~ Dr.P.S Ajrawat
Migraine is a French word, which means one-sided headache. However, this term has been used by doctors and laymen alike––incorrectly––to describe many different types of pain in the head and neck area. Most headaches are misdiagnosed as migraines. According to recent studies, more than 90% of headaches are myofascial in nature and only about 6% are migraines.
Traditional diagnostic methods, such as MRI or CT scans, EEG, and X-rays, often fail to identify the underlying cause, namely, the myofascial trigger points producing these headaches.
When I started treating spreading the gospel of multimodality pain management 25 years ago, both the general public and medical professionals often wondered, to put it frankly, what the hell I was talking about. They often questioned where I was coming from and my rationale. They felt puzzled that all they had read or heard did not quite match what I was saying. So they were skeptical when I said migraine headaches do not exist. They remained skeptical until I began producing results by treating patients with shots in the head, neck, shoulders, and upper back.
In addition, I started employing preventive measures, such as proper use and consistency of pillows during sleep, protecting the neck and shoulder muscles against cold drafts at night during winter or summer months, daily exercises of neck muscles, and correction of skeletal disproportion (i.e. short legs or short hemi-pelvis, short arms, and rounded shoulders, which could precipitate headaches repeatedly if uncorrectedby measures like heel and butt lifts, as well as a chair with adjustable side arms.). In addition, I advocate proper posture and use of ergonomically designed furniture with proper back support. Excessive computer use and poor arm support often lead to an overloading of neck, shoulder, and arm muscles, which often leads to two common pain disorders, myofascial headaches and so-called carpel tunnel syndrome. In addition, patients can suffer from pins and needles and numbness in particular areas of their hands due tocervical nerve entrapment (entrapment neuropathy) in the neck muscles.
Despite the failure of traditional methods,myofascial headaches respond very well to treatment. With appropriate treatment, I have dispelled many myths about the diagnosis and treatment of Migraine Headaches. My pain management techniques offer the promise of long-lastingheadache relief and even complete cure.
Treatment begins with a thorough evaluation and appropriate diagnosis. Once the diagnosis has been made, I design a treatment plan that includes multi-modality therapies.
The most important modality is injections into the trigger points, leading to deactivation of trigger points and spinal reflex, which allows muscles to regain their normal flexibility and range of motion. Therapeutic exercises, including stretching and strengthening of the affected muscles, also play a significant role in healing. In addition, narcotic and non-narcotic pain medication, as well as antidepressants, are prescribed, and are reinforced by meditation therapyand psychotherapy if necessary.Elimination or correction of complementary factors, such as short leg, hypothyroidism, or poorly designed furniture, is very essential. The patient’s active participation, cooperation, and compliance, including follow-up treatments and visits, are absolutely essential for a favorable treatment outcome.
Parallel with these treatment modalities, I introduce measures to deal with factors that perpetuate the pain or may have triggered it in the first place. One example would be to correct the inequality in length in the patient’s legs.
Ergonomics, the science of designing workplace equipment to fit the worker and prevent repetitive strain injuries, may also play a role in the treatment or even prevention of myofascial pain. For example, for a person sitting all day in front of a computer, a properly designed computer chair is essential, as well as use of an appropriate-sized pillow or pillows with right consistency (usually medium foam)for sleep.
All these treatments, in combination, can heal and prevent myofascial headaches. I have often told patients, “Your diagnosis is myofascial headache, not migraines, and I shall prove it to you sooner than later, perhaps on your next visit when I start treating you.”
Often the first treatment brings the much desired and long-awaited results, which are maintained by follow up treatments. I have treated hundreds of headache patients successfully and have been called a miracle man.
I am not a miracle man. I am a skilled but humble doctor who understands the true sources of pain and how to treat it effectively. I am dedicated to making this paradigm shift available to the whole of ailing humanity. Ten years ago I submitted my taxonomy of myofascial headache treatment to the Library of Congress.
One of my patients, Ms. KP, had been suffering from migraine headaches for 12 years.
“The pain was so severe I cannot describe it,” she says, “but you might imagine how it would feel if someone hammered a sharp nail into your eye and out your temple. The pain affected the entire side of my head, extending down the back of my neck, and even caused me to vomit. To curb the pain my doctor would give me an injection, which only put me to sleep. After each injection it took four days for my body to recover and to function normally again.
“Of course, this affected my family life, my work, and my self-esteem. I averaged two migraine headaches a month. On the last visit to my family doctor, I broke down in tears and said that I could not handle this pain any longer. He recommended that I try the Washington Pain Medicine Center. Since working with Dr. Ajrawat, my life has changed. I never knew that feeling good, felt so good.”
Like Ms. KP, my patient Magicsuffered from chronic headaches for many years.
In 1997, he started to get blurred vision, headaches, and often felt the need to vomit. He couldn’t figure out why this was happening. Over time he saw several doctors and had numerous tests and scans done, but the results always came back negative. He even tried to change his diet, but still found no relief.