Introduction

Headaches and migraines affect over 40 million Americans and costs the healthcare system 17 billion dollars to treat annually. There are over 300 different types of headaches according to the International Classification of Headache Disorders, 3rd edition. Most of the diagnosed headaches are migraines.

But are they really?

In today’s blog, I’ll discuss the differences between common types of headaches and how to treat them effectively.

Diagnosing your headache

A licensed healthcare provider should always conduct the diagnosis of your headache. They must be certified or specialized in the treatment of headaches. Many headaches are a result of serious, life-threatening pathology which should be ruled out through a thorough evaluation and imaging.

Thankfully, the majority of headaches are not life-threatening and are managed with conservative care. Nonetheless, diagnosing the correct type of headache is crucial for treatment or management strategies.

The most common types of headaches people suffer from are Migraines, Cervicogenic Headaches, and Tension-Type Headaches. They each show with specific symptoms, yet share a lot of overlap between each other. Within each headache are multiple sub-categories that are not expressed in this blog. By and large, these headaches share similar characteristics about symptoms, but treatment for each is very different.

Below is a chart comparing the symptoms of each headache and how they are similar and different.

The over-arching similarities between these headaches is that

1. They are all painful, and
2. They all have a cervical part.

This means that the neck and the headache are somewhat related.

In the case of cervicogenic headaches, the neck is the absolute cause of the headache and shares a strong relationship. As the neck improves, so does the headache.

Tension-Type and Migraine headaches share a cervical part, but are not necessarily related. Meaning the neck is involved, but treating the neck will not completely resolve the headache symptoms.

Why does neck pain cause headaches?

If you didn’t have a headache before, you probably will after reading this section.

People long believed that headaches were due to pressure changes inside the brain. This included changes from blood or cerebrospinal fluid. While this mechanism is still being explored, it does not account for the pain felt during most reported headaches.

Cervicogenic, tension-type, and migraine headaches all have a cervical part. This is through an interaction between the upper three cervical vertebrae and their associated soft tissues. It also involves the trigemino-cervical nucleus.

The trigemino-cervical nucleus is located in the brainstem, the bridge between the spinal cord and the brain. It has different sections. These include mesencephalic, main sensory, and spinal nuclei. These sections get proprioception, touch, pain, and temperature from the first three spinal nerves (C1, C2, and C3). The trigeminal nerve originates in this nucleus. It distributes sensation and motor functions to the face along three separate branches. These branches are the Opthalmic, Maxillary, and Mandibular nerves.

The upper spinal nerves and the trigeminal nerve share a common nucleus. Thus, the electrical signals can become mixed up and misinterpreted. Hence, when you have neck pain, you will also experience pain along the path of the trigeminal nerve. This includes pain along the temple, behind the eye, in the jaw, or even in the mouth.

This phenomenon occurs in other places in the body as well. A heart attack is an injury to the myocardial tissue in the heart. But common associated symptoms include pain elsewhere in the body, commonly in the left shoulder and jaw. Some women even report back pain with a heart attack. This is true for other organs as well. Pain in one tissue often results in referred pain perceived somewhere else.

Knowing this, how should this change the way we treat headaches?

Treating the headache

Most providers recognize the link between the neck and head via the trigemino-cervical nucleus to be legitimate. Nevertheless, the overwhelming first line of treatment for headaches is medication. This approach helps with some cases. Yet, current research does not support medication as a primary method for long-term management of headaches or migraines.

Research does, though, support movement-based care. And I say this with a grain of salt. Current research supports good movement-based care.

This is why social media is flooded with exercises like the ones described in the video above. These exercises work for some. However, the results are very short-lived. They do not result in any meaningful change at the tissue level.

Proper treatment of headaches without medications involves restoring range of motion in the cervical and thoracic spine, retraining the many muscles in this new range, strengthening the muscles against heavy loads with appropriate training adequate for building strength, introducing fresh blood flow (local inflammation) to the site of injury, and address long-standing habits (posture, medication use, diet, emotional state, etc.) that are exacerbating the headache.

To find out more about how Ascend Physical Therapy can help you get rid of your headaches, book a call. Click the button below.