We are inundated with choices in every area of life compared to previous generations. There are now thousands of electricity and gas tariffs and suppliers that you can compare on hundreds of comparison sites. There are almost as many choices of hot and cold beverage in your high street coffee shop. While choice and personalisation can feel like a nice thing it can also leave us feeling overwhelmed and even when we do make a choice we often end up wondering whether we’ve really made the best one anyway.

It’s difficult enough choosing a coffee let alone choosing a clinic or a healthcare professional to help you deal with a chronic health condition. If you have a chronic health problem (or problems) it’s likely that you’ve tried various different ways of tackling it – from seeing  your GP or a specialist, to researching for yourself, self-help, or consulting other healthcare professionals. If all of these endeavours have not got to the bottom of your problem you’re likely to feel frustrated and disappointed at the waste of time, money, and hope – and the fact that you’re still suffering.

When you’re continuing to look for help and solutions it can be incredibly confusing. Even if we confine ourselves to back pain (approximately 1,110,000,000 Google results) the information and misinformation out there is truly mind-boggling. You want to make the best possible choices for you but how do you even begin to narrow down your options?

As a clinical team specialising in helping patients with chronic back pain we have some advice for you to consider when choosing (or not choosing) a clinic.

  1. Don’t choose a clinic or a clinician who can’t talk to you about and demonstrate the positive (and less positive) results that they have achieved with patients like you. By that I mean patients with very similar conditions to you. Back pain isn’t a condition, it’s a symptom. Back pain can have a myriad of causes. If someone simply says they ‘treat back pain’ they may not have the sufficient expertise to help with YOUR type of back pain.
  2. Don’t choose a clinic or clinician who can’t provide you with any patient testimonials or who nobody you know has ever had good results with. Check out their social media reviews or there are lots of social media forums (support groups for health conditions, local community groups etc. or just your friendship groups) where you can ask for recommendations or post about a clinic you’re thinking of visiting to see if anyone has any experience. Of course just because others have had good or bad experiences doesn’t automatically mean you will; but it can help to reassure you and make your choice easier.
  3. On the other hand don’t choose a clinic or clinician just because they helped your friend / auntie / brother-in-law’s half-sister. Their problems and needs might have been quite different than yours. Also speak to the clinic about your specific healthcare and personal needs to better establish if they are right for you.
  4. Don’t choose anything or anyone who claims a 100% success rate or to be able to treat every type of back pain. There is no clinical evidence of a single product or individual being able to demonstrate this kind of success.
  5.  Don’t choose a clinic without speaking to their team and asking lots of questions. You need to feel comfortable with the personality or ‘vibe’ of the clinic as well as its clinical reputation. If you don’t feel that they ‘get’ you and that you can put your trust in them you are far less likely to achieve satisfactory results. Some clinics (like ours) are very happy to have you visit the clinic to speak to someone in the team and have a look round before you book an initial appointment. This is a good thing. Take advantage of it.
  6. Don’t choose a clinic just because it has a shiny website or marketing materials. While this can sometimes indicate that the clinic is successful and professional it can also indicate that they have focused more on brochureware than on patient care. Have a look for yourself at the premises – perhaps pop in and speak to the reception team prior to booking an appointment. This will give you a better sense of the real clinic.
  7. On the other hand don’t choose a clinic just because it’s cheap. It’s often the case that you get what you pay for. Even good clinics run offers from time to time but clinics that consistently charge under the market rate for a service might have to do so because they aren’t good enough to hold on to their new patients.

Of course there are lots of other factors that can come in to your choice of clinic. But we’ll leave it to 7 for now. After all, you already have more than enough choices to consider. Venti Soy Quadruple Shot Latte with No Foam anyone?

It’s a bit of a cliche isn’t it? The stereotype of the headachey woman who uses ‘one of her heads’ as an excuse for anything from not wanting sex to skiving off work or just not wanting to deal with an emotionally-tense situation. As with most stereotypes there is certainly some truth in this one – science has proven that women really do suffer from more headaches. But science has also shown that headaches are not just in women’s ‘heads’ – in their minds – and we now understand much better why women are more prone to headaches than men.

Hysterical women?

It’s not that long ago that many doctors believed that headaches in women were due to ‘hysteria’  and an inability to manage stress. Women who experienced headaches (or mental health issues) were often ridiculed and dismissed when seeking help for their headaches and even seen as malingerers.

Thankfully our clinical understanding of headaches has moved on significantly with the advancement of research and clinical practice in fields including endocrinology, imaging and pharmacology. Historically the vast majority of medical research has been carried out using male patients but we increasingly understand that in many ways women’s bodies do not respond in the same way as men’s. In the case of headaches there are different things happening physiologically in the bodies of men and women, and ultimately, headaches are rooted in biology.

Women and Headaches

Many studies have been conducted that suggest women are more prone to migraines (around 3 times as many women as men) and they’re actually more prone to other types of general headaches as well.

One of the biggest reasons why women get more headaches is hormone fluctuation during the menstrual cycle. Oestrogen is a hormone that has been closely linked to headaches and it is much more prevalent in women. Both in terms of headaches and other types of chronic pain there is evidence that levels of pain tend to vary based through a woman’s menstrual cycle, and that some pains feel worse during the premenstrual period and during menstruation.

There’s also a phenomenon called cortical spreading depression (CSD) that is believed to cause headaches, and evidence that women may have a lower threshold for CSD compared to males. Another theory is that females have thicker gray matter in parts of the brain that manage pain processing, whereas other studies point to adverse childhood experiences and more exposure to physical abuse as reasons why women have more headaches.

Researchers have also found that women tend to experience stronger episodes of chronic pain that lasts longer than men. This goes beyond pain in the head and can extend to the neck, back, knee, and shoulder too. Other conditions, like fibromyalgia, rheumatoid arthritis, and irritable bowel syndrome, are also more common among women. When several of these conditions occur simultaneously in the body, the pain can become unbearable and lead to psychological problems and permanent disability. Too often these pain symptoms and conditions are seen and treated as ‘separate’ illnesses where they may actually have similar underlying causes and ‘interact’ with one another. Treatment for some conditions can even have side effects that worsen other pain symptoms (have a look at the possible side effects leaflets of many over the counter and prescription medications and ‘headaches’ will very often be inclued).

Men and Headaches

Although women are more prone to headaches overall, that certainly doesn’t mean that men don’t get them. Younger boys have more headaches than young girls – until girls reach puberty. Although headaches are more common among women there are specific types of headaches that disproportionately occur in men – cluster headaches, for example, are six times more frequent in men. Men in their 20s to 50s are most likely to develop these types of headaches, with genetics, smoking, and alcohol use

Some psychologists and doctors believe that in general, men focus on the physical effects of pain, while women focus on the emotional effects. Since emotions associated with pain are usually ‘negative’, those who focus on emotions may feel a second dimension of pain on top of the physical.

What can you do about your headaches?

If you suffer with severe or frequent headaches it can be debilitating. Fortunately in the vast majority of cases the underlying causes are not sinister (e.g. brain tumours) but it can be frustratingly difficult to identify what factors are causing your particular headaches to recur as it is often a combination of things.

There are a number of underlying medical conditions that can cause chronic headache symptoms – for example anaemia (low iron, B12, folate), Vitamin D deficiency and menopause – many of which can be checked for with a blood test and are quite easily treated. If you suffer with chronic headaches and your GP hasn’t spoken to you or looked into these possibilities it’s well worth speaking to them again.

Having an understanding of some of the things that can cause headaches specifically in women and keeping a headache diary might help you to identify patterns and triggers for your headaches and this can also be really useful information for your doctor or clinician. Your doctor may be able to advise lifestyle changes that might help – for example, reducing consumption of alcohol, caffeine and carbonated soft drinks.

If you’ve ruled out any sinister or underlying causes, tried some lifestyle adjustments, and you find that you are still having headaches, you might consider a consultation with a physical therapist – like a chiropractor or osteopath who specialises in treating patients with chronic headaches. Recurring headaches can often originate from, be made worse by, or be accompanied by, symptoms in the face,  jaw, neck, shoulders, and upper back. By looking at the patterns of tension and alignment in your whole upper body, and treating areas surrounding and connecting into your head, therapists may be able to  help you to achieve a gradual – or in some cases a rapid- improvement in both the frequency and severity of their headaches.

For many headache sufferers even knowing that their headaches are not ‘all in their head’ and finding a clinician who is able to look at their headaches from different perspectives and ‘believes’ them can be a powerful first step.