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Headaches & Migraines

Headaches can vary from mild aching to sever debilitating pain, that can be on both or one side of the head. They tend to last anywhere from 30 minutes to days. There are neck conditions, muscle strains or spasms that will contribute or even cause your headaches. Some of the long list of headaches are: cluster headaches, sinus headaches, temporal arteritis, cervicogenic headaches, and tension headaches. There are also more serious conditions that can present with headache so its always important to have them evaluated.

Migraines and cluster headaches may have accompanied symptoms called a prodrome or aura.

Prodrome = a symptom indicative of an approaching disease. (Fatigue, malaise, lethargy, stiff neck, mood changes, anorexia, food cravings, chilled feeling, diarrhea or constipation, fluid retention, increase frequency of urination) Occur 24-48 hrs prior to HA onset. A prodrome may be associated with a number of different headaches and/or systemic diseases.

Aura = focal neurological (sensory, motor, language) symptoms typically evolving over a period of 5 to 60 minutes (usually < 20 min). They usually proceed a headache but onset of the aura may occur simultaneously with the onset of the pain, and some patients experience aura without headache Most auras are associated with the visual system {flashes of color, wavy lines, shimmering spots, scintillations, visual distortions, hallucinations, or visual loss} or auditory disturbances {unusual sounds or tinnitus, sometimes hearing loss}, however the patient may experience paresthesias, hemiparesis (paralyzed on one side of the body), aphasia (inability to make spoken phrases), hypersensitivity, hypoesthesia (decrease in the ability to touch), ataxia (unable to walk), change in level of consciousness, diplopia (double vision), vertigo, etc.

A pathognomonic sign of migraine is a certain type of aura called a Fortification Spectra. In fortification spectra, first the vision blurs, and then there appears a slowly expanding paracentral scotoma (blind spot), surrounded by luminous scintillating geometric forms, which enlarges and moves laterally until it disappears outside the peripheral vision. This takes between 10-30 minutes.

Other less serious headaches like cervicogenic and tension headaches can be brought on by stress and prolonged or sustained postures. These occur more often in females. Tension type is usually on both sides and the pain can be described as a squeezing sensation in a headband like distribution. Cervicogenic headaches are caused by the bones in the cervical spine and symptoms are increased with certain motions.

Treatment used may be physical therapy modalities, getting rid of any triggers, to taking steps to reduce stress. If you have never tried chiropractic care, you owe it to yourself to see a chiropractor to help manage your pain.


Tension headache

 

What is a tension headache?

 

Tension headache is something that almost everyone will experience once in their lifetime. It is typically on both sides of the head and causes a pain that feels like a tight headband is around your head. These headaches can also be aggravated with activity and even be a throbbing type pain. These are typically caused by stress or poor posture.

 

 

What’s going on when I get these headaches?

 

Typically, the problem starts in the neck or midback from poor posture or stress causing these muscles to become hypertonic or tight. Muscles commonly associated include those at the base of the skull (suboccipitals), in the upper shoulder (trapezius or levator scapulae muscles), or the most common and almost always present with the other muscle tightness is the splenius capitus muscle. What’s very important about the splenius capitus muscle is its job as the most powerful head extensor in the body, but even more important is what travels through it, the greater occipital nerve. This nerve is responsible for sensory to the head and neck area, it is purely sensory meaning it only causes feeling and does not have the ability to make muscles contract.

 

 

 

What causes the muscle to become tight?

 

It’s from poor posture. The postural muscles of the neck and low back are muscles that resist fatigue. They do this by becoming shorter and tighter when they get close to being fatigued like sustained forward head posture at the computer or looking down at your phone all day. When they become tighter they constrict the greater occipital nerve causing your headache.

 

How can chiropractic help?

 

Chiropractic uses spinal manipulation to create a stretch reflex to the muscles that cause them to relax as well as fix any other underlying joint dysfunction. Remember what we covered in the facet syndrome module, that joint dysfunction leads to sensory nerve irritation that then leads to a motor response causing muscle spasm and splinting. This splinting can then be related to that tightness you are experiencing in the neck that compromises the greater occipital nerve as it passes through that muscle (splenius capitus) and now your headache becomes a symptom. Manual therapy also helps to relieve trigger points that have developed from chronic contracted muscles.

 

 

 

 

 

 

Written by: Christopher G. Stine, M.S., D.C.

Illustration by: Frank Netter from Atlas of Human Anatomy 6th edition