Tag Archives: headache

THE MONSTER OF ALL HEADACHES

migraine

Did you know there are 11 types of headaches, each with varying causes and symptoms, and all are painful in fluctuating degrees? Fortunately, most headaches are common and short lived, however one type of headache may prove to be life altering.

Migraine headaches typically occur on one side and may be accompanied by throbbing, nausea, and/or sensitivity to light and sound. Some may experience an aura of lights or flashing just prior to the migraine and while there are different triggers to set off a migraine, there is more and more evidence of genetics playing a role.

Common migraines may last one to several days and may be alleviated by OTC (over the counter) medication like Ibuprofen, rest, or ice. Chronic Migraines, however, are more serious and more difficult to treat.  These headaches last 15 or more days a month for a period of three or more months. In the past, prescription medications were commonly used as were alternative approaches like meditation and acupuncture.

Some fast facts about migraines:

  • They affect over 4 million people daily in the United States
  • 85% of all sufferers are women
  • 70% have a family history of migraines
  • 91% are unable to work or function normally during their episodes

While medications are helpful for the onset of a migraine attack, it is important to avoid overuse of these medications. Currently the only FDA approved intervention for Chronic Migraine is Botox or Onabotulinumtoxin A and has been in use for over ten years. It is also effective in relieving spasticity (muscle contraction) and cervical dystonia (painful spastic twisting of the head). The treatment is performed in office and takes about 30 minutes or less. A tiny dose of the Botox is injected into specific nerve endings to block pain signals to the brain. The most common side effect is a temporary sore neck which may be alleviated with icing.

Ashot Kotcharian, MD is a Board Certified Interventional Pain Management physician at Sarasota Orthopedic Associates. He joined the orthopedic group after serving as Assistant Professor of PM&R at Johns Hopkins University School of Medicine. SOA has three locations and offers appointments on a same day/next day basis when needed. For more information go to www.SOA.md or call 941.951.BONE.

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HELP FOR THE LADIES: HOW TO MANAGE YOUR ORTHOPEDIC PAIN

Does gender affect orthopedic injuries and conditions? The simple answer is:  you bet it does.  Consider the differences and where women are at higher risk and experience conditions exclusive or largely related to gender. More important, let’s look at how women can prevent risk.

Feet and Ankles

With 26 bones and 33 ligaments, so much can go wrong on both men and women. While genetics is a factor, women are two times more likely to experience foot injuries than men. So, what’s the variance? Those shoes! Stiletto heels … flip flops … pointy toes … any of these can cause a number of painful conditions like hammertoes, plantar fasciitis, bunions, poor posture, back pain and ankle strain. What to do? Be sure to stretch your calf muscles daily, opt for wedges when you want height, look for shoes with support, and alternate heel heights daily.  Check out Vionic.com for some stylish, yet practical choices.

spike shoes

Knees

Women have a higher risk for ACL tears than men. There are several theories as to why, however a common belief is that the space in a woman’s knee is narrower, leaving it at greater risk than men. Strengthening exercises like seated leg raises, side-lying leg raises, and calf raises may help. Always check with your physician prior to starting any exercise routine.

Headaches

Women are more prone to experience headaches, particularly tension headaches and chronic migraines. Of headache sufferers in the U.S., 70% have a family history of headaches and for chronic migraines, 85% are women. Among the reasons, aside from genetics, are diet, allergies, stress, sound, hormonal changes, and posture. There are multiple treatments for headaches including Botox injections of the head and neck to relax muscles. An Interventional Pain Management Physician can determine if you are a candidate.

Shoulders

This topic is common with women. Carrying a large shoulder bag can throw your body out Botof alignment causing multiple conditions. “Heavy Purse Syndrome” can create shoulder and neck pain from muscle overuse. It can also throw your entire body out of position and affect your gait. A change in posture may lead to falls.  There are a few things you can do to avoid discomfort: Use a wide strap for your bag and frequently alternate sides for carrying. Remove items you don’t need … do you really need to carry your partner’s keys or all those pens and candy? Make sure your bag weighs no more than 10 pounds.

shoulder bag

Back and Neck

Back and neck pain may be related to any number of reasons including a too-heavy purse, poorly fitting shoes, or weak muscles. Even frequent texting lowers your neck and can put extra pressure on your neck and spine … it’s good to follow mom’s wise words, “Sit up straight”! When lifting heavy objects be sure to lift properly by maintaining a wide base of support at your feet, squatting from the knees and hips (NOT at the waist), and maintaining a straight back. Pregnant women are more susceptible to low back pain due to swelling tissues along with changes in the musculoskeletal system. If a woman has back pain prior to pregnancy, she is two times more likely to experience it during the pregnancy.

Osteopenia / Osteoporosis

Lastly, the aging process may sometimes be unkind. Osteoporosis is a common condition affecting over 10 million Americans. Of those, 80% are women. It is predicted that one in two women over the age of 50 with osteoporosis will eventually break a bone. What to do?  Exercise and diet play a significant role in keeping bones healthy.

What’s a girl to do? The good news is that YOU are in control. Keep these helpful hints in mind:

  • Strengthen your muscles with exercise
  • Watch your diet and maintain an optimum weight
  • Practice good posture
  • Empty out that purse
  • Wear smart shoes with support
  • Lift properly
  • Use a cross body purse instead of a shoulder bag
  • See your physician if discomfort persists

One small change can make a huge difference. Be well!

Sarasota Orthopedic Associates has three locations and offers same day / next day appointments when needed. Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

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Meet Ashot Kotcharian, MD: Interventional Pain Management Physician

Kotcharian lab crop

This is a continuing series of interviews we do with our physicians here at SOA. Dr Ashot Kotcharian is a Board Certified/Fellowship Trained Physical Medicine & Rehabilitation Physician with a specialty in Interventional Spine and Sports Medicine. Dr Kotcharian has a strong background in interventional therapies for spine disease, complex pain syndromes, peripheral joint disease, and sports injuries. He served a most distinguished career in medicine as Assistant Professor of PM&R at Johns Hopkins University School of Medicine. Learn more about what motivates him and how he spends his time when not at work.

What inspired you to become a physician? What inspired me to become a physician is the legacy of my great grandfather. He was my namesake. Although I have no memory of him I grew up hearing so much about him. Before me he was the only physician in our family history. I grew up listening to stories of his work and all the good he did treating those who were ill.  I knew early on that just like my namesake I too wanted to have a career that can result in good to others and help those who are ill. One of my younger sisters was born with epilepsy and has a learning disability. As a young boy I witnessed how much my parents cared for her. From city to city, hospital-to-hospital, my parents searched for the best medical treatment available. Seeing her go from one hospital to another, I wondered why nobody could help her become better. I watched my parent’s worried faces and how hard they tried to get answers and care for my sister. Once they were able to get her the care she needed and the doctors were able to get her seizures under better control the relief and joy it brought was immeasurable. This is what I wanted to do with my life.  I wanted to be able to take away peoples pain, fear and confusion and give them hope and relief.

Why orthopedics? While on my journey through medical school and residency training what I found myself enjoying the most was anatomy and musculoskeletal medicine. I learned how crucial good understanding and knowledge of anatomy can be in diagnosing nerve injuries, ligament tears, or radiculopathies. I developed a greater interest in diagnosing and treating patients who presented with muscle and tendon injuries, repetitive stress injuries, as well as back and radicular pain to name a few.

What do you love most about your job? I love how in this field the convergence of good anatomical knowledge, physical exam skill, and history taking can often lead to diagnosis without a need for invasive tests.  I get a satisfaction out of being able to arrive at the solution simply from what the patient told me and what I find on my physical exam. I get a satisfaction from knowing that I was able to treat disabling pain be it from back, muscle or tendon injury, without the need of invasive surgery.

What is your biggest challenge? Helping my patients through difficult diagnoses where treatment options are few and without a “cure” can definitely be challenging.  I would also say that being able to convey the importance of daily exercise, stretching, as well as proper posture is another big one.  While I have a lot of skills and tools with which to help stop pain, its what the patient is able to do on their own at home and in their daily life that can really keep the pain from coming back. If I weren’t an orthopedic physician I’d be either a martial art instructor or a university professor. Although, to be honest, this is a difficult question, because I can’t see myself doing anything else. I truly love what I do and I am very passionate about it.

Your proudest moment? My proudest moment is completing my fellowship training.  As I looked back at my journey through medical school, residency, and fellowship I knew I was becoming the person I wanted to be and the person I wanted my sister and great-grandfather to be proud of.

Where is the most interesting place you’ve travelled?  Why? It would have to be Rome.  The layers and layers of ancient history, the architecture, the people, and the food were truly amazing.

Any hobbies?  Activities? One of my biggest passions outside of medicine is martial arts, exercise, and mindfulness meditation. I have been a student of martial art since I was just a kid. Most of my studying and training has been in Taekwondo and I have earned a rank of 2nd degree black belt. I have also studied some techniques of hapkido, karate, kungfu, and Brazilian jujutsu while attending a mixed martial arts school. What I love most about martial arts is the respect, the discipline, the mindfulness, and the physical exercise.

What’s your next adventure? I don’t really know. I am pretty happy exploring the Gulf Coast for now.

Your guilty pleasure food? Oh gosh, too many probably.  Hamburgers, Chinese food, fried chicken, pizza, oh now you’re making me hungry!

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Sarasota Orthopedic Associates has three locations and offers same day/next day appointments when needed.  For more information on Dr Kotcharian or any of our physicians click here.

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Meet Dr Raye: Interventional Pain Management Physician

Raye lab cropped

We sat down with Sarasota Orthopedic Associates physician, Dr Justin Raye to learn what motivated him to pursue the medical profession and how he helps his patients non-surgically.

What inspired you to become a physician?

I always had an interest for human physiology as well as health/fitness, which led me to pursue a major in Physiology and Kinesiology at the University of Florida. As an undergraduate I volunteered in multiple different health/medical related fields in order to experience each possible career first hand. I became confident I wanted to become a physician after working closely with physicians within the Orthopedics and Sports Medicine Institute at UF. I felt I was able to align my interests for athletics and human physiology while having the opportunity to closely interact and affect the lives of those within my community.

My father suffered from heart disease and had to undergo multiple cardiac procedures under the care of multiple different medical teams. When I was in high school he underwent his second open-heart surgery at Shands Hospital in Gainesville Florida. I was able to observe the interaction between multiple physicians as they helped care for my dad with the common goal for him to have the most successful outcome. Everyone was very professional and caring as they put in long hours yet always took the time to make sure my family was thoroughly informed. I knew from that experience that one day I wanted to put in the hard work so I would have the chance to be a part of a team in order to help others live their best quality of life with their family by their side.

My mom is a nurse and has always been a positive influence as I expressed interest in a medical career. She has always been someone in my family to talk to with a common interest of medicine.

Why orthopedics?

The musculoskeletal system and the biomechanics regarding movement of the human body have always been strong interests of mine throughout my medical education. I enjoy interacting with others while applying my knowledge in order to help my patients improve their pain in order to improve their overall quality of life.

What do you love most about your job?

I enjoy affecting someone’s life in a positive way whether it’s by performing a procedure to decrease their pain or by taking the time to listen to and educate them on something that will impact their health. I can’t express how much I enjoy hearing that someone is getting better or moving back to some of the activities they love because their pain is improved.

What is your biggest challenge?

I enjoy listening to my patients and clearly explaining to them their problem while at the same time making sure they understand all planned treatments.  I wish I could take even more time with each patient. I definitely do my best to answer all questions because it is important to me for my patients to be well informed regarding their care.

If you weren’t an orthopedic physician, what would you be doing?

If I weren’t an orthopedic physician I’d be a professional soccer player in Barcelona (HaHa). Realistically though, I would have probably further explored my undergraduate major of exercise physiology and looked into teaching at the college level or becoming a strength and conditioning coach for a university or professional athletic team.

Your proudest moment?

Graduating medical school. The hard work and sacrifices along the way make an accomplishment that much better when you finally achieve it.  I would never change a thing and ask myself, how can use my knowledge to improve the lives of others.

Where is the most interesting place you’ve travelled?  Why?

I recently travelled to St Lucia for a week to relax and take in the culture/beauty of the island. We were able to spend several hours on the beach but also had the opportunity to hike the Gros Piton Mountain, go snorkeling in the coral reefs, and sailing at sunset.  We are already planning our next vacation- Spain or a short Euro trip!

Any hobbies?  Activities?

I really enjoy playing and watching just about any sport. I grew up playing soccer and always enjoy a game of pick up basketball. I plan to get more involved with golf. I am a big Florida Gator fan and try to get to Gainesville for football games as much as I can.  I enjoy being outside whether it’s boating, fishing, paddle boarding or just spending time with family and friends.

What’s your next adventure?

I am always looking for a new place to explore and trying new things. My sister recently told us that Barcelona has been one of her favorite places that she travelled which is high on our list. I am open to all suggestions.

Your guilty pleasure food?

Pizza for sure. I also enjoy a good burger and BBQ ribs.

Dr Raye is an Interventional Pain Management Physician at Sarasota Orthopedic Associates and his treatment focus includes, but is not limited to, back/neck pain, sciatica, spinal compression fractures, headaches, and chronic regional pain syndrome. His therapies include RFA, SCS, and regenerative therapy among many other non-surgical treatments. SOA has three locations and accommodates patients on a same day/next day basis when needed.

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TEXT NECK? What You Need To Know …

texting adults

Those who experience pervasive, uncomfortable symptoms such as neck and shoulder pain, headaches, and numbness and tingling in the arms and hands might be surprised to learn that smartphone use could be the culprit. “Text neck” is caused by poor posture while using handheld devices. The average head weighs about 10 pounds, which puts substantial weight on a neck bent at 60 degrees to read a smartphone screen. While this condition is an epidemic, it’s also preventable. Untreated, this may cause damage to the neck or spine. Here’s what smartphone users need to know about avoiding text neck.

Adjust Posture

The correct way to look at a phone to avoid straining your neck is to hold it at eye level. Your head should be held upright with ears directly above your shoulders. While on a phone call or streaming media, using headphones can help encourage better posture.

Switch to the Desktop

Save long articles to read later at the monitor, where positioning makes users less likely to compromise posture. Instead of checking and replying to emails on the phone, set aside time every day to do so at the desk rather than bending your neck uncomfortably.

Take a Break

It’s called text neck for a reason. Rather than relying on texting alone, reduce symptoms by picking up the phone and calling the recipient for more lengthy conversations. While taking a break, stretch your neck and shoulder muscles to provide relief. Set an alarm on the phone to encourage hourly breaks.

Use Voice Dictation

Take advantage of this smartphone function to dictate messages while holding your head upright. This will help reduce the amount of time spent looking at the screen.

If you’re struggling with symptoms of text neck you may want to consult with one of our physicians at Sarasota Orthopedic Associates. We offer diagnosis and non-invasive treatment of issues that affect the musculoskeletal system. We offer same-day appointments when needed at our three convenient locations.  The mission of SOA is to get our patients back on their feet, back to work, back in the game, and back to life.

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TEXT NECK … Is that really a “thing”?

texting adults

Indeed it is. Think about it. We spend much of our day with our heads lowered to read our smartphones. It’s not unusual to see people “text-walking” or worse, driving while texting. With all the advantages of having a world of information at our fingertips, there is also an associated health risk.

There are over 4 billion mobile devices in the world and the average American usage is 2.7 hours per day communicating on these devices. It’s no wonder we have sore necks and shoulders. In fact, it’s becoming an epidemic affecting millions and it’s growing.

Constant lowering of the neck to look downward puts the spine in an unnatural curve that can cause reduction in the cervical spine, thus creating a “pain in the neck”. Worse, that pain can radiate through the shoulders, creating tension, and even debilitating headaches. As the situation intensifies, the arms may become weak, numb, or tingle. Over time, this pattern can become lingering and as a result, a challenge to treat.

The average head weighs about 10 pounds. When tilted downward 15 degrees, the force of your head on your cervical spine increases to about 25 pounds. The more tilt, the more weight; that can be up to as much as 60 pounds of force on your neck. Prolonged tilting downward creates excessive strain causing stress injury. Over a long period of time it may even lead to spinal misalignment, early onset of arthritis, disc compression, or nerve damage.

text neck

So how do we combat this growing concern? Resistance and strengthening are keys to reinforce the neck and shoulder muscles and offset damage. Taking frequent breaks, maintaining good posture, and doing neck stretches help circumvent damage. Most important, when using a mobile device, place it at eye level to avoid tilting of the neck. Remember … Hold Your Head Up!

If you believe you have “text neck” or any form of musculoskeletal pain, Sarasota Orthopedic Associates has four convenient locations to help you alleviate your discomfort. We offer same day appointments when needed. Give us a call at 941-951-2663 (BONE) or check our website here for more information.

 

Sources:   WFLA; LA Times; Today Health & Wellness

CERVICOGENIC HEADACHES

Headache1      cervicogenic headache

Cervicogenic headaches are characterized as head and neck pain originating from the cervical region, a type of secondary headache. This classification is due to the source of the headache being in the neck.  Cervicogenic headaches may be from muscle pain and spasms of the neck muscles, cervical facet joints, or the occipital nerve, located at the base of the skull.  Multiple studies have indicated that cervicogenic headaches may be under-diagnosed, with estimates of prevalence ranging from 2% up to 22%.

Any injury to the neck or cervical region of the spine can lead to cervicogenic headaches. This injury may be an acute, sudden injury resulting from an automobile accident, a sports-related injury, or a fall, or it may be the result of a long-term sustained injury caused by bad posture or degenerative changes with age.

Cervicogenic headaches rarely present auras or nausea that are commonly associated migraine headaches and the pain is not responsive to traditional migraine medications.  However, cervicogenic headaches have been known to precipitate migraine headaches. Appropriate diagnosis of cervicogenic headaches is done by a thorough history and physical exam. Another way in which cervicogenic headaches can be readily diagnosed is if treatment of the neck is able to provide rapid relief from the headache.

PT myofascial release

The specific treatment for cervicogenic headaches varies by patient and by what is found to be the cause of the headaches. If the problem found in the neck is a result of musculature, then muscle-specific treatment options may provide relief. Such treatments include muscle relaxants, physical therapy including myofascial release, and/or trigger point injections into the muscle. For patients whose cervicogenic headaches are a result of damage to the cervical facet joints, there is often underlying inflammation contributing to pain generation. In this case, an interventional procedure known as a radiofrequency ablation (RFA) can block the pain signal being generated from the joints. To directly address the nerve triggering the cervicogenic headache, the occipital nerve, nerve blocks can be administered to inhibit the problematic signaling.

Appointments are made by calling 941.951.BONE (2663). Visit our website by clicking  here for more information about Sarasota Orthopedic Associates.