Updated August 31, 2016
It‘s 10 hours into your shift and the call volume has just not let up. As soon as you get to the emergency department, your dispatcher asks when you can clear for a call that is pending. Before you know it, the old familiar headache begins to make its presence known. You reach for the pill bottle, only to realize that you have not had much water today.
While all too common in today’s EMS environment, this level of self-neglect can have profound and lasting effects on your overall health and wellness. Headaches are not normal, nor should they occur even on an infrequent basis. Turning to pharmacology is not the solution either. As a clinician colleague of mine used to say, “Headaches are not a lack of acetaminophen.“
Headaches (cephalgia) have many etiologies, ranging from tumors to allergies to muscular origins. For the scope of this article let’s focus on the soft tissue and environmental factors that often cause our symptoms.
Dehydration
Headaches can come from dehydration, and is the first and easiest one to correct. How do you know if you’re properly hydrated? You should be looking for a restroom every 60-90 minutes. The sensation of thirst is a late indicator. Water is our best source of hydration.
Fatigue can also lead to headache symptoms. While this can be difficult to work around in EMS, we really do need our rest; it’s why many EMS systems are slowly moving away from the 24-hour model. As a side note, dehydration will also make you more tired, so drink that water.
Diet
Foods that can cause an inflammatory response are everywhere, especially in the fast-paced, fast food culture of EMS. In some people, fried foods, dairy products, sugars, and wheat products can cause a chronic low level of inflammation in the body that often leads to “vague“ symptoms such as headaches. When I was in the clinic treating patients, we removed dairy products from chronic pain patients’ diets. For many of them, their pain rapidly dissipated.
The bottom line here is to identify what foods cause reactions in your body and them limit or even avoid these foods. For example, omit dairy or wheat from your diet for a week and see how you feel. If your symptoms lessen or disappear, you may have an intolerance to these foods.
Posture
Head position is very important to the overall wellbeing of all the soft tissue and bony structures in your neck. A forward head position, also known as an upper crossed syndrome, has been tied to everything from headaches to rotator cuff tears and bone spurs in the cervical spine. This position will also create an environment ripe for disk herniation.
Upper crossed syndrome will also make the muscles in the back of the neck, shoulder blades and middle back very tight as they attempt to fight the chronic forward pull from the head. To ‘correct’ the underlying postural issue, it’s imperative that we not only address the faulty posture, but also try to correct the underlying pattern: the forward head and rounded shoulders.
First, realize that our society has become very sedentary and as we continue to enjoy the convenience of modern technology, our bodies are paying the price. As I write this and as you read it, we are both in a forward head position. As we look at the screen, type, scroll and share content, we are forced into upper crossed syndrome. This not only creates the problem, but also reinforces it.
Every day you sit in the truck, study or stare at your phone, your posture learns a pattern, in this case a bad one. Since the body constantly tries to self-correct, over time it will form trigger points and adhesions as the muscles weaken from the constant forward pull. The common locations for these nasty pain-producing points are the upper trapezius, levator scapulae, rhomboids, thoraco-lumbar paraspinals and surprisingly, the pectoralis minor muscles.
First and foremost, adjust your seat, sit up straight, stop leaning forward and stand whenever possible. Reduce the offending pattern, which in this case is sitting and leaning forward.
Next, address the tight muscles in the front of the body to stop the chronic pull on the neck and shoulders. Stretch the pectorals and laterals, and then mobilize them using a tool like a massage ball. Even better, visit a massage therapist.
After shutting off the head-forward pattern by sitting straighter, attack the muscles that cause most of the headaches. Stretching the trapezius, scalenes, levator scapulae and rhomboids will help, but your efforts are best spent mobilizing the muscles using a massage ball or with massage.
By keeping the tissue loose and understanding that the symptom and cause of the headache are often different, we can apply a more scientific approach to managing the pain and not allowing those nasty headaches to bother us anymore.
