Can You Get an Mri for Headaches Unnecessary Testing Leads to Anxiety

February 14, 2022 Post a Comment

The Complete Guide to Chronic Tension Headaches

A detailed, science-based tour of stubborn headache diagnosis and treatment, for both patients and professionals

Close-up photograph of a face squinting in pain from a tension headache, cropped to show just some forehead, an eye, and bridge of the nose.

Almost every second human being existence has had a tension headache & one in ten have had a migraine, putting headaches in the top x most disabling conditions (meridian 5 for women).

The 2 master kinds of mutual headaches are tension-blazon headaches and migraines. Almost half of the population knows the hurting of tension headaches, and i in ten get migraines, and more women — making headaches 1 of the peak 10 most disabling conditions, and the acme five for women.one That's a lot of aching heads.

Migraines are usually worse than tension headaches, but non necessarily: some migraines are quite tame, while "merely" a tension headache can be shockingly vehement and stubborn. Some migraines plow out to be monstrous tension headaches.2

Chronic tension headache: how long tin can they last?

What if you've had a tension headache for a calendar week? Maybe many times? Or what if you just have a constant tension headache, indefinitely? All these awful scenarios can still exist "just" a tension headache or another musculoskeletal headache, and most are — but the longer a tension headache lasts, the more likely there's something else going on.

This tutorial is by and large nearly chronic tension headaches, simply with enough of comparison and contrasting with migraine and many other kinds of headaches. It's about troubleshooting unexplained headaches that may or may not take anything to do with "tension." There's lots ahead about diagnosis and when to worry nigh headaches, the multitudinous causes of headaches,iii reviews of all the all-time and most pop treatment options (rarely the same thing). There are some instance studies, some dad jokes, and plenty of "fun facts" and mythbusting forth the way.4 Headaches are awful, just they are too interesting!

Tension Headache versus Migraine (Quick Version)
Tension Headache	Migraine
musculoskeletal hurting	neurological "brain ache"
mostly less awful	oftentimes worse … but not always!
usually both sides	usually one side
pressure, tightness	throbs with pulse
noise sensitivity	light sensitivity
few weird symptoms	weirdness standard

The nature of the beast: what is a "tension" headache?

Kids similar to ask "why?" When yous reply, they like to inquire it over again. And once more. And again. If you're ever trying to explicate what a tension headache is to a child, you're going to hit a brick wall quickly, because "tension headache" is not a clear concept. Why practise people get tension headaches? Because of stress and, er, tension. But why? Um… I gauge, well, tension is painful…

And why is that?

Experts are stumped by this too, because "tension headache" is just a grab-all term for whatever unexplained headache that isn't a migraine and doesn't seem to be scary in any other way. A better name might be musculoskeletal headache, or perhaps just undiagnosed headache, rather than blaming "tension," which is extremely vague. The moment in that location's a better and more than specific caption for a headache than "tension," it ceases to be a tension headache. Simply until so…

Most of us know all too well that headaches are strongly linked to stress.v Stress either causes hurting directly and/or it causes other things to go wrong that injure, ordinarily assumed to be musculoskeletal problems — trouble with basic, joints, and meat.6 Simply exactly how nosotros get from stress to headache is quite uncertain.

How stress makes heads ache (peradventure)

Is there such a affair as a pure stress headache, where the only trouble is with your feelings? A completely sensory phenomenon, involving no concrete stress of whatever kind? Probably, aye: as if life wasn't difficult enough, nosotros humans have the ability to transmogrify emotional distress into discomfort (somatization). If it'due south possible for us to feel terrible hurting when there's absolutely aught actually incorrect with us — which information technology is, unfortunately78 — and so a headache might exist the almost routine example of it, probably the most common class of psychosomatic pain, where "headache" near literally ways "painful thinking."

Simply it's more likely there's usually some kind of intermediate physical step. That is, feelings cause something to happen in the flesh which, in turn, is the actual cause of aching in the head. But what would that be, exactly?

"Musculus tension" is the main doubtable — non a well-established fact scientifically, but seemingly obvious to anybody.nine Most of the time, for most people, a "tension headache" feels like muscular tightness effectually the head, neck, and confront, and shoulders, specially sore, stiff suboccipital muscles nether the back of the skull, and the jaw muscles, peculiarly in the temple.

Funny animated gif of two strange animated characters rapidly opening and close their jaws, as a funny way of emphasizing that heavy use of jaw muscles may cause tension headaches.

Jaw muscles get used heavily. That may atomic number 82 to some headaches.

Muscle tension is probably inherently uncomfortable and the master mechanism by which stress causes headache, but muscles can also probably go into worse trouble than mere tension. The neck, jaw, and shoulder muscles are routinely sore, full of (hypothetical) trigger points ("musculus knots," actual knots non included)ten that radiate hurting all over your caput, and sometimes down into your neck, shoulders and even artillery equally well.11 These tender spots in muscle are either literally tense (contracted), or they but feel like it,12 which is 1 of the reasons we call it a "tension" headache. The problem is that these sensitive spots are barely understood, and their function in headache is unconfirmed.

Despite all the scientific dubiety, treating many unexplained headaches can exist every bit simple as just learning about these "perfect spots" for massage. I will talk over musculus pain much more after on in the tutorial.

Simply information technology'due south not all near tension

Feelings of "tightness" could but be a symptom of other kinds of headaches. A lot of unexplained headaches are probably caused not past stress, directly or indirectly, but by other musculoskeletal problems, simpler than the exotic physiology of migraine, but y'all would be surprised how zany musculoskeletal hurting can become. Many headaches are probably cervicogenic headaches ("from the cervix"), but even that simple thought has been amazingly controversial.xiii

Become TO Pinnacle • CONTENTS • NOTES

Function 2

Diagnosis of Tension Headache

When to worry about a headache (and when non to)

Safety offset, please: astringent and foreign headaches need medical investigation. There are many types of headaches — literally hundreds of them — and some take serious medical causes. Headaches can be their ain problem (primary), or they can exist a symptom of something else (secondary). You demand to run across a doctor, stat, if your headaches are:

unusually severe, more than seven/10 prove
unusually persistent (more than a day at higher pain levels, more than a week at moderate pain levels)
unusually sudden, a so-called "thunderclap" headache, which comes on in seconds to minutes14 (but as much fun every bit they sound like)
unusual in any other style15
associated with other worrisome symptoms, specially facial numbness16

The worst sneaky common crusade of headaches is probably torn vertebral arteries. Headache is the only symptom of upward to one-half of these cases in the first few days, but information technology is usually a really weird headache. More on this subsequently.

And a headache can be all that and still turn out to exist a tension or musculoskeletal headache. So delight, don't panic.

Is headache a symptom of COVID-19? (Or other common infections?)

It'southward non one of the "classic" COVID-19 symptoms, only it's certainly possible — in 8% of cases co-ordinate to one report,17 14% of cases in another.18 That'due south roughly the aforementioned percentage of patients suffering from widespread body aching, and and so headache is probably more often than not just a function of that phenomenon.

The symptoms of most infections are not straight acquired by the damage they do to our tissues, especially at beginning. We cannot feel cells existence killed by the SARS-CoV-2 virus, or any other virus; what we feel is our immune system's reaction to the invasion. One purpose of that reaction is to forcefulness us to stay still — too known as residuum — by and large by making movement experience difficult and unpleasant. This "sickness behaviour" is a generalized reaction to many kinds of biological threats in all animals.19 It's quite prominent in COVID-nineteen.twenty

So why exercise just fourteen% of COVID-19 patients go a headache? Some people are more than vulnerable to developing headaches, and an infection tin expose that vulnerability because cytokines lower our pain threshold dramatically, making everything and annihilation more likely to injure. The variation could too exist due to the initially infected tissues.

What's the worst case scenario for tension headaches?

"I don't know, I can imagine quite a chip."

Han Solo, Star Wars (Episode IV)

I'll beginning this off with my own example: in the autumn of 2017, I had a balmy tension headache for several weeks, almost non-stop (just ane slice of my own chronic pain problems). It would surge up to moderate severity in the evenings, and there were a few patches that were impressively bad, but it was the grind of abiding pain, regardless of severity, that I remember really took its toll on me.

And this is a fairly typical instance of the most common worst case scenario: not especially crippling in whatever given moment, but still severe and exhausting. The grind is part of the severity of the pain, which anyone with chronic tension headaches can chronicle to. Here's what an old friend of mine had to say about it, and he has a lot more experience with that grind:

I detect low level chronic pain much worse than infrequent acute pain. It is a weird thing (perhaps not for someone with your knowledge base) that I tin can easily shrug off significant pain like getting kicked in the face in martial arts … but steady depression level stuff like headaches mentally breaks me pretty quickly.

I didn't properly appreciate this until I'd felt it. There is zip "mild" about mild hurting when information technology but won't let up. It's difficult for me to imagine what a whole year of that would be like; a couple months was bad enough. As is so often the case, one must live with a trouble to really empathise it. More and more, I wonder how I could possibly publish a skillful website about pain if I didn't besides endure from it. "Lucky" for me, I exercise have that experience.21

The worst possible tension headaches

Headaches are so mutual and diverse that nearly anything is possible. Billions of people, hundreds of millions of headaches… somewhere out there, there are people with some truly spectacular headaches. Sky'southward the limit.

What if we consider primary tension headache lone? In that location's all the same extraordinary potential awfulness in such a huge population, but there probably are limits: tension headaches probably tin can't actually knock someone downwardly and keep them at that place, bold there really is nothing else worrisome going on. Fifty-fifty the worst intensity will come in waves, easing with sleep or rest or fourth dimension; and headaches that drag on for years and decades, effectively permanent, won't be constantly disabling. Extremes of both intensity and chronicity are possible with tension headache, simply probably not both. A headache that is continuously disabling for long periods is almost certainly not just a tension headache.

See the footnotes for 3 examples, spanning the range from "definitely possible for a tension headache"22 to "it might be possible but a bit unlikely"23 to "there'south probably something else going on here."24

So the worst boilerplate25 example scenario is "just" the "annoyance" of chronic headaches … plus their worst common consequences, indisposition and exercise intolerance, which in turn has even more serious consequences, especially other kinds of pain. People with bad, chronic headaches are in significant long term danger of poor health.

Although tension headaches can be amazingly severe — again, they tin exist more vicious than lesser migraines — even the worst aren't unsafe in the short term. (This as well applies to migraines, even though they tin exist bad enough to trounce your volition to live.) The master thing is just to recognize — with expert help — when a headache is not just a headache. Consider the chilling (but entertaining) story of scientist Yvette d'Entremont:

I got the worst headache of my life and it didn't go away. This horrible anguish took residency behind my left eye and refused an eviction discover. I consulted endless doctors and it took viii months to detect the showtime medico who would start getting my headaches under control …

Later a multi-year diagnostic odyssey, Yvette's headaches proved to be caused by a combination of ii medical problems (Ehlers Danlos Syndrome and celiac disease). Then, once more, odd astringent headaches should always exist taken seriously.

GO TO TOP • CONTENTS • NOTES

Tension headache vs. migraine

Tension-type headaches are more than mutual than all other types put together, past a long shot. But heads tin can anguish in many ways. And then many ways! You would not believe. And and so confirming a headache type can be hard or impossible.

Tension and migraine headaches are the main primary headaches — headaches that are the main problem, rather than being a mere symptom of some other trouble, like dehydration/hangover headaches, which are secondary. Simply a headache's chief-ness is only a part of our ignorance of the specific cause. "Primary" headache is really just another way of saying "unexplained" headache. The moment a specific cause for a headache is identified, in a •poof• of nomenclatural smoke, the headache is demoted to secondary, and becomes a symptom of whatever nosotros know to exist causing the problem.

Migraines have many distinctive features, because they involve brain part. As mentioned higher up, although migraines are often severe, the give-and-take migraine is not just a fashion to say "it'due south a really bad headache." A migraine is a dissimilar kind of headache. They commonly stick to one side of the head (except in kids), typically in front or near the temple. They final for at least a few hours and as long as (ugh!) 3 days. The pain is related to encephalon claret vessels, so migraines are often pounding in sync with your pulse (or possibly alpha encephalon waves—information technology'southward complicated). Light sensitivity is common and can be severe. Migraines may be caused or aggravated past concrete exertion, or triggered by foods and smells, most famously (and depressingly) wine and chocolate. And in that location needs to be a design of at least several attacks for an official diagnosis.

And finally, the most distinct characteristic of migraines, the infamous "aura": weird visual, auditory, and other neurological disturbances27 that develop over 5-20 minutes and concluding for almost an hour. Migraine auras are a warning sign that a migraine headache may follow, but not all migraines accept auras … and not all auras are followed by migraines.

It'south also possible to have a variety of other migraine alarm symptoms for up to a day or ii beforehand: fatigue, mental fog, neck stiffness, constipation, strong food cravings.

If any of this weird migraine stuff sounds like you, then y'all probably exercise not take tension headaches. Or not simply tension headaches, at any charge per unit — people who get migraines tin also get tension headaches.

Hither's a more than detailed version of the tension headaches vs. migraine tabular array:

Tension Headache vs Migraine: What's the Difference? More than detail!
Tension Headache	Migraine
musculoskeletal pain, peculiarly spreading into the head from the jaw and neck	neurological "brain anguish", formerly classified as a "vascular" headache but no more ("information technology's complicated")
mostly less awful, but astringent tension headaches are just as bad every bit any migraine	often worse, but they actually can be milder than tension headaches (or fifty-fifty painless, consisting just of not-pain neurological symptoms)
frequently on both sides	commonly just one side
feels like pressure, tightness	feels similar throbbing with pulse
dissonance sensitivity	light sensitivity and visual disturbances common
smell intolerance (osmophobia) never occurs with tension headache	occurs in ~40% of instance
no weird symptoms, though they can exist bad plenty to cause malaise	many weird symptoms, particularly sensory disturbances, auras and prodromal symptoms

GO TO Tiptop • CONTENTS • NOTES

Other primary headache types: cluster, exertional, thunderclap, hypnic, and more than

There are two major master headaches, the migraines and the cluster headaches, and so a big "other" category. This section is devoted to those others.

None of these headache types are mutual.

Cluster headaches are cousins to migraines, but are more severe, distinctive, eye-o-axial, and a hundred times less common. While migraines can be mistaken for tension headaches, cluster headaches cannot: they are just also awful and odd. The pain is nearly always around and/or above one centre and/or the temple, and that eye may droop, leak, and smashing. Victims frequently pace miserably, agitated and restless. These headaches occur in clusters of many headaches for a while (and so at that place'southward nothing for weeks, months, or even years).

Photo of dramatic lightning slashing across a blue-black sky, representing thunderclap headaches.

"Thunderclap" headaches: exactly what information technology sounds similar & simply as bad. Ane of the best examples of a distinctive primary headache.

The other primary headaches (though several of these could too be symptoms of other conditions). Notice how these tend to just exist descriptive names — because that'due south all we've got.

stabbing headache — nasty intermittent stabbing pains mainly in eye, temple, and side of the head
cough headaches — acquired past cough (duh), but also straining on the toilet and holding the breath strongly (valsalva maneuver)
exertional headaches — not-migraine headaches that occur simply during/subsequently exercise, and the offset fourth dimension one of these happens it'southward critical to make sure it'south not related to a brain drain
sex headaches — exactly what it sounds like28
thunderclap headaches — likewise exactly what information technology sounds like, and just as bad (I accept personal experience with these)
hypnic (slumber) headaches — these wake people from sleep

GO TO Peak • CONTENTS • NOTES

The secondary headaches (when headache is a symptom or complication of something else)

Hopefully I don't need to explain that hangovers can cause headaches. Merely did you know that your brain might be leaking? Or total of tape worm eggs? Or that there's a kind of stroke that results in only a headache? Some headache causes are quite sneaky and bizarre.

For instance, long ago a homo hid a trivial wad of marijuana up his nose, and then lost it up there and forgot it for most twenty years — oops! — until it started causing severe headaches:

Through the years he suffered recurring sinus infections and had trouble breathing out of the right side of his nose. But he didn't connect the bug to his lost cannabis. Information technology wasn't until 18 years later — when he was struggling with headaches and had a CT browse of his encephalon — that doctors finally discovered the petrified pot.

That is a perfect, bizarre example of a "secondary" headache.

A headache that has a clear cause is secondary to that cause, a symptom rather than the illness. And of class there's a big murky grey zone between primary and secondary headaches.

So patently almost anything tin can give you a headache, only here's some advisedly selected examples where the cause of a headache could easily be overlooked or misunderstood.

None of the serious causes of secondary headache are mutual. Fifty-fifty the most common serious ones are extremely unlikely to be the explanation for whatsoever one person's headache. All possible secondary causes of headaches combined are fairly common, though. They add together upward to common!

•

Aneurysm, a torn artery in the cervix, is the most worrisome common cause of headaches that tin can actually pass for a tension headache, at least at first. In addition to the large carotid avenue, small arteries in the side of the neck supply the brain with blood, the vertebral arteries. These arteries are somewhat vulnerable to being pinched off or even torn. If the artery actually tears, which can cause brain damage due to the loss of claret supply to the brain, information technology'south called vertebral artery "dissection," or VAD.

Distrubingly, VAD may only cause neck/head hurting — no other symptoms — which is disturbingly fiddling indication of a dangerous injury. It'southward not clear how common these pain-only cases are, but it's at least one in ten in the first solar day or two.29 Every bit time goes on, the symptoms are likely to become too strong and weird to pass for tension headache. But it is hypochondriac nightmare fuel, because it's a serious problem that tin pass for an ordinary, common one. But information technology's not a perfect mimic: the pain is unremarkably astringent, one-sided, with an unfamiliar quality (usually throbbing and constrictive). It is an injury, and it probably feels similar it if you stop and think about it. For more than information, see When to Worry About Neck Pain … and when not to!

•

Feet is a strong driver of practically every conceivable kind of pain, but headaches are right at the top of the list (along with chest pain). Even normal stress tin practise this, but when worries are severe and prolonged, headaches are a super mutual symptom. Headaches are a standard sideshow to panic attacks.

•

Jaw problem is strongly linked to headaches (temporomandibular joint syndrome and bruxism, teeth grinding). Jaw pain is ascendant in almost patients, unlikely to be missed. Merely, for a few (probably less than 5%) the main symptom is actually headache, and the connection doesn't get fabricated. I volition devote a chapter to the jaw's part in headache.

•

Eye strain is also strongly linked to headaches. Every bit with jaw problem, it's ordinarily obvious that the headache is secondary — but not always.

•

Cerebrospinal fluid leaks — literally leaks in the membrane that wraps your brain and spinal cord — are often subtle, causing mainly headaches and face, cervix, and arm hurting, although there'south a laundry list of other odd symptoms. The big clue is that these headaches flare when you're upright. Despite this signature symptom, CSF leaks often go undiagnosed. If you have chronic headaches that usually feel improve on your back, and specially if your health feels a chip delicate in full general, definitely look into this: Upright Headache? Call up CSF Leak! For many patients, just the words "upright headache" volition spark a revelation.

•

Temporal arteritis is an inflammation of arteries in the temple, with a lot of symptoms: severe headache, fever, scalp tenderness, jaw pain, vision problem, and ringing in the ears are all possible symptoms, forth with cervix pain. It'south near unheard of in people younger than fifty, and information technology ordinarily occurs in people with other diseases or infections. However, it may exist possible to have a relatively minor case bad enough to cause pain but not severe enough to be hands diagnosed.

•

Post-concussion syndrome involves a lot of headaches. Yes, it'due south truthful: a sharp blow to the caput can cause headaches! You heard information technology here outset. PCS is "a complex disorder in which various symptoms — such as headaches and dizziness — final for weeks and sometimes months after the injury that acquired the concussion." Postal service-concussion headaches cannot exist directly treated — they are "brain aches" caused by direct trauma to the brain — with the possible exception of exercise.30 Plainly that is not a tension headache, but the pain might pb to tension headaches as a complication, which might partly explicate why recovery time from post-concussion syndrome is so notoriously unpredictable.31 And there could be involvement of other tissues in many cases, such equally trauma to musculoskeletal structures throughout the head and neck (specially whiplash), causing cervicogenic headache. So fifty-fifty though the hurting of post-concussion syndrome headaches tin can't be direct treated, it may come with other types of headache that tin exist.

•

Drug side effects and withdrawal. Drug side effects are probably a common sneaky cause of headaches (related: side furnishings of some food additives, like perhaps MSG, more on this below). More surprising is that headaches are a side consequence of hurting-killers, which seems tragically unfair, like coffee that makes you drowsy. Merely it'southward for existent, and information technology's known as medication-overuse headache (MOH). When you take a lot of pain killers, they may pre-empt the production of your body'south own pain-fighting chemical science, and that can have nasty consequences when you lot finish taking the drugs, resulting in worse pain than e'er. This is role of the phenomenon of the well-known and serious withdrawal symptoms from some drugs; it is a less well-known problem with over-the-counter pain-killers. Given how common analgesic usage is, some people with recurrent headaches are probably suffering from bouts of rebound pain, occurring in the occasional gaps between erratic but generally excessive use of pain killers. Definitely something to sentry out for. I will devote a whole chapter to this topic.

•

Chronic sinus inflammation is probably a surprisingly mutual cause of headaches. Astute sinusitis is not subtle, just chronic inflammation from chronic infection or allergies can be surprisingly hard to nail down, and remarkably like to tension headaches. Or you could have both, because having chronically painful sinuses is stressful!

•

A few other possibilities:

Ear infections (usually fairly manifestly an ear problem)
Irritation from hats, helmets, goggles, ponytails… and face shields and masks! A minor new hazard in time of COVID-19.32
Glaucoma (damaged optic nerve, frequently caused by high eyeball force per unit area)
Dehydration is probably an over-hyped cause of headaches (read more than below)
Monosodium glutamate is another over-hyped cause of headaches (read more than below)
There are a few possible causes of headache related to exotic neck problems, like chiari malformation, tethered string syndrome, and atlantooccipital instability (read more)
Enemies that are "crushing your head."

Become TO Acme • CONTENTS • NOTES

Office three

Causes of Headache

Major factors in so-called tension headaches and other unexplained headaches

This part of the tutorial discusses the causes of headache, just it can also exist seen as "diagnosis continued."

For this topic, diagnosis is hard to separate from etiology (the nature of the animal). In virtually of my books, I talk about the nature of a problem before I talk about how to confirm the diagnosis. Only it'due south the other way effectually here, considering you can't talk near headache causes until it's clear what kind of headache nosotros're talking about — and then information technology seemed of import to explain and eliminate a whole bunch of other possibilities outset.

And yet even "tension" headache is not one affair, non even remotely. Information technology breaks down into many possible specific causes that make the label of "tension" irrelevant. And every one of thoses causes has distinct diagnostic implications. Then this isn't but about the causes of tension headaches, merely the causes of whatsoever kind of headache that tin can't easily be diagnosed, and digging into them volition advise more than diagnostic possibilities.

One of the best examples is using a cervical nervus block — injecting a numbing agent to encounter if the hurting is coming from the neck. If the pain goes away, bingo, you've discovered that a neck result is the cause of your headache — not tension. A nerve block is non a big bargain, but a needle deep in the upper neck isn't a piddling process either. For most patients, it will never even exist on the radar every bit an option.

And then crusade and diagnosis are basically incommunicable to divide with headache. Every major cause needs its own diagnostic arroyo. Then we'll continue the diagnosis/cause discussion with the mother of all plausible, common "tension" headache causes: the cervicogenic or neck-powered headache.

From the neck or not? The cervicogenic headache debate

"Jane" was a nurse, just 23 years old, and she'd had the same headache since she was 20, a constant throb on the right side of her head. She worked in a radiology section, and had to wear a lot of pb aprons. She blamed those heavy aprons for the headache, always dragging her downward.

She had an acutely sensitive spot on the back right side of her neck, though, just a scattering of inches south of the pain. And she had more than hurting every fourth dimension she turned her cervix that style.…

Finish OF FREE INTRODUCTION

Purchase total admission to this tutorial for USD $ nineteen 95. Proceed reading this page immediately after buy. A second tutorial nigh muscle pain is includedfree. Run across a complete table of contents below. Well-nigh content on PainScience.com is free.?

Almost everything on this website is free: about 80% of the site by wordcount, or 95% of the bigger pages. This page is only one of a few big ones that take a price tag. There are also hundreds of gratis articles. Volume sales — over 69,900 since 2007? This is a tough number for anyone to audit, because my customer database is completely private and highly secure. But if a regulatory agency ever said "show us your math," I certainly could. This count is automatically updated in one case every day or two, and rounded downwards to the nearest 100. It includes all individual and arranged books for sale on PainScience.com since 2007, and excludes a trickle of before sales, donations, and gifts. — go along the lights on and allow me to publish everything else (without ads).

Q. Ack, what's with that surprise toll tag?!

A. I know it can make a poor impression, but I have to make a living and this is the all-time way I've found to keep the lights on here.

CURRENCY ?

Paying in your own (non-USD) currency is always cheaper! My prices are set slightly lower than electric current exchange rates, but near cards charge extra for conversion.

Example: as a Canadian, if I pay $19.95 USD, my credit card converts it at a high charge per unit and charges me $26.58 CAD. But if I select Canadian dollars here, I pay only $24.95 CAD.

Why then different? If you lot pay in United States dollars (USD), your credit card will convert the USD toll to your carte du jour's native currency, but the card companies often accuse likewise much for conversion — it'southward a way for them to make a little extra money, of course. So I offer my customers prices converted at slightly improve than the current charge per unit.

read on any device, no passwords
refund at whatsoever fourth dimension, in a week or a yr
telephone call 778-968-0930 for purchase help

IDVendor Information

company	PainScience.com
possessor	Paul Ingraham
contact	778-968-0930
refunds	100%, no time limit + Customers are welcome to ask for a refund months later buy — I sympathize that it can take time to decide if data like this was worth the price for you.
more than info	policies page❐
payments

What do you lot get, exactly? An online tutorial, volume-length (49 chapters). Free updates forever, read on any device, and lend information technology out. Eastward-book only! More than

Q. What am I buying? Is there an actual paper book?

A. Payment unlocks access to 39 more chapters of what is basically a huge webpage. There is no paper book — I simply sell volume-length online tutorials. This format is bully for instant delivery, and many other benefits "traditional" e-books tin can't offer, specially hassle-free lending and updates. You get free lifetime admission to the always-current "live" spider web version (and offline reading is easy too).

Read on any device. Lend it out. New editions free forever.

Q. I just don't like reading on the estimator! Is at that place whatsoever way around that?

A. The design and applied science of the book is ideal for reading on tablets and smart phones. You can also print the book on a home printer.

A. Yep! Feel gratis to lend your tutorial: I do not impose silly lending limits like with nearly other ebooks. No complicated policies or rules, just the laurels system! Y'all buy it, yous tin share it. You lot tin also give it as a gift.

Secure payment takes about 2 minutes. No password or login: when payment is confirmed, you are instantly granted full, permanent access to this folio.More than

Q. Is it safe to employ my credit carte du jour on your website?

A. Literally safer than a banking concern machine. Payments are powered past Stripe, which has an A+ Amend Business organisation Bureau rating. Card info never touches my servers. It's easy to verify my identity and the legitimacy of my business: just Google me [new tab/window].

Q. I tin really get a refund at any time?

A. Yes. All PainScience.com ebooks have a lifetime money-back guarantee.

Q. Why do you ask for contact information?

A. To forbid fraud and assist with order lookups. Yous aren't "subscribing" to anything: I never send email to customers except to confirm purchases.

Q. Can I buy this anywhere else? Amazon?

A. Not nevertheless. Maybe someday.

See the "fine impress page" for more nigh security, privacy, and refunds. No legalese, just plain English.

Collect them all. Go an "e-boxed" prepare of all 10 PainScience.com tutorials, ideal for pros … or patients with a lot of bug.MORE

Save a bundle on a package

The e-boxed set is a bundle of all 10 volume-length tutorials for sale on PainScience.com: x books about 10 different common injuries and pain problems. All x topics are (all links open free intros in a new tab/window): muscle strain, muscle pain, back and neck pain, 2 kinds of runner's knee (IT band syndrome and patellofemoral pain), shin splints, plantar fasciitis, and frozen shoulder. (Headache coming soon, autumn of 2019.)

Well-nigh patients only demand one book, considering most patients have only one trouble. Merely the set is ideal for professionals, and some corking patients do desire all of them, for the didactics, and for lending to friends and family unit. And, of course, you lot do go a substantial discount for the bulk purchase. Only no rush—complete the gear up later on, minus the price of any books already bought. More than data and purchase options.

Plus …

Many and so-called "tension" headaches take zilch to exercise with muscles or tension. But a lot of them do, probably nigh of them, and for all those cases it'southward important to empathize the potential and limitations of mod ideas about why musculus hurts and how to help it. The basics of muscle pain are covered right here in the headache tutorial, but an entire huge additional volume on the topic is automatically included.

CURRENCY ?

Paying in your own (non-USD) currency is always cheaper! My prices are ready slightly lower than current exchange rates, but most cards charge extra for conversion.

Case: as a Canadian, if I pay $19.95 USD, my credit card converts it at a loftier rate and charges me $26.58 CAD. Just if I select Canadian dollars here, I pay only $24.95 CAD.

Why so different? If yous pay in U.s. dollars (USD), your credit carte will convert the USD price to your card'due south native currency, but the carte du jour companies often accuse likewise much for conversion — information technology's a way for them to brand a niggling extra money, of course. So I offer my customers prices converted at slightly better than the current charge per unit.

read on any device, no passwords
refund at any fourth dimension, in a calendar week or a yr
call 778-968-0930 for purchase aid

I apply a MythBusters arroyo to health care (without explosives): I have fun questioning everything. I don't merits to have The Answer for tension headache. When I don't know, I acknowledge it. I read scientific journals, I explain the scientific discipline behind key points (in that location are more than than 200 footnotes here, drawn from a huge bibliography), and I always link to my sources.

For instance, there'south skillful bear witness that educational tutorials are actually effective medicine for hurting. ? Dear BF, Gandy M, Karin E, et al. The Pain Grade: A Randomised Controlled Trial Examining an Internet-Delivered Pain Management Program when Provided with Different Levels of Clinician Back up. Pain. 2022 May. PubMed #26039902 ❐ Researchers tested a serial of web-based hurting direction tutorials on a grouping of adults with chronic pain. They all experienced reductions in disability, anxiety, and average hurting levels at the end of the eight week experiment as well every bit three months down the line. The authors concluded: "While contiguous pain direction programs are important, many adults with chronic hurting can do good from programs delivered via the internet, and many of them do not need a lot of contact with a clinician in order to benefit." Good information is good medicine!

And I've worked hard for many years to provide the best information about tension headaches bachelor anywhere — not only more of it, but ameliorate.

But in that location are limits to current scientific cognition about headache. Non everyone tin be helped. The goal of this tutorial is to help y'all navigate the maze of medical uncertainty and contradictions, and the many possible causes.

This tutorial does non requite yous a magic bullet for headaches, but it does provide readers with many ideas and "upgrades" to their arroyo to the problem. Most people who think they've "tried everything" accept non actually tried everything. With some more informed and rational experimentation, many cases can improve from beingness disabling to at least manageable.

All of that is hopefully worth more than than several sessions of concrete therapy, at a fraction of the cost.

CURRENCY ?

Paying in your own (non-USD) currency is ever cheaper! My prices are set slightly lower than current exchange rates, but almost cards accuse actress for conversion.

Instance: every bit a Canadian, if I pay $19.95 USD, my credit bill of fare converts it at a loftier charge per unit and charges me $26.58 CAD. But if I select Canadian dollars here, I pay but $24.95 CAD.

Why so dissimilar? If you pay in U.s.a. dollars (USD), your credit bill of fare will catechumen the USD cost to your bill of fare's native currency, but the card companies often charge too much for conversion — information technology'south a manner for them to make a fiddling extra coin, of class. So I offer my customers prices converted at slightly meliorate than the current rate.

read on any device, no passwords
refund at any fourth dimension, in a week or a year
phone call 778-968-0930 for purchase help

Office iii.2

Appendices

What's new in this guide?

This commodity was originally published in 2004, and evolved slowly for more than a decade earlier I got more serious about updating it in 2016. Updates take been fairly regular and logged ever since.

Regular updates are a key characteristic of PainScience.com tutorials. Every bit new scientific discipline and information becomes available, I upgrade them, and the most contempo version is ever automatically available to customers. Different regular books, and even east-books (which can be obsolete by the time they are published, and can go years between editions) this document is updated at least once every iii months and often much more. I also log updates, making it easy for readers to encounter what's changed. This tutorial has gotten 67 major and minor updates since I started logging carefully in late 2009 (plus countless minor tweaks and bear upon-ups).

Nov 3, 2022 — New ruby flag: Added "facial numbness," based on Ugradaret al. [Updated section: Diagnosis of Tension Headache: When to worry about a headache (and when not to).]

2021 — Science update: Updated the affiliate with a citation to an of import new study showing that in that location are no obvious neck abnormalities in headache patients. [Updated section: From the neck or not? The cervicogenic headache contend.]

2021 — New chapter: Adjusted from the recent blog post, with some noun extra speculation about the plausibility of a tight frenulum causing headaches. [Updated section: Tin your natural language cause headaches?]

2021 — Proofreading: Commencement top-to-bottom proofreading for this volume since launch, catching many minor erros that crept in doing about a dozen updates over the concluding twelvemonth and half.

2021 — Minor polishing: A petty editorial smooth, and a chip of elaboration about the role of psychotropic effects. [Updated section: The cannabinoids: marijuana and hemp, THC and CBD — "information technology's complicated!".]

2020 — New section: No notes. Just a new chapter. [Updated section: Sinus irritation and irrigation.]

2020 — New department: No notes. Merely a new affiliate. [Updated section: Smoking.]

2020 — New content: Added coat hangar pain from orthostatic hypotension to the collection of more exotic types of cervicogenic headache. [Updated section: More exotic cervicogenic headaches.]

2020 — Scientific discipline update: Cited a boom-in-coffin 2022 report of dry needling for neck pain. [Updated section: Massage, self-massage, and other trigger indicate therapies for headache.]

2020 — Science update: Added more detail and citations about headaches caused by physical irritation around the caput, including (sigh) personal protective equipment like face up masks. [Updated department: Hats off! Eliminate minor sources of physical stress that cause headache.]

2020 — New content: Added a substantial new sub-section, "Trigger points, schmigger points: the many other kinds of muscle injury and dysfunction." [Updated section: More than exotic cervicogenic headaches.]

2020 — COVID-19 update: Added information about headaches as a symptom of COVID-xix. [Updated department: Diagnosis of Tension Headache: When to worry about a headache (and when non to).]

2020 — More information: Expanded the description in the spirit of helping people empathize "what to expect," what are the limits, with some new examples. [Updated department: What'south the worst case scenario for tension headaches?]

2020 — Upgraded: More than item, more references, and more than advice. [Updated section: Pills, pills, pills: treating headache with over-the-counter pain-killers.]

2020 — New chapter: No notes. Just a new chapter. [Updated section: Medication-overuse headaches (AKA rebound headaches) and other medication madness.]

2020 — New chapter: Alcohol has come up in a variety of means. In that location'southward a demand to reconcile them. [Updated section: A fleck more about booze.]

2019 — Major upgrade: More detail, editorial color, and references. [Updated section: Botox for chronic daily headaches.]

2019 — Book launch: The headache guide has been free since I outset introduced information technology in the early 2013. Six years and hundreds of hours of development after, it joins my inventory of full-blown books. Information technology'due south the second addition in 2022 (afterwards frozen shoulder this summer), after years without any new ones. It is now for sale for $20 USD. All existing boxed set customers volition have access automatically — someone who bought a set in 2009 is getting a new book out of that buy a decade afterwards.

2019 — New chapter: No notes. Merely a new chapter. [Updated department: Soothing the jaw: managing jaw clenching, grinding, and chronic hurting.]

2019 — New chapter: No notes. Just a new chapter. [Updated department: The part of the jaw (and the muscle most likely to put the "tension" into a tension headache).]

Archived updates — All updates, including 57 older updates, are listed on another page. ❐

2004 — Publication.

GO TO TOP • CONTENTS • NOTES

Acknowledgements

Thanks to every reader, client, and book customer for your curiosity, your faith, and your feedback and suggestions, and your stories nearly of all — without you, all of this would be impossible and pointless.

Writers go on and on nigh how grateful they are for the back up they had while writing i measly book, but this website is really a much bigger project than a book. PainScience.com was originally created in my so-called "spare time" with a lot of assistance from family and friends (encounter the origin story). Thanks to my wife for countless indulgences big and small; to my parents for (perchance blind) religion in me, and much copyediting; and to friends and technical mentors Mike, Dirk, Aaron, and Erin for countless useful chats, repeatedly saving my ass, plus really building many of the nifty features of this website.

Special thanks to some professionals and experts who have been particularly inspiring and/or directly supportive: Dr. Rob Tarzwell, Dr. Steven Novella, Dr. David Gorski, Sam Homola, DC, Dr. Marker Crislip, Scott Gavura, Dr. Harriet Hall, Dr. Stephen Barrett, Dr. Greg Lehman, Dr. Jason Silvernail, Todd Hargrove, Nick Ng, Alice Sanvito, Dr. Chris Moyer, Lars Avemarie, PT, Dr. Brian James, Bodhi Haraldsson, Diane Jacobs, Adam Meakins, Sol Orwell, Laura Allen, James Fell, Dr. Ravensara Travillian, Dr. Neil O'Connell, Dr. Tony Ingram, Dr. Jim Eubanks, Kira Stoops, Dr. Bronnie Thompson, Dr. James Coyne, Alex Hutchinson, Dr. David Colquhoun, Bas Asselbergs … and almost certainly a dozen more I am embarrassed to have neglected.

I work "lonely," but not really, cheers to all these people.

I accept some relationship with anybody named higher up, simply in that location are also many experts who have influenced me that I am non privileged to know personally. Some of the most notable are: Drs. Lorimer Moseley, David Butler, Gordon Waddell, Robert Sapolsky, Brad Schoenfeld, Edzard Ernst, January Dommerholt, Simon Singh, Ben Goldacre, Atul Gawande, and Nikolai Boguduk.

GO TO Superlative • CONTENTS • NOTES

Notes

Stovner Fifty, Hagen 1000, Jensen R, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007 Mar;27(iii):193–210. PubMed #17381554 ❐ "Globally, the percentages of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache and 3% for chronic daily headache. Our calculations indicate that the inability owing to tension-type headache is larger worldwide than that due to migraine. On the Globe Health System's ranking of causes of inability, this would bring headache disorders into the ten most disabling atmospheric condition for the ii genders, and into the five most disabling for women."
Many people assume "migraine" is simply a word for a really bad headache, and some people even dramatically boast nigh the severity of tension headaches by calling them "migraines." But a migraine is definitely a different kind of fauna than an ordinary headache. If yous can walk around talking well-nigh the fact that you lot have a migraine, you probably don't have a migraine. Although they can exist tolerable in their early stages, and some can even be surprisingly mild, as a general rule they are much more serious than the worst tension headaches. About migraines will take their victims flat on their backs in a darkened room.
There are literally hundreds of defined types of headaches, based on a stupendous variety of known causes, and enough more than that are based merely on a distinct pattern of symptoms.
Does dehydration cause headaches? How about MSG? Is ruddy wine a headache "trigger"? If tension is the problem, why don't muscle relaxants work? Do you really need a oral cavity guard for your clenching and grinding? All this and more than volition be discussed.
Martin PR. Stress and Primary Headache: Review of the Research and Clinical Direction. Curr Hurting Headache Rep. 2022 Jul;20(7):45. PubMed #27215628 ❐ "…although some researchers take questioned whether stress can trigger headaches, overall, the literature is still supportive of such a link."
As opposed to the neurological "brain ache" of migraine. Or the pathological and traumatic causes of another headaches (like inflamed arteries, brain impairment, drug side effects, and so on). There will be much more about other possible causes of headaches below.
Espay AJ, Aybek Due south, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2022 09;75(9):1132–1141. PubMed #29868890 ❐
Truly pure psychosomatic pain is probably a real phenomenon, merely it's not as articulate as it should be. The strange-but-truthful phenomenon of functional neurological disorders is well-studied: seizures, paralysis, incomprehension, and other neurological symptoms in the absence of any neurological disease (encounter Espayet al for a scholarly source, or this more than accessible talk: Suzanne O'Sullivan @ 5x15 — The reality of imaginary illness xix:xxx). If we can paralyze ourselves with our minds, we can probably make ourselves hurt as well.
The closest affair to persuasive evidence of a link between headache and muscular tension is a 1991 survey of headache patients (see Lebbinket al) which constitute quite a strong link: much higher prevalence of neck muscle tension in headache sufferers particularly, plus other links. More than about these results later.
And so-called "muscle knots" — AKA trigger points — are small unexplained sore spots in muscle tissue associated with stiffness and soreness. No one doubts that they are there, merely they are unexplained and controversial. They can be surprisingly intense, crusade pain in disruptive patterns, and they grow like weeds around other painful problems and injuries, but most healthcare professionals know little nigh them, so misdiagnosis is epidemic.
Fernández-de-Las-Peñas C, Simons D, Cuadrado ML, Pareja J. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Electric current Pain & Headache Reports. 2007 Oct;11(5):365–72. PubMed #17894927 ❐
This review of the scientific literature, unfortunately, has little scientific literature to review: not much research has been washed on the relationship between trigger points and neck hurting, and — every bit is then often the case in musculoskeletal health care — "additional studies are needed." Nonetheless, the authors suggest that "it seems that the pain contour of neck and caput syndromes may exist provoked referred pain from TrPs in the posterior cervical, head, and shoulder muscles" and that there is some evidence "that both tension headache and migraine are associated with referred pain from trigger points."
This is a bit sneaky of me, a convenient dodge effectually the controversy about the nature of trigger points. If the feeling of tension either is a literal wrinkle, or it simply feels that fashion, I've covered all my bases. My coin is on literal contraction, but I realize that there'south a lot of scientific uncertainty about that. The subjective sensation of wrinkle and tightness, however, is indisputable: well-nigh of the homo race knows that feeling, and doesn't hesitate to describe it like it'south a wrinkle. And the simplest explanation for the sensation would probably exist that trigger points hurt even if they aren't actually lilliputian contractions, and our brains interpret "uncomfortable movement" as "tightness." I go into considerable detail about the awareness of tightness in another article: You're Really Tight: The 3 most common words in massage therapy are pointless.
Bogduk Northward, Govind J. Cervicogenic headache: an assessment of the evidence on clinical diagnosis, invasive tests, and treatment. Lancet Neurol. 2009 Oct;8(ten):959–68. PubMed #19747657 ❐ "Although the International Headache Society recognises this type of headache as a distinct disorder, some clinicians remain sceptical." I'll return to this topic in more than detail after in the tutorial.
Devenney E, Neale H, Forbes RB. A systematic review of causes of sudden and severe headache (Thunderclap Headache): should lists be evidence based? J Headache Hurting. 2014;15:49. PubMed #25123846 ❐ PainSci #53381 ❐ Thunderclap headaches accept literally dozens of possible causes, some scary, some not so scary. The classic scary cause is encephalon haemorrhage (mostly subarachnoid hemorrhages), and it'southward of import to rule this out … and in many cases information technology is ruled out. Well-nigh cases are never explained and never corporeality to anything. And there's the cases acquired past eating extremely hot chili peppers. "What could possibly get incorrect?" Here's the news story, and the instance report in the British Medical Periodical.
Severe throbbing or constrictive neck and/or head pain may be the only symptom of an artery tear (encounter Arnold, Kerry, Maruyama) with a high run a risk of a stroke, but it is almost always a strange pain: Arnoldet al reported that most patients "considered the hurting to be unique and unusual compared with previously experienced headache or cervix pain episodes. Nevertheless, pain was often interpreted initially equally migraine or musculoskeletal in nature by the patient or the treating doctor." See scary causes of neck pain for more detailed red flag information about this.
Facial numbness is routinely a sign of a dangerous cancer or infection (meet Ugradar) — please ever take this symptom seriously! Otherwise, I am referring to weakness, disturbed vision, or any other neuro-ish symptom. Obviously it's an emergency if you detect any of the large-3 stroke signs: face drooping, arm weakness, speech difficulty.
Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-nineteen infection. EClinicalMedicine. 2022 2020/04/06. PainSci #52605 ❐
Report of the WHO-Communist china Joint Mission on Coronavirus Illness 2022 (COVID-19). Accessed 2020-04-06.
Ingraham. Chronic, Subtle, Systemic Inflammation: One possible sneaky cause of puzzling chronic hurting. ❐ PainScience.com. 9601 words.
This virus seems to provoke more cytokine production than, say, the common common cold, and it's the cytokines that primarily cause the symptoms of "sickness behaviour." Information technology'southward also probably prone to information technology because it'southward a more serious infection — they call it the "novel" coronavirus considering information technology'due south new to us, a virus too different from other coronaviruses for our immune system to have whatever experience with it.
I had ever been "decumbent" to aches and pains, which is really why I started this website. But in 2022 I graduated to the pain big leagues: serious chronic hurting, fatigue, and exercise intolerance plus many other baroque symptoms, all unexplained, making me a archetype fibromyalgia patient. You tin can read my chronic pain story on my personal web log: "Chronic Hurting & Tragic Irony."
Alan's headaches are nasty by near people's standards, but notwithstanding well within the realm of possibility for tension headaches. He has a low-class dull throb in the back of his head almost all the time. It usually worsens throughout the day, merely he tin can still work and play through the fog of discomfort. Roughly weekly, he has a flare-up of pain intense enough to end normal action; he could still function in an emergency, but he normally just goes to bed early and it's back to the dull throb in the forenoon, like a balmy hangover.
Judith's headaches are bad plenty for their nature to be cryptic: can a tension headache really exist this bad? It is possible, but at this level you lot practice have to start wondering if in that location'south more going on. Judith has pain equally abiding as Alan's but more than intense: it'due south almost e'er difficult for her to think clearly, difficult to speak and make normal facial expressions, difficult to sleep and practise — some days she can, some she can't. She can usually muddle through at work, simply she takes all her sick days, usually to accommodate her occasional episodes, which are as harsh as any migraine she'southward ever heard of (merely without classic migraine symptoms), until she regresses to her miserable mean.
Aaron'south headaches are too severe non to strongly suspect something more than than "tension." Similar Judith, his pain is substantial and abiding and has been for a long time, simply he also has severe episodes that develop rapidly, and are so frequent and disabling that he can't hold down a normal job, so he's become erratically self-employed and financially stressed. He almost never can sleep or exercise properly, and so he feels like he'southward aging rapidly, and is starting to develop widespread aches and pains. Theoretically all of this could still be "just" a tension headache, merely it would have to exist very rare.
Not the very worst possible. In this reckoning, we trim off the extreme outliers, and only consider the boilerplate of all other cases that would exist considered severe.
Zanchin 1000, Dainese F, Trucco Grand, et al. Osmophobia in migraine and tension-blazon headache and its clinical features in patients with migraine. Cephalalgia. 2007 Sep;27(9):1061–1068. PubMed #17681021 ❐
Seeing shapes, bright spots, flashes. Hearing noises or music. Jerking or twitching. Pins and needles in an arm or leg. Problem speaking. Just about annihilation hallucinatory or brain-disturbed. People with migraine auras sometimes think they are having a stroke.
"Not tonight, dear, you'll requite me a headache."
Headache-simply VAD might be anywhere from 10 and l% of cases. The uncertainly is probably because it matters when you ask: the symptoms tin evolve over several days, equally with any injury. Arnold 2006, Kerry 2009, and Maruyama 2022 all propose lower numbers. Bogduk, a specially skilful source cited a lot in this guide, goes much higher:

Sixty percent of patients with aneurysms of the vertebral artery or the internal carotid avenue present with headache every bit the sole characteristic. Within a thing of a few days, aneurysms typically declare themselves by the onset of neurovascular features. However, during this period, the headache may be misdiagnosed equally common cervicogenic headache, unless the practitioner is alert to the possibility of aneurysm.
Leddy JJ, Haider MN, Ellis M, Willer BS. Exercise is Medicine for Concussion. Curr Sports Med Rep. 2022 Aug;17(8):262–270. PubMed #30095546 ❐ PainSci #52267 ❐
More from the Mayo Clinic resource page on mail-concussion syndrome: "In well-nigh people, mail service-concussion syndrome symptoms occur within the offset seven to 10 days and become away within three months, though they can persist for a year or more than."
Jy Ong J, Bharatendu C, Goh Y, et al. Headaches Associated with Personal Protective Equipment - A Cross-exclusive Report Amongst Frontline Healthcare Workers During COVID-19 (HAPPE Report). Headache. 2022 Mar. PubMed #32232837 ❐ This is just a survey of nurses who already had a headache problem, who "either 'agreed' or 'strongly agreed' that the increased PPE usage had affected the control of their groundwork headaches." In that location'due south more substantive evidence that I will talk over below.

There are 170 more footnotes in the total version of the book. I really like footnotes, and I endeavor to have fun with them.

Jump back to:

The introduction
Paywall & purchase info
Tabular array of contents
Top of the footnotes

CURRENCY ?

Paying in your own (non-USD) currency is always cheaper! My prices are prepare slightly lower than current exchange rates, but most cards charge actress for conversion.

Example: as a Canadian, if I pay $xix.95 USD, my credit carte converts it at a high rate and charges me $26.58 CAD. But if I select Canadian dollars here, I pay only $24.95 CAD.

Why so unlike? If you pay in U.s.a. dollars (USD), your credit carte du jour will convert the USD price to your bill of fare's native currency, but the bill of fare companies often accuse too much for conversion — it's a way for them to make a little actress money, of course. And so I offer my customers prices converted at slightly better than the current charge per unit.

read on any device, no passwords
refund at any fourth dimension, in a week or a year
call 778-968-0930 for purchase help

garfieldourn1970.blogspot.com

Source: https://www.painscience.com/tutorials/headache.php

Garfield Ourn1970

Can You Get an Mri for Headaches Unnecessary Testing Leads to Anxiety

The Complete Guide to Chronic Tension Headaches

Chronic tension headache: how long tin can they last?

The nature of the beast: what is a "tension" headache?

How stress makes heads ache (peradventure)

Simply information technology'due south not all near tension

Diagnosis of Tension Headache

Is headache a symptom of COVID-19? (Or other common infections?)