All about headaches

Headaches are common; often disregarded and attributed to dehydration or stress, but there is often more to them and much that can be done if the correct cause is identified.

The most common type of headaches are Tension Headaches.  In simple terms the muscles in the neck exert a pull on their attachment points at the base of the skull and the upper neck, which then also transfer that tension to the forehead and temples.  This type of headache usually comes on with poor posture, or stress, and lasts from a few hours to several days.  It is usually very responsive to acupuncture or manual therapy, and NICE (The National Institute of Clinical Excellence) has approved Acupuncture for the treatment of Tension Headaches.  Manual Therapy aims to reduce the muscle spasm, mobilise the underlying joints and enable better neck posture to prevent recurrence. 

Often headaches can be caused by problems in surrounding areas such as the neck, jaw, or eyes.  Cervicogenic Headaches are commonly caused by spinal degeneration which either refers pain to the head directly, or causes local muscle spasm and therefore a secondary tension headache.  Treating or managing the underlying neck condition will improve the headache.  Jaw pain is often associated with clenching and grinding of teeth, and poor bite patterns.  Your dentist can prescribe a mouth guard to prevent too much pressure being applied through the teeth.

Migraines are often easier to recognise. They are characterised as one-sided throbbing headache around the temple.  In approximately 75% of cases there is a trigger.  These triggers include stress, menstruation, noise, odours, heat, neck pain, and certain foods.  Classically there are often preceding symptoms called Aura which might include changes in vision or smell, but sometimes none at all.  The old theory was that Migraine was caused by inflammation of blood vessels in the brain, but more recently it has been shown to be a neuropathology triggering overactivation of the Trigeminal Nerve.   Some people are predisposed to Migraine because they have genetically abnormal ion channels.  The nerve cells rely on ion channels to transmit signals, and if they are abnormal the nerve cell becomes sensitive and unstable.  If this happens there is a wave of abnormal signalling across the brain which is experienced as the aura.  The aura and/or the other triggers act together to overactivate the Trigeminal nerve which produces the headache.    Although the genetic abnormality in ion channels cannot be treated, a lot can be done to remove the other triggers.  Interestingly neck pain is reported as an important feature in 69% of Migraines, and there is often a significant overlap between tension headaches and migraines.  This means that by treating the concomitant Tension Headache or neck pain an important trigger of the migraine can be removed.

Medication overuse headaches are caused when people take painkillers too often and are more common than you might think…   5-10% of people with headaches get them because they are taking painkillers too often.  This type of headache is manifested as frequent or daily headaches that develop over several months of taking painkillers (for migraines or headaches). If you take painkillers for your headaches more than twice a week for more than three months see your pharmacist or GP.

 

The most serious headaches are bleeds on or in the brain, or masses in the brain.  These types of headaches are accompanied by other symptoms which may include: fever, sudden neck stiffness, changes in cognition or movement or personality changes, or headaches which worsen when coughing and sneezing, or with exercise.    

 

Posted on December 11, 2015 .