing wrong on these.

Dr. Andrew Bang:

Gold star for John. Someone give him one.

John Horton:

Yeah. And the nice thing with that is that's something you can do, and you don't even need to be awake while you do it. So that's a great first tip, adjust your sleeping position.

Since we're talking about positioning, I'm guessing your posture the rest of the day can also play a big role in whether these tension headaches show up.

Dr. Andrew Bang:

Exactly. So like we said, we're going to focus on what you do the most. So we spend seven, eight hours of sleep. What's the next thing we do the most? It's typically our job. OK? And the biggest thing I see when I got into practice … I thought, John, I would see carpenters and landscapers, and that would be the bulk of my patients. Right? Physically active jobs. And yes, I do see those, but funny or not, I see the more of the office, the desk jockey who's constantly sitting all day long.

And so, whenever you do some activity repeatedly for a long period of time, that's when you're going to run into issues, and that's what brings on things like tension headaches. So no matter the job you have, whether it's sedentary or active, if you do a repetitive action or motion or stay in one position, you're going to run into problems. Yeah. So let's focus in on the desk jockey right now because I know you and I get quite a bit of that. I do a lot of notes.

John Horton:

Yeah. A lot of time at the desk here. So how should I be sitting to make sure that I'm not bringing on one of those tension headaches, despite the work bringing it on sometimes?

Dr. Andrew Bang:

So let's talk about your legs and feet first. So we always think, what do we put our joint into the most neutral plane of motion? So most of our joints have anywhere from 100 degrees to 180 degrees of range of motion. And so, we want to put that in the middle. So we think about the 90 degrees. Right? That's a good rule of thumb, meaning my feet are resting either on the floor or a box or a stool, depending on how tall I am. So I'm pretty dang tall. So I don't need a box. But if you're 5'5" or shorter, you may need a stool.

John Horton:

A little vertically challenged.

Dr. Andrew Bang:

Vertically challenged. Let's be correct about that. Yes, because your chair might be, so created for someone my size, but you can't always replace your chair. Those are expensive. So you bring in free solutions or inexpensive solutions so that your knees, hips and ankles can all be in that 90/90 position, then that allows your back to kind of rest up against the chair.

A lot of people say, "Well, do I need a lumbar support pillow?" Well, lumbar support, in general, is supposed to be a reminder of where you're supposed to be. Right? If I lean away from that lumbar support, it pushes me too far forward, which is uncomfortable. So that pillow is a great reminder to help you sit up straight and tall where your chest opens up and your head is more in a neutral posture. OK? So then your spine is sitting in its normal S curve, the way it's supposed to be if your head and shoulders align. The biggest thing, I think, we run into is where our head stoops forward. We've all done this.

John Horton:

Yeah. Oh, as the day goes on, you can almost feel it. There's a droop. Your shoulders start to hunch. You kind of get that beaten down.

Dr. Andrew Bang:

You get fatigued.

John Horton:

Yeah. That fatigued feel, yeah.

Dr. Andrew Bang:

Yeah. And I think, John, that's what you want to remember is, no matter what job you have, whether you're a desk jockey or landscaper, anytime you do something repetitively, you're going to get fatigued. So you got to create some sort of break in that routine so that those muscles that are working really hard can take a break. So that's why the sitting-standing desk combination is amazing.

John Horton:

Now, I'm amazed as we're talking this through because we're talking about tension headaches here, that you basically have to start thinking about things from your feet on up in order to stop these headaches from hitting.

Dr. Andrew Bang:

No, you really do. Let's say I sit really poorly in my low back. That's going to force me to pitch my neck forward. Or let's say I lean to my right or left constantly throughout the day and rest my chin on my hand. My low back's in a curved position in the wrong direction. That's going to create muscle tightness. Then, I'm going to try to recoup that most of times by leaning the other way, and then you're just fighting yourself all day and running into issues.

Yeah. So creating that opportunity for movement is huge. Yes, taking breaks is really important, which are also being decreased, simply because if you work at home, how far does it take you to walk to the restroom? It's like 10 steps. Where, if you're in an office workplace, you could be walking 50, 100, 200 steps just to get to the restroom, which was actually good.

Yes, it was decreased productivity, but probably increased productivity, because you got moving a little bit. Your blood pressure went back up to a normal rate because you're moving. You think a little more clearly, and we don't even maybe get up as much for water anymore, because everyone has those giant water bottles. How big is your water bottle, John?

John Horton:

No. I stick with my pint glass.

Dr. Andrew Bang:

There you go.

John Horton:

So I'm in good shape. I have to keep getting up and going to get more.

Dr. Andrew Bang:

I have a teenager. He's carrying this monstrous ... I don't even know, it's half a gallon of water.

John Horton:

Yeah. I know so much of this is how you're positioned and then what it does to your head. And I know on a previous podcast, you mentioned your head is ... think of it like a bowling ball. So when you pitch forward a little bit, it throws everything off.

Dr. Andrew Bang:

Oh, yeah. There's some great studies on that, and you can look it up really simply to find out, "What happens to my head as it goes forward?" Yeah, that's crazy. It goes from that 10-pound bowling ball to where if you're looking down 30 degrees, it's almost 50 pounds of pressure, 45, 50 pounds of pressure on your head and neck. That's crazy, which if you did that for a minute or two, that's not a big deal, but the fact is, we don't. We get lost in a project or lost in something. And then before you know it, you've been down there for an hour, and no wonder your neck hurts, and you have a tension headache.

John Horton:

All right. So when we're in a spot and we kind of naturally get to this sort of position where the head kind of pitches forward and you can feel it, you get those tight muscles in your neck and shoulders … you always have great tips here. What are a few just simple stretches we can do sitting at our desk to kind of work out those kinks and get everything loosened up and back where it should be?

Dr. Andrew Bang:

Good. OK. So I'm glad you asked that. I think the first rule of thumb is what I keep kind of hammering today on this podcast, is motion. I had this patient years ago when I first started practice. She said motion is lotion. I stole it from her. I wish I could give her credit. I can't remember her name, but it's so true. It's funny, but it's so true.

So you can't just be stuck in one spot, man. You've got to move. You got to get the full range of motion of your neck, because … OK, let's say, John, one of my favorite neck stretches is so simple. You, with your left hand, grab the side of your chair. Lean your body as far as you can to the right, and then you feel the tension all the way through your head, neck.

John Horton:

Oh, it just cracked.

Dr. Andrew Bang:

There you go.

John Horton:

I don't know if the mic caught that.

Dr. Andrew Bang:

So that's the wrong type of podcast today, John. We're not doing that one. No. So you laterally flex your head so your ear is touching your shoulder while you're holding the chair.

John Horton:

OK.

Dr. Andrew Bang:

It's so easy. The thing is, that only covers the side motion of your neck. Right? And so, what you can never go wrong with is moving your joint through its full degree of range of motion. So yes, I could sit and stretch side to side, but, like I saw you doing, you rotated your neck. So then take your neck as far as you can right, as far as you can left, as far as you can down, as far as you can up.

And when you work through the full ranges of motion, you relubricate the full joint. You also cause a release in the tension of all the muscles that kind of work the neck and shoulders when you're moving your neck through its full degree of range of motion, and the same is true for your back or your shoulder or your wrist. This is huge. When we're sitting so much, now you got to worry about, "Well, what's my wrist doing? Am I getting carpal tunnel from this?" Dah, dah, dah, dah. There's a million different things when it comes to me getting stuck in my work position that's going to cause musculoskeletal pain, including tension headaches.

John Horton:

Yeah. You brought those things up, and I feel like those are movements we kind of naturally do when you feel your neck getting a little tight. I mean, you do that. You look back and forth and side to side and rotate it around. So just every so often, taking a few seconds and doing that is enough to keep your neck feeling good and maybe keep those tension headaches away?

Dr. Andrew Bang:

Well, yes. Yes, kind of. So I saw you do it again. I'm sorry. If you're listening, you can't see what John's doing, but I can. So he did do a little side-to-side and a little right-and-left rotation. The thing is, I don't think we take it to its full potential. You just kind of roll your head once or twice and think you're good.

But actually, go as far as your body will let you to the right, and then you want to give yourself at least a 10- to 20-second hold in that direction, then go other, then go other. Right? Forward. Go back. Get to the full range you can get because once you sit there for about five seconds, you'll notice, "Oh, I can go a little further." And then the extra, next five, "Oh, a little further." And by the end of the 20, you've gone much farther than when you started. Right?

John Horton:

So push yourself a little bit as you're doing it and really try to get a deep stretch on your neck.

Dr. Andrew Bang:

Yeah. That full range that that joint, whichever joint it is, allows you to get without pain, go to it.

And then is stretching the only thing you should do? No. In fact, let's say you stretch, John, and you're like, "Man, I still feel like crap," or "My neck still hurts." Sometimes, you got to activate that muscle because it's been sitting so long, it's just stretched out already too much. And so then, it's activating the muscle through some easy things like ... that's called isometrics, where you can literally push your head into your hand and create muscle contraction, but you're not creating a lot of movement. Or you could pop on the floor and do some push-ups or do some squats or wall sits, really simply, to kind of activate the muscle that's hurting. So yeah, if the stretch doesn't feel good, doesn't fix your problem, activate the muscle through any kind of exercise or contraction. Does that make sense?

John Horton:

Yeah. Oh, absolutely.

And what about shoulders? We're kind of focused on the neck here. The shoulders, what kind of things can we do just to kind of loosen those up a little?

Dr. Andrew Bang:

Yeah. So back to using your chair, your office chair as a help. If you will, hold the office chair. So reach down with your right hand and grab the side of the office chair. When you lean to the left, you'll feel that trap stretch really good, and then you can kind of do a stretch/exercise at the same time, but now contracting the trap. You're trying to pull up the seat of your chair, but it's not going anywhere. Right?

John Horton:

Oh, yeah. I totally feel that.

Dr. Andrew Bang:

And you're just stretching. Yeah.

John Horton:

Right. Grab the bottom and lean to the one side, and you totally feel it right there with your trapezoid. Right?

Dr. Andrew Bang:

Exactly. And so, you're stretching it and you're tightening it, then you're relaxing, and that allows blood to come back through it. Then you tighten it again, and you kind of squeeze the blood out, then you relax, and more comes in. Our blood carries oxygen to the cells of the muscle. And so then, you're forcing more blood to get in there because you're contracting it and relaxing it. It's super easy, super effective. It's just a matter of reminding yourself to do it.

John Horton:

I already feel better. Every time I'm on with you, you always bring up these things, and I do them as we're talking about them, and I end the podcast feeling loose and good.

Dr. Andrew Bang:

Maybe we should meet up for lunch someday.

John Horton:

Yeah.

Dr. Andrew Bang:

I can actually show you what a real treatment feels like.

John Horton:

Now, we've gone over a few massages here or a few stretches here. I want folks to know, if you look in the comments here or in the links, we're going to try to post a link to a video of Dr. Bang going through some stretches that you can try. So you can do that when you're done listening to the rest of this conversation. So we talked about some stretches.

What about massages? I mean, those always seem good for working out a few kinks. Is that something we should maybe look to to kind of reduce tension headaches?

Dr. Andrew Bang:

Who doesn't love an amazing massage? And there's some pretty cool science that shows why a massage feels good. When you do manual massage over muscles, you release your natural endorphins and enkephalins. Those are your painkillers that you naturally produce on your own. It decreases mental fatigue and stress. So if it's a super stressful day at work or you've had these events you're planning for, they actually decrease that stress, which helps with tension headaches.

The cool thing is, is yes, you can run out to a massage therapy office or a person or clinic or whatever, but there's some really cool things you can use on your own to create some of that relief. Have you heard of a massage cane before?

John Horton:

No, but it sounds like something I need now. Yeah.

Dr. Andrew Bang:

A lot of companies make them. So if you just get on a website, any big website to search for things and hit massage cane — they'll look like a big hook, a plastic hook with some knobs on some different portions of this hook — and this hook allows you to push the ball into a tight muscle. And then using your arms, you're holding the cane, the massage cane. You're pulling down, and you can push into those muscles that get really tense from sitting all day at work or other jobs that you have that create a lot of muscle tension, and they work great in the neck, shoulders, low back, other parts of your body. They're amazing.

Foam rollers are another really easy thing that you can do to relieve a lot of stress in your mid-back, which can sometimes contribute to that, and those are a big tube of foam that you can sit and roll your muscles on, whether it's your chest, your lower back, legs. Have you used one of those before, John?

John Horton:

I love mine.

Dr. Andrew Bang:

Yeah. They're amazing. There's some really cool things called ... they're like a little Chirp Wheel™, and I'm not trying to push that company, but that concept. It's the same idea as that foam roller, but it's a little smaller, puts a little more pressure onto the spine or other muscles, which is great.

And then there's just a lot of self-massage. Literally, you can just take your own hand. Just pulling and pushing tension on your own muscles is a great way to create some self-massage.

It doesn't feel as good as when someone else is doing it, but it's definitely something you should consider doing if you're getting a tension headache.

Take your thumb, and along the base of your skull, there's something called the suboccipital muscles. You just jam your thumb up in there and just rest your head back onto it. It kind of hurts in the moment, but you're pushing out, again, that old blood. You're allowing new blood to return into that space. You're pushing out some metabolites that build up as you use a muscle. Massage is fantastic. I can't say enough about it.

John Horton:

What about just a simple temple rub? Because I think that's the one thing, you get a headache, and you instantly go up there, and you start rubbing away. Does that actually work, or does it just feel better in the moment because you feel like you're doing something?

Dr. Andrew Bang:

No. Yes. It seems temporary because you're probably only rubbing it temporarily, but why does it actually work is the question. Right? So one of the reasons we have headaches is the blood flow inside the ... or not just inside the skull, but around the skull. Right? You have your skin and small, tiny muscles of your face, but there's blood vessels that run in and out of that. And when blood vessels expand or contract too much, that's what creates this headache sensation.

Sometimes, in tension headaches, that's more muscular, but in other headaches as well. So when you do rub your head and you're like, "Oh my gosh, that feels good," you're kind of changing the blood flow. Right? You're probably squishing some of those blood vessels that are the contributor of the headache, and that blood has to go somewhere else. So it finds a blood vessel that's maybe not irritated. So it feels relieving.

So you can definitely use that. In fact, I give a lot of patients who I teach how to do even some just light pressure on the skull, where they almost squeeze their own skull with their hands to create that feeling of relief from the swelling or the stretching of the blood vessels that causes the pain, and this is as simple as lightly squeezing on your temples, like you said, or lightly squeezing in the front and back of your head, or if you've ever had a headache — you ever pushed on your own eyes?

John Horton:

Yeah, because it feels better for some ... is that just because you're putting extra pressure on your head?

Dr. Andrew Bang:

Yes.

John Horton:

And this whole thing with the tension headache, like we said, it feels like there's a band kind of squeezing. Is it almost like you kind of squeeze it back in and it comes back out a little bit more and you feel slightly better?

Dr. Andrew Bang:

Yes, because you're pushing those areas where the pressure is too high. You're kind of pushing on that, so it forces the blood to go other places in the skull. That's why it feels relieving in that moment. When you stop doing it, the tension can return. But if you keep doing the stretches, some slight exercises, change positions, maybe get a drink of water, maybe you're dehydrated — that's another cause of tension headaches — pound a big, giant glass of water, push on those spots, you can get tension headaches to reduce.

That's the nice thing. Because they're more common, they're typically less intense than a migraine that would cause vomiting or crazy auras with your eyes, debilitating. Tension headaches, gratefully, are one of the more milder headaches you can get. So you can actually work through them quite a bit by doing some of these things we've been talking about.

John Horton:

Well, I was going to say, because we've covered a lot here. So let's roll through here and just put together a little bit of a tension headache defense plan. And so, from everything we've talked about, I'm going to roll through. It sounds like, one, manage stress. Sounds like that's one of the key things you need to do up front.

Dr. Andrew Bang:

Yup. Managing stress is easy to do by, first, even exercise. And so, if you're really stressed … so you go for a 10-minute walk or even do 10 minutes of meditation. It's crazy that the research on how little meditation you have to do to get a giant benefit is out there. Maybe we can find a story to link into the comments for people to look-

John Horton:

…yeah. Oh, I was going to tell everyone we did a fabulous podcast with Dr. Young on breathing techniques. That's exactly kind of-

Dr. Andrew Bang:

…perfect.

John Horton:

...what we're talking about. It can take you down right in the moment.

All right. So we're going to manage stress. You went over adjusting how you sleep, look to get into that better position where you're not wrenching your spine and getting your neck all kooky, and you made it sound like back sleeping is probably the best. And if you're on your side, keep it a little straight. Don't curl up into that fetal position.

Dr. Andrew Bang:

Yup. Perfect.

John Horton:

This we didn't cover, we kind of touched on it, I think, a little bit, but adjusting how you look at your phone because we all spend way too many hours staring at that little device, and I take it that can be a big source of building up that tension and that pressure in your head.

Dr. Andrew Bang:

Oh, for sure. So as we mentioned in the bowling ball scenario earlier, your head does weigh about 10 pounds. And so, if you spend a lot of time using your phone, there's some easy things you can do. First, you can prop ... let's say you're right-handed. You hold your phone with your right hand. You take your left hand on your belly so you can prop your elbow and arm of your right hand, so your phone is more straight in front of you.

That's really your best posture. Or I suppose you could use something to hold it up for you if you're using it a lot, but that's not really convenient. You just got to get it up where your head is more in a neutral posture. I like using voice-to-text. I use it more now than I ever have because same thing: When I'm texting, it's like my chin is resting on my chest, which puts a lot of-

John Horton:

…it just goes down. Right. You have that phone down, almost in your lap, and it's like, you can feel your head just go down, and you can feel the pressure it puts on your shoulders and your back.

Dr. Andrew Bang:

I've loved the creation of things that are on the back of your phone. My daughter uses this octopod. I think it's called an ... so she will stick it on her mirror while she's doing something, like a tutorial of makeup or something. She's a teenager. So it makes sense. But I have on my phone the ring where you can hold your phone a little easier up so I can view it easily, and without getting hand or wrist fatigue from holding it funky, because it's a weird shape.

John Horton:

All right.

Dr. Andrew Bang:

Those are simple and easy things and effective.

John Horton:

Well, and all these seem like they're pretty simple and things you can do. And then also, you mentioned hydrating enough, exercising, all things we can kind of do just to keep those muscles loose and maybe keep those tension headaches away. A few things that are a little more, like maybe the next step that I want to kind of touch on is whether or not they're worth pursuing acupuncture. Is that something that can help?

Dr. Andrew Bang:

Yeah. For sure. So let's talk about in general, when do I go to a provider that's a physician, acupuncturist, chiropractor, physical therapist for my headaches? When do I know? And then I'll comment on the acupuncture. So it's like, if you get a tension headache or a headache in general one or two times a month, you can probably manage that, and that's probably something you're doing that you can easily change and control.

If it starts to be where you have a weekly headache and/or you don't know the cause of your headaches and they start becoming even more frequent, or let's say you have a headache that lasts three days, a headache can come on because of illness, too. I don't even know if we talked about that. You could just be sick. Right? You get a headache, whatever. Stressful day, headache. But if they become consistent, multiple in a row, or more than three a month, you reach out to a provider.

Acupuncture is fantastic. Let's say you want to try that. That's great. They use the needling to help relax the muscles. It decreases stress. It shoots out those endorphins we talked about earlier, like massage does, too, to give you instant pain relief. And then there's some points that they've found that they can actually use that can help with chronic headaches, which is amazing.

John Horton:

I'm guessing a chiropractic treatment would also be something you might recommend.

Dr. Andrew Bang:

For sure. I mean, any kind of physical modality — the massage therapy, the chiropractic, the physical therapy. We're trained similarly to approach the body as a mechanical point of view. So we stretch the muscles. We rub the muscles. We give you exercise, stretch, et cetera. So those are fantastic providers to see if you're getting tension headaches and you want some training on how to prevent them and how to work through them when you get one, and those three providers can really help with that. They obviously use unique specialties inside of that, but all three are fantastic. And then, of course, you have your physician. Right?

John Horton:

Yeah. And that all makes sense, and it sounds like that's a good place to start, as you said, if you're having these problems and they're kind of persistent. They keep coming up.

One thing that I was doing research, that kind of jumped out at me, is maybe an unusual thing that folks wouldn't think of, is making sure that you do your regular dentist appointments. How does that-

Dr. Andrew Bang:

…oh, yeah.

John Horton:

...tie into possible tension headaches?

Dr. Andrew Bang:

Thanks, John. I didn't even think about that. That's so good. OK. There are some people who have a habit of clenching, and this could be while you sleep. They call it bruxism, clenching, same thing. That grinding while you sleep, or even daytime grinding. When you're into a project, that might be your stress-relieving trigger, is to grind. You're kind of ... or you might be a gum chewer. You love gum. That creates so much tension inside the skull and the jaw muscles that chew that can lead to tension headaches, and I have seen that.

And so, you see a dentist, they can sometimes see, "Oh my goodness, you grind at night." You didn't even know it. You've tried everything to make your headaches go away. They don't go away. You've done all the tricks and tips that we've talked about today, and they're still there. It could be your dentist saying, "Hey, I think I see some wearing on your teeth." They can help get you set up for using a night guard.

Yes, you'll still grind with the night guard, but it's not as intense because it's a plastic guard that takes some of the stress off your teeth and off your muscles as you're sleeping, and it saves your teeth, too. So yes, see your dentist. If you chew a lot of gum, maybe switch to mints — and there's some triggers or easy things you can do if you're a daytime grinder.

If you will, take the tip of your tongue and just kind of touch it to the roof of your mouth, it forces your back teeth to open, and then that can be a trick you use. You know, "Oh, I do grind. I just can't break that habit." Every time you become conscious of the grinding, you put your tongue up there on the roof of your mouth, and you hold it there until you forget, and then that will, over time, slow. You'll change that habit.

John Horton:

These are all great tips to kind of prevent it. If you have a tension headache that hits, I think we all know the over-the-counter medicines that you can hit. We all have plenty of those in our cabinet. What about heat or cold? Are those things that we should kind of lean on or that we could lean on to maybe kind of dull that pain?

Dr. Andrew Bang:

For sure. Of the two, ice is preferred, and there's science behind that, and it does something to the blood vessels and the nerves. Blood vessels and nerves are buddies. They run right by each other, and also your lymph system. Those three things are constantly together. So when you apply ice to your temples or forehead or back of your head, the superficial — that means the outer blood vessels, capillaries, nerves — they get affected by that ice or heat.

The cold is great because it numbs the nerve's ability to send signals back to the brain. So that's why you feel better when you put ice on something. OK? And so then, also, it can help reduce the inflammation of those superficial vessels. So yes, put ice, back of the head, front of the head, sides of the head, whatever gives you the most relief. Use that instead of heat when it comes to tension headaches.

John Horton:

That's good. With ice, you want to make sure you cover it up so you don't have ice directly on the thing. As kids, we used to call them boo-boo packs. It looked like a bumblebee or something like that, and you'd put it on there. It was a little softer, kind of do the job.

We've covered a ton here. And I think if people are dealing with tension headaches, you've given them so many ways that they can maybe prevent them or maybe tamp them down a little bit in the moment.

I guess just final thoughts here, let's kind of wrap things up — if you are dealing with tension headaches, it sounds like maybe the first thing you should do is look at your habits and how you're going through daily life, and you might see the solution to the problem in that.

Dr. Andrew Bang:

For sure. Wherever you spend your most time is statistically most likely where your problem is coming from. So yeah, reevaluate your sleep and what you do for your living. And then every once in a while, it's something else. I always joke with patients, we got to look for horses, not zebras. Zebras exist. They're just not as common as you're going to see horses. So that's true within your life, and your tension headaches are coming most likely from something you do and see all the time. So adjust those because then, usually, you find your solution.

John Horton:

All right. Well, next time I go in, I'm going to start looking at everything that's happened during my day, and I'm sure I'll be able to find the trigger. Dr. Bang, thank you yet again for coming in. And like I said, our conversations are always fun, always interesting, and I always feel like I leave with some really helpful tips that'll help me live a little better.

Dr. Andrew Bang:

Yeah. That's what I hope, and thanks, John, for the opportunity, and thanks to all the listeners for following up, because it's important to take control of your health. You are really the champion of your own health.

John Horton:

Perfect way to wrap things up. So thanks again, Dr. Bang.

Dr. Andrew Bang:

You're welcome.

John Horton:

Tension headaches can come and go for a variety of reasons, and many of them are under your control. If you're experiencing frequent headaches, give some of Dr. Bang's suggestions a try. It might be all you need to find relief.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.