How Headaches are a Pain in the Neck

Headaches

At one point or another you may have dealt with a headache. It has been found that 96% of the population will experience a headache of some sort during their lifetime. At this moment, approximately 40% of the population is dealing with a tension type headache, while around 10% are dealing with migraines. Headaches are also seen more often in women than men and can happen at any age. The effect of a headache can vary greatly, from a mild, temporary annoyance to severe disability. Migraines are included in the classification of neurological disorders which is the leading worldwide cause of disability. Severe headaches and migraines not only cause loss time from work and decreased work productivity, but also decreases in quality of life and leads to other issues such as depression. 

The International Headache Society recognizes over 150 different types of headaches. This article is not going to dig down into each one, but rather just discuss the more common ones and how to recognize them. Below are some of the most commonly experienced headaches. 

Types of Headaches

– Tension headaches are ones that most people have felt. The symptoms are a dull sensation in the head that is usually on both sides of the head. They are triggered during periods of increased stress.

– Cluster headaches are more intense than a tension headache. The onset is sudden and can be typically behind one eye. They can happen multiple times in a day which is why they are called cluster headaches. Some other symptoms people experience are nasal congestion, watery eye, and swelling around the eye.

– Migraines are the most commonly known headache. They are more intense than a tension headache and described as a deep pulsing on one side of the head. They can cause the person to be sensitive to light, sound, and smell. People with migraines typically will experience nausea and vomiting as well. About one third of people experience an aura before the onset of one. An aura is a sort of visual disturbance, such as a partial loss of vision or flickering spots. They can be brought on by certain triggers such as stress, loud noises, bright lights, or hormonal changes. People with migraines typically need to see a physician to rule out any serious issues, or be given medication to manage severe episodes.

– Sinus headaches are felt in the face over the sinus area. Allergy sufferers will tell you it feels like built up pressure in the sinus cavity. You can usually treat it with a decongestant or an antibiotic if it progresses to a sinus infection.

-If you are a coffee or soda drinker, you may have experienced a caffeine headache. Since caffeine affects the blood flow to the brain, if you suddenly cut back or cut out caffeine you can develop headaches. The treatment is just to gradually wean yourself off caffeine.

– Post-traumatic headaches are similar to migraine or tension headaches but these come on after a head injury. These vary depending on the extent and location of the injury. These do need to be evaluated by a physician to ensure no serious issue is going on and have them managed.

– Cervicogenic headaches are ones that are often misclassified as something else, but arise from a mechanical issue in the neck rather than a chemical response in the brain. They can be treated with physical therapy, but let us first look a little more at them.

Cervicogenic Headaches

Cervicogenic headaches account for around 15-20% of the total number of headaches, which are caused by tension or injury in the neck. The symptoms are similar to a migraine because they typically affect one side of the head. The pain starts in the neck and/or back of the head and wraps around the top of the head, almost like a ram’s horn. Another difference is that the headaches are accompanied by neck pain and/or stiffness. People often believe it is just a tension headache or if the symptoms are more severe, a migraine, so they are treated with medication with no resolve. Physical therapy is very beneficial in evaluating and treating cervicogenic headaches without relying on medications. How can physical therapy get rid of headaches? Let’s talk about what you can expect from your first session to your last.

Examination

At your first session, the therapist will dive into the history of your symptoms, such as the location, how long they have been going on, what triggers them, and what eases them. An often overlooked subject is the past medical history. Things such as whiplash from an accident or even a change in job or hobbies could have been the start of these symptoms. Please do not dismiss the questions as absurd or irrelevant because each piece of information given helps determine what is actually going on. These details also will let a therapist know if they can help you or need to send you to a specialist for further treatment. 

The big portion of the initial session is your physical examination. This is where the therapist will assess things such as your posture, neck range of motion, muscle strength, and even the mobility of the vertebra in your neck. When looking at posture a common finding in someone with cervicogenic headaches is whether they have a slouched posture. The upper back is more rounded which then causes the head to go forward. This unnatural position can lead to tightness and weakness in areas of the neck causing pain and headaches. Next, your neck motion will be assessed to determine if you have any loss of motion in your neck. Your therapist should be able to notice where there this compensation is coming from.

The strength in the muscles of the neck can play a factor as well. Due to the forward head position, weakness develops in some of the deep stabilizer muscles. Testing your ability to hold certain positions will show if you have any weakness in them. The therapist may also have to physically place their hands on you to feel how the vertebra in your neck move, or if you have any tender spots in muscles. If you have areas of your neck that are not moving or tender areas, then it can trigger pain and headaches. Once completed, your physical therapist will combine all this information to develop a treatment plan. 

Treatment for Headaches

Now that you and the therapist have gathered this information, what will you be doing for treatment? It can be a variety of things depending on what has been found. Manual therapy techniques have been found to be beneficial. The therapist may move around the joints in your neck to gain some motion in areas that are tight or “stuck”. This could include what is called High velocity low amplitude (HVLA) manipulation, which allows the therapist to adjust joints and is frequently associated with a pop. These are not often performed at the first session or even early in the treatment due to safety. They are reserved for later if you are making some progress and it has just plateaued. A quick manipulation of the joint can gain motion and further your recovery. 

Dry needling is another technique that is beneficial. It has been documented that certain muscles can develop what are called trigger points and these trigger points can produce headaches. Dry needling is done with a very small fine needle that is put directly into the seized muscle to cause it to relax. Not all therapists perform manipulations or dry needling but the ones that do are highly trained and skilled at doing them, so feel free to speak with them about it if they suggest it. You will be given exercises or movements to do both in therapy and at home. 

If you have weakness in the deep muscles of the neck, exercises to work on strengthening these muscles will be given. It is also important after you have any manual therapy work done, to do some exercises to use the new mobility that you have gained. This trains your body and nervous system that you have a new area to move into and allows you to keep it. The exercises that you will be given will depend on your specific needs. 

The overall most important part of treatment is education. Education on posture and the importance of putting your body into a good position. Also, education on what causes your headaches and how to address them. When a patient is fully informed and educated about what is going on, how to treat it and the expectations, their recovery is much easier.

Headaches can come in all sorts of ways from a minor issue to a serious condition. If you experience symptoms such as a sudden severe headache, issues with vision or dizziness, or gradually worsening headaches, please see a physician to rule out any serious issues. If you feel that your neck and headache come on around the same time, get in to see a physical therapist to determine if your issues are actually stemming from your neck and get you on the path to recovery. 

For an individualized treatment plan to help you with your headaches, migraines, or associated neck pain, consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them.  Remember to also check out our Facebook, Instagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!

Written by Matt Huey
Edited by Alexander Franz
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES