Common Headaches in Austere Environments, by DocDogMom

Introductory Disclaimer: The following is not to be considered formal medical advice. Please consult your physician regarding proper diagnosis and treatment of headaches or any condition.

Headaches are some of the most common maladies that I treat in my healthcare practice. Without question, I expect these to increase even more during difficult times. I would like to offer a few tips regarding treatment of the most frequent types of headaches, in the event that your physician is not available.

Headaches of many types are typically triggered by factors such as dehydration, poor diet, overexertion, stress, illness, trauma, and sleep deprivation. This can interfere with a person’s level of functioning, including attention and concentration, problem-solving, endurance, and resilience. As such, a seemingly innocuous condition such as a headache can potentially put the well-being of an entire group in danger.

First off, there are many different types of headaches. The best treatment is determined once the proper diagnosis is confirmed. It is beyond the scope of this article to offer an overview of all headache types, which would take several volumes. I will focus on the most common types, which are easily recognized and treatable in austere environments.

Rebound headache. This is also known as medication overuse headache. This is a headache that occurs upon abrupt discontinuation of various substances, such as caffeine and over-the-counter pain relievers. In other words, those of us who are accustomed to drinking our daily cups of coffee or soda may have severe headaches once this is no longer available. It may also be seen in patients who use over-the-counter (OTC) headache medication daily for months on end. Contrary to what the pharmaceutical industry would like the public to believe, these medications are not intended for chronic use. They should be taken only a few days per week, or regularly if needed for a limited period of time, a few weeks at most. Fortunately, these types of headaches are temporary. It typically resolves on its own after days to a few weeks. Recognizing this, the time to treat this is now, prior to exposure to a stressful environment.

There are a few ways to approach this. The first one of which is to gradually decrease your consumption of caffeine or another offending agent. There will be headaches, but they will gradually dissipate over time. The second way is to stop the offending agent “cold turkey.” This can be very uncomfortable, and many sufferers do not have the willpower to see it through to a successful result. Unfortunately, many people will find themselves forced into this situation. The third way is to discontinue substances with the help of temporary medication, such as a course of steroids. This would require a prescription from your physician, so it would behoove you to look into this prior to any societal upheaval.

Muscle tension headache. As the name suggests, this consists of muscle spasms and contraction of the muscles of the head and neck, most frequently neck and shoulders, back of head, forehead, and temples. It may also occur around the eyes and in the jaw, due to clenching and squinting. Sufferers describe a tight, squeezing, aching sensation. There may also be a burning, electrical sensation as nerves are pinched within the muscles. This can be exacerbated by stress, sleep deprivation, dehydration, and overexertion. In other words, the typical SHTF experience.

Typical treatment includes anti-inflammatories, muscle relaxers, physical therapy, and restful sleep. In austere environments, sufferers can compensate by obtaining a massage of their head, neck, and shoulders, drinking plenty of water, obtaining good rest with a comfortable pillow, and relaxation techniques. They may also apply warm compresses to the posterior neck and shoulders. Magnesium is a good muscle relaxer. This can be taken in the form of magnesium oxide. Typical dose is 400 mg twice daily and as needed. The main side effects include soft stool, which may not be bad if a person is eating lots of MREs. Alternatively, patients can trial the herbs Valerian and chamomile for relaxation. A patient may also consider use of an anti-inflammatory agent such as naproxen or ibuprofen for a limited time. Aspirin may also be used for adults. Of note, children should never be given aspirin under any circumstances because of the risk for Reye Syndrome, a devastating disease.

Migraine. This is a very broad topic. Typically migraines begin to develop in adolescence or early adulthood, they do not surface in mid to late life. Therefore, the sufferer is most likely already aware of their diagnosis. Migraines are usually involving one side of the head, especially involving an eye. However, in some patients, both sides are affected. They are typically described as severe, pounding, accompanied by nausea, and at times sensitivity to light or noise. They may also have some distortion of their vision. Sufferers can often be found laying in a dark room with a pillow over their head. Migraines can be triggered by many of the same things that trigger tension headaches: sleep deprivation, dehydration, poor diet, processed foods, and weather changes as a result of barometric pressure fluctuations, to name a few.

There are two approaches to migraine treatment. One of which is using a medication as a rescue once the headache begins. If headaches are occurring frequently, the second course of action is use of a preventative medication which would be taken daily, in order to minimize their frequency of occurrence. Optimally, suffers should try to lay in a stockpile of medication that is used to treat their headaches under normal circumstances. If this is not possible, they can use magnesium oxide 400 mg twice daily, also riboflavin (vitamin B2) 400 mg daily, which are reasonable preventatives. These would be taken on a daily basis regardless of headache status and may take a few weeks to start working, so be patient. A different course of medication is used for rescue when a headache occurs. It is important to take the medication as early as possible once the headache starts to maximize benefit.

Patients can take an anti-inflammatory of choice (Naproxen or ibuprofen, preferably) accompanied by diphenhydramine (Benadryl) together. They should also drink plenty of water. This is similar to treatments administered in the emergency department. It is effective, but note that it can be sedating. In addition, patients should lay down in a dark, quiet environment and take a nap if possible. Some people obtain relief with peppermint in the form of tea or aromatherapy , which has the added benefit of reducing nausea that may also accompany the headache. Other herbs include skullcap for use as a rescue, one may consider use of feverfew or butterbur as a preventative on a daily basis.

Concussion. I am hesitant to broach the subject due to the complexity and risk of complications, but I believe it is important since it will be a frequent occurrence when SHTF. If a head injury of any type occurs and professional medical help is still available, I urge you to seek out proper care. This is because seemingly mild injuries can potentially result in hemorrhage, brain swelling (cerebral edema and herniation), seizures, permanent impairment, and death.

Having said that, I will continue with the discussion of concussions. They are also known as a mild traumatic brain injury (TBI) and can occur as a result of a fall, jostling/jolting event (acceleration/deceleration injury, also known as contracoup), or blow to the head, though this does not absolutely need to occur. Patients may or may not have loss of consciousness. The symptoms may begin immediately or shortly thereafter. Patients frequently describe headache, vision changes, disorientation, ringing in the ears, lightheadedness or vertigo, nausea, and vomiting. If the patient is unconscious, basic life support and CPR protocols should be followed as necessary (I encourage everyone to complete a BLS and CPR course, at a minimum).

Initially, the patient should not be moved until other injuries are ruled out, such as neck injury. Patient should be moved to a safe environment when able to do so. They should be assessed for level of consciousness, orientation, and pupils and eye movements observed. Check facial and tongue movement for symmetry. Also check symmetry of strength of arms and legs, as well as coordination with touching their nose. If pupils are two different sizes, unequal movements, or level of consciousness is impaired, this constitutes an emergency and additional treatment should be sought immediately.

Assuming none of the aforementioned are present, conservative management can be pursued. The patient should drink fluids and rest quietly for a few hours. They can then gradually increase their activity level so long as it does not worsen their symptoms. Screen time, i.e. electronic devices, can worsen symptoms and should therefore be minimized. Tylenol may be taken as needed for headaches. Fortunately, most minor concussions completely resolve within two weeks. Some may linger for longer, especially if the patient overexerts themselves and does not allow time for recovery. Another red flag is if the patient would sustain another concussion before fully recovering from the previous one.

Again, this is meant to be a brief overview of headaches in extreme settings. It is not meant to be a comprehensive assessment of all causes and types of headaches. If at all possible, professional medical advice should be sought. In the event that it is no longer available, then these suggestions may be helpful.