Pain and tension in the muscles of the neck and shoulders is often linked to migraines. In this episode, Dr. T explores the root causes of chronic pain, including crucial factors that are often overlooked, and how we can incorporate that understanding to develop a comprehensive treatment plan.
- The JUMP START Challenge
- The 9 Primary Migraine Miracle RESOURCES
- Our favorite source of collagen (Great Lakes brand)
- MIGRAI-NEVERLAND, our premier resource for those who want to find their pill free path to migraine freedom
- Migraine Miracle Facebook group
- The book that started it all – The Migraine Miracle
Welcome to the Migraine Miracle Moment. I’m your host, Doctor Josh Turknett. I’m a neurologist, migraine specialist, migraine sufferer, and author of the book The Migraine Miracle. In this podcast, you’ll learn all about how to find your path to migraine freedom without pills. Let’s get started.
Okay, welcome to The Miracle Moment. So in today’s episode, which is another Question of the Week, I’m going to be covering an issue that I imagine is a significant one for many of you. And I know that because the question I’m addressing this week is one that I’ve received many times, both in the neurology clinic and in our Migraine Miracle community. And that is the issue of chronic pain and tension in the neck and shoulders, and its contributions to migraine. Now, chronic neck and shoulder pain is a really common problem, and another one that’s unique to modern humans, along with chronic low back pain. And many migraineurs recognize, specifically, chronic neck and shoulder pain and tension as something that seems to increase their vulnerability to migraines.
So in today’s episode, I’m going to be talking about several ways in which we can address not just chronic neck and shoulder pain, but really any chronic musculoskeletal pain of any kind, regardless of the part of the body that’s affected; because for the most part, the principles that I will be reviewing aren’t really specific to any one part of the body. This is also another issue where the typical approach is not only too narrowly focused, causing us to ignore some of the major factors, but also another scenario where the conventional response often trades short-term relief for longer-term suffering, or creates a longterm problem.
So again, this was a question that was submitted by one of our Migrai-Neverland members for a recent clinic chat. And for those of you who don’t know, the clinic chat is our weekly group coaching session that we hold inside of Migrai-Neverland, where our members submit questions in advance, and then we gather for a discussion around the topics that are submitted. So, it’s one of my favorite things about our Migraine Miracle community, as it allows us to dig into many topics that are highly relevant to the migraineur, and to those who are putting the plan into action. And it helps keep me on my toes, and keep me actively researching some of these really important areas.
And so, participation in these group coaching sessions is one of the many benefits of Migrai-Neverland membership. And to learn more about that and all the other resources that we offer inside of our member community, you can go to MyMigraineMiracle.com, and just click on the “resources” link that you see on the top menu. Also, don’t forget, if you’re signing up for Migrai-Neverland, use the discount code “moment,” that’s M-O-M-E-N-T, when you register to get $30 off as a thank you for being a podcast listener. I should also add that our next Jump Start challenge starts September 15th. So, the Jump Start is our 30-day challenge that’s designed to get you off and running with a full head of steam with the Migraine Miracle plan. And you can learn all about what’s involved with the challenge by going to MyMigraineMiracle.com/jumpstart. And you can take part in that challenge by either signing up for it directly, or becoming a member of Migrai-Neverland. As one of the benefits of membership, is that you have access to all of our 30-day challenges as many times as you’d like.
We also have a private Facebook group for our Migrai-Neverland members. And earlier today, we actually had a really great comment from one of our members that I wanted to share. So I’m going to read this comment from [Jo 00:03:48]. So she writes, “So, I’ve been a member for 40 days. Joining gave me the courage to go cold turkey on the sumatriptan. So in that time, I have had five migraines; one aborted with half a 100 milligram Imitrex, so I’ve endured four pretty vile migraines. However, this is pretty amazing, as normally, I would take approximately 14 tablets a month, so nearly 20 in this period. Amazed I have managed. I’ve let some people down, missed a few deadlines, but I warned everyone in advance what I was doing. And this helped me to just give in and allow myself the time to address the problem, rather than just pushing through it. So I’m sure the mindset change has been a major help. Today is my eighth day, migraine free.”
So that was a wonderful post for many reasons. If you’ve listened to this podcast, you know that it’s nearly impossible to slay the beast for good when the abortive migraine medications are still in the picture. But tapering off of them is incredibly hard to do, and takes an incredible amount of courage. And what I love about our community is that hearing these stories of others who’ve gone through it, and made it to the other side, and slayed the beast, is often the very thing that gives you the courage to do so yourself. So Jo’s story of courage here is going to give someone else the courage to follow in her footsteps, and the cycle continues, which is awesome. I also like that she acknowledged that she was making a real commitment to her health by doing this. She knew that it might take some sacrifices to make it where she wanted to go, and she knew that could mean letting some people down, at least in her eyes. But she still decided that that was worth it.
Now, that should be obvious, as what could be more important than our health. But so often, we put our health and our wellbeing beneath our other obligations. And so, not surprisingly, our health and wellbeing suffers as a result. So hopefully, her story will also inspire those who read it or hear it to make their own health and wellbeing a top priority.
All right. So let’s get on to our Question of the Week, which was posed by Dana, one of our Migrai-Neverland members. And her question was, “Could you discuss muscle tension in the upper body and neck, its contribution to headaches, and if there are any proven ways that fit into the Migraine Miracle plan of lowering this pain? It seems there’s so much snake oil out there, but are there any methods that work reliably to reduce upper back and neck pain?” So, great question here from Dana, and you may have discerned that there is a pattern to the topics and questions that I tend to cover on the podcast. So usually, it’s going to be an area that’s relevant to many of you, and an area where there’s a lot of confusion and misinformation. And this topic is certainly no exception.
So this question about chronic pain and tension in the neck and shoulders opens the door to a number of different issues, including the complexity of pain in general. So it allows us to cover a lot of ground. And just so that we’re all on the same page, what I’m going to be talking about here is chronic pain and muscle tension that’s occurring independently of a migraine. So it’s not a symptom of a migraine. Otherwise, we’d be treating it the same as we treat any other acute migraine symptom. And furthermore, the response that I’m going to give here generally applies to any type of chronic or recurring musculoskeletal pain, as the underlying principles are going to be the same, regardless of where in the body the problem is experienced.
Because of its proximity to the head, pain in the neck and shoulders is thought to perhaps increase our vulnerability to migraines more than pain elsewhere; though this may not be the case, and there’s not really a lot of evidence that indicates that this is true. So I think it’s more likely that any increase in vulnerability that comes from chronic pain in the neck and shoulders is related to mechanisms that are also common to chronic pain that arises anywhere in the body.
So the first question that’s important to think about here is, as always, what is the root cause of the problem? And it’s important to remember that all of our sensory experience, including pain, is a product of the brain. And the reason we have a pain system to begin with is to alert us when there’s some sort of threat to our body, so that we can change our behavior accordingly to minimize or eliminate that threat. So when everything in the pain system is functioning as it should, pain should only occur in this scenario. And so, we can refer to this as adaptive pain. So it’s pain that has a purpose. But the perception of pain can also be generated directly by our brain. So we can experience pain in any part of our body, including the head, even in the absence of any problem there. So we can refer to this as maladaptive pain, or pain that has no purpose.
So if you were to stick an electrode in the part of the brain that senses pain in your big toe, and you turn that electrode on, you’re going to have pain in your big toe, even though there’s nothing wrong with that big toe. And we’re, overall, biased very heavily towards believing that pain in a body part always reflects a problem in that body part. So even when that surgeon is stimulating your brain with an electrode, you would still have a hard time convincing yourself that there’s no pain in your big toe. So we think that all pain is adaptive pain, kind of naturally. And that’s, generally speaking, a smart way to go about it, right? It’s better to assume the worst in that sort of scenario, and assume that there is a threat to the body and act accordingly.
But in this day and age, this is often times not the case. And every one of you listening is intimately familiar with one type of maladaptive pain, and that’s migraines. So in this instance, we have pain in our head without any disturbance in the cranium, right? There’s no threat, or insult, or injury in the head that’s producing that pain. It’s the pain system itself being turned on by the migraine process. And there are other types of well-known maladaptive pain syndromes, including phantom limb pain; so, where you can have chronic pain in an arm or a leg that’s no longer there; as well as things like fibromyalgia, which is also known as chronic, widespread pain, so that is also a condition that’s resulting from a problem in the pain system itself, rather than a problem in the body.
Now an example of adaptive pain, or pain that has a purpose, would be the pain that you’d feel immediately after you broke your leg, for example. So in that instance, your body is telling you not to move or put weight on that leg, so that you don’t worsen the problem. Or the most classic example that’s usually given is touching a hot stove, and the pain that you’re experiencing there is to get you to take your hand off the stove before that heat causes tissue injury. Now, most pain that is chronic or recurring, including chronic neck and shoulder pain, but really any type of chronic musculoskeletal pain, is going to have a mix of these two types; so both adaptive and maladaptive pain components. In other words, some of that pain is coming from a problem in the part of the body where it’s felt. And some of that pain is likely coming from malfunctions in the pain system.
And so, how much each of these two components contributes to our total perception of pain is going to vary from one person to another. But the most important point here is to remember that both are likely at play, especially when there’s a chronic condition. And both need to be accounted for if we’re trying to treat it. As you might imagine, the maladaptive components are almost always overlooked. But any type of root cause approach requires that we address every factor. So for any chronic musculoskeletal pain, let’s first talk about how we would address the first category, the adaptive pain. So remember, this is a pain that has a purpose. It’s due to some type of disruption in the integrity of a part of the body. In the case of the original question, it would be a disruption in the integrity of the connective tissues in the head and neck.
And here, by and large, this boils down to inflammation. So the adaptive pain of any chronic type of musculoskeletal condition is almost always going to be mediated through inflammation, which then stimulates pain receptors in those tissues. And that pain signal is then ultimately registered in the brain. Now in the case of an acute injury, that inflammation is usually from the injury itself. So you tear or rupture a tendon, and it kicks off the inflammatory process. For a chronic problem, like that mentioned in the original question, that inflammation is likely to be from overactivity in the inflammatory system. And if this is not the case, then it’s likely from repeated injury. And if that’s true, that’s almost always going to mean there’s some sort of underlying structural problem that needs to be addressed; either through physical therapy or surgery.
Now, that’s going to be the minority of cases of chronic musculoskeletal pain of any type. So what that means is that, for the remainder of folks, the best way to reduce the adaptive pain component is going to be through reducing inflammation. And there are several ways we can do this. So the first way we can reduce inflammation, which is one of our most powerful, is through our diet. So as I talk about in the book and elsewhere, one of the primary issues with our modern diet is that it’s pro-inflammatory. And it’s likely not a coincidence that almost every disease of civilization has inflammation as one of its signature features. And different foods can exert an inflammatory effect for different reasons. So for example, consuming foods that disrupt the gut can increase gut permeability, allowing things inside the body that don’t belong there, which then stimulates our immune system and leads to inflammation.
Another mechanism would be the excessive consumption of omega-6 fatty acids, which are abundant in the industrial seed and vegetable oils that are used so commonly today, especially in processed food. And excessive consumption of omega-6 fats also is pro-inflammatory and leads to excessive production of inflammatory factors in the blood. So we basically just have our inflammatory system on high alert in the typical modern diet. So the smallest, little thing will kick it off. So simply moving to an ancestral diet, like the Migraine Miracle plan, is going to eliminate the vast majority of inflammatory issues that are arising from diet.
That being said, there are some additional dietary modifications that one might consider in certain circumstances, if after adopting an ancestral diet, there’s still an indication that there may be some issues with chronic inflammation. And that may be arising either from a gut that hasn’t healed, or from particular sensitivities to certain foods. And the typical suspects there would be dairy, particularly dairy protein, nuts and seeds, nightshades, artificial sweeteners, and sometimes eggs. So one approach would be to eliminate every potentially inflammatory food all at once, and then reintroduce them one at a time, assessing your symptoms as you do. Another approach would be to maintain a diary, looking for any type of connection between flares in pain, or other inflammatory symptoms, after consuming one of those aforementioned foods.
The second way we can reduce our inflammatory response is through managing sleep and stress. So both insufficient sleep and excessive stress promote the release of stress hormones that promote inflammation. And both of these factors also contribute to the promotion of maladaptive pain in the brain. So with insufficient sleep and excessive stress, we get a double whammy. It’s increasing inflammation in the tissues, and it’s worsening the maladaptive pain components in the brain. And you might could argue that insufficient sleep is the most underappreciated contributor to chronic pain. So often, folks improve once they start sleeping better. And it’s also likely true that it’s pretty much near impossible to get any type of chronic pain condition under control without adequate sleep.
The third way we can address the adaptive pain component is to strengthen the affected tissues. So right after an injury, not using the affected area is helpful to reduce further damage. But protecting it or using it less for extended periods of time hurts more than it helps, again contributing to both adaptive and maladaptive pain. On the adaptive side, using the area less will weaken the support structures, leading to worsening inflammation over time. So the same movement, the same activity, will lead to more inflammation if the tissue itself is not as strong. So all of us should be engaging in regular resistance exercise for a multitude of reasons. But here, targeted exercises that strengthen the affected area is especially important to make sure that the connective tissue is strong.
Additionally, ensuring that you’re consuming enough collagen in your diet is super important in this context. So, we’ve talked a lot about the uses of collagen inside of our Migrai-Neverland community, but I’m not sure if it’s come up yet on the podcast before. But there is certainly reason to believe that at least part of why chronic musculoskeletal pain issues are so prevalent is because of our dietary deficiency of collagen. Collagen is an essential part of our connective tissue. And the primary dietary source of it is the connective tissue of other animals. And collagen is an essential material for tissue repair. So we can’t properly heal from any kind of injury if we don’t have the raw materials that we need, and one of those fundamental materials is collagen. So vegetarians definitely need to be supplementing with it, as does anyone who isn’t eating the gristly bits of meat regularly.
One thing that’s happened in the recent past amongst Westerners is that we’ve become increasingly picky about what parts of the animal we’ll eat; and nowadays, stick mostly to eating the muscle meat, or exclusively. And the downside there is that we miss some really key nutrients if we do that. That includes the nutrients that are found in organ meets, like liver and kidney. But it also includes things like collagen in the gristly parts of meat. So just as you need to supplement with specific vitamins, if organ meats are not a regular part of your diet, it’s also important to supplement with collagen if you’re not eating the gristly parts of meat.
Another important part of reducing the adaptive pain component is making sure you’re getting plenty of sunlight to generate adequate vitamin D, which is also critical for supporting tissue strength. So getting sun against the skin is the best way to generate vitamin D. And the best way to store up for wintertime is to ensure that you’ve gotten a tan during the summer months. And if that’s not the case, then supplementing, while not as good as vitamin D from the sun, is at least better than nothing.
Okay, so just to review the key ways of reducing the adaptive pain component, the first being an ancestral diet. So the key principle of the Migraine Miracle plan is to eat like a human, or to eat evolutionarily appropriate foods, which will take away the vast majority of pro-inflammatory foods that are in the diet; and then potentially, looking for any other individual sensitivities, depending on one’s progress. We also talked about ensuring adequate sleep and reducing stress as key ways of reducing stress hormones that are also pro-inflammatory; and then tissue strengthening through a number of means, including resistance exercise, focusing on the particular areas involved, along with ensuring adequate amounts of collagen. I should also add that getting lots of regular movement, a low level of movement, is hugely important for keeping all of the connective tissues strong. And lastly, we talked about the importance of adequate sunlight and vitamin D in supporting the health of the tissues.
Okay, let’s now talk about the second category, the maladaptive component of chronic pain. And this is the part of the pain that’s coming from the pain system not working properly; so not from a problem in the body or in the tissues, where the pain seems to be coming from, but in the brain itself. And to understand how we can help in this particular area, it’s useful to know what factors lead to those maladaptive changes in the pain system in the first place. And there’s a pretty good body of research now on this topic. So our goal here, with any type of treatment, is to try to restore the pain system back to normal, so that it’s once again giving us an accurate reflection of the condition of our body; not one that’s wrong or misleading.
So, what are the factors that the research in this area indicates that promote maladaptive pain? So one is disuse or reduced use of the affected area, so not using or using the affected area less than normal for an extended window. So our brain’s sensory system changes pretty quickly. If you’ve ever had a limb, an arm or a leg, put in a cast for any length of time, you know how strange it feels after that cast is removed, and that’s because of all the changes that occur in the brain during that time. So when a part of the body doesn’t receive its normal input for any length of time, it only takes a few days for this to start happening. You start seeing distortions in the way sensory signals are processed, and those tend to worsen the longer that input is not normal. So not using a limb or using it less is functionally similar to keeping it in a cast.
The second thing that tends to promote maladaptive pain is excessive focus on the pain itself. So I had a recent podcast episode on this topic, and it was titled How Migraines Change Your Brain. And the take-home message there is that excessive focus on pain enhances the perception of the pain at the level of the brain. So over time, this will change the brain in ways that makes our experience of pain more intense. The third thing that tends to promote the development of maladaptive pain is heightened emotion, or stress, or stress hormones. So anything that’s promoting the activity of the sympathetic nervous system, or our fight-or-flight nervous system, is going to enhance or promote the development of maladaptive pain. And the longer that goes on, the worse this gets. And of course, that’s tied into the second thing, where if you’re excessively focusing on pain, that’s often times triggering a fight-or-flight response; which, again, those two factors together will enhance our perception of pain over time.
So now that we understand what factors kind of lead to this development of maladaptive pain, it helps to guide to the sorts of things that we should do to kind of cut it off at the head or reverse it. And the first would be to ensure that we’re using normal movement patterns in the affected area. So as I said, often times, concern that you’re going to cause further injury, which comes from us interpreting that our pain is adaptive and not maladaptive, leads us to use that part of our body less, which then further amplifies the problem. So again, unless there’s some type of true, underlying structural problem that needs to be specifically addressed, that pain is no longer adaptive, and it’s giving us a misleading signal. So the best approach there is to use the part of the body as normally as we can. And the goal is to give the brain normal sensory input from that affected area.
Another really useful approach is mindfulness practice. So as I mentioned, excessive focus on pain tends to increase the maladaptive component, and also tends to worsen things by stimulating our sympathetic nervous system, or our fight-or-flight response. So learning how to manage this particular reaction is really helpful. And mindfulness has been demonstrated, time and again, as a key way of doing this. So mindfulness, as it pertains to pain, involves learning how to observe the pain without judgment or reaction, so without it stimulating that fight-or-flight response; and also learning to redirect the area of focus to another part of the body. And the third way we can address this maladaptive component is by ensuring adequate sleep. So our nervous system requires sleep in order to learn, to adapt, to detoxify, to modify itself, and to grow. And so if we’re trying to restore normal pain signaling, we need all of these things to happen, because we’re trying to change our brain.
All right. Just to briefly summarize the key points, almost all chronic or recurring pain is going to stem from a mix of adaptive and maladaptive components; meaning adaptive pain, or pain that has a purpose, and maladaptive components, or pain with no purpose, that arise from changes in the pain signaling parts of our brain. And if we want to effectively treat chronic pain, we have to address all of these components. So for the adaptive part, that means primarily targeting inflammation. And for the maladaptive part, that means minimizing any excessive activity in the fight-or-flight system, giving our brain the time it needs to grow during sleep, and restoring normal movement patterns in the affected area. And on that last point of restoring normal movement patterns, for anything that’s been going on for any length of time, working with a physical therapist is probably going to be useful because often times, you may be entirely unaware of the changes in the way you’re using a particular part of the body.
And lastly, as I said earlier, I do think that any type of recurring pain does raise our vulnerability to migraines. And most likely, the link to migraine is mediated through increasing our sympathetic nervous system activity; so through the hormones that are released when pain is being perceived. Again, we tend to think that if it’s in the neck and shoulders, it’s more significant because it’s close to the head, and that’s where migraine pain is. But when we kind of break it down into the mechanisms, that idea makes a little less sense.
Okay, so that wraps up my response to Dana’s excellent question. Chronic pain, in general, is a big and important topic, as it impacts so many people. We talk about how our typical drug-centered treatment of migraine has turned what should be an episodic problem into a chronic one, making migraines worse for most people over the long run. And the same thing has happened, more generally, with all types of chronic pain, for exactly the same reasons. So the typical approach most people get is just to be prescribed a drug for pain relief, whether that’s an anti-inflammatory or an opiate. And this has resulted in the tragic opiate epidemic that we now face.
So one of the many awful things that happens with the use of opiates is that it radically alters the body’s own pain system. So it is about as powerful a tool for creating a maladaptive pain system as you could imagine. So it quickly turns things that shouldn’t be painful into things that are painful. And so not only, in these cases, are we not treating the root cause; we’re making that root cause worse and worse, and we’re creating entirely new sources of chronic pain.
So again, root cause approaches are always the optimal way to treat anything, but that does require that we understand the causes. And so hopefully, the preceding discussion provides a more comprehensive picture of what that can be. And fortunately, most of the things that you do to address the root causes are things that are also going to increase your resilience when it comes to migraines.
Okay, so that’s all for today. Thank you so much for listening to the podcast. If you enjoy it, and you want to help others discover it, it would be awesome if you could leave a rating and review in iTunes. Now, it’s time to take this information and use it to slay the beast.