Headache is the third most common chronic pain disorder of the Western world, and is an enormous healthcare burden. Many people across Australia and the world suffer from headaches on a regular basis. It is commonly debilitating in nature and can affect daily life. Headache is a symptom of a range of neurobiological disorders, including some of the most common and universal. Adults aged 20 – 50 years are the most likely sufferers but children and adolescents are affected too. The term ‘headache disorder’ encompasses many conditions that vary in severity, incidence and duration. It is vital to exclude pathological headache, to diagnose the major forms of primary headache, and then offer the latest in evidence-based management.
So what sort of headache do I have?
Due to the large variation in presenting symptoms with headaches, many people are not aware or are ill informed as to what headache they are suffering and immediately diagnose themselves as suffering a “migraine headache”. Migraine headaches are quite common but they are surprisingly not the most common and are very frequently over diagnosed. Different types of headaches require individual treatment approaches so correct diagnosis is important if you want to successfully manage your headache. An accurate and prompt patient history, neurological screen and neuro-musculoskeletal examination should be implemented with the gathered information essential in the correct diagnosis and management.
What is undisputed is that migraine and tension-type headache are the most prevalent and have the greatest impact on public health, owing to their disabling potential.
For this blog we are going to address these two most common types of headaches. We will talk briefly about diagnosis and management/treatment of each of the types of headaches and how chiropractic can help you. It is important to remember that migraine and tension-type headache exist on a continuum. Although they can appear quite distinct from one another at opposite ends of the spectrum, they merge together in the middle and demonstrate significant overlap.
Tension Type Headache
Tension headaches represent approximately 38% of all presenting headaches. Onset is generally in teenage years and peaks during the fourth decades before declining. Recent studies have shown the average prevalence as 36% for men and 42% for women. This means that about 7 million Australians are likely to suffer from tension type headaches. 60% of those with tension-type headache experience reductions in social activities and work capacity.
These types of headaches are shown to have a close correlation with muscular tightness within the cervical spine. Poor posture and stress are also heavily linked as they progressively overload mechanical structures responsible for eliciting the headache symptoms. They also tend to occur slightly more in women. Recent research into tension headaches has revealed that they can be progressive in nature and transform into a chronic form of tension headache which are significantly more disabling and costly. This highlights the importance of early diagnosis and implementation of treatment to reduce the likelihood of progression.
So how do I know if I’m suffering tension type headaches?
The key features for diagnosis of a tension type headache are:
- Mild-moderate, tight, heavy, pressuring like headache affecting both sides of head and/or neck
- Tautness/tenderness of scalp, neck and shoulder muscles
- Neck movements (active or passive) restricted by muscular stiffness and discomfort
- Not worse on exertion
- Will only have either sensitivity to sounds or light, not both
Education tends to be the first step in successfully managing these types of headaches. Helping you understand the major factors in head pain can help reduce levels of stress and anxiety and enlighten you to the significance and influence of personal belief in pain perception. Understanding that most likely this pain is a result of deconditioning rather than damage or degeneration can ensure the patient this issue can be managed.
Manual forces such as spinal manipulation, release techniques and trigger point therapy are all forms of controlled and targeted tissue deformation. These work by disrupting self-reinforcing patterns of pain signalling and sensitisation. By exploiting reflex analgesic effects at the spinal cord level, and recruiting descending inhibitory mechanisms, we can help the brain to regain inhibitory control over tissue inputs. Adjustments to the neck and surrounding joints have been proven to help control/remap sensory input and improve motor control of the targeted areas not only improving stability but also improving pain inhibition. (READ MORE ABOUT HOW CHIROPRACTIC ADJUSTMENTS HELP TO ALLEVIATE PAIN)
It is then when we may address the motor control of the neck which commonly contributes to the development of these conditions in the first place. A guided self-management strategy could involve tasks that improve neck muscle activation (such as chin tuck exercises) and those that stimulate a process of motor relearning. The key message here is that a focus upon improving neck movement control, and overall movement health, is likely to bring a significant benefit.
While you surely hear about migraines quite commonly they are actually less common than tension type headaches. Approximately 10% of headaches are migraines and they do present with quite a variety of symptoms. About 15% of the population suffers from migraine at some stage in their lives. Migraine often first appears in childhood, adolescence, or early adulthood but affects the greatest number of people between 35 and 45 years of age. There are more than three million migraine sufferers in Australia, meaning that more people suffer from migraine in Australia than diabetes, asthma, or coronary heart disease. Migraine is also a very debilitating condition, affecting your ability to function in everyday life. Nearly all people who suffer from migraines report a reduction in social activities and work capacity.
Migraine is a disorder of brain function, and so does not show any structural changes during brain scans. It is thought to be caused by temporary changes in blood vessels and chemicals in the brain.
It is basically the manifestation of an abnormally excitable brain in genetically susceptible individuals. The result is not only nasty headaches, but also a host of other autonomic, cognitive, emotional and musculoskeletal disturbances. Furthermore, these can occur both during the headache or outside of the pain presentation. A strong genetic component to migraine has been suggested by the fact that patients very often have a family history of migraine.
The key features for diagnosis of migraine headache
- Typically lasting from 4-72 hours
- Typically one sided – however approx. 40% of migraine sufferers perceive the pain on both sides
- At least 2 of – one sided head pain, pulsing or throbbing, impairing daily activities, intensified by exertion
- At least 1 of – nausea/vomiting, light sensitivity, sound sensitivity
- Occasionally associated with ‘aura’ symptoms – visual, sensory or speech fogginess/changes (not lasting more than an hour)
Now it is important to understand that treatment of migraine is similar to the treatment of a condition like diabetes – once you have the condition, it is difficult to fully cure it. Rather our focus becomes more about managing the symptoms of the condition. Fortunately, chiropractic care has been shown to be an effective method in managing many of the symptoms of migraine. Early intervention is vital in controlling migraines. The earlier the patient seeks care, the more likely an effective management protocol can be developed and implemented.
Education is also very important in treating migraines. Understanding and identifying certain triggers that cause migraine episodes can help reduce and avoid these instances. Educating about the pre-migraine symptoms and patterns can help the patient identify a likely attack in advance and allow time to seek adequate treatment to minimise and control the severity of the headache.
Ultimately reducing neural excitability bombarding the nervous system is the key when addressing and minimising symptoms of a migraine. Addressing surrounding neck, shoulder and upper to mid back muscle tightness/spasm and joint mobility can reduce neural excitability and help the sufferer relax. Spinal manipulation of the mid back and neck has also been shown to improve mobility and reduce dysfunctional neurological feedback into the central nervous system which can be responsible for migraine attacks. Improvements in posture is another well known response to chiropractic manipulation and studies have shown improvements in posture can reduce frequency and severity of migraine attack. (READ MORE ABOUT HOW CHIROPRACTIC ADJUSTMENTS HELP TO ALLEVIATE PAIN)
Healthy nutritional and exercise advice can also be beneficial in stress reduction and thus limit or reduce the likelihood of migraine attacks. In the severe cases NSAIDs (non-steroidal anti-inflammatories) have been shown to be helpful in some cases, as were typical strong analgesics such as codeine based paracetamols. However drug use is generally not suggested as it can lead to dependency issues and addiction (especially opiate based pain-killers).
The take home message with migraines is to seek prompt advice and treatment, as this can heavily influence migraine management. Although most migraine sufferers are unable to completely cure themselves of migraines the severity and frequency of the attacks can be controlled.
Excluding pathological headaches from primary headaches are vital. There are several signs you should look out for that can indicate a possibility of a more sinister cause of headaches. If you have any of the following it is strongly advised to consult your GP regarding this promptly to ensure adequate management:
- Are headaches a new symptom for you (recent onset)?
- Do you have any other new symptoms that are noticeable even when you don’t have a headache (focal neurological signs such as changes to your balance, vision, sensation or strength)?
- Do your headaches sharply worsen with coughing, straining or bending forward?
- Have your headaches suddenly changed in character, frequency or intensity for no reason (progression of symptoms)?
- Have you or your partner noticed any changes in your personality, memory or ability to think clearly (cognitive changes)?
Headaches are by no means a simple condition, but with the right approach we can hopefully help to make life a lot easier for you. We have some great success stories with headache sufferers, so if you’re living with recurrent or ongoing headaches give us a call and see how we might be able to help.
Dr Grant Colombo (chiropractor)