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We have assembled a list of Frequently Asked Questions and Answers for your information. FAQs-Headaches and Migraines, for FAQs-Backaches for Chronic Pain. If you cannot find an answer here please feel free to contact us.

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Question - What is Chronic Daily Headache?

Answer -This is the name that many headache doctors are now giving to patients who have lots of headaches. Some of these patients don’t even have a headache every single day, just most days. Doctors have many names for this condition. You may have heard the names: Chronic Tension-type headache, Combined headache, Chronic Tension-vascular headache, Chronic migraines, Rebound headache, Medication-induced headaches, Medication overuse headaches, Transformed migraine and Chronic Mixed Headache. At our clinic, we prefer the name Chronic Mixed Headache because these daily or almost daily headaches are usually made up of a mixture of Tension-type and Migraine headaches with a component of rebound headache thrown in for good measure.

Question - Is it normal to have a headache almost every day?

Answer -  No. Although 5-10% of the population may suffer with daily or almost daily headache, it is definitely NOT normal. This condition is usually caused by a number of headache triggers and causes combined with a genetic predisposition, and is treatable. Your best bet to get help is at a clinic that specializes in the treatment of headaches and uses a multidisciplinary approach.

Question - I get a migraine once every month or two. Do I need to come to your clinic?

Answer - If your migraines are predictable, consistant and don’t impair your normal life, you do not need to be seen at a specialty clinic like ours. You should see your family physician and tell them about your headaches. Even if you’ve reported your headaches in the past, you should bring up the topic every 6-12 months, as there are many new treatments available that can minimize the impact your headaches are having on your life. If your doctor doesn’t recommend any treatment, ask them to refer you to the Headache & Pain Relief Centre, and we’ll take care of you. Top

Question - My headaches aren’t that bad-does that mean they’re not migraines?

Answer - After all these years, we still don’t have a definitive test to diagnose migraines. Your doctor will listen to your symptoms and a description of your headaches and tell you if they are likely to be migraines or not. The decision is based on a number of factors, not just how bad the pain is. The location, nature and duration of the pain also help make the decision. The timing and triggers of the headache can help. A very important factor is what other problems go along with the headache. A pounding headache over one side of your head only, that lasts most of the day and stops you from working is suggestive of migraine. If it consistently hits you just before or at the start of your period and makes you nauseous and sensitive to light and sound, it is definitely a migraine. Top

Question - I'm wondering when to go to the emergency department?

Answer - Most of the time a headache is just a headache, especially if it's the same type of attack that you have had many times in the past. There are certain symptoms, however, that could mean your headache is something much more dangerous, and you should get to the emergency room right away. Any headache that is the "worst one ever" should be seen by a doctor. This might be caused by bleeding in the brain and could be fatal. Headaches that are getting progressively worse over time should be checked out. Headaches that are worse in the morning before you get out of bed, especially if they flare during the day after bending your head down, need further investigation. Any headaches causing long lasting neurological problems (not just the same aura as previously), headaches associated with a fever, drowsiness or accompanying another progressive medical condition should prompt a visit to the doctor. Migraines don't usually start in someone past their 40's or younger then their 20's. These need investigation. Top

Question -  I have sharp pain in both my ears. My ENT says my ears are fine. Could this be coming from damaged jaw joints?

Answer - Yes, but more commonly the pain represents abnormal muscle activity only. Overworked jaw muscles can send pain to the ears, temples, top of the head or even to the face. These muscles can go into spasm from jaw alignment problems, or because other nearby muscles are in spasm. Most often there is no damage in the jaw joint (TMJ). We will investigate this by MRI if necessary. Top

Question - I’ve charted everything I’ve eaten, my periods and the barometric pressure for the last three years. Why can’t I figure out what’s causing my headaches?

Answer - Most headaches, especially if they happen frequently or continuously, are the product of numerous triggers firing at the same time. There is rarely just one trigger, otherwise you would have figured it out long ago. Another problem is that there are many “hidden” triggers. Two of the commonest ones are the joints of your neck and the muscles of your jaw. I call them “hidden” because most patients don’t realize they may have a problem in these areas, let alone their role in triggering headaches. Other factors can be medication rebound, poor eating habits and lack of deep, restful sleep. Top

Question - What are the most common causes of Backaches?

Answer - Most doctors focus on the intervertebral discs and the facet joints. Problems in these areas cause the majority of first-episodes of back pain. After repeated episodes or prolonged pain (i.e. chronic back pain), the surrounding tissues such as muscles, nerves, ligaments and S.I. joints are always involved. Poor posture, changes in the way you walk, sit and stand and uncoordinated muscle activity not only prolong the pain, but make it worse. All of these factors can be grouped together by the term "biomechanics". Unless your biomechanics are properly assessed and treated, you have very little chance of relieving your chronic back pain. Top

Question - My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Is this true?

Answer - Absolutely not. While it is true that the damage to your joints can't be undone, you do not have to go on suffering the same burden of pain. The pain you feel is produced (and felt) in your brain, as a result of signals sent not just from the damaged joints, but also the surrounding muscles, nerves, ligaments and other joints that may not be damaged, just overworked trying to protect the damaged area. All of this "compensation" in the surrounding area can be treated with a great reduction in total pain. Also, we now have ways of boosting the pain-fighting part of your brain, which can filter out much of the pain-causing signals before they trigger the pain. Lastly, we now know a lot more about how the typical pain patient's diet is actually boosting the inflammation in their body, which keeps the pain cycle going. Top

Question - Is it true that a bulging disc can be normal?

Answer - Yes. Many of us walk around with bulging discs and are not in pain. That is why it is dangerous to focus too much on the X-ray/C.T. scan/M.R.I. and not on the person with the pain. Our approach starts with and focuses on the patient. What is the history of your pain? How long have you been dealing with it?  What sort of treatments have helped and which ones didn't? Also, we analyze how you walk, the alignment of your entire spine, your strength, flexibility and more. X-rays and so on can help give us the complete story, but we'd prefer to treat you and your pain, not just a lab test. Top

Question - What's the difference between acute and chronic pain?

Answer - Acute pain is the unpleasant sensation that warns you when something gets injured, or goes wrong in your body. This is very useful and important, and we'd be in big trouble if we didn't have this part of our nervous system. Chronic pain on the other hand, is ongoing pain felt long after the injury has taken place. Sometimes, people experience chronic pain and doctors can't even find an injury in the first place. Scientists now believe chronic pain represents abnormal changes in our pain detection system. You could say that we move from acute pain to chronic pain when our brain starts to believe that producing pain is a normal part of its job. It has gone from being a symptom (of some other problem) to a disease unto itself. Although we still can't measure our brain chemicals directly, I suspect a big part of chronic pain is related to a deficiency of brain transmitters (chemicals). Top

Question - I had an episode of shingles last year and now the area really hurts. Is there anything I can do about this?

Answer -This is called Post-herpetic neuralgia (PHN) and represents damage to the nerve endings by the shingles virus (a form of Herpes). There are many new treatments which can help relieve this type of pain. There is no cure, but fortunately, the pain tends to lessen over time on its own.

Question -  How is pain measured?

Answer - Doctors use something called a Visual Analogue Scale to measure a person's pain level. This is a number system ranking from 0-10, where 0 represents no pain at all, and 10 represents the worst possible pain. The patient is asked to pick a number that best represents the amount of pain they feel. The problem with this system is that someone's 4 might be the same as someone else's 7, i.e. it is purely subjective. At the Headache & Pain Relief Centre, we focus more on function. What sorts of things are you able to do despite your pain? What activities make your pain worse? What can you not do anymore because of your pain? If your pain were 50% better, what activity would you choose to do? What is important to you? What activity goals can we set to gauge your improvement? This way, even if your pain doesn't go away completely, your quality of life can improve.

Question What is osteopathic therapy?

Answer - Osteopathic therapy is an holistic, hands-on treatment approach based on the tenet that given an opportunity, the body is capable of great healing, adjusting and self-repair.

Osteopathic therapists believe most of the pain and problems we suffer stem from abnormalities of body posture and mechanics. They look at the soft tissues, which includes the muscles, ligaments, tendons, nerves and especially the fascia, as a major determinant of joint function. By correcting abnormal and dysfunctional movements of the soft tissue, many of the body imbalances that cause pain will recede, allowing the body to heal. An osteopathic therapist will ask you a lot of questions, pertaining to your diet, lifestyle, exercise, work and homelife. They will perform a complete examination, check your X-rays and give you an explanation for your pain. In most cases, gentle hands-on treatment will give you some relief almost immediately, and will be followed by a simple home exercise routine.

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