Headache is one of the most common disorders experienced in the population, with up to 15% of us taking pain relieving medication for headaches at any one time. Recurrent headaches have a significant impact on quality of life for those who suffer them. Often obtaining an accurate diagnosis of the cause and best course of management can be a frustrating process, with many sufferers being given multiple different diagnoses for their condition.
Headaches tend to be classified as either primary or secondary headache syndromes. A secondary headache is one which occurs as a direct result of an underlying medical condition. This can be as serious as a brian tumor or as benign as an ear infection. Primary headache is when the headache itself is the primary problem. These headaches include migraine, tension and cluster headaches.
There are over 200 different types of primary headache described in the literature, classified according to symptoms rather than an understanding of their pathology. This classification system was created by the International Headache Society and designed for research purposes, not for clinical use.
What Causes Primary Headache?
While it has long been accepted that there are pain sensitive structures in the head and neck, which when irritated can result in “cervicogenic” headache, the cause of many other primary headaches such as migraine have not been so well understood. The classification of headache and migraine contains significant overlap of symptoms and behaviour between many headache types.
Recent research has identified a second mechanism for the neck to contribute to the generation of headaches. This raises the possibility that these headaches and migraines may not be separate conditions, but instead often share a common driver, with the severity of the condition being a big determinant of the symptoms experienced.
The upper 3 levels of the neck share the same pathway in the brainstem as the trigeminal nerve, which supplies the head and face. Poor mechanics at these levels results in increased mechanical signals being transmitted through this pathway. In the nervous system, an increase in signalling along a pathway often leads to sensitisation of that pathway, acting like an amplifier in a stereo.
As a result, there is a heightened response to what would otherwise be perceived as normal signalling from the head and face, which may now be interpreted as painful, resulting in headache. Often this results in the appearance of triggers such as red wine, stress, exercise and hormonal changes as being responsible. Treatment to restore normal mechanics turns down the amplifier, normalising the brains processing of information from this pathway and reducing headache symptoms.
Essentially, anything which places that joints and muscles of the neck under prolonged excessive load may contribute to the onset of headache symptoms. This may include, poor posture, hypermobility, poor desk set up, degenerative changes to the neck, excessive physical loading at work, home or in the gym. Resolution of the headache symptoms involves first restoring normal joint and tissue mechanics of the neck. This will may involve the use of massage, stretch, joint mobilisation and quite specialised techniques to target specific levels of the neck involved.
Identification and removal or modification of the overloading factors is important to prevent recurrence of the symptoms. This may involve simple things such as modifying your desk set up to more involved interventions such as provision of exercises to strengthen the neck and shoulder postural muscles.
Diagnosis of the role of the neck in your headaches will involve a thorough history and physical examination of the neck and typically involves the use of quite specific techniques to stress the different levels of the neck to assess their possible involvement. So if you have been suffering from regular headaches, don’t continue to put up with pain and decreased quality of life. Contact one of our highly experienced physios today for and assessment and treatment plan to get you back In Balance!
Article by Jim Burke
