Headache

This summer something happened to me. As I was walking down a scenery path, something hit me. It happened so quickly that I felt as if I had been hit by a drop of burning oil that I could not manage to wipe away. Turns out that the culprit responsible for my pain was a bee, or a wasp, I never actually saw it so it could really be either one. What I was certain of, however, was the amount of pain I was experiencing. My body didn’t like it one slightly bit. I was also very confused, why did this insect decide to sting me? Why me? Why on my hand? I had to find answers. I actually had never been stung before. That was my very first encounter and I really didn’t know what to do.

My fiancé, having been stung many times before, was kind enough to inform me to raise my hand above my heart line until we reached home. Once there we would finally be able to put some ice to soothe the pain. Thinking about it now, I realize there were actually two actors at play in this scenario: pain and inflammation. They were interrelated. Inflammation caused pain and pain caused inflammation. It’s a truly terrific vicious cycle we got there. As previously mentioned in the Bring Up Pain article, pain is an adaptative mechanism that forces us to take an adequate action to free us from danger or from something the body interprets as potentially harmful. Where inflammation, also an adaptive mechanism, is there in contrast to provide an ideal environment for healing. One way it achieves this is by sending chemicals to the skin to increase sensitivity. This is the component responsible for the pain we feel when dealing with an inflamed body part. This is also why just the mere rubbing of our clothes after a sunburn is nearly unbearable. We call this increased sensitivity, allodynia. This is meant as a way to keep us from making the injury worse.

Apart from the aforementioned insect sting and sunburns, there are many more events that can lead to development of inflammation. Think about blemishes (pimples), injuries, headaches, arthritis, only to name a few. All of us at one point or another has, or definitely will, experience inflammation. There is absolutely no way around it. Well, not naturally at least. So I believe it’s essential to know how to recognize it. To do this, experts rely on a principle called the five cardinal signs of inflammation. Here, even though you might not know them in terms of their names, you know them at least from experience. So there is really no need to get scared!

The first sign, you guessed it, is pain. This is a necessary step, but still a dreadful step. This is the most obvious sign. It’s a major warning that signals us to pay attention to what’s actually going on. Without it, we would probably carry on with our days with absolutely no knowledge that something wrong is happening. This is also the main, if not only the only sign that transpires when we get a headache. Not that all headaches are signs of inflammation, it’s still a common source. We often get them when we don’t get enough oxygen to our brain cells. That could be caused from a bad sitting position, anxiety or even other health problems. You can discover that the only act of massaging the back of your neck can prove itself sufficient to relieve a headache. This happens because you are restoring blood flow by relaxing muscles that can compress the blood vessel walls. By putting a stop to the compression, enough blood can finally reach your neurons and deliver the oxygen it so dearly wants. Now that your brain cells get enough oxygen, there is no more need for inflammation and thus no need for pain.

The second sign is redness. This is a visual cue that you probably got to experience last time you got pimples. I’m talking about the one that hurts, the one that seems all perky and purulent. They are not only painful, they are also obviously visible by their coloration, red. If you want an additional example of this, think about sunburns. The lobster shade that you adopt after taking that extended sunbath is definitely a manifestation of inflammation. This should be taken as an unquestionable warning sign to get the Fick out of the sun, or pursue at your own peril. Taking in too much ultraviolet rays (mostly from the UVB type) will cause damage to your outer skin layer which will lead to inflammation. To avoid this, it’s really easy, use a proper sunscreen. This tiny bit of advice is so well known that I don’t even know why I bother repeating it here. We know that we should do it, but we don’t. Thus, I am here taking a pledge that I will, from now on, use sunscreen before lengthened sun exposure. Are you brave enough to join me?

Now if you fail to protect your skin after it has turned red, by running away from the sun to the shade, you will probably see soon enough blisters appearing. These are also called edema, which is the third cardinal sign. They contain something we call the inflammatory soup. That soup contains pain mediators, hormones, chemicals, and immune cells. They all contribute to different functions of inflammation, which some of them were mentioned earlier. The immune cells are the one responsible for protecting and defending the affected site against outside invaders, think about that venom from the insect bite I spoke of at the beginning. Some chemicals and hormones will be involved in stimulating cell reproduction (or multiplication). This will help heal wounds, like the skin you damage with the sunburn.

As a fourth sign, we get increased heat. This is not only really obvious when we touch ourselves after a sunburn, it is also really evident when we get a fever. That fever appears because the body, or more precisely your immune cells, perceived a widespread infection with an external agent. It could be from toxins, bacteria, parasites or viruses. By itself, a slight fever is often sufficient to kill living organisms like bacteria and parasites, but it’s completely useless against things that are not alive, like toxins and viruses. This is why fever that gets really intense is frequently associated with viral infection or toxin exposure. If we fail to care for the fever in these cases, it might cause us harm and this is why medical experts give us medication to quench the fever. In most cases, it actually targets inflammation directly which ends up also alleviating pain.

At last there is the loss of function that marks the final signs. This takes the longest to settle in but is, nonetheless, one of the major drivers for hospital visits. This is the less evident sign, as it bears somewhat of a very confusing title. Don’t worry this will be made very clear with examples. If you consider sunburn, the skin is so damaged that it can’t serve as the ultimate barrier anymore; therefore it has lost function. The hypersensitivity we experience is actually a testimonial to that. It is screaming to you that you have to keep all things away from it as it can no longer protect you by itself. Now if you consider a twisted ankle, the loss of function manifests itself through the near inability to walk over it. Your ankle which normally allows you to perform a walk, now pains you anytime you use it. This pain prevents you from performing the exact action it was meant to accomplish.

Now that you’re familiar with the five cardinal signs of inflammation, you may feel comforted in knowing that there exist some ways to help reduce the inflammation responses. Probably none of them will come as a surprise to you. When the inflammation is localized (only in your foot, for example), external (not in your airway or other internal organs) and acute (not a long-termed response), you can refer to the acronym RICE for treatment. “R” stands for rest. Reducing movement will prevent more stress from damaging the tissues further and help the healing process. “I” is for ice, placing ice indirectly (not straight on your skin) on the affected area will slow down the immune response. This will reduce swelling and pain. “C” corresponds to compression, by exerting pressure on the skin you are reducing the volume available for the inflammatory soup to occupy. This should lead to reduced swelling and increase mobility. Finally, the “E” refers to elevation, by lifting your body part slightly above your heart you are improving blood circulation in the area, leading perhaps in the loss of swelling and increased mobility as well.

If ever you are faced with a situation that is so bad that none of these helps, you may require medication. Ibuprofen, commonly known in North America as Advil, is an over-the-counter openly available anti-inflammatory medication that you may want to use or at least keep in your cabinet. If Ibuprofen fails to help, there are more anti-inflammatory medications, some of them even stronger, that require a prescription for procurement. In these cases, you will need to set a visit with your family physician or go through an emergency clinic to obtain the prescription.

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I hurt myself constantly and I am certain you do too. I am so clumsy, though I am not sure why. Maybe I try to hurry up a bit too much, I hate wasting time by lingering on any task for too long. So, for example, I often end up hitting my big toe on one of the corners of the bed base trying to get out of bed in a hurry or cutting myself on a razor haphazardly left in the bathroom drawer when trying to find my eye cream. Other than hurtful to my ego, those experiences hurtful to my body, which leads to pain. Pain is always taken for granted. You are hardly waking up every morning dreading the idea that you’ll eventually experience it, but when it does finally happen you are neither surprise. Pain is experienced by most of us, but despite its universality, very few understand how it works. Actually, can someone please tell me what the heck is pain and how can I fricking get rid of it?

It took me many years of undergraduate studies and then graduate studies to finally understand its main mechanisms, which I will now share with you. I hope that by the end of this article, you not only come to understand pain, but to appreciate it for its complexity and its vital necessity.

When you think about pain, probably you are thinking about it the same way I did before starting my post-secondary studies. I thought pain was the result of injury. You break your skin; it hurts. You hit your foot; it hurts. You fall; it hurts. You get my point. But that doesn’t explain the headache you got last week, nor does it explain the heartburn you got last time you ate greasy food. It’s easy to point fingers at possible culprits for our pain, but it’s not really clear why it causes the pain in the first place. Why does not drinking enough water causes me headaches?

So, let’s break everything into small steps. The very first thing your body does is feeling things, this is called perception. But when the body perceives something that may be hurtful to you, it becomes known as nociception. The body can sense things that are called stimuli (plural of stimulus) which is a fancy word for sensations. Those stimuli can be of thermal (heat or cold), mechanical (pressure or tension), or chemical (inflammation or toxins) nature. Then considering our example giving earlier, hitting my big toe, and cutting myself led to nociception of a stimulus of mechanical nature. As for the headache and the heartburn, it was from chemical nature. For the headache, there was probably not enough oxygen and for the heartburn, too much acid.

Now let’s look at this nociception closer. The changes are perceived by some detectors that we call pain receptors, or more specifically nociceptors. Those nociceptors can differ greatly from each other. They can have different endings which make them able to detect specific types of stimulus or they can also vary in size. The latter will influence how fast the nerve will carry the signal to the brain. It’s this difference in size that makes you sense two pain waves. For example, when you hit your toe. You first grab your toe, but it really was a few seconds after you grabbed it that the intense and sharp sensation started kicking in. This is because the large nerves carried the information related to location and nature of the pain faster than the smaller nerves. It’s those smaller nerves that were responsible to carry the information related to the intensity and emotional nature of the pain and is delayed. This whole process that we just went through is called transduction.

After transduction there is conduction, which is for us step 2. This step explains how the signal is actually sent to the brain. It will probably not be any news to you, the signal is carried by nerves, or neurons. All these neurons are organized into something that resembles a family tree. In your family tree there are your siblings, your cousins and obviously yourself. All of them serve as an analogy for the first-order neuron or most commonly called primary afferents. As suspected, they stem from wherever you can feel (skin, ears, organs, etc.), and they end at the spinal cord. In your family tree, there are also your parents, your aunts, and your uncles. Those are like the second-order neurons, there are generally fewer than the previous group. They are located in your spinal cord. Then, you have your grandparents. Those are like the third-order neurons and are present from the end of your spinal cord to your brain. Simple, isn’t it?

After the signal has reached through all the three levels of neurons and finally the brain, then there is transmission. Transmission refers to the mechanism to which all different information will be sent to their appropriate processing section. Then an output signal will be produced and will be modulated depending on its intensity and its relevance. If the intensity is too much and is not relevant, the signal may be tuned down, or reciprocally up if the situation is reversed. So that makes up two steps: Transmission and Modulation.

The very last step is Perception, and it relates not to the initial perception we introduced when we talked about transduction, but to the final products that leads to a reaction. It is at that moment you grab your toe

So, if I try to summarize everything, first you feel; secondly, the signal goes through three levels of neuron up to the brain; thirdly, the signal is interpreted by the brain; fourthly, the signal is tuned by the brain and lastly it is sent back to the appropriate location to create a reaction. Normally, it takes all those steps to induce pain, but there are some cases where the pain seems to appear out of thin air. That pain is often said to be neuropathic. Where signals are generated in the absence of stimulus detection which is common in chronic muscular diseases.

Reversely, there is another disease that leads to the inability to generate pain. Doesn’t that sound wonderful, right? People affected by congenital insensitivity to pain with anhidrosis (CIPA) would disagree. Pain is a protective mechanism that forces you to have a reaction when faced to a potentially harmful stimulus. Without pain, most people with CIPA will die before the age of 25. They usually end up burning themselves seriously, biting off their tongues or scratching to the bone, which could eventually lead to infection, which can also lead to death. These are only examples of things that may happen to you without the ability to generate pain. Pain is so important since it is there to avoid putting yourself under unnecessary harm.

Pain can also be split into two categories: acute and chronic. We talk about acute pain when dealing with a situation that is sudden and ephemeral (that doesn’t last in time). In contrast, we talk about chronic pain when it’s persistent in time, usually more than three months. So all previously mentioned pain examples were actually all acute, apart from chronic muscular disease. It’s neuropathic nature which tends to be difficult to treat, renders it a chronic disorder. Fibromyalgia is a good example for this, to learn more read Bring Up Fibromyalgia.

Now to avoid pain you have different strategies. You can simply take some analgesics like acetaminophen (Tylenol) or ibuprofen (Advil), and if the pain is really intense, morphine. There is also the placebo effect that is really strong in helping face pain. Grabbing your foot when you hit it also greatly helps since it creates some natural inhibition of the pain through a process called the gate control theory. Mindfulness has also been shown to be helpful by redirecting our attention to external stimuli. Obsessing over our pain is detrimental. At best, it blocks the downregulation of the pain and at worst it promotes its upregulation.

Now that you know where pain comes from, my advice to you is to accept it, to cherish it, to listen to it and to respond to it with kindness. Pain is a necessary evil that is an intricate part of life. Whenever you feel pain, remember that you are living, and most important, that you are living science.

Bring Up Science

Bring Up Inflammation – How does it help

Bring Up Pain – Where all of this hurt comes from