Headache and Migraines

It is estimated that between 75-90% of the population experience one or more headaches every year.  Most of these will be benign and but mildly annoying, however, some will be debilitating and have a significant impact on well being (2,7,9). Because headaches are so common, most people think that getting a headache is a normal part of life .  

Common headache causes include:


Tension Type Headache

About 38% (1) of the headaches are tension headaches.  Whilst they share considerable overlap with migraine, they are distinguished by the role the cervical spine and the scalp, neck and upper shoulder soft tissues.

You may experience a tight vice like feeling in the head as well as soreness in the shoulder or neck regions. This may include ‘trigger points’¹ in overused muscles that refer pain into the head region (7). Persistent Headaches may be accompanied by depression, anxiety and sleep disturbance. Visual OR hearing sensitivity may also occur but less intense than in migraines. Imbalances in the neck muscles may also be found and most people tend to have neck problems (8).

Migraine

About 15% of the general population have migraine, which has substantial health and socioeconomic costs (2). Migraine is usually unilateral with pulsating and moderate/severe headache which is aggravated by excertion. It can be accompanied by light and noise sensetivity, nausea and sometimes vomiting (3).Migraine exists in two major forms, migraine without aura and migraine with aura.  Those who get an ‘aura’ within 30- 60 minutes prior to the headache may experience various visual and or, speech disturbances, plus sensory disturbances, such as numbness or parasthesia around the mouth or face. Individual variations between attacks are common. The cause of migraine is debated and unclear (3).  Some triggers may include stress, lack of sleep or over sleeping, missing a meal, diet, certain medications, caffeine, alcohol, hormonal and weather changes. Migraines have a definite genetic link and are noted as a disease process. Management for sufferers may include:

1. Understanding what are your triggers.
2. Becoming aware of the sometimes subtle ‘prodromal’ impending signs.
3. Taking action as early as possible to minimise or prevent the headache.  This may includes manual therapy such as a chiropractic adjustment (4,5) and other practical strategies.

Cervicogenic Headache

Only about 4% (6) of headaches have a direct link to cervical spine dysfunction. A history of neck trauma can usually be found within a short time of headaches commencing. The majority of headaches arise from structures innervated through the upper cervical spinal nerves. (Including discs, facet joints) Typically the pain is of a dull and aching nature to the neck and head. Movement of the neck can aggravate or relieve the pain.

Cluster Headache

These are characterised by clusters of short lived attacks of severe pain, usually around the eye and more common in men. These can occur daily over a period of several weeks and due to the short duration of each episode (15-180 minutes), analgesics offer not much assistance.  The pain can be one sided around the eye region or temples, facial sweating, teariness, runny nose, swollen or drooping eyelids can occur and can start in seconds.  Research suggests that cluster headaches may be related to the sinuses, the nervous system, or biochemical disturbances (7,8).  

Sinus Headache

Headache causes, types and treatments can get confusing. Migraine is often misdiagnosed as sinus headache, for example. A sinus headache from sinusitis happens when you get an infection and your sinuses become inflamed. You usually have other symptoms such as congestion, fever and fatigue
 
Other headache causes and treatments

There are many more reasons why you may have a headache, such as high blood pressure, infections, allergies, alcohol and drugs are other examples (7,*).

How does chiropractic help?

Headaches may be symptomatic of an underlying condition such as hypertension, infection or other issues. If pain is present for more then a couple of days seek attention from your primary care provider. There are a number of effective treatments for headaches, such as manual therapy and appropriate self management strategies, for example appropriate excercises, advice on posture, ergonomics and sleeping positions (1,3,4,5)


References:
(1) Fernández-de-las-Peñas et al. Myofascial trigger points and sensitization: an updated pain model for tension-type headache. Cephalalgia, 2007, 27, 383–393
(2) Russell MB,Kristiansen HA,Saltyte-Benth J, et al. A cross-sectional population-based survey of migraine and headache in 21,177 Norwegians: the Akershus sleep apnea project. J Headache Pain 2008;9:33947. doi:10.1007/s10194-008-0077-z [CrossRef][Medline][Web of Science]Google Scholar
(6)  Hall T, Briffa K, Hopper D. Clinical evaluation of cervicogenic headache: a clinical  perspective. The Journal of Manual & Manipulative Therapy. 2008:16 (2) 73-80
(7) https://www.betterhealth.vic.gov.au
(8) www.headacheaustralia.org.au  Headache Australia is a division of the brain foundation established in 1970 by members of the Australian Association of Neurologists and the Neurosurgical Society of Australasia

Additional References:
  • The Clinical Training and Communication Program, Module 3 Headache & The autonomic Nervous System. A. Nicolson and M. Long (Version 2.1,2010) Chiropractic Development International, Wahroonga NSW.
  • Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther 1997; 20(5):326-30.
  • Boline PD; Kassak K; Bronfort G; Nelson C; Anderson AV. Spinal manipulation vs. amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther 1995; 18(3):148-54.
  • Nelson CF; Bronfort G; Evans R; Boline P; Goldsmith C; Anderson AV. The efficacy of spinal manipulation, amitriptyline and the combination of both therapies for the prophylaxis of migraine headache. J Manipulative Physiol Ther 1998; 21(8):511-9