Headaches or Migraine
Types of Headache
What is the Cause of Your Headache or Migraine?
As a headache or migraine sufferer, you’ll know how disruptive and inconvenient a severe headache or migraine attack can be. Not only does a relentless headache or pulsing migraine impact you, but also your immediate family and friends. With over 300 potential cause of your headache, an accurate diagnosis is essential to guide the proper investigations, treatment and management of your headache disorder.
Head pain can have many causes, not just a migraine. Correctly identifying the cause will lead to better treatment. I will explain some of the differentiating diagnostic criteria later in this article, but let’s prioritise the small group of headache sufferers who have a significant reason to seek prompt medical attention and further investigations of their headache source.
When Should You Be Concerned about a Headache?
In a small percentage of patients, there is, unfortunately, a sinister cause of your head pain, which require investigation. We call these Red Flags because they can be vital signs of more sinister underlying conditions such as brain tumours, aneurysm, stroke, meningitis and other systemic illnesses. If you experience any of the following symptoms, please seek the urgent advice of your healthcare professional.
You MUST thoroughly investigate any Red Flags!
Please check with your doctor to investigate further if your headaches have any of the following characteristics. Your headache is:
- History your worst ever headache or a different headache to your usual.
- Exertion triggers your headache (e.g. exercise, cough, sneeze or sex).
- Age is higher than 50 years.
- Despite treatment, your headache persists.
- Acute onset.
- Central nervous system findings. e.g. motor weakness, memory loss, slurred speech.
- HIV or other immune system compromise
- fEver or other systemic symptoms, e.g. weight loss, rash.
If you have any of the above HEADACHE Red Flags symptoms, we strongly recommend that you consult your doctor immediately.
Less Urgent & Severe Headache Types
Fortunately, the vast majority of headaches do not require urgent medical investigation and should respond positively to treatment depending upon an accurate diagnosis.
What is Causing Your Headache or Migraine?
Historically the diagnosis of headaches and migraine was based on whether or not your head pain involved pulsatile “throbbing” or not. Any headache that was “throbbing” would affect the head’s blood vessels was a “migraine”. Any headache that was “not throbbing” was labelled a “tension-type headache”, despite there being no evidence of increased tension in the muscles of the scalp or forehead.
Headache & Migraine Research
Researchers have luckily improved our knowledge of headache sources. Things have changed and will continue to evolve as researchers and healthcare experts grow their diagnostic criteria and categorisation. As we currently stand, there are over 300 causes of headaches and migraine. That’s a lot more than the two first options! The numerous potential reasons can make it very confusing to diagnose and treat.
Of the over 300 causes of headache and migraine, most problems are migraine, tension-type headache or neck headache. These are the most common headache causes, and interestingly, they can also co-exist.
Neck & Jaw Headache
At PhysioWorks, we have a particular interest in assessing, diagnosing, and treating migraine and headache disorders. In particular, we focus on the diagnosis and treatment of a neck headache and jaw headache. Your headache physiotherapist will be able to assist your headache or migraine diagnosis and point you to the appropriate health practitioner if required.
Common Causes of Headache & Migraine
Specific Migraine - Headache Types
- Neck Pain
- Bulging Disc
- Wry Neck
- Text Neck
- Pinched Nerve
- Cervical Radiculopathy
- Facet Joint Syndrome
- Neck Sprain
- What Causes Cervicogenic Headache?
- How Do You Get Rid Of A Neck Headache?
- When Should You Be Concerned About A Headache?
What's Causes Cervicogenic Headache?
Your neck headache originates from a variety of musculoskeletal and neurovascular structures. These structures include the upper three neck joints, C2/3 disc, spinal cord coverings, and neck muscles. Dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).
Upper Neck Joints
The most likely source of your neck headache is a dysfunction of your upper neck joints. Your neck muscles or nerves become involved from pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.
The most common cause of a neck headache is the dysfunction of your upper three neck joints. The most common neck joints involved are your:
- atlantooccipital joint (O-C1),
- Atlanto-axial joint (C1/2), and
- C2/3 cervical spine joints.
In simple terms, your neck joints can cause a neck headache or pain if they are either too stiff or move too much (e.g. wobbly and unsupported by weak muscles) or locked in an abnormal joint position, e.g. a locked facet joint or poor neck posture. Once your neck joint becomes stressed and painful, the pain signals refer to the trigeminocervical nucleus in your brainstem. You start to feel a neck headache or, in some cases, face pain!
Your neck and headache physiotherapist can assess and correct neck joint dysfunctions that result in a neck headache. Their professional diagnosis and treatment are essential for neck headache sufferers.
Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse—this further demands your overworking muscles resulting in muscle fatigue-related symptoms. Your deep neck flexors are frequently weak or lack endurance. Your neck muscles work best when they have healthy resting tension, length, strength, power and endurance.
Your skilled physiotherapist assesses and helps you correct any muscle imbalances that result in a neck headache.
Cervical and Occipital Nerves
Nerves in your upper neck may become pinched by extra bony growths, e.g. arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in the neural motion known as neuromechanosensitivity or abnormal neurodynamics. Irritation of your upper neck structures refer to pain messages along the nerves and cause your headache. In simple terms, your neck is the "switch", nerves are the "power cords", and your headache is where the "light" comes on.
Your headache physiotherapist can assess your neuromechanosensitivity.
How Do You Get Rid Of A Neck Headache?
Quality neck physiotherapy can have a speedy and effective result for relieving your neck headache—the key to better treatment response in confirming your diagnosis. After your assessment, your physiotherapist will start you with treatment techniques that address your problems.
Your neck headache treatment may include all or some of the following techniques:
- Stiff neck joints may need to be loosened or unlocked via joint mobilisation (gentle gliding techniques), joint traction or, in specific cases, a gentle and localised joint manipulation technique.
- Hypermobile (or dynamically unstable) joints may require specific deep neck muscle strengthening exercises to stabilise, control and limit the joint movement available.
- Tight or overactive muscles may require muscle stretching, neck massage, acupuncture, dry needling, trigger point release or other relaxation techniques.
- Weak muscles may require specific strengthening exercises. This weakness may include your postural shoulder blade and neck muscles.
- Nerve dysfunction identified by your physiotherapist will depend upon your specific examination findings. Neurosensitivity is a common finding that needs addressing with attentive, professional care.
- Posture correction via specific posture exercises, posture awareness techniques, posture taping, or a brace.
- Provide helpful advice on preventing neck dysfunction in the future, e.g. workstation setup, ergonomics, awkward neck positions and postures to avoid.
Who Treats Cervicogenic Headaches?
In addition to relieving your neck headaches, your physiotherapist aims to address why you are experiencing neck headaches. After all, helping you to avoid future neck headaches is a crucial component of your rehabilitation. Chronic headache sufferers typically resolve their neck headaches within days or weeks.
Relief of your neck headache is quite often immediate! If a neck headache solely causes your trouble, it is common to experience instant relief as you walk out of the clinic.
Depending on the severity and the specific underlying causes of your neck headaches, most sufferers will experience a reduced headache after your initial consultation.
For more information, please consult your neck headache physiotherapist.