You have a headache? You certainly are not alone! Fifty-nine percent of Canadian adults report suffering from some form of headache.1 Headaches can be debilitating, but most often feel like unpleasant discomfort, pain or pressure that can be addressed by manual therapies, relaxation and rest, hydration and even short-term use of pain medication.
Yet, in severe cases, the pain can be unbearable and last for many hours or even days. In 2010, an estimated 2.7 million Canadians reported being diagnosed with a migraine headache2. Research indicates that the number of migraine sufferers is likely under-estimated since not everyone seeks care from a healthcare professional, and are likely undiagnosed.
Similarly, thanks to the help of Dr. Google, many Canadians resort to searching the internet to self-diagnose and self-manage. However, like many sources of pain, the causes of headaches are not all alike. Hence, the remedies will also differ. If you are concerned and looking for relief, seek help from a qualified healthcare professional. Like other MSK conditions, headaches can be differentiated by a comprehensive examination and strategies to relieve the pain can be identified. Talk to your chiropractor or other healthcare provider about your pain and headache today.
Here are a few types of headaches to consider:
The most common type of headache, tension headaches are characterized as diffuse, dull, aching pain typically described as tightness around the head. Not surprisingly, the most common trigger for tension headaches is stress. Generally, this type of headache can be managed by decreasing your stress, applying a cold or hot pack and improving your posture. Conservative care, like chiropractic, can also help relieve symptoms and prevent recurrence.
Migraine headaches can present differently from person to person. Symptoms may include disturbed vision, nausea and vomiting, sensitivity to light, and are often accompanied by sensory warning symptoms (aura). Sufferers may need to lie down in a darkened room until the symptoms ease. The causes of migraine headaches are not yet known, but there are a number of triggers that are associated with migraines including stress, sleep deprivation, changes in the environment and certain foods. A migraine can last hours or even days.
A cervicogenic headache is classified as a secondary headache because the pain is referred from structures of the neck. Since the origin is usually related to the cervical spine, managing pain can include manual therapy and recommended at-home exercise to address postural issues and dysfunction.
What causes headaches?
As stated earlier, the causes of migraines and other types of headaches are not entirely known. Commonly, joint dysfunction, muscle tightness and poor posture can lead to the development of pain and specifically headaches. The changing barometric pressure that accompanies an abrupt shift in the weather is also thought to trigger migraines.
Here are a few other headache triggers that you might want to avoid where possible:
- Skipping meals
- Loud, sustained noise
- Sleep deprivation
Sourced from the Canadian Chiropractic Association
Depending on the type of headache, your healthcare practitioner may recommend spinal manipulation, soft tissue therapy, home exercise, relaxation and/or nutritional counselling. For more information about how chiropractors approach headache treatment, read the key recommendations for practitioners on the Canadian Chiropractic Guideline Initiative’s webpage.
2. Pamela Ramage-Morin and Heather Gilmour, “Prevalence of Migraine in the Canadian Household Population,” Statistics Canada, Health Reports, Volume 25, no. 6. June 2014.
Headache Referring Behind My Eye!
Have you ever experienced a headache that refers from the back of the neck to your eye? The sensation that I experience is often quite sharp and localized to one side of my head (usually the right side). These type of headaches are quite commonly experienced by many individuals in the population. Perhaps, increased stress, working at the computer for long hours or long commutes maybe responsible for these headaches…
There are a variety of headaches out there – migraine, cluster and tension-type to name a few. The headache that I am referring above is known in the medical literature as a “cervicogenic headache”.
What is a Cervicogenic Headache?
A cervicogenic headache is caused by an abnormality of the structures in the neck. What structures you ask? Basically, the muscles, nerve, bone, fascia and other soft tissues located in the neck area. A cervicogenic headache is sometimes debilitating and is a condition that accounts for 15% to 20% of all headaches. The criteria for diagnosing a cervicogenic headache is as follows:
A. Pain is referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfilling criteria C and D
B. Clinical, laboratory and/or imaging evidence of a disorder within the cervical spine or soft tissues of the neck known to cause headache
C. Clinical signs that implicate a source of pain in the neck.
- 1. Reduced range of motion
- 2. Mechanical exacerbation of pain
- 3. Focal neck tenderness
- 4. Trigger points that refer to the head
D. When myofascial tender spots are the only cause, the headache should be diagnoses as tension-type headache and not cervicogenic.
What is the cause of a Cervicogenic Headache?
An issue to the neck muscles and other surrounding tissues/structures (bones and joints) are responsible for this type of headache. Whether it be a strain or strain, trauma or fall, our soft tissues and joints can become involved and negatively influenced. Sometimes the C0-C1 joint (first neck joint between the spine and head) or those neck joints below become tight/locked or restricted for whatever the reason. Furthermore, sometimes the muscles in the areas also become tight and tender. A question that is difficult to answer is what causes what – Is it the joint tightness that causes the muscle pain/tightness OR is it that tight muscles that cause the joint pain and thus the cervicogenic headache? This is like the classical chicken and egg scenario. What came first the chicken or the egg? My guess is that the headache can be caused by either structure (joint or muscle/soft tissue) and that both structures influence one another. When the joint is tight, the muscle become tight and when the muscle is tight, the joint does not move as well.
What Evidence Based Treatment Options are Available for Cervicogenic Headache Suffers?
I find that a chiropractic adjustment helps to alleviate my neck and cervicogenic headache symptoms quite quickly. I get cervicogenic headaches periodically – once a month. When I feel that my neck is tight and stiff and a headache is coming on, I have a colleague of mine adjustment my neck and upper back area. Sometimes the relief is instant!
According to some of the latest research on cervicogenic headaches, the following treatments are effective. Spinal manipulation therapy two times per week for 3 weeks. Joint mobilization 8-12 treatments over 6 weeks. Deep neck flexors exercises twice daily for 6 weeks. It is important to note that there is no consistently additive benefit of combing deep neck flexor exercises and joint mobilization for cervicogenic headache. Sourced from “Clinical Practice Guideline for the Management of Headache Disorders in Adults – Jan 2012?
After each treatment, it is important to reassess the condition.
I hope you have found this blog educational. Remember, it is always important to rule out serious conditions which may also be a source to a headache. These conditions should be ruled out first before any treatment is commenced. Always consult your health practitioner prior to commencing any treatment. Thank you for reading my blog Headache Referring Behing My Eye.
Dr. Luciano Di Loreto, HBSc., D.C.