Dr. Richard Bruno is Chairperson of the International Post-Polio Task Force and Director of The Post-Polio Institute and International Centre for Post-Polio Education and Research at Englewood (NJ) Hospital and Medical Center. His new book, The Polio Paradox: Uncovering the Hidden History of Polio to Understand and Treat "Post-Polio Syndrome" and Chronic Fatigue, will be published by Warner Books in June 2002. Please e-mail questions directly to him at ppsforum@newmobility.com.

Note: This column is for information purposes only and is not intended as a substitute for professional medical advice.

Q: At least once a week I get a sharp pain on one side of my head, sometimes the left, most often on the right. I sometimes I wake up with a headache, but also get one at the end of the day when I am tired. My neck also hurts on the side where my head hurts and I often feel nauseated. My doctor says I have migraines. But I don't have flashes in front of my eyes and I have thrown up only once. Is my headache a migraine?

A: Probably not. Patients tell me they have migraine headaches because they have pain on one side of their head plus nausea. But despite the nausea, most polio survivors don't have migraines. Headaches in polio survivors are most often the result of muscle spasms in the neck, upper back and shoulder muscles. When a muscle on one side of the neck goes into spasm, it causes not only a one-sided headache but also pushes on the vagus nerve in the neck--the nerve that makes the stomach "turn on"--and causes nausea (January 2002 PPS Forum). Such single-sided headaches sound like migraines, but aren't.

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Unfortunately, polio survivors are prone to muscle spasm pain. In our 1985 national survey, headaches were reported by one third of polio survivors while neck and back pain occurred in nearly three-quarters. Why are polio survivors spasm-prone? Many have muscle imbalances, where stronger muscles on one side of the body spasm when they try to compensate for weaker ones. Weak muscles spasm when they are being forced to do too much work. And poor posture forces weak muscles to try to hold you up so you don't topple over. Muscle imbalances, compensation and poor posture in your neck, arms, shoulders and upper back--even your lower back, hips and legs--can lead to neck muscle spasms and headaches. When it comes to posture and spasms, the tail bone is connected to the head bone.

Spasms are also triggered by emotional stress. Our post-polio surveys found that anxiety and hard-driving type A behavior are common headache triggers and that emotional stress is the number one cause of neck and back pain.

How do you treat headaches and other muscle spasm pain? First, you need to make sure that the pain is indeed caused by a spasm. A morning headache can also be a symptom of sleep apnea (May 2002 PPS Forum). A daytime headache can be a sign of high blood pressure or hypoglycemia.

But if spasms are causing pain, you need to take the stress off your muscles and correct imbalances from head to toe. You need to slow down, pace activities and rest during the day, even lie down for your two 15-minute rest breaks. You also need to balance your body, front to back and side to side--so that weak muscles don't have to fight gravity to keep you upright. Painless posture is crucial, whether sitting, standing or walking (See "Oh My Achin' Back").

A physical therapist with lots of experience treating both PPS and chronic pain can help. Therapists can teach proper posture and suggest braces and assistive devices to balance your body while standing and walking. Using a lumbar cushion while sitting--and a contoured, fiber-filled cervical pillow while sleeping on your back--ensure good posture and turn off back and neck spasms day and night. Since heat is usually more helpful for spasms than is ice, physical therapists can do ultrasound--the deep heating of muscles using sound waves--and you can warm your muscles at home by taking a hot bath or shower and by using a heating pad.

But be careful. Too many physical therapists use the "shake and bake" method: gentle massage after your muscles have been heated by a hot pack. Although massage and heat can relax muscle spasms and make you feel better for a few hours, if you don't take the stress off your muscles and change posture, the spasms and pain will return.

Once your spasms do start to relax, a home stretching program is indispensable. With help from your PT, find a few stretches for the specific muscles in spasm. Stretch just before bed, first thing in the morning, every half hour during the day and whenever you feel muscles tightening. A handful of stretches combined with reduced stress, proper posture and rest will keep muscles relaxed day and night, prevent spasms and stop those headaches!