Headaches and migraines are a serious burden for many people. I’ve had many occasions where I’m treating someone in the clinic for a completely different injury and they mention that they get frequent headaches. After asking a few questions we often have enough information to say “did you know that we can probably fix it?”. We’ve covered headaches and migraines before here.
You are right to ask how. We are learning more and more is that the upper neck is often the culprit for causing headaches.
Some of this research and clinical rationale has come from an Australian Physiotherapist named Dean Watson.
Treatment can be simple at times and very effective. Sometimes if the headaches are longer standing or related to your work or regular activities the treatment becomes more difficult but you can often still make a significant improvement.
So where should you start on the journey fixing your headache?
Check with your GP about your headaches
There are hundreds of documented medical causes for headaches. Some are very common and easily resolved, like dehydration. Others can be more far more serious like brain tumours or aneurisms. Fortunately these are far rarer.
Getting a check up with your GP is a logical place to start when figuring out why you get headaches, especially to rule out anything nasty.
Headaches vs migraine
What is the difference? Technically a migraine can come on without a headache. However most people have a decent sized headache to go along with the other symptoms. These can include:
- Nausea or vomitting
- Light sensitivity
- Smell sensitivity
- An “aura” – disturbances to vision that can include difficulty focussing, flashing lines etc
- Pins and needles in the hands or face
To see a full detailed list of migraine symptoms visit the Headache Australia Website.
Related Article: Fast Relief from Migraine Headaches
Previously vasodilation (blood vessels expanding temporarily) in your brain was thought to be one of the main causes of migraines. However it has been well established that the vasodilation happens after your migraine starts.
Consequently this is thought to be a symptom of your migraine rather than the cause. Some of the drugs that you may take for a migraine were designed to stop this from occurring.
However in physiotherapy terms the treatment for migraines and headaches is very similar. Read on to find out why.
How is your neck related to headaches?
Research has shown that your neck can be the underlying problem causing headaches or migraines. Even if you don’t have neck pain. The 3 highest vertebrae (C1, C2 and C3) have nerves adjacent that connect directly to your brainstem.
Whereas all the vertebral levels lower have nerves that connect to your spinal cord. Consequently if you have some muscle spasm, joint stiffness or general movement dysfunction at one of those upper 3 levels then part of your brainstem can become “hypersensitised”.
Since your brainstem is the gateway to the brain for the majority of the body’s nerves, this poses a slight problem. A normal signal travelling up your spinal cord can also become abnormal as it passes through the hypersensitised brainstem. Consequently setting off a headache or migraine.
Triggers for headaches
Assuming your neck is the issue, it doesn’t really matter what your triggers are. A good example of this is if you’re trigger is lets say chocolate. Chocolate is a fairly common trigger for migraine sufferers. If you end up with a headache or migraine only affecting one side of your head then you probably need to ask why. The chocolate should chemically affect both sides of your brain evenly right? When that chocolate signal is passing through your brainstem there is a good chance that 1 side of your neck is hypersensitising it. As a result setting off your headache or migraine on that side.
This process can apply to any of your triggers. Including foods, drinks, light, sleep, fatigue, exercise, menstruation and the list goes on. Your trigger isn’t the issue. More likely your neck and consequently your brainstem is the root cause.
Some of the drugs used to treat migraines actually have a desensitising effect on the brainstem which is why they work so well.
Signs that your neck might be related
As stated earlier, not all headaches are related to your neck. How do you know if yours is?
Here are some common findings in the clinic:
- Your headache is predominantly on one side.
- You had a injury to your neck (like whiplash) around the time the headaches started.
- You have neck and shoulder pain at the same time the as headache.
- Certain postures set your headache off – it can be sitting, driving, cycling, sleeping position, looking down at your phone too long. Sometimes well after you have finished being in that posture (up to 48 hours).
- You get worse with fatigue – end of the work week, end of the work day.
- You wake up with it after a bad night sleep, or on a different pillow – can be again related to neck posture.
If you fit in this list it is still worthwhile checking your symptoms with your GP. For me, I never had any headaches until I had a very specific neck injury. Since then, if I sit slouched with my chin towards my chest for too long I can get migraine type symptoms. Usually not until a day or 2 later though, which can be annoying because I feel fine at the time! Fortunately they are very treatable.
What can physiotherapy do to fix your headache?
Similar to other musculoskeletal issues you’ll need a thorough assessment. Particularly as previously suggested paying close attention your upper cervical spine. We check which joints are stiff or tender and selectively treat those, rather than treat your trigger or symptoms.
Usually we can give some home exercises and techniques to keep those joints loose. Often we look at strengthening some of the neck musculature to avoid having you fall into bad postures in the future.
You don’t need to throw away the things that help like medication, heat packs, massage or any other therapies that have been helpful in the past.
If something goes wrong it is still worth your while having those strategies for symptom management. But by treating your upper cervical spine complex hopefully you shouldn’t need them much.
The other useful resource that a client of mine showed me is an app named Migraine Buddy . It tracks your triggers, symptoms, frequency, time etc so that you can get a better picture of what works and doesn’t work for you for your headaches.
There are probably other apps out there but I’ve only looked at this one and it was quite comprehensive and potentially useful if you struggle to link your headaches to anything.
If in doubt talk to your local physiotherapist in conjunction with your GP. It really does help if your physiotherapist has experience in treating headaches and migraines.