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Headaches and Migraines - more than a pain in the neck!

A headache refers to pain or discomfort in the head, face or upper neck region, often characterised by aching, throbbing, or pressure. Headaches can vary in intensity, duration, and frequency, and they can be caused by a variety of factors such as stress, muscle tension, joint dysfunction, dehydration, certain foods or drinks, lack of sleep, hormones, underlying health conditions, or environmental factors. There are 4 main types of headaches.

Tension headaches: These are the most common type of headache, characterised by a dull, aching pain and a feeling of tightness or pressure around the forehead or the back of the head and neck. They are often caused by stress, poor posture, or muscle tension in the head, neck, or shoulders.


Migraine headaches: Migraines are usually more severe than tension headaches and are typically characterised by intense throbbing pain, often on one side of the head. They can be accompanied by symptoms such as nausea, vomiting, sensitivity to light and sound, and visual disturbances. They can be triggered by factors such as hormonal changes, certain foods, stress, lack of sleep, sensory stimuli like bright lights or strong smells, or neck dysfunction.


Cluster headaches: These are intense headaches that occur in clusters or groups, often around the eye area. They tend to come on suddenly and are usually accompanied by symptoms such as redness or watering of the eye, nasal congestion, and restlessness. 


Sinus headaches: These headaches occur when the sinuses become inflamed due to sinusitis or allergies. They typically cause pain and pressure in the forehead, cheeks, and around the eyes, and may be accompanied by symptoms such as nasal congestion, runny nose, and facial tenderness.


What causes headaches and migraines to occur?


Headaches often stem from accumulated triggers over time, culminating in the onset of a headache or migraine. Potential triggers may include:


  • Stress – leads to tight muscles and joints, and altered to posture

  • Weakness of neck, trunk and upper limbs

  • Poor posture - can result in excessive load through the muscles and joints of the head and neck

  • Temporo-mandibular joint (TMJ) dysfunction – joint that moves the jaw in front of the ear

  • Dehydration

  • Eye strain

  • Caffeine withdrawal 

  • Dietary factors

  • Fatigue/lack of sleep 

  • Direct sunlight/heat

  • Underling health conditions


It's important to note that everyone may experience headaches differently, and what triggers a headache for one, may not affect another in the same way.


Relationship between neck pain and headaches?


In clinical practice, we see many patients with neck pain that often don't report having headaches unless we inquire about them. There is frequently a disassociation between headaches and neck pain, often viewed as separate problems. However, it is quite common that someone with chronic neck pain and stiffness, also experiences headaches.


We also see patients who do present for specific treatment of headaches who may or may not have obvious issues with their neck. However, we will always assess the neck and upper back as a potential source of headache. Muscles in the neck and upper back and the upper three levels of the neck (cervical spine) can all refer pain into the head and face to varying degrees.


A combination of joint and soft tissue mobilisation, plus specific prescribed prescription and lifestyle advice are often very successful to remedy headaches, and migraines which are also frequently related to the neck.


What to do if you experience headaches

If headaches are constant or severe, especially of new onset for no apparent reason, it’s advisable to consult your GP for discussion and possible further investigation.


If your headaches are a recurrent issue and not a medical concern here are some tips:


Keep a headache journal

One of the most important things when dealing with headaches is to know your triggers. By knowing your triggers, you can address them. Try using a journal to document your headaches, noting in the time of day it occurred, when in the week or month it occurred, and the activity you were doing whilst it occurred e.g. work, physical activity, or inactivity. This will start to give you clues about triggers, e.g.

  • Monthly headache in females may mean headache has a hormonal/menstrual cycle relationship

  • Morning headaches may lean towards issues with sleep quality, pillows, sleep position

  • Weekend headaches may link to stress, indulging in food or alcohol, or less caffeine compared to working week


Keep fit, strong and active

Resistance training has demonstrated favourable outcomes in mitigating the occurrence of headaches. It is advisable to integrate three sessions per week of moderate resistance training, complemented by alternating days of active recovery and aerobic exercises such as walking, cycling, or swimming.


Manual Therapy

Manual or ‘hands on’ therapies such as that provided by Osteopaths, Physiotherapists, and Myotherapists, can be a great way to reduce pain and tightness of the muscles and joints of the upper back and neck which often refer pain to the head.


Be mindful

Mindfulness offers a holistic approach to managing headaches by allowing people to be in tune with their body including stress levels, thoughts, and emotions related to pain. Through mindfulness practices such as meditation, deep breathing, and body scanning, individuals can develop greater resilience to discomfort and reduce the impact of stressors that contribute to headaches. 


Hydration and nutrition

It is important to consuming 2-2.5L of water per day, eat a nutritious diet avoiding obvious triggers, and eating at intervals that suit your constitution - some people need to eat at regular intervals to minimise drastic changes in blood sugar, others do well with intermittent fasting type approaches.


Headache and migraine management often focuses on addressing specific triggers. Therefore, personalised treatment approaches are crucial for effective management – and don’t forget, it might be your neck! 


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