Headaches are one of the most common complaints that we see at our office. Headaches come after neck and back pain. Although there are many causes of headaches we have found that many different types of headaches originate from mechanical problems in the neck. Some headaches such as migraine and cluster headaches are related to vascular problems. These often include nausea and/or vomiting and can be quite disabling and require rest in a dark, quiet place sometimes for a half or a whole day. Other headaches can be categorized as “tension” headaches. These usually result from tightness in the muscles in the neck and upper back caused from stress, work, lack of sleep, sinusitis, trauma such as whiplash, and others. Pain can be felt in the upper neck or the back of the head as well as in the frontal, sinus region, top or sides of the head. It can vary from a throbbing pain to an ache to just a constant pain.
So “how does chiropractic work?” To answer this, let’s first discuss what we do when the headache patient comes in. First, the history is very important! Here, we’ll ask “how/when did the headaches start. This may glean the actual cause of headaches such as a car accident or injury of some sort.
Next, we’ll ask about activities that increase or create the headache, which gives us ideas of how we might help manage the headache patient. For example, when certain activities precipitate the onset of a headache, we will modify the workstation and/or give specific exercises on a regular schedule to keep the neck tension under control. When information gathered about what decreases or helps the neck pain and headaches, we will recommend treatments often that can be done at home such as a home traction unit. This would be suggested if we are told that “…pulling on my neck feels great!” The quality of pain (throbbing = vascular, ache and tightness = neck), intensity of pain (0-10 pain scale), and timing (worse in the morning vs. evening) help us track change after treatment is rendered, usually gathered once a month.
What most people don’t realize is that mechanical dysfunction of the vertebrae of the neck will cause increased muscle tension as well as irritate the delicate nerves that control blood flow into the head. Improving the movement or alignment of the bones in the neck can relieve the pressure and irritation that results in headaches. How do we get misalignments or dysfunction in the joints of the neck? This can be due to trauma such as falls or car accidents. Repetitive stress such as hours of work on a computer, poor posture or stress can also take a toll over time. In many patients it is a combination of activities that took place often years before which has led to chronic and recurring headaches. The examination evaluates these issues as well as attempts to rule out other more serious causes, which can occur but are more rare. Nerve function by checking reflexes, sensation and muscle strength as well as correlating information like positions that decrease arm or leg pain will be included as any position that reduces pain in the arm or leg must be incorporated into an exercise. X-rays may include bending “stress” views so that ligaments (that hold bones together) can be evaluated for “laxity” (torn and unstable). When this is found, we avoid adjustments to these vertebrae. We also evaluate the jaw or TMJ for involvement.
As you can see, if is very important do a thorough evaluation so headache patients can be properly managed. Treatment approaches include: 1. Adjustments; 2. Soft tissue therapy (trigger point stimulation, myofascial release); 3. Posture correction exercises and other exercises; 4. Education about job modifications; 5. Co-management with other health care providers, if medication or injection therapy is needed.