Headaches affect just about everyone at some point and they can present themselves in many different ways. Some people only experience pain in one part of their head or behind their eyes, some people experience a pounding sensation inside their whole head, and some people even experience nausea, while others do not. The pain itself may be dull or sharp and may last for anywhere from a few minutes to a few days. Fortunately, very few headaches have serious underlying causes, but those that do require urgent medical attention.
Although headaches can be due to a wide variety of causes, such as drug reactions, temporomandibular joint dysfunction (TMJ), tightness in the neck muscles, low blood sugar, high blood pressure, stress and fatigue, the majority of recurrent headaches are of two types: tension headaches (also called cervicogenic headaches) and migraine headaches. There is a third, less common, type of headaches called a cluster headache that is a cousin to the migraine. Let's start out by taking a look at each of these three types of headaches.
Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers. Most people describe a tension headache as a constant dull, achy feeling either on one side or both sides of the head, often described as a feeling of a tight band or dull ache around the head or behind the eyes. These headaches usually begin slowly and gradually and can last for minutes or days, and tend to begin in the middle or toward the end of the day. Tension headaches are often the result of stress or bad posture, which stresses the spine and muscles in the upper back and neck.
Tension headaches, or stress headaches, can last from 30 minutes to several days. In some cases, chronic tension headaches may persist for many months. Although the pain can at times be severe, tension headaches are usually not associated with other symptoms, such as nausea, throbbing or vomiting.
The most common cause of tension headaches is subluxations in the upper back and neck, especially the upper neck, usually in combination with active trigger points. When the top cervical vertebrae lose their normal motion or position, a small muscle called the rectus capitis posterior minor (RCPM) muscle goes into spasm. The problem is that this small muscle has a tendon which slips between the upper neck and the base of the skull and attaches to a thin pain-sensitive tissue called the dura mater that covers the brain. Although the brain itself has no feeling, the dura mater is very pain-sensitive. Consequently, when the RCPM muscle goes into spasm and its tendon tugs at the dura mater, a headache occurs. People who hold desk jobs will tend to suffer from headaches for this reason.
Another cause of tension type headaches comes from referred pain from trigger points in the Sternocleidomastoid (SCM) or levator muscle on the side of the neck. These are much more common in people who suffer a whiplash injury due to the muscle damage in the neck region.
Each year, about 25 million people in the U.S. experience migraine headaches, and about 75% are women. Migraines are intense and throbbing headaches that are often associated with nausea and sensitivity to light or noise. They can last from as little as a few hours to as long as a few days. Many of those who suffer from migraines experience visual symptoms called an "aura" just prior to an attack that is often described as seeing flashing lights or that everything takes on a dream-like appearance.
Migraine sufferers usually have their first attack before age 30 and they tend to run in families, supporting the notion that there is a genetic component to them. Some people have attacks several times a month; others have less than one a year. Most people find that migraine attacks occur less frequently and become less severe as they get older.
Migraine headaches are caused by a constriction of the blood vessels in the brain, followed by a dilation of blood vessels. During the constriction of the blood vessels there is a decrease in blood flow, which is what leads to the visual symptoms that many people experience. Even in people who don't experience the classic migraine aura, most of them can tell that an attack is immanent. Once the blood vessels dilate, there is a rapid increase in blood pressure inside the head. It is this increased pressure that leads to the pounding headache. Each time the heart beats it sends another shock wave through the carotid arteries in the neck up into the brain.
There are many theories about why the blood vessels constrict in the first place, but no one knows for sure. What we do know is that there are a number of things that can trigger migraines, such as lack of sleep, stress, flickering lights, strong odors, changing weather patterns and several foods; especially foods that are high in an amino acid called 'tyramine'. You can reduce the likelihood of migraine headaches by making some lifestyle changes. Many migraine sufferers find it useful to avoid caffeine which is found in chocolate, coffee, tea, cola and other beverages. Unfortunately a sudden significant decrease in caffeine consumption can also trigger a severe headache or migraine, so it is best to wean oneself off of caffeine slowly. Chiropractic care can help minimize symptoms while reducing caffeine consumption.
We also recommend avoiding cigarette smoke (even second-hand), chemical cleaning products and artificial air "fresheners", and synthetic fragrances including those found in scented hair and bath products and laundry detergents. All of these can trigger migraines in sensitive individuals.
Cluster headaches are typically very short in duration, excruciating headaches, usually felt on one side of the head behind the eyes. Cluster headaches affect about 1 million people in the United States and, unlike migraines, are much more common in men. This is the only type of headache that tends to occur at night. The reason that they are called 'cluster' headaches is that they tend to occur one to four times per day over a period of several days. After one cluster of headaches is over, it may be months or even years, before they occur again. Like migraines, cluster headaches are likely to be related to a dilation of the blood vessels in the brain, causing a localized increase in pressure.
Chiropractic Care for Headaches
Numerous research studies have shown that chiropractic adjustments are very effective for treating tension headaches, especially headaches that originate in the neck.
A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that "spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than commonly prescribed medications." These findings support an earlier study published in the Journal of Manipulative and Physiological Therapeutics that found spinal manipulative therapy to be very effective for treating tension headaches. This study also found that those who stopped chiropractic treatment after four weeks continued to experience a sustained benefit in contrast to those patients who received pain medication.
Each individual's case is different and requires a thorough evaluation before a proper course of chiropractic care can be determined. However, in most cases of tension headaches, significant improvement is accomplished through manipulation of the upper two cervical vertebrae, coupled with adjustments to the junction between the cervical and thoracic spine. This is also helpful in most cases of migraine headaches, as long as food and lifestyle triggers are avoided as well.
Headache Trigger Points
Trigger point therapy for headaches tends to involve four muscles: the Splenius muscles, the Suboccipitals, the Sternocleidomastoid (SCM) and the Trapezius. The Splenius muscles are comprised of two individual muscles - the Splenius Capitis and the Splenius Cervicis. Both of these muscles run from the upper back to either the base of the skull (splenius capitis) or the upper cervical vertebrae (splenius cervicis). Trigger points in the Splenius muscles are a common cause of headache pain that travels through the head to the back of the eye, as well as to the top of the head.
The Suboccipitals are actually a group of four small muscles that are responsible for maintaining the proper movement and positioning between the first cervical vertebra and the base of the skull. Trigger points in these muscles will cause pain that feels like it's inside the head, extending from the back of the head to the eye and forehead. Often times it will feel like the whole side of the head hurts, a pain pattern similar to that experienced with a migraine.
The Sternocleidomastoid (SCM) muscle runs from the base of the skull, just behind the ear, down the side of the neck to attach to the top of the sternum (breastbone). Although most people are not aware of the SCM trigger points, their effects are widespread, including referred pain, balance problems and visual disturbances. Referred pain patterns tend to be deep eye pain, headaches over the eye and can even cause earaches. Another unusual characteristic of SCM trigger points is that they can cause dizziness, nausea and unbalance.
The trapezius muscle is the very large, flat muscle in the upper and mid back. A common trigger point located in the very top of the Trapezius muscle refers pain to the temple and back of the head and is sometimes responsible for headache pain. This trigger point is capable of producing satellite trigger points in the muscles in the temple or jaw, which can lead to jaw or tooth pain.
Avoid Headache Triggers
- Stress may be a trigger, but certain foods, odors, menstrual periods, and changes in weather are among many factors that may also trigger headache.
- Emotional factors such as depression, anxiety, frustration, letdown, and even pleasant excitement may be associated with developing a headache.
- Keeping a headache diary will help you determine whether factors such as food, change in weather, and/or mood have any relationship to your headache pattern.
- Repeated exposure to nitrite compounds can result in a dull, pounding headache that may be accompanied by a flushed face. Nitrite, which dilates blood vessels, is found in such products as heart medicine and dynamite, but is also used as a chemical to preserve meat. Hot dogs and other processed meats containing sodium nitrite can cause headaches.
- Eating foods prepared with monosodium glutamate (MSG) can result in headache. Soy sauce, meat tenderizer, and a variety of packaged foods contain this chemical which is touted as a flavor enhancer.
- Headache can also result from exposure to poisons, even common household varieties like insecticides, carbon tetrachloride, and lead. Children who ingest flakes of lead paint may develop headaches. So may anyone who has contact with lead batteries or lead-glazed pottery.
- Avoid synthetic fragrances in hair and bath products and laundry detergents.
- Foods that are high in the amino acid tyramine should also be avoided, such as ripened cheeses (cheddar, brie), chocolate, as well as any food pickled or fermented foods.
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Dr Greg MIllar DC
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