Headaches and Migraines

There are two types of headaches;

1) Primary Headaches include tension–type, migraine, cervicogenic, and cluster headaches and are not caused by other underlying medical conditions. More than 90% of headaches are primary.

 

2) Secondary Headache result from other medical conditions, such as infection or increased pressure in the skull due to a tumour. These account for fewer than 10% of all headaches.
Descriptions of the Primary Headache Types:

  1. Tension–type Headaches Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers. As many as 90% of adults have had tension–type headache.

    Tension–type headaches usually involve a steady ache, rather than a throbbing one, are described as a feeling of pressure or tightening, may last minutes to days, affect both sides of the head, and and do not worsen with routine physical activity. It may also be accompanied by photophobia or phonophobia (hypersensitivity to light and noise, respectively.). Nausea is usually absent. Some people get tension–type (and migraine) headaches in response to stressful events. Tension–type headaches may also be chronic, occurring frequently or daily. Psychologic factors have been overemphasized as causes of headaches.

 

  1. Cervicogenic Headaches.

Cervicogenic headache originates from disorders of the neck and is recognized as a referred pain in the head. Nerves from the upper neck converge with nerves from scalp and face on to the same nerve in your spine, which gives rise to headache when the upper neck joints are tight or inflamed.

Cervicogenic headache (CHA) is a type of headache causally associated with cervical myofascial tender spots combined with cervical spine dysfunction.

(Headache Classification Subcommittee of the International Headache Society 2004) 

The reported prevalence of CHA varies from 13.8% to 17.8% of the headache population in different epidemiological studies.

(Anthony 2000, Nilsson 1995, Pfaffenrath 1990)

 

Cervical headache is often precipitated by neck movement and/or sustained awkward head positioning (such as painting the ceiling, or washing the floor) and can reproduced with pressure over the upper cervical or occipital region on the symptomatic side.

  1. Migraine Headaches Migraine headaches are less common than tension–type headaches. As many as 6% of all men, and up to 18% of all women experience a migraine headache at some time.

    Among the most distinguishing features is the potential disability accompanying the headache pain of a migraine: migraines may last 4-72 hours, are typically one sided (60% of reported cases), throbbing, of moderate to severe intensity, and are aggravated by routine physical activity.

    Nausea, with or without vomiting, and/or sensitivity to light and sound often accompany migraines. An “aura” may occur before head pain begins–– involving a disturbance in vision, and/or an experience of brightly coloured or blinking lights in a pattern that moves across the field of vision. About one in five migraine sufferers experiences an aura.

    Usually, migraine attacks are occasional, or sometimes as often as once or twice a week, but rarely occur daily.

  2. Cluster Headaches Cluster headaches are relatively rare, affecting about 1% of the population. They are distinct from migraine and tension–type headaches. Most cluster headache sufferers are male – about 85%.Cluster headaches come in groups or clusters lasting weeks or month. The pain is extremely severe but the attack is brief, lasting no more than a hour or two. The pain centers around one eye, and this eye may be inflamed and watery. There may also be nasal congestion on the affected side of the face.

    These “alarm clock” headaches may strike in the middle of the night, and often occur at about the same time each day during the course of a cluster. A history of heavy smoking and drinking is common, and alcohol often triggers attacks.

According to Kapandji (Physiology of the Joints, Volume III), for every inch your head moves forwards, it gains 10 pounds in weight, as far as the muscles in your upper back and neck are concerned, because they have to work that much harder to keep the head (chin) from dropping onto your chest.

n  This also forces the suboccipital muscles (they raise the chin) to remain in constant contraction, putting pressure on the 3 Suboccipital nerves. This nerve compression may cause headaches at the base of the skull. Pressure on the suboccipital nerves can also mimic sinus (frontal) headaches.

Cervicogenic headache (CHA) is a type of headache causally associated with cervical myofascial tender spots combined with cervical spine dysfunction.

(Headache Classification Subcommittee of the International Headache Society 2004)

n  The reported prevalence of CHA varies from 13.8% to 17.8% of the headache population in different epidemiological studies.

(Anthony 2000, Nilsson 1995, Pfaffenrath 1990)

Rene Cailliet M.D., famous medical author and former director of the department of physical medicine and rehabilitation at the University of Southern California states:

Head in forward posture can add up to thirty pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture (FHP) may result in the loss of 30% of vital lung capacity. These breath-related effects are primarily due to the loss of the cervical lordosis, which blocks the action of the hyoid muscles, especially the inferior hyoid responsible for helping lift the first rib during inhalation.”

In a study published in the Spine Journal (2009), 80 patients with chronic cervicogenic headache were randomized to receive either 8 or 16 treatment sessions with either chiropractic care (Spinal Manipulation or SMT) or a minimal light massage (LM) as the control group. Both SMT groups improved much more than the control groups, with greater improvements in the group that received more care.

References

Dose Response and Efficacy of Spinal Manipulation for Chronic Cervicogenic  Headache: A Pilot Randomized Controlled Trial. The Spine Journal 2009 (Feb): 10 (2): 117-128

Tuchin PJ, Pollard H, Bonello R. A Randomised controlled trial of Chiropractic Spinal Manipulative Therapy for Migraine.  2000. J Manipulative Physiol Ther. Feb;23(2):91-5.

Noudeh YJ, Vatankhah N, Baradaran HR.  Reduction of current migraine headache pain following neck massage and spinal manipulation. Int J Ther Massage Bodywork. 2012;5(1):5-13.

Hubbard TA, Kane JD. Chiropractic management of essential tremor and migraine: a case report.  J Chiropr Med. 2012 Jun;11(2):121-6. doi: 10.1016/j.jcm.2011.10.006.

Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, Shaw L, Watkin R, White E. Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther. 2011 Jun;34(5):274-89.

 

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