Headaches are not fun. Migraines are even less so. Unfortunately, most of us experience one or the other, or even both. In fact, 47% of you reading this article will have at least one headache this year. While talking with my sister in law the other day, she pointed out that some people do not consider headaches and migraines to be treatable or preventable. I’m here to tell you that they can and I am living breathing headache-busting proof.
Let’s take one step back. I used to experience quite intense and sometimes debilitating headaches that felt like an ice pick was being driven into the back of my skull, straight into my eyeball. Not fun and definitely not conducive to work. Even as a doctor, it took me close to a decade to a get rid of mine. So what took me so long to “cure” my headaches, considering the multitudes of treatments I have tried in the past? Well, the fact is all the care I received did help, but only temporarily, until I found the key to my long-term success, which is to say I finally identified and corrected the underlying causes of my headaches.
My goal is to guide you past your symptom, the headache, and start understanding potential physical causes of the problem, step by step. This is how I help my headache patients and this how I helped UCSF’s migraine patients. Ready? Let’s begin.
First Step: Identify the Trigger
Studies show that there are many different causes for the symptom called a headache: nutritional, psychological, neurological, and/or musculoskeletal. We will be focusing on the latter two.
To begin, first ask yourself: What brings them on?
Here are a few examples of headache types and what differentiates them from other headaches:
Answer: “I did not drink enough water yesterday, today, or in general.”
Please drink 64-80 oz water per day. You are 70% water, so your body will give you all sorts of grief if you do not replenish its main component. Remember 64 oz is the MINIMUM you need to maintain basic hydration.
Answer: “It hurts when I turn my head quickly from side to side”
You may have a problem in your sinuses, not a neuromusculoskeletal issue. Being able to differentiate between a neuromusculoskeletal and a non-NMS issue is important. For sinus issues, I like to start with a saline wash concept, such as a neti-pod, but you should have to consult an allergist or EENT for more major issues: unresponsive infection, deviated septum, or chronic reoccurrence.
Answer: “When I am stressed.”
Cause: Nerve Hypersensitivity
Your body is programmable and learns new habits constantly. Your nerves “learn” through a process called neuroplasticity or the programming of new neural pathways. Current research suggests that if you have chronically tight soft tissue in your shoulders, neck, or scalp this can both cause headaches and program a headache pathway into your neurophysiology. So even if you find and address the soft tissue cause, stress and tension can still trigger the hypersensitive nerves. Once triggered, the programmed pathway will create the perception of a headache without major soft tissue involvement.
Stress headaches of a musculoskeletal and neurological type will require a two-step process to correct.
- Identify and work with the injured musculoskeletal structure – I.E. Basic chiropractic, massage, or manual therapy
- Work with a technique that can re-train your neurological responses – I.E. Neurological reeducation such as Chiropractic Biophysics or Chiropractic Neurology
Answer: “When I’m working at the computer.” [Or similar prolonged downward focused activities.]
Cause: Repetitive Stress Syndrome due to Poor Posture
Poor posture is one of those simple, yet complex concepts. Think repetitive stress syndrome for your entire neck and upper back.
When sitting at a computer or working a desk job, most people’s heads jut out in front of their shoulders and/or they tilt their heads downwards for hours at a time. Now imagine your head is like a bowling ball on a large spring, your neck. If the ball is directly over the top of the spring, the structure retains its shape and balances the ball. Alternatively, if the bowling ball is pushed forward, the spring collapses forward. Picture the spring collapsed for the equivalent time you spend on a computer or looking down at your Iphone/pad/android each day and think about the shape of the spring once you try to bring the ball back to a vertical balance. It will no longer remain a nice unbent spring and neither will your neck if your posture is poor.
Having poor posture is a very easy way to repetitively damage your musculoskeletal system and train your nervous system into hypersensitivity.
- Proper ergonomics will help to slow this process
- Postural correction through exercise, stretching, neuromuscular reeducations, and lifestyle modifications will aid non-traumatic postural imbalance
- Structural correction may be necessary if there is a history of significant neck trauma, such as a car accident
Next time you have a headache, make a mental note or log of what you were doing at the onset. You may find that your triggers are one or more of the aforementioned examples.
Next Step: Where do you feel your headaches?
You may ask yourself, “Ok, I know when I get them, but how do I know if my headaches are from my muscle(s), my joints, my posture, or nerves?”
Here’s the breakdown of headaches that once identified, can be treated through a hands on approach:
Pain from the shoulders to the skull:
Hypertonic muscles or “knots” can refer pain along the length of the muscle, at their attachment point, and/or insertion points. This phenomenon is called a trigger point. While this condition can occur in many parts of the body, trigger points in the shoulders and neck will refer specific and re-creatable pain patterns up the neck to the skull and mimic headaches. A skilled body worker will be able to help out you here. You describe where you feel it and they may be able to literally put their finger on the offending muscle and have you say, “That’s my headache!”
General area or diffuse achy pain on the base, back or sides of your skull:
Joint inflammation, also known as arthritis, can cause the perception of pain in areas removed from the joint dysfunction and is termed sclerotogenous pain referral. In relation to headaches, joints in the mid to upper neck can refer “achy” pain into the base and along sides of the skull. This is easily diagnosed through your description and neck compression testing. See the Pain Referral Patterns chart to see if your headaches match up with what our scientist found when studying joint inflammation.
Temples, forehead, and around the eyes:
Headaches here may be due to nerve irritation, more specifically your trigeminal nerve. The trigeminal nerve controls the skin sensation over your eye, forehead, cheekbones, and jaw. The proposed mechanism behind these headaches is that nerves become irritated due to mechanical tension.
In other words, the nerves, which are supposed to be protected by the structures of your neck, instead have direct pressure applied to them due to muscular imbalance, joint dysfunction, and/or postural deviation. Once inflamed, these nerves refer a pain signal or “headache” to the areas they control – the temples, forehead, and around the eyes. The main muscles that are supposed to protect the trigeminal nerves are the suboccipital musculature. One of the proposed mechanisms for trigeminal nerve headaches are the dysfunction of these suboccipital muscles.
If your headaches present in the trigeminal controlled area, here is a simple way to test the suboccipital muscles involvement. In the video, Scott Schwartz, co-owner of San Francisco’s Psoas Bodywork and Massage, shows us an active isolated stretch of the suboccipital muscles. If your headache reduces through the use of this stretch, there is a very good chance that you have just identified the area contributing your headaches.
Side Note: Chronic TMJ and jaw issues may also create headaches in this area, history of trauma to the neck versus trauma to the jaw will help to differentiate the potential reason.
Any and all of the pain areas listed above:
The underlying cause here may be poor posture. Remember postural imbalances damage entire regions of your body, which means that if left unchecked these bodily distortion will lead to muscle trigger points, joints related pain referral, and injury to the nerves. The end result is multiple types of headaches from multiple sources in your neck.
This is why poor posture tends to muddle the ability a physician’s ability to diagnose the “main problem”. A misdiagnosis or incomplete diagnosis can reduce both lasting relief from needed treatments and falsely discourage the headache sufferer from seeking treatment.
I believe this is why the notion that a headache of the neuromusculoskeletal source can be treated conservatively is not universally understood.
The Final Step: A Multidisciplinary Approach
Now, you are armed with a basic understanding of when your headaches are triggered and what underlying structures maybe effected.
So what is the right combination of treatments for you?
The headaches mentioned in this article may respond favorably to one or more of the following:
- Massage Therapy
- Ergonomic Assessment
- Postural Correction
- Structural Correction
Often, the solution requires a multidisciplinary approach to truly correct the underlying issues. For me, I was able to cure my headaches through a combination of chiropractic to reduce arthritis, muscle work to break up the scar tissue in my neck, structural correction in my neck, exercise to retrain the neurology, and postural correction to prevent the process from repeating itself. For some of my patients, it is as simple as few good adjustments and focused muscle work. The difference is my issue stemmed from a neck trauma over 15 years ago and therefore needed a comprehensive approach.
If you work with me, you quickly realize that no two people are alike. Your body is the sum of your experiences good or bad. Each of us has a different history, different job, and different obstacles in life. That’s why I challenge you to put thought and careful consideration into the when, where, and what quality of your headaches and then bring this information to the appropriate health care provider. If they are the right person for the job, they will ask you the very same questions. You want a headache detective.
Start with conservative care, keep a log of what treatment relieved your headaches, and be patient. The body can only repair itself so fast. Typically, the right combination of treatments will begin to yield results in 2-3 weeks with more solid improvement in 6-8 weeks.
That means, with the right care, in 2-8 weeks you can feel better, function better, and live with a higher quality of life.
So I will leave you with one last question: What are headaches stopping you from doing?
For more information, you can contact me directly at firstname.lastname@example.org or setup a consultation by calling 415-373-3897.
This article was written by Dr. Scott Levin. A chiropractic physician and clinical director at PostureWorks – A health center for chiropractic postural and structural correction in San Francisco.