What is a Migraine?

This new year has been a bit rough, we are only in the second month of 2014, and I have had about 10 days where I have not had some form of migraine pain. Which is, needless to say, making me a wee bit grumpy. These continuous sort of migraines over a span of days, or as of now weeks, I like to describe as being similar to a North Korean radio, you can turn it down but you can never turn it off. *rim-shot* Ha! Thank you! You’re a lovely audience, I’ll be here all week folks! Try the veal!

He knows what I’m talkin’ about

Migraine pain can really ruin your day (or weeks!) it can be crippling pain that makes it hard to think, or do anything really. The pain can cause nausea, issues with your vision (I get bright spots of light as a precursor, sometimes I have “tunnel vision”), plus the fun muscle spasms in your head, neck and shoulders. In its worst stages the pain reduces me to a feeble, trembling being, only able to beg for water, and the pain to end. You feel like your mind has fractured, and it is hard to think. It feels like your head has exploded and then has grown too small. Any sort of movement or light can increase the pain, and the pain can be so extreme you start vomiting. For me, the pain can be soul crushing at times, you hurt so much it hurts to even think. The best image I can find to convey how I feel when I suffer an attack is this.

Yup, pretty much like that.

On the good days, it is just background pain, which thankfully allows me to still function, and even if I really don’t feel like doing anything, I can force myself into living life like pain isn’t there, as much as I can. That pain though, it doesn’t leave it only turns down. It lurks behind your eye, sometimes it sneaks around in the back or side of your head. Always there, waiting. Reminding you that things could get worse at any time it would like it to. The fear of that sort of pain can stop your life completely. It can also make you stop your normal routine, and frankly it can be hard to fight the thoughts of “if I go do X, will it all get so much worse?” And this is where you have to say to yourself, “Well self, it could come back, and I could spend all my time avoiding everything because it might hurt, but where is the fun in that?” Sometimes it even helps to keep the charade of routine, distraction from the pain by focusing on other things can help a lot. The biggest help is keeping a pain diary, writing down things that are outside of routine, or just normal routine (if there are no changes) should be noted. Doing this helps a lot in finding patterns that will help you deal with your migraines possibly ahead of time, as well as allowing yourself and your doctors treat your pain more effectively.

Migraines have been studied by doctors for thousands of years, even the ancient medical Eber’s Papyrus mentions some of the symptoms, and the school of Hippocratic medicine knew of migraines and symptoms like visual disturbances with possible relief from vomiting. Galen referred to them as hemicrania (half-head), which lead to the term migraine – which has evolved from a corruption of the original Greek term he applied to the syndrome. In historical times trephination was frequently used to treat migraines, thinking that there was pressure in the head that needed to be released, or in some cases “evil spirits.” Even though these surgeries occurred as far as 7,000 BCE, they did not always end in death, as there is evidence of bone mending around a large percentage of the skulls.

Looks like it would be fun, right?

What is a Migraine?

So really, what makes the difference between a headache and a migraine? Migraines are so well known, we probably have all heard the term, and it is because of this notoriety it becomes easy to fall into the self diagnosis trap of any extreme headache must be a migraine.  But, what is a migraine? Migraines are defined as an attack lasting from 4 to 72 hours, characterized by throbbing pain in the head on one, or both sides of the head. The throbbing headache is accompanied by other symptoms which are usually diagnosed by doctors using the “5, 4, 3, 2, 1 criteria“:

• 5 or more attacks fulfilling the next two below listed requirements, apparently if you suffer from migraines with aura 2 is enough to diagnose. Episodic is less than 15 days a month and chronic is more than 15 days.
• 4 to 72 hour duration of the migraine untreated or treated.
• 3 at best or at least 2 of the following symptoms – unilateral (sometimes bilateral) location of pain, pulsating or throbbing pain, “moderate to severe pain intensity” (that means near crippling where everything just seems to suck , to crippling pain where everything does suck , especially movement). Finally if movement aggravates the pain – this is the sort of pain that if you make any sort of movement you get an increase in pain, that means something as simple as sitting up or moving makes you wish you didn’t and it causes you to avoid movement or normal tasks.
• 2 symptoms listed, but you need just one of them to be diagnosed- nausea and/or vomiting, or light and/or sound sensitivity (sometimes you get just one, sometimes 2 sometimes all 4, depends on the sufferer and that days migraine)
• 1 there is only 1 thing it could be, that means all other possible issues are ruled out and all that is left is a migraine.

If you don’t meet these qualifiers, you may want to look into tension headaches since that is the most common painful headache that is not as extreme as a migraine. Tension headaches can become migraines sometimes, so it is always best to discuss symptoms with a doctor to be sure you are being treated correctly. It is really important not to self diagnose with migraines, if you are suffering from extreme headaches there could be other, and possibly life-threatening causes. It is best to get an official doctor’s diagnosis, than find out too late you have a brain tumor.

Migraine Phases

So now we know what sort of symptoms manifest with actual migraines, and what criteria a doctor would use to diagnose your headaches. If you have all of these symptoms, you should know how a migraine works so that you can note things in your pain diary that are precursors or even possible triggers (we will go over triggers further on). To make it easy, we will look at how migraines work broken out into the four medically recognized stages:

1. the prodrome phase – this is a fancy medical term, but what it basically means is the pre-symptoms. Everything that happens before you get a migraine that makes you go, “oh wait, this might be a migraine.” That is the prodrome. This can include mood swings, depression, mania (extreme happiness), fatigue, food cravings, neck spasms, bowel issues, or even sensitivity to sounds and light. Usually for each person what they get is different, no one sufferer has the exact same precursors as another. These warning symptoms can be noted and acted upon to reduce migraine pain once it hits. Careful notation of your mood and other things daily will help you to find out what your prodrome symptoms are, and then you can work out how best to fend off your migraine.
2. the aura phase – put your Stevie Nicks outfits away, this is not what you’re probably thinking. Auras are a visual disturbance (ie. hallucination of sorts see examples here). Not all migraines have visual disturbances, but if you are going to have it, it comes after the precursor symptoms of the prodrome. It can be small points of dancing light like I have, or could be blurriness, squiggly lines, blind patches, all sorts of visual issues. Other symptoms that may occur in this phase are “pins and needles” feeling in arms or legs, and some experience speech issues.
   
3. the pain phase – my least favorite phase. This is the migraine rubber meeting the migraine road, this is when you have that pain in your head. That throbbing with every heartbeat, that pain that makes it difficult to move and sometimes triggers vomiting, and sensitivity to light for me. Others may also experience sensitivity to smells, general nausea, and fatigue. There are a few more symptoms listed, and I find a lot of sites list irritability as a symptom, but really who isn’t a bit grumpy when they hurt? Classically this is pain only on one side, or unilateral, but some migraine sufferers of “no aura” migraines will have bilateral pain (that means both sides of the head hurt).
4. the postdrome phase – these are the after affects, lingering pain, and that headache hangover feeling are what I tend to see after mine. You can also experience, mood swings still, cognitive issues, stomach upset, and even weakness. You may not get any of these or you may have all of them, some people even feel even better than before the migraine afterwards, so every body and its post-migraine reactions are all different for everyone.

Different Types of Migraines

There are also different types of migraines, not just one! Just like there isn’t just one type of headache! They are grouped by symptoms to help differentiate between the types. These terms are set by International Classification of Headache Disorders which is the group that releases the official classification of headache as used by the World Health Organization. The ICHD is published by the International Headache Society, which is a charity organization for headache sufferers of all sorts that has formed to advance the cause of headache sufferers.

Because headaches of all sorts suck.

The ICHD lists the different types of migraines one can have, they are grouped together based on the symptoms one experiences:

• Common Migraine – This is the most common form of migraine, and was previously known as hermicrania simplex. It is a neurological disorder and is characterized by a “throbbing” headache usually only affecting one side of the head (in fancy science terms that is called unilateral) but mostly centering on the right side of the head. This is classified as a moderate intensity type of migraine and can cause nausea, sensitivity to sound and light (that is phonophobia and photophobia in fancy science terms), but does not cause the seeing of auras. This is a visual disturbance that can be caused by other migraines, and is different to the spiritual auras that most are probably thinking of when auras is mentioned. These can be like lights, blobs, lines, all sorts of things and they are not present in this sort of migraine. Menstrual migraines are a subset of this group.
• Classic Migraine – this sort of migraine has the symptoms like the one above, except it can manifest with auras, but it doesn’t always have them. Along with visual disturbances more severe symptoms could include neuropathy, motor weakness, difficulty speaking and other symptoms. This sort has two subgroups of migraine types. Basilar type migraines are thought to be caused due to spasms in the basilar artery (that supplies the brainstem) and this type manifests some of the more extreme symptoms like difficulty speaking, vertigo, and other brain stem related symptoms. The other type of migraine subgroup is familial or sporadic hemiplegic migraine, sporadic if you have them occasionally and familial if someone in your family also has them. Both of these manifest with normal pain and auras, but only the classic type of migraine is also accompanied by possible motor weakness.
• Childhood Periodic Migraines – also like or sometimes referred to abdominal migraine. This one is debated and it generally causes a lot of migraine symptoms, sometimes without an actual migraine. Some think these could be a herald of migraines later in life.
• Retinal Migraine – ocular migraine is another name you may have heard of, there are visual disturbances, a patch of vision loss, or there will be loss of vision in one eye. These also tend to include symptoms of light sensitivity, the throbbing headache, and nausea.
• Chronic Migraines, status migrainosus & everything else – If your migraines last for more than 15 days a month for 3 months, those are chronic migraines. If they last more than 72 hours that is what is known as status migrainosus, which is just a fancy science term for never ending migraines. Then there is everything else that doesn’t fit in these groups lumped in here.

What causes a migraine? What are Triggers?

Migraines are a bit like other neurological and pain disorders in that there are a lot of theories as to what causes a lot of them but no one really knows fully why they happen. They are a neurological syndrome, but all of the details of them still elude us. There are a few theories on what causes them, some think there is a lot to do with genetics, since some can run in families but this doesn’t hold true for everyone. Also women are more likely than men to experience migraines, and there are even menstrual migraines that specifically occur around a cycle. There also seems to be ties with facial nerve compression, TMJ issues, muscle spasms in the neck and head (which is not just a cause but a symptom too), diet, exercise, weight, hormones, mental disorders (such as depression, anxiety etc), strong smells, changes in the weather/barometric pressure, and even change in routine are some of the things thought to “trigger” migraines.

Triggers are what seems to cause your migraine attacks, everyone’s are going to be different. To find out easily what your triggers are, you should keep a pain dairy of what occurs when you do and don’t have migraines and eventually you will be able to zero in on what is triggering your headaches. A fellow student in my Tai Chi school told me her’s were just triggered by excitement mixed with a change in routine. This meant birthdays for her could be extremely challenging. She has been able to listen to her body enough to where she now can regulate her migraines through controlling things that trigger them, as well as medications. It is so important to listen to your body, it will always tell you when something is going wrong. Be observant, notice patterns in changes with activities, changes in weather or foods, and you will find what triggers your attacks, and hopefully help avoid pain for yourself. For myself changes in weather always triggers pain and migraines, so I watch the weather closely, and when a large front is headed my way, I know I am going to be more likely to have an attack. So I try to minimize stress, and keep my routines in the time leading up to a weather shift, and this seems to help reduce severity of attacks.

Treatment of Migraines

Back in the old days they used everything from Coca-Cola, to pretty much straight cocaine, and laudanum (alcohol and opium), to treat pain and migraines. As well as a plethora of other “snake oil” cures that you could find in the local pharmacists. Some of them made some crazy claims on how effective they were.

Seems legit.

Now treatments are becoming more advanced as we learn more and more about how the brain and nervous system work. So how do you treat these nasty migraines in the modern day, if we still don’t know what causes them? Well are finding newer better drugs, or therapies, on the market but as of now there are three main ways of treating migraines – analgesics and/or NSAIDS, triptans and/or ergotamines, and migraine medications.

Analgesics – you’ve probably seen this word before pop up on this blog, Analgesia means “relief from pain.” Anything that can relieve pain can be lumped into this group. Specifically for migraines some narcotic analgesics are used as well as NSAIDS (we will go over next). Narcotic drugs can be taken orally and intravenously, depending on severity of the pain and can be administered by an ER doctor or your pain doctor. For me, I find the injections to relieve the pain a lot faster than a tablet but should also be only used in a real pain emergency. Personally due to my extended migraines, and pain levels I was prescribed hydromorphone (most commonly known as Diluadid) which is like morphine, and a very powerful opiate painkiller. This is a rescue pill that I only take in extreme situations, I find that my normal a pain medication sometimes works, and have had success with my herbal remedies. But sometimes even that isn’t enough, and when you would consider selling your own soul to end the pain, it is a welcome relief to have handy. One should always use narcotics of any strength with caution, they are not only highly addictive but rough on your body.

ProTip: Try using an anti-nausea medication or an herbal remedy to help keep those pesky pills down during severe attacks. Things like peppermint, chamomile, ginger or fennel can help settle things.

NSAIDS – this stands for Non-steroidal Anti-inflammatory Drugs, that means things other than narcotics or corticosteroids to treat pain. Aspirin and Ibuprofen (commercially known as Advil) are the most commonly known of these, Naproxen (commercially known as Aleve) is another one that you will find in most stores. Paracetamol (commercially known as Tylenol) isn’t in this group since it also includes a mild anti-inflammatory aspect. These are all much less addictive than any narcotic medications, though they can have side effects like blood thinning, they can have an effect on your liver, and they are rough on the stomach. Overall though, these are a great choice due to their lack of addictive substances, and are over the counter medications that anyone can obtain.

ProTip: Excedrin Migraine was not listed up there since it is sort of a blend of things, it contains the same chemicals as Tylenol and Aspirin, but also has caffeine. If you are sensitive to things like that you may want to avoid this option, but you may want to opt for it though if you regularly consume caffeine and get headaches from lack of your daily does since this can also be a cause of migraines.

Triptans – These are specific migraine drugs, there are a few that are common on the market one well known one is Sumatriptan (Imatrex), there are many others, but this seems to be the most common one I run into, and also take it. How these work is they cause the serotonin receptors to constrict and this means that chemicals that cause inflammation are not able to be released, they seem to have an effect on nerve cells and blood vessels as well. These you need to take early in the attack to have these work, and are not as effective if you take it later in the attack. They are also not as effective for long term migraine attacks (attacks that span over a few days). These can be in tablet form, inhaler form and in injections, so this is a drug that can be administered even if there is vomiting with the migraine pain.

Ergotamines – this is an older medication and not as frequently prescribed these days, you may have heard of ergot before as well. Ergot is a type of fungus that grows on grain plants that humans consume (rye, wheat, barley, etc). This type of fungus can cause hallucinations, and is suspected for being a driving factor in inexplicable behavior in humans in history, like the Salem witch trials. It is a pretty complex chemical so unless you are familiar with brain chemistry, just know it causes a lot of chemical reactions that are pretty complex but end up relieving migraines effectively (and if you are read the wiki on it, pretty interesting stuff). The possible reason it is still so effective is the lysergic acid in the ergot, and could explain why the fungus psilocybin has been so effective in treating painful cluster headaches and for some migraine sufferers. This is an older medication as mentioned previously but it is still being prescribed for those with migraines that last more than a normal attack, like with status migrainosus. Like the triptans they also need to be taken early in the attack, when taken at the first signs of attack they prove to be most effective.

Anti-migraine Medications – this is sort of a lump all the rest here group. There is all sorts of other medications that has been used to treat, and hopefully prevent, chronic migraines. Botox is one I am intimately familiar with, I have had this procedure twice and hope to have a third soon. Botox is a “watered down” form of the Botulinum toxin, best known for ruining canned foods in the early days of canning (after cans, but before can-openers). This is a neurotoxin that is injected for therapeutic purposes in spots around the head and neck, this then pretty much paralyses them into relaxation and hopefully reduces or completely prevents migraines. I have found this to be an effective treatment, the only down sides are it is expensive, and it only lasts a few months before you need to be “topped up.” Besides botox there are a few other sorts of medications that have been used, anti-depressants, especially tricyclic antidepressants, have proven to be effective in treating some sorts of migraines. Another would be anti-convulsants, example like topiramate (commercial name Topamax), that is used to treat migraines and seizures. Finally Calcium and beta blockers have also proven effective for relaxing the blood vessels, and hopefully preventing migraines. These are more extreme measures to treat the more vicious and frequent attacks, and generally are considered some of the last lines of defense in combating migraines.

Alternate Treatments – Acupuncture is a great option, as well as massage, Graston, and just focused relaxation exercises work as well. I recently was inspired by a fellow sufferer, and new information on placebos, to try to “trick” my brain into thinking that a bandanna tied on my head would “hold” my head together (since frequently it feels like it has exploded, or soon will. The pressure of the fabric helps make that area feel like it is held together, and was in a recent attack the difference between pain to where I vomit and pain, but no vomiting. It is now the “magic bandanna” for migraines. I have also used cold and heat, I tend to prefer heat but sometimes cold works better. And of course there are always herbal options I have listed, and tried, for preventing or assisting with relieving your migraines and headaches.

So, now you know more than you probably ever wanted to know about migraines! And hopefully will be a bit more understanding, if you weren’t already, of any suffer of a migraine. They are not the run of the mill type of headache as you can see. The best thing as always though is to stay positive about your treatments and keep searching with your doctors to find what works best for you and then stick with it.

If you would like to read more information on migraines here are some good resources:

• WebMD Information on Headaches and Migraines
• Migraine Research Foundation
• American Migraine Foundation
• The Mayo Clinic – Migraine Definitions
• The International Headache Society
• The International Classification of Headache Disorders

Wintergreen

I am on week two of my “continuous migraine,” and I have had to pull out a lot of my “big guns” to treat myself, along with my other doctor given medications. I have been robot-ing through life until we can find a treatment that works. Even though it has been rough, I have got to keep on trucking. I know that soon we will find something! Then it will be nice to pick up all those things you have to set aside because they aren’t vital to existence. But, it won’t be long until I am back to my usual self, and done with those things and on to new ones! 🙂

Luckily, to help me get through things, I have wintergreen handy. This is a powerful little plant, that seems so common, yet also rare. You might be tempted to think, that wintergreen is one of those plants of the mint family that seem to pop up everywhere, and you would be like most people, wrong. Don’t feel bad though, it is very mint like in scent, and tends to be found alongside mints in candy. Wintergreen though, is from an entirely different family of plants. Wintergreen is a shrubbery, with bright red berries, that creeps through gardens and forests sprouting up from its expanding network of rhizomes. Commonly known as eastern teaberry, checkerberry, and other local names, it has been long used by Native Americans, and after their arrival American colonists and their descendants for centuries.

Almost like bright little cherries, good to eat if you are in the wild or just in the garden.

Generally the way people would be familiar with the smell or taste of wintergreen would be from gums, candies, dental care items (toothpaste, mouthwash, etc), and tobacco products. It is in some root beers, sodas, and (if you like martinis) vermouth traditionally has wintergreen in it. While very similar chemically to therapeutic wintergreen, wintergreen flavoring is usually made from a type of birch, sweet birch or Betula lenta it is a similar chemical make up, but not exactly the same. We will get more into the chemicals of wintergreen later though.

It was well known in Native American healing arts, as a herb for rheumatoid and joint issues, headaches and general aches & pains. This little plant was even used as a tea substitute during the American Revolutionary War, and the berries were sold in Boston in the early years of the States as a treat. There was a belief in the US Colonial eras that chewing the young leaves in spring would protect children’s teeth from decay. Jams, pies and other confection type items are made with the berries, though they are rather slightly medicine like in taste and can be offensive for some palates.

The chemicals that makes them different is why we are interested in a specific wintergreen to treat pain, the one we want is Gaultheria procumbens. While it isn’t as well known in its raw state (just the oil or plant) as it is in pre-made preparations. It is in a lot of joint pain rubs, and it is that “medicine-y” scent that it has that can be off putting to people who don’t care for the medicinal smells of some pain creams and rubs. This is so commonly used in these creams since this herb is a fantastic analgesic, mild local anesthetic, antispasmodic, and anti-inflammatory.

This is not an herb that I would list as mostly harmless, it is something you can actually use too much of, so this should be used judicially, mindfully, and carefully. This is some pretty powerful stuff, and the oils are very concentrated and contain methyl salicylate which can cause blood thinning, and in large doses can be like overdosing on Aspirin. It is very close to the chemical that makes Aspirin work, and is in a lot of other preparations, is salicylic acid. Both of these acids, methyl and salcylic, work as an anti-inflammatory, they suppress the enzymes (like cyclooxygenase, aka COX, we talked about before) that cause inflammation. This also means that if you have bad reactions to Aspirin, or other similar medications, you want to avoid using this, in my humble non medical opinion, even externally. If you aren’t you should still be careful since the dose between helpful and harmful with any medications is very small, so I say unless you are being guided and dosed by a professional. Also if you are taking any sort of blood thinners, this is not something you want to try without professional advice first. One ounce of essential oil of wintergreen is equivalent to 171 Aspirins, a teaspoon is a whopping 21.5, so I think it is best to stick to using this externally. Always better to be safe than sorry! 

Now, just because it has the potential to do this doesn’t mean you should avoid this very useful plant and oils. Their therapeutic power is fantastic, and as long as you use any plant in the right amounts and treat them with respect you should never have an issue. You should never be careless about anything you put in, and sometimes what you put on, your body.

So now that you are sufficiently knowledgeable about wintergreen, how do you use it?

Well firstly, if you are lucky enough to have your own wintergreen plant in your garden there are a few ways you can use the leaves.

You can make an infusion, or tea, with these leaves, but to extract the chemicals that you need to treat pain they must first be fermented slightly. There seem to be a few different camps on what time of year is best to harvest the leaves, some say young, some say in the fall when they go red. Any point in their cycle, as long as they aren’t dead, seems to be OK for making an infusion or tincture in my experience. Most plants will have natural yeasts that live on them as natural flora, but you may have to do an assisted fermentation if you do not see activity after a few days (usually 3 is enough).

Wintergreen Infusion (tea) for Compresses

• Mason jar
• Wintergreen leaves, fresh enough to fill the jar
• Water, enough to cover

Bruise or roughly chop the leaves and place them in the jar, cover with water and seal. After 3 days you should see bubbling, a sign of fermentation. If you do not see bubbling, you can add a quarter teaspoon of yeast to the jar. Or if you are very brave, you can leave the jar open and see if you can entice a wild yeast to ferment your leaves. This does leave your infusion open to mold and other nasty things growing in your jar, and is really the last resort sort of option. If you are only able to get dried wintergreen leaves you would only want to use the same amount for this recipe.

You do not want to use this recipe internally at all, this is best used as a compress for sore areas. To use this you simply heat a small amount of the liquid and allow it to cool to as warm as you can stand and soak a towel or other absorbent cloth in the liquid and apply directly to painful areas. This is great for joint, arthritis, over exertion, muscle spasms and other pains from general working out and life.

Wintergreen Tincture

• 32 oz Mason jar
• 10 oz Wintergreen leaves, fresh or 7 oz if dried
• Grain alcohol to cover

Fill the jar with the wintergreen and cover with the alcohol, shake daily for 3-4 weeks. Strain and bottle and store in a dark place. For this you can use about 20-30 drops in some warm water, and use a compress to apply it to the painful area. You can also massage the tincture directly into the skin, but I suggest using much less 5-15 drops at most. This is a great way to topically treat pain, and inflammation from spasms, joint pains or just sore tired muscles. Remember even if it is on your skin it is still being absorbed and going into your body, don’t think that you can use more topically since its safer. And again, I would not suggest taking either of these recipes internally.

Wintergreen Massage Oil

• 1 oz Carrier oil
• 20-30 drops Wintergreen essential oil

Mix well, and store in dark container. This oil can be rubbed directly into the skin, but care should be taken to avoid sensitive skin areas. This is another great way to treat muscles and joints that are in pain or inflamed.

ProTip: You can reduce the wintergreen oil to 10-15 drops and add other oils to help with pain or other issues like: lavender, valerian, chamomile, rosemary, eucalyptus, etc, etc.

You can, if you are a wildcard like me, use wintergreen oil directly on your skin (known to most as neat application). A drop or two is all that is needed, and then just massage it into the painful area. This is my favorite way of using this oil, and it is one of my go to oils for migraines and painful muscle spasms. I don’t use this oil every day, and I try to limit its use to 1 drop or so every 8 hours, and I change it up and try not to use it twice in a row, or over consecutive days if I can help it, mostly because I find that it is best to be overly cautious with these things. But despite my caution, I love this oil and I find its relief when the pain is very bad, especially with migraines, to be the difference between feeling so horrible that I hate everything, and being happy about life. Which if you suffer from migraines is a big difference.

As always do your own research, find out what works best for you and make sure to always check places like WebMD for interactions before using any sort of medication, herbal or otherwise. This is one that I can not stress enough that if you are in doubt at all about dosage or interactions with medications you are currently taking, ask a professional!

Are Essential Oils Whack? Is Therapeutic Grade a Ruse?

Talking to my favorite blogger in the blogosphere, the Ascenscion House (cause she’s the best <3), she set me on a path to re-examine my oil use. Thanks to her I looked a bit more into essential oils, grades, uses, and the labeling. I read a great blog series that makes some great points, she did some great research on what “therapeutic grade” is (technically nothing I found to my dismay), and puts it in a nice concise way for everyone to read. Which I suggest you do. Yes, the whole 6 entries. I like a lot of what she has to say, and she has changed my mind on a few things. But, I don’t totally agree with all her points, I will go over that further down, though she did firmly cement my belief that doTerra is not so great based on the behavior of some of its affiliated people and they will never be getting my money.

So here is my views.

First off, I love herbal remedies, and herbal medicine, since like, always. I blame my reading of Clan of the Cave Bear in Junior High, and wanting to be Ayla when I grew up. Only recently, due to my issues, have I begun to really learn and use these in earnest. Before it was just fun facts to know, and for cooking. But now things are serious, and once I realized I had a concentrated way to use these great herbs, and they were even more effective, I was hooked. Essential oils are great! I think they are a great addition to any pain management arsenal, and everyone should have a bottle of lavender just for bug bites, burns, scars, and abrasions. Once you start pretty soon you become a lot like this –

I mean seriously people, its the best.

But essential oils are an unregulated product, the FDA does not police them. Which that means there are no government constraints around labeling and packaging. Now I must point out the FDA frequently won’t even consider things that would be extremely beneficial for the population, despite scientific tests at times, and will approve things that they then recall. I have experienced for myself the fear and anxiety you get when you call your pharmacist back after a mysterious voice-mail telling you they won’t fill your pills, and their reason is the FDA has recalled them due to causing heart issues. They had been approved, and on the market since 1955. Also, some oils in Europe are tested with Gas Chromatography and Mass Spectrometry, which I am very familiar with. The problem with the Euro testing though is, they are only looking for certain things. If you are looking to find seed beads in sand, and you are using a sieve with inch wide holes, you won’t find a lot of beads but it doesn’t mean they aren’t there. These tests are sort of the same, since these are only testing for flavorings, or perfumes, the tests aren’t going to be as precises, or looking for the same things, as a more in depth test. This could be a great way to help identify and be able to set known grades of oils in the future but it is sadly not utilized to its fullest in Europe and not at all in the US.

Personally, I feel the point of essential oils being strong since they are usually condensed versions of the oils that make most herbs “work,” is sort of an obvious thing. Which since common sense, isn’t as common as it should be, I guess I should point that out. These are really strong, and not to be trifled with. You are using phenomenal, cosmic amounts of biological matter, to make an iiiiiiiiitty bitty amount of oils.

Yup. Exactly.

It takes 10,000 pounds of rose petals to make 1-7 pounds of oils, depending on the technique used. That is a lot of mass with a very small output of oil as you can see, and is part of why rose oil is so ridiculously expensive. The usual process for extracting the oils is called distillation. The best way to distill or extract the essential oils is with steam, there are other methods like chemical extraction but this introduces chemicals to the mix and means that the oils are not only what the plant itself produces.

So, oils are the condensed plant, and made through a process called distillation, preferably done with steam. The oils are extracted by the heat vaporizing them (why you should keep the lid on your tea if you are making herbal teas), and then cooling them so they condense into their oil state. Early European Alchemists and early Middle Eastern Islamic scientists, thought that vapor was the spirit of the liquids, hence our still calling hard liquor “spirits.” Just like distilled alcohol (derived from the Arabic word al-kuḥl) is stronger than if you were drinking a normal fermented beverage. Think beer’s strength vs brandy (distilled wine). So you need a lot of stuff to do it, and of course there will be an expense for higher quality ingredients (which again you need a lot of), as well as labor, and specialized equipment (since this is not something you can normally do in your back yard). What all this all boils down to for you is, that this is something where you will (generally) get what you pay for. Expensive will usually (but not always) mean better quality. I have found that the less you pay, the less effective it is with some oils. I try to test a few before going with one I like, and I have found my more expensive oils do much more for pain than the less expensive. Now, brains lie, so this could be entirely the placebo effect, so in all honesty I don’t know how accurate that is, but that’s what I have found.

If you are just looking for something just for its aroma, the less expensive is definitely the way to go. For bath time, for diffusing, and things like that, I will always reach for my cheap oils. That way I feel I can use as much as I like, and they aren’t just going down the drain when they are just there for the smell. The reason the cheaper oils don’t always work as well is they tend to have additions, adulterates or differences in processing (done with chemicals or too much heat breaks down the active chemicals in most herbal medicines), even if the bottle says 100% pure. This is why I would suggest avoiding cheaper oils if you are considering ingesting your oils. Mostly since you don’t know what they could have added, and that can be dangerous. You should always talk to a doctor or some professional before taking anything that WebMD doesn’t say is perfectly safe to ingest in large amounts. Again, common sense!

So, if they are condensed, logically, that means the oils are super condensed form of that plants medicinal chemicals, and that means they are super-duper strong stuff. To think that all oils, or anything that is strong enough to work, is 100% “safe” to use just willy-nilly, is just absurd. Anything that can have an effect on you, should be taken with respect and care. Just like fresh or dried herbs, use them with common sense, do your research, and it is always a buyer beware situation. It is the responsibility of the purchaser, that means you, to make sure they are using their purchases wisely. And it is up to you to ensure your own safety. One should never assume that anything at all can be taken in any amount and be safe, even water and vitamins become deadly poisons in certain amounts. Everything, like I love to say, should be taken in moderation, but since they are so potent it can be easy to over do it with essential oils. Even easier to go wrong if you don’t understand the plant itself in its natural state. You should also always start with small amounts, internally or externally. If you are applying it to your skin it is best to dilute it first. I may be a wild west lady that shoots from her hip, and generally applies a lot of them neat (undiluted), but that may not work for you. I always apply them to a test patch, and then diluted, before I ever attempt a neat application. If you are planning on ingesting the oils, start with 1 drop, and if more is required step up drop by drop to find the point where symptoms subside. I used this method to work out my dosing for my lactose intolerance with fennel, 3 drops for me for most things milky, but heavy cream, fresh cheeses, and cheese sauces (oh I love you evil Alfredo sauce!) needs 5 to prevent the intense cramping. 

I have mentioned a few times that you want to avoid adulterated oils. That means, oils containing chemicals that were not part of the plant. The adulteration issue is an old story in human history, and is usually found hand in hand with a product that is unregulated. Then because of lack of regulation, there is a far larger chance of issues with quality of the products, like possibly toxic chemicals. You can even read a great, well written history of how foods have been adulterated in the past in the book Swindled: The Dark History of Food Fraud. Or if you feel more contemporary, just look at the current example of unregulated e-cigarettes. There are already studies coming out, saying that there is a possibility they are worse for people than traditional cigarettes. If there isn’t some sort of way to ensure quality, there will always be dishonest sales people that will take advantage of this to adulterate and make more off less. 

Personally after all the information I have read, I will continue to use Young Living, if I am considering ingesting my oils, or if I am wanting to get maximum pain treatment effect. I base this currently wholly on personal experience, since I have used a few cheaper oils and they just don’t seem to compare for pain treatments, but again, that could all be in my head. I also am ingesting them at my own risk, so if I develop some sort of weird issue later because of this I feel it is worth that risk to alleviate my daily pain. Also YL, does note on their site, in their handouts, and on the bottles the ones you should not take internally. A few of the really bad ones to ingest have child-safety lids as well. I don’t have children, but this is still a good feature as I can identify them by touch if needed. They also stress to not use them neat, and dilute them more than even I agree with. Currently the YL bottles you can take internally are labeled as such. Now, while they (YL) are the more “upscale” oil vendor (read as: expensive), while they do have great customer service, and reward points you can spend, they definitely don’t carry a wide enough range to have everything I need. So for everything else I happily will be giving my money to, (as always local first) my local herb store (if you are in the Austin TX area I highly recommend Garden of the Ancients), Mountain Rose Herbs, and thanks to Whole New Mom, and her great detective work, Native American Nutritionals (I just put in an order and I am excited to see how well they work 🙂 yay!). 

So now you know!

And you know how I feel about essential oils, their labeling, and use. Hopefully this will encourage you to look more into essential oils and what they could be doing for you. But don’t just take my word for it, do your own research, and decide for yourself!

Side note: I have also come across some documentation of YoungLiving and the FDA on classifying some of their products as supplements, so it is possible they may come under FDA regulation soon. I also did my own gum-shoeing, and sent a few inquiries out to see if I could get responses on this, hopefully I hear back and can share the info. Also they are starting to label their bottles with “Therapeutic Grade Essential Oil Supplement.” Which I have been trying to get the whole story on, and hope to hear back on what that exactly means.

What is a Cortisone Shot?

Most people hear “steroids” and most will immediately think of some iron pumping, professional athlete-type, ‘roid rager with biceps the size of VW bugs. Most media coverage of steroids involves a lot of negative press, giving steroids which can be very helpful a bad name… and did I mention ‘roid rage?

Now, now Arnold what did that camel do to you?

Cortisone is a steroid, but it isn’t the sort that would make anyone bulk up, be the terminator, or hit home runs. Those sort are Anabolic or Androgenic steroids, they do not help with pain. Cortisone shots are a steroid hormone, also known as corticosteroid, and though there is sometimes other stuff in the shots, it is the important bit that makes them work. (The other stuff is generally saline, and local anesthetic.)

Believe it or not, your body naturally produces a certain amount of this already, it is made in the Adrenal glands, who besides the brain endocrine glands and the thyroid, is a huge part of keeping your body healthy and working right. Think of the endocrine system sort of like the internet, it is the system your body uses to send out signals and make sure that all the trillions of cells are all on the same page about what is going on, or can all act in unison if necessary. Like when your body says, “hey, I am sick” its all the things that make you feel that you are sick. That is your immune system, triggered by your endocrine system to respond to start fighting things, which is what makes you feel bad when you are sick. The cortisone produced by the body is produced when the body is stressed, and stress can occur if you are injured or in danger which triggers with the fight or flight response. So you are basically creating a large wash of those “we are in stress” chemicals, and this can have a great healing effect for some people, or at least the reduction of pain. It does also mean your body is in an unnatural state and that can have some side effects.

Cortisone was discovered in the 1940’s by two guys from the Mayo Clinic, it was hailed as a miracle drug (aren’t they always?) and was the reason the discoverer’s got a Nobel Prize in the 50’s. There are now a plethora of drugs that are corticosteroids such as but not limited to, (and these are just their names, not commercial names) prednisone, methylprednisolone, prednisolone, dexamethasone, and the well known hydrocortisone. There are many ways to take corticosteroids, orally, topically, injection, and inhalers are a few ways. I am generally talking about cortisone products used to treat pain though in this entry, and they are usually injected into the body.

In a lot of ways cortisone was a miracle drug, it helps ease chronic pain, pain from injuries, it treats autoimmune diseases, it helps with organ transplants preventing rejection, and many, many other ailments. Most of the cortisone injected is synthetic but still chemically similar to the natural thing, and it works pretty much the same as the natural stuff, just in larger amounts. It works because it helps to suppress the body’s natural immune response, that is how this great drug helps to inhibit rejection in someone with a newly transplanted organ. This suppression means though, you need to be very careful about your immune system. It can cause other issues that I will discuss further down in this post, but that is the biggest one I have had to battle with.

Inflammation is your body’s natural healing response, but sometimes that signal is sent in error, or is sent too much, and pain happens. Cortisone helps to reduce that inflammation, and alleviate some of that pain. Now that is not to say when you receive an injection (which is generally how my pain is treated) it will be instant pain relief. You are putting a needle into a site that is already irritated, and just generally pretty upset with things if you are in pain. Then you are injecting fluid into that area, which will create artificial swelling of that area. The swelling is very small, you wouldn’t notice it externally, but small is all that is needed for a nerve to notice. So an injection can actually put you in more pain than when you started, but believe me, it is all so very worth it if it works. Especially since the pain generally only lasts a few days.

Now, the skill of the doctor is also a big part of this pain levels post-procedure. I have had some pain doctors who are just absolutely horrible, they will just poke you anywhere, and not care if you complain. Or that you are in far more pain than before the injection. I had one that was attempting to alleviate neck pain, and I spent the next 3 days wondering if I really could cut my own arm off, since that was better than living with how it felt after the injection. My arm eventually became sort of normal again, after a few months luckily. But it has become a huge issue since then. My current pain doctor is much more precise and uses fluoroscopy, and other tools to be sure of where she is “poking” me. I find with her more precise methods I not only rarely experience post-procedure pain, but also have better results with my pain reducing. That is not to say I don’t have occasionally mild injection site soreness, like I said, poking already upset areas, but it is far less than what I have experienced at the hands of others. Normally if you are in pain after the procedure you can rest assured that it will probably only be the worst the day after, lessening the second day and nearly gone by the third. If you don’t find your pain reducing after the third day, you really need to be talking to your doctor. That third day should be the day that you will see exactly what the procedure accomplished, and for me they have usually been good results.

There are also many names that these sorts of injections go by which can make it confusing, and that doesn’t mean they’re in the same places for everyone or the same amounts of steroids. But you should be aware of what is being put in you with each procedure, and below are some informative videos to start you off on what some of the ones I have experienced over the years. If you are interested in some more great videos on common procedures, see the video link at the end of this entry. If you are afraid of needles, probably should avoid all these videos.

Trigger Point Injections – I generally get these as a quick fix to hold me over until we can schedule a procedure.

Nerve Block(er) Injection – these have brought a lot of relief for a lot of different symptoms, I suggest using a pain clinic that has your pain doctor injecting these rather than just a radiologist (one should still be present for the procedure though).

Sympathetic Nerve Block – not to be confused with the above, this is different. I find this helps me the most with my CRPS issues with neurological pain. Definitely not a video for the squeamish about needles.

Now for the sorta scary bit. This is where I list all the things that can go wrong from cortisone injections (or general corticosteroid use). Side effects to getting these injections can be the following (with some of my own tips):

• Change in your body’s response to stress – we already said that cortisone is part of the fight or flight response, which is a body’s response to stress. Obviously if you pump your body full of chemicals that are there during stress, it throws things off. You really need to be mindful that just like if you have thyroid issues and take thyroid medication the actual gland can go “well, my work here is done” and just turn off. Your adrenal glands can do something similar and this can last for up to a year after the injections. You may find that you get light headed, or aren’t able to deal with sudden surprises or stresses, make sure you recognize when you are getting stressed and do all you can to soothe and calm your body so that it does not reach an overly stressed state. Also let other doctors know you have had corticosteroids so they can compensate if necessary in any non-pain procedures.
• Hoarseness – yeah, it can make your throat dry, and make your voice raspy. I do a lot of hot teas with honey and lemon, and occasionally break down and buy over the counter throat lozenges to help with this. Water is a big deal after these injections. Hydrate, hydrate, hydrate. It helps.
• Infection/Illness – Skin is breached with injections, and any scrape or cut from a fall or kitchen accident could become infected. We already know the immune system is suppressed so that means the natural responses to fight off even things like a paper-cut are not present. Make sure you take extra care with cuts and abrasions, take them all seriously and monitor them. If the skin around them becomes red, inflamed and tender, you may have to deal with an infection through medical means. Seek a doctor if something like that happens. This is also true for colds, flus, and everything else you can catch. Wear a mask if you can when going out, and try to avoid sick people. Also make sure you are getting sleep, taking vitamins, and doing all you can daily to boost that immune system.
• Osteoporosis – this for women is the biggest danger, I discovered recently that I was having issues with calcium as well as other vitamin deficiency. Cortisone breaks down a lot of the stuff our body uses to work, or makes those chemicals harder to take up, make extra sure you are compensating for this, and doing strength exercises to ensure that there is no bone loss. You really need to worry about this if you are like me, and getting a lot of these over a long period of time. If you get a few and then no more, not as big a deal.
• Weight Gain/Fluid Retention – UGH, I hate this one! Cortisone makes me ravenous sometimes, like eat the entire fridge and still hungry type craving for food. This is something you just have to be stern with yourself and fight, but it does make that fight just the bit harder. About six months after the steroid use you should see a decrease in the weight, and if you are careful while you are getting these injections you shouldn’t see excessive gain. Just be mindful, watch what you eat, get exercise just like normal. High sodium diets also cause water retention, check for swelling and if you find it (and its not weight gain) make sure you speak with your doctor.
• Mood Changes & Insomnia – Hey, we all have bad days, right? But make sure that bad day isn’t one you decided is bad before things even happen. Look at your mood and assess it, is this really how I feel? Do I normally react like this to these sorts of things? If the answer is no, think about what “flipped that bitch switch” as I like to say. Make sure you are doing all you can to keep a positive happy outlook on things, yoga, meditation, tai chi, all of those are great ways to help combat all mood issues this and everything else that comes with pain causes. It can also make you have issues with sleeping, but when you are in pain you don’t sleep anyway. I suggest for this, natural sleep aids, I have discussed a few but there are tons out there I still haven’t covered yet. Find what works best for you on both of these and use it!
• Elevated Blood Sugar –  this is a definitely possible side effect if you are like me and getting these a lot, over a long period of time, and could lead to diabetes. Watch your weight and always look for signs of diabetes. Diabetes is not a fun thing to have so keep and eye on this, check out the ADA site, and make sure you aren’t at risk. No one wants to have the diabetes!
  

  Least of all this cat.

• Atherosclerosis – a big word that means basically your walls of your arteries getting hard. It puts you at risk for heart disease and other circulatory issues. If you are smart and are living a healthy lifestyle, this probably won’t even be an issue. Others, not following that, well you might get it anyway? Why tempt fate?
• Aseptic Necrosis – this is by far the scariest thing in this list. This can happen and it is not pleasant, it means parts of your bones are dying inside you. Which is the stuff of nightmares to be sure! The most vulnerable place for this issue is the hip joint, which is less the side of your body and more your groin area. So if you are getting injections close to your hip, monitor pain in your groin area and if you have any, get to a doctor quick fast. You can get this in other places but it is pretty rare, and is accompanied by pain, most of the time.

I have mentioned a lot in my posts that I frequently get injections to help with pain, and that if you are getting these regularly make sure you are taking all your vitamins, and take care of your immune system. I have them a lot, probably more than is really good for my body according to a lot of information, but its down to a matter of quality of life. More injections and I can move, have less pain, and basically live life. Less injections, and it is back to the cane and being trapped in my own immobile hurting shell. Frankly, it becomes for me one of those “damn the consequences” sort of things. I do wish that there were other ways, I have attempted many things, and am always looking for new avenues, but these really allow me to remain a functional human until that other treatment can be found. Others, depending on the level of pain you are in, and your specific condition may not need as aggressive treatments.

Not everyone reacts well to cortisone, and some patients not at all. Cortisone should also never be your first option, only after doing physical therapy, chiropractic, stretching, diet/weight loss, and all the other avenues available, besides surgery, should you consider getting a cortisone injection as that last thing before you decide on surgery. Don’t let that scare you off if you need it, but don’t make it your go to solution, unless you have to. Look at your situation, discuss it with your doctors and make sure you educate yourself on some of available treatment options, and the issues cortisone can cause for your specific issues.

For the videos I mentioned earlier that give a great explanation on all sorts of steroidal injections used for back pain, or other back/nerve related pain go here.

Remember, I am not a medical doctor so your professionals should be guiding you and helping you make your decisions. But don’t ever trust their word completely, look up what is being done, make sure you are familiar. Educate yourself as much as possible, no one will do it for you!