By Bodie Logan Physiotherapist
Headaches can often be painful, debilitating, long-lasting, and come one without warning or obvious triggers. There are numerous types of headaches, some are serious that requires medical attention, and others can be treated rather easily and effectively.
Today I am going to explore the various types of headaches that we most frequently see in the clinic and go through the role your physiotherapist can have in determining some of the causes of headaches and how to treat these, where appropriate.
Before we get into some of the musculoskeletal causes of headaches, I will start with a warning.
If any of the following symptoms are also present, please do not ignore them, consult a Doctor or medical help: Dizziness or Vertigo, Blurred or double vision, Drop attacks (sudden loss of power without loss of consciousness), Nausea / Vomiting, Disorientation or anxiety, Sudden onset of tinnitus, Tongue of fascial numbness, Pallor, tremor, or sweating, any other neurological symptoms.
Sudden, severe sharp pain located on one side in the upper region of the neck and base of skull, for which there is no previous history of these symptoms should also be treated as suspicious.
If none of the above apply, then your physiotherapist may be able to provide treatment and management advice for your symptoms and help determine an underlying cause of your headache.
One of the most common types of headache we see in the clinic are Cervicogenic headaches, which is simply a term that is used to define headaches that arise from musculoskeletal dysfunctions in the neck. Cervicogenic headaches are secondary headaches, which is a headache that is caused by an underlying condition. This sets them apart from other headaches such as migraines and cluster headaches, which are known as primary headaches.
Typically, a cervicogenic headache can be provoked with certain neck and head movements or sustained static postures which can cause pain starting at the back of the head and radiates forwards, typically down one side.
The key difference between migraines and cervicogenic headaches is that 88% of migraines start in the anterior parts of the head (front of the head), whereas only 20% of cervicogenic headaches start in the anterior part of the head.
A cervicogenic headache is hypothesized to be a referred pain from the upper cervical region of the neck (the area around the uppermost 3 vertebrae) and their associated nerves. There are many structures in this area of the neck such as joints, muscles, ligaments, and intervertebral discs that could be driving symptoms. Other muscles such as the trapezius, scalenes, pectoralis muscles, sternocleidomastoid, levator scapulae, and sub-occipital muscles have also been previously implicated in cervicogenic headaches.
Identifying and being aware of the triggers of your neck pain and headache is the first step to recovery, we are often unaware of how habitual we can become with regards to sustained postures and repetitive movements. Often the body will find the most ‘efficient’ way to perform a movement, particularly if we perform this movement quite regularly. This can cause over-use and fatigue of certain muscles and imbalances across different muscle groups if it becomes a long-term movement pattern. With regards to cervicogenic headaches, this often involves the smaller stabilizers of the head and the neck (Sub-Occipitals) as well as creating tension through some of the larger neck and shoulder muscles such as SCM, Trapezius, and Levator Scapulae.
To put this all into some context let’s use sustained postures as an example with the increase of people working from home during the COVID19 pandemic and relate this back to the anatomy of the neck.
Here we go with the dreaded sustained ‘chin poke / Netflix neck/text neck’ posture due to poor office/home office set up. (Disclaimer: There is no one, ideal, posture. Sitting for too long in any position habitually is likely to influence muscle tension)
Ideally, all things being equal, the head is normally well-balanced sitting on top of the upper cervical vertebrae. The forces anteriorly and posteriorly are generally close to neutral with the average adult head weighing approximately 5.5kgs. Shifting the head beyond the body’s natural center of gravity line anteriorly results in greater forces to the neck musculature. Over time, the body tries to find ways to adapt to hold the head up to maintain straight-ahead vision.
This has a twofold effect:
Muscles become lengthened and therefore weakened: Deep neck flexors (Longus Coli and Capitus), Lower cervical and upper thoracic erector spinae and the scapula retractors (Rhomboids and Middle Trapezius)
Muscles become shortened and tight: Sub-Occipitals (Small stabilizers of the head on the neck), Chest muscles (Pectoralis Minor), and the Levator Scapulae muscles
Below is a picture outlining the relative weight of the head once it is taken beyond neutral. As you can appreciate, the relative force and work the muscles now must perform are increased considerably.
Here at 4 Life Physiotherapy, our therapists are well trained in identifying the key driving factors to your headaches and neck pain. If the above sounds familiar or relevant to you, feel free to drop in for an assessment consultation to discuss management strategies and treatment.