THERE IS NO SUCH THING AS A “NORMAL” HEADACHE!
A headache is your body’s way of letting you know that there is something wrong. There are many types of headaches. The first step in knowing what to do about your problem is to understand the various types:
Cervicogenic literally means “originating in the cervical region (spine, joints, ligaments, muscles, nerves).” Symptoms of cervicogenic headaches vary, but one of the distinguishing signs is that the pain starts at the your neck and then starts to move up into the head, although neck pain isn’t always associated. There may also be pain in the forehead or behind the eye. The upper neck is usually the area of the cervical spine that is the most tender. It is critical to restore the proper position of the head and neck to allow muscles to function optimally in a balanced state, reduce inflammation and subsequent irritation to the tissues that are responsible for the pain signals.
Pain generators that may be responsible include:
Neck Facet Joints
These are connections between bones of the spine, mostly on the posterior aspect of the vertebra. Spaces between the facet joints are where the spinal nerves exit. A single facet joint problem between two vertebra could result in a dull-like, achy pain or dysfunction throughout multilpe levels may have a more widespread pain pattern. Osteoarthritis can affect these joints with longstanding suboptimal biomechanics. Spinal manipulation has been shown to be effective in relieving this type of pain as have facet blocks or injections.
Muscle Trigger Points
These are palpable taut bands in the skeletal muscle. When pressure is applied to these areas, there is a referral of pain to a different area. There may be a twitch response or “jump sign” when pressing on these points as the patient is caught off-guard by the intense pain. Manual therapy including massage, cupping, scraping and active-release-therapy (ART) are effective in releasing trigger points. Shockwave therapy is also an excellent non-invasive, but more aggressive therapy to break up these trigger points. Trigger point injections can be done by using a small needle to penetrate the bands and insert anesthesia such as lidocaine.
Figure 1: Head and Neck Trigger Point Referral Patterns
There are eight spinal nerves that exit through small holes between the vertebrae called foramen. With degeneration of the intervertebral discs and/or moderate to severe osteoarthritis, the resultant decreased opening (foramen) may irritate these nerves. Each level of spinal nerve affects a a different muscle group, organ and incoming sensory information to the brain via the spinal cord. Often times when a spinal nerve route is irritated there is a specific direction that the pain travels and prolonged nerve root irritation may affect reflexes and muscle tone (atrophy). Disc injuries are most commonly associated with spinal nerve root pain.
The Suboccipital Triangle and Nerve
This “triangle”, refers to three muscles at the top of the neck (rectus capitis posterior major, obliquus capitis superior and obliquus capitis inferior) and is extremely important to the brain in terms of sensory input. It is bound at the top by the occiput (skull) and at the bottom by the C2 vertebra (Axis). The number of proprioceptors, called muscle spindles within the rectus capitis posterior major muscles are amongst the highest in the entire body, hence owing to its importance. The other areas of highest mechanoreceptor concentration include the jaw joint and feet. These receptors in the muscles of the triangle relay the position of the head and neck to the brain. If there is a significant head tilt, then constant signals are sent to the brain in an attempt to correct it. If the body is unable to correct itself, this often leads to a chronic pain in the neck and headaches, due to spasm of these muscles and compression of the suboccipital nerve which lies beneath the tight muscles. Prolonged imbalance in the suboccipital group can lead to global postural imbalances and jaw problems (TMJD).
The NUCCA procedure, which we perform in our clinic, aims to restore balance the head and neck by using the Atlas as a mechanical level to balance the skull and lower neck. This decreases stress in the muscles of the suboccipital triangle and is one mechanism in which headaches are addressed.
A migraine is a chronic neurological disorder defined by bouts of moderate to severe headaches with associated autonomic nervous system symptoms. They are one of the most common complaints in the emergency department and doctor’s offices and 3 times more common in women than men. Migraines may be classified into two primary types: classic and common migraines.
Perception of an aura, sensitivity to light (photophobia), sensitivity to sound (phonophobia) and typically pain is increased with physical activity. May be associated with vomitting.
This type of migraine accounts for 60-80% of all migraines. This type lacks of an aura, has a tendency towards nausea photophobia, phonophobia and is often relieved by sleep.
Potential Causes of Migraines
There are many environmental triggers for migraines. The most common precipitators include:
- Intense smells and vapors like gasoline, perfumes and candles
- Weather changes such as a change in barometric pressure, humidity and extreme wind
- Chronic mold exposure
- Heavy metals such as mercury, aluminum and lead
- Bright, flashing lights. Excessive sunlight exposure. Overexposure to blue light from fluorescent lighting, TV’s etc.
Everything we eat and drink has the ability to lower the threshold for a migraine:
- Tyramines are compounds found in aged cheese, nuts, smoked fish, fava beans, fermented cabbage and soy and wine. These should be avoided.
- Eliminate sulfites found in wines, soups, jams, dried fruit and potato chips
- Alcohol in general affects the mitochondrial production of energy, negatively affects digestion often disrupting a balanced microbiome and intereferes with important liver enzymes.
- Avoid artificial sweeteners such as aspartame and food coloring.
- Having a food sensitivity test is recommended to determine which common foods you may be eating that cause a delayed hypersensitivity reaction. These foods can be either eliminated or put into a rotation diet plan.
- Proper hydration levels should always be considered. When you are dehydrated there is a temporary contraction of brain tissue, pulling away from the skull which could irritate the neural tissue (meninges).
- Low blood sugar either from inadequate food intake, eating sugar rich foods which cause a cycle of high blood sugar to low blood sugar or irregular meals are all associated with the onset of headaches and even migraines.
Medication should never be self dosed or administered and only used under the direction of a physician. That being said, prescribed medication can still be overused in a phenomenon called medication overuse headache. If you are on prescribed medication and not experiencing a positive decline in the frequency or duration of migraines then you should consider changing medication under the direction of your physician or investigating the root cause(s) in more detail.
Your Sleep & Stress Response
Lack of sleep and the inability to properly cope with stress is very common, especially in larger, busier cities where long commute times are the norm.
- Sleep deprivation but also poor sleep quality should be assessed. Limiting exposure to blue light helps in some patients.
- A regular sleep schedule should be adhered to if possible
- Meditation, exercise, practicing deep diaphragmatic breathing and massage are appropriate strategies to cope with stress.
- High stress creates a more tonic, tight muscular contraction state. Trigger points develop and the tightness pulls on the skeletal system further exacerbating a headache.
- The flight or flight reflex from short term stress is severely taxing on the body and spikes cortisol (stress hormone from the adrenal glands) which elevates adrenaline. Prolonged, unresolved stress can actually tank the cortisol production and manifest as chronic fatigue, dizziness, sleep disruption, mood changes, weakness and headaches.
- There is some evidence that migraines are associated with increased pain and tenderness in the upper neck. It becomes even more significant if pressing on a sensitive area recreates the pattern of head pain. (source)
- Decreased flexion rotation. Assymetry in axial rotation – the “no” or “left-right, right-left” motion, specifically passive rotation of the upper neck has a correlation with headache and migraine.(source)
- It is not uncommon for a migraine headache to start as another type of headache, such as cervicogenic headache, then transition to a full blown migraine.
For women, before the menstrual cycle is initiated, there is a sharp decline in estrogen and progesterone. This has been coined the term, “hormonal migraine”. In women approaching menopause (peri-menopause), the more frequent fluctuation in hormones may also be a trigger. Mapping out your monthly cycle and moderating the extreme fluctuations may help. We have found the use of bioidentical hormone therapy to help in some patients or a deeper dive into multiple body systems with Functional Medicine.
Tension headaches are the most common type of headaches among adults. They are commonly referred to as stress headaches. A tension headache may appear periodically (“episodic,” less than 15 days per month) or daily (“chronic,” more than 15 days per month). An episodic tension headache may be described as a mild to moderate constant band-like pain, tightness, or pressure around the forehead or back of the head and neck. Research shows that decreasing stress through certain exercises, meditation, manual therapy, chiropractic adjustments, acupuncture and addressing internal biochemistry may be an effective treatment option for tension headaches and headaches that originate in the neck (3).
A cluster headache is one-sided head pain that occurs in clusters during a certain period of time and may involve tearing of the eyes and a stuffy nose. These types of headaches are four to five times more frequent in men than women, and tend to begin at night.
Cluster headaches typically last from 30 to 90 minutes and it is not uncommon to have multiple episodes per day with intermittent pain free periods. Oxygen therapy can help reduce the severity and duration of cluster headaches.
The cause of cluster headaches is currently unknown. but the working theory is that they are connected to the hypothalamus and are triggered by changes in the sleep-wake cycle, serotonin changes and changes in hormones such as melatonina and cortisol.
HEADACHE TREATMENT IN MIAMI
If you or someone you now suffers from headaches, we would be happy to do an evaluation to determine if it is the type of problem that we deal with. We offer a wide variety of laboratory diagnostics and evaluate you from a stress and structural viewpoint as well. Our treatment options are often natural in natural, but we have a strong referral network for cases that we are not able to help with.