The Headache Healer’s Handbook. Jan Mundo

you stair-step down slowly from the medication you are taking.

       How to Read This Book

      Although you might be tempted to skip directly to the acute treatment parts of the book that show how to relieve your headache or migraine on the spot, don’t do it! Transforming long-standing chronic headache patterns is a process that requires you to integrate new practices one by one, over time.

      For example, I typically work with clients in fifteen to twenty one-hour weekly sessions, and more if we do bodywork or headache relief, or if a client has a history of trauma. A class series typically runs eight weeks, two hours per week. Both have homework and practices in between. The weekly spacing allows participants to integrate a new practice before learning the next, and I encourage you to take your time in working through the chapters.

      The pacing depends on the individual because each person’s headache puzzle is different. Find what feels balanced for you. Some areas might take more of your attention than others. You have the book, and you always have your body, so you don’t necessarily have to wait a whole week for each new lesson. The idea is to take action without getting overwhelmed. If you read through but don’t engage, you will stand still. If you go too quickly (e.g., quitting caffeine cold turkey), you might get rebound headache. If you go too slowly, the continuity of balancing multiple life factors could get lost.

      Here’s what I recommend: To achieve the promised results, follow the program steps in order. Each practice teaches the skills needed to advance to the next level. That way, you will develop as you go, build on what you learn, and be prepared for each new step.

      On the other hand, if you do have a headache or migraine episode (from a nonserious or previously diagnosed condition), you might try skipping to the hands-on therapies in part 4. Then, when you are feeling better, you can return to the prevention chapters about diet and stress reduction, which are vital components of the Mundo Program.

      Like Rome, your headaches weren’t built in a day, and they need to be carefully deconstructed brick by brick. As you build your new foundation, you will have all the tools you need to reassemble yourself into a healthier person. By embodying each new skill in turn, you will give yourself the best chance for success.

       Your Support Team

      Making lifestyle changes is no small feat, and it’s helpful to have support. If you have a friend who has headaches, why not enlist each other as headache healing buddies? How about forming a group with several people, so you can read the book and implement the lessons, exercises, and practices together?

      Whether you’re reading this on your own or with a buddy or group, the goal is to go beyond reading and move into action, which is the only thing that will change your situation. A support group, whether in-person or online, can provide a forum for sharing information — new books, therapies, and approaches — with people just like you who understand. But to make change, you must move beyond information and research. The headache healer’s philosophy is proactive. It’s not enough to read, plan, or hope; we have to act and institute new ways of being. To that end, a support group whose members encourage each other to make changes, stay on track, and leave their headaches behind can be very valuable.

      Surround yourself with people who focus on positive change, committed listening, and taking action. Notice the mood and tone of the group you join. Do you leave feeling positive and energized? Is it rigorous and compassionate, or does it keep people stuck and complaining? Shaming or sentimentality can spiral downward into self-blame and victimhood — and a know-it-all who takes over and inserts opinions aggressively can stifle progress and make you doubt your own inner voice.

      Look for avenues where you can give and receive strength and helpful encouragement to keep your momentum going. Put yourself out there instead of retreating and feeling misunderstood or ashamed. I encourage you to admit your truth and engage with others in a community of healing. It’s a giant step forward.

       2 What’s Your Headache Type?

      What’s your type? No, not your blood type or the type of man or woman you are attracted to! I mean your headache type.

      In this chapter, we examine the characteristics and symptoms of four basic headache types — tension, migraine, cluster, and medication-overuse headache — and describe danger signals of headaches that are caused by more serious medical conditions. We also look at the characteristics of headaches formerly known as mixed and now folded into the diagnosis of migraine. (As a reminder: This book is educational and does not diagnose, so please get a diagnosis from your healthcare provider.)

      The International Classification of Headache Disorders, 3rd edition (the beta version, abbreviated here as ICHD-3 beta), defines and codes headache types so that doctors can diagnose and prescribe treatments for their patients.¹ Created by a committee of the International Headache Society, this diagnostic tool classifies headaches by characteristics, symptoms, and frequency into approximately three hundred types and subtypes, ranging from episodic to chronic and primary to secondary.

      With a mind-body approach, we don’t use the classifications for diagnosis and prescription. Instead, by knowing your headache type, you can demystify your symptoms and know which practices and therapies to turn to and when. Can you find your headache type below? Do any of the definitions fit your diagnosis or what you had suspected? Keep in mind that research and definitions evolve over time, and your symptoms may span several categories. As a neurologist specializing in headache noted — of course, all this was decided by a committee, and patients often don’t fit into neat categories.

       Types of Headaches

      The following definitions include qualitative, somatic descriptions and ICHD-3 beta classification parameters.

       Tension-Type Headache

      Popularly known as tension headache, tension-type headache is the most common and least-researched headache type. It is characterized by tightness and pressure on both sides of the head, and the pain, which is steady, dull, and nonpulsating, is compared to a tight hatband or having one’s head stuck in a vise. People often complain of a stuck, knot-like pain in the lower skull, back of the neck, shoulders, upper back, or jaw. Tension headache was previously termed muscle contraction headache because those areas can feel tender, tight, and contracted. Tension headache can last from thirty minutes to a week.

      Routine physical activity does not tend to make these headaches worse, nor are they accompanied by nausea or vomiting, as in migraine. Nevertheless, they can be debilitating. Some people with tension headache are sensitive to light or sound. If tension headache occurs fifteen or more days per month for three months or more and is not due to medication overuse, the diagnosis changes from episodic to chronic tension-type headache.

       Migraine

      Migraine is a primary disorder that is characterized by recurrent, debilitating attacks of throbbing, pulsing, or pounding pain, usually located at the sides and front of the head and face, especially forehead and temples. Despite its origins in the Latin term hemicrania — meaning “half skull,” because the pain is often one-sided — migraine can affect one or both sides of the head. During an episode, the pain can even move around — or migrate from one side to the other. An episode typically lasts four to seventy-two hours and is often accompanied by other symptoms.

      Migraine is divided into two main subtypes. Migraine without aura (previously termed common migraine) is the most common. Migraine with aura, previously termed classic migraine, is preceded or accompanied by a set of neurological symptoms, collectively termed aura, that can last from several minutes to an hour. Visual disturbances are the most common aura type and can take the form of scintillations — such as flickering lights, spots, or lines — and scotoma, a loss of some or all of a visual field that is otherwise normal. Other types