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Dr. Rommel Hindocha, D.C.
Peninsula Spine & Sports Rehabilitation
1740 Marco Polo Way, Suite 4
Burlingame, CA 94010

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According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraines. About 20% of children and adolescents also have significant headaches. One of the most common reasons for headaches may be untreated whiplash injuries from automobile accidents. If you have been involved in a car accident an have not recieved an evaluation, please go to and get an initial evaluation now or call Peninsula Spine and Sports Rehabilitation for Dr. Hindocha’s initial exam.

Below is a list of the most common types of headaches.

Tension headaches: Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.
Migraines: The exact causes of migraines are unknown, although they are related to blood vessel contractions and other changes in the brain as well as inherited abnormalities in certain areas of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. They can last from 4 hours to 3 days and usually occur 1 to 4 times per month. Migraines are associated with symptoms such as light sensitivity; noise or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine they often look pale, feel dizzy, have blurred vision, fever, stomach upset, in addition to having the above listed symptoms. A small percentage of pediatric migraines include recurrent (cyclic) gastrointestinal symptoms, in which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis -- about once a month. These types of migraines are sometimes called abdominal migraines. Unfortunately, many headaches have been misdiagnosed as "Migraines".

Mixed headache syndrome: Also called transformed migraines, this is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common, although the most severe, type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term "cluster headache" refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last 2 weeks to 3 months. The headaches may disappear completely (go into "remission") for months or years, only to recur.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Acute headaches: Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician's office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.

Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull. Some studies have shown that hereditary may play a role in certain headaches especially migraines.

Headache pain results from signals interacting between the brain, blood vessels, and surrounding nerves. During a headache, specific nerves of the blood vessels and head muscles are activated and send pain signals to the brain. It's not clear, however, why these signals are activated in the first place. There is a migraine "pain center" or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin, and other inflammatory substances that cause the pulsation to be painful. Serotonin is a naturally occurring chemical essential for certain body processes.

Other causes of tension headaches include eyestrain and neck or back strain due to poor posture.

Arm, Wrist and Hand Injuries What are the most common types of injury to a hand or wrist?

Most sports are “hand intensive”. The hands and wrists are composed of many small bones, ligaments, tendons, and muscles. As a result the hand and wrist absorb a lot of wear and tear that can be both painful and debilitating. Most injuries to the hands and wrists can be categorized as either acute (usually single trauma induced) or chronic (overuse or repetitive use). Acute injuries usually occur in high contact sports. Included in this group of injuries are bone fractures, joint dislocations, sprains, ligament and tendon damage. Chronic injuries occur most often in sports with excessive repetitive movements such as baseball, tennis, and golf swings. Injuries in the chronic group include tendon inflammation and dislocation, nerve damage, and stress fractures. Acute injuries may require surgical repair whereas chronic injuries are less likely to do so.

When should I see my doctor about a hand injury? Most minor hand injuries can be treated with RICE (rest, ice, compression, and elevation). You should see your doctor if you have any of the following: severe pain, numbness, or swelling; coldness or discoloration in the wrist, hand or fingers; abnormal twisting or bending of a finger or hand; grinding sensation in hand, finger, or wrist movements.

The treatment will be determined by the severity of the injury. Finger injuries are often treated by splints or taping to an adjacent uninjured finger. For breaks and other trauma, braces and casts are sometimes necessary to immobilize the injured area.

Carpal Tunnel Syndrome

You're typing away at your desk and suddenly feel a sharp pain or numbness/tingling in your wrist, shooting into your thumb and hand. You take a small break and stretch your wrists, but it doesn't go away this time. It's quite possible that you are developing carpal tunnel syndrome - a neuropathy (nerve disorder) that often strikes people whose occupation requires frequent hand usage such as having a job that requires you to be at a work station. Frequent repetitive motions such as typing and use of a mouse accompanied by poor ergonomics can lead to this condition. Carpal Tunnel Syndrome (CTS) is a painful and often debilitating disorder affecting the hands and wrists. The symptoms of carpal tunnel syndrome include numbness and tingling in the hands, primarily the thumb and thumb pad, index, middle, and inner half of the ring fingers. Many sufferers of CTS report increased symptoms at night, making sleep difficult.

Advanced stages of carpal tunnel syndrome result in decreased fine dexterity movements of the fingers, such as buttoning a blouse, and reduced grip strength. Also, the thenar pad (palms) may undergo muscle atrophy (shrinking). Carpal Tunnel Syndrome occurs when the median nerve, one of the major nerves that supplies the upper extremity, is compressed in the carpal tunnel: a narrow passageway in the wrist formed by the carpal bones and the transverse carpal ligament- a strip of tendon that supports the wrist from the bottom.
The contents of the carpal tunnel include the median nerve and the flexor tendons of the wrist and fingers (the tendons that enable you to form a fist). Carpal tunnel syndrome is often the result of a combination of factors that press on the median nerve and tendons in the carpal tunnel. The disorder can also be due to a congenital (born with) predisposition where the carpal tunnel is smaller in some people than in others. Many times the cause of pain earlier diagnosed or thought of as carpal tunnel is actually related to some other area that the median nerve follows. Other areas of median nerve root entrapment include a ligament near the elbow or the area of the shoulder called the thoracic outlet and the cervical spine (neck area).