MICHAEL NOONAN

Headaches: A common ailment often misdiagnosed

Posted June 13, 2013, at 11:48 a.m.

Headaches are very common, especially tension headaches. The World Health Organization estimates that 65 percent of men and 80 percent of women are affected by tension headaches, and that one in 20 adults gets a headache every day.

Headaches are rarely a sign of a serious or life-threatening problem, especially chronic headaches. But despite being so common, they are typically misunderstood.

The “tension” in tension headache is assumed to be in the muscles of the scalp. But while the scalp muscles can cause some local pain, they are not the major players in headache. This distinction belongs to the neck, and is not limited to the muscles — the joints of the neck are major contributors to the production of headache as well.

In order to understand how a neck problem causes headache, you have to understand how referred pain works. Referred pain is caused in one location but felt in another. Other common examples are pain in the arm caused by heart disease, and right shoulder and upper back pain caused by an inflamed gallbladder.

Not every muscle causes referred pain, but many spinal muscles do. Researchers have mapped out the typical patterns of referred pain for every muscle, and I have a chart of these patterns in my main treatment room, on the wall that faces the patient. I use that chart several times a day, especially for headache patients who are skeptical that the pain across their forehead is actually stemming from the neck and shoulders. There is nothing like a visual aid to get this point across. One look at the chart and they say, “Yup, that’s my headache right there.”

An even stronger case is made for the patient when I squeeze the tender point in the neck and they feel pain in the head, duplicating their headache. It is almost an eerie feeling, especially when the pain in the head is more intense than in the neck muscle I am checking. And typically the patient had no idea that there was such a tender spot in their neck. In the beginning, I am often accused of squeezing too hard, but after a few weeks of treatment the spot is no longer tender to pressure (and the associated headache is usually gone also). My experience in treating many of these cases is that if these types of neck problems are the cause of a patient’s pain, there is no medication that will give more than temporary relief.

There is another reason to avoid medication use for chronic headache. Believe it or not, one of the most common causes of daily headache is painkiller use, especially the painkillers given for headache. Known as rebound headaches or medication overuse headaches, they are caused by the most commonly prescribed headache medications, including Fiorinal, Tylenol, all NSAIDs including aspirin, Zomeg, Imitrex, and any painkiller that contains caffeine. The first challenge for some of my chronic headache patients is to wean them off their painkillers so we can stop the rebound headaches.

Another way headache is misunderstood (and often misdiagnosed) is due to the fact that there are several neck structures that all refer pain to the forehead. This type of headache is often mistaken for a sinus headache, and I have seen patients endure years of sinus treatment only to find relief when their neck is treated. They typically do not come to the office for the headache, since they do not know the problem is originating in the neck; they usually start care for neck pain or some other condition. A few treatments to the neck and often the headaches improve or even disappear, much to the surprise (and relief) of the patient.

To further complicate matters, problems in the joints and muscles of the neck actually can interfere with sinus drainage. Some patients with chronic sinus congestion leave the office after a neck treatment with sinuses draining for the first time in years. The connection between the neck and the sinuses can be described as a “two-way street,” in that neck problems can cause sinus congestion and pain, and sinus inflammation can cause reactive tension in the neck muscles. Treating only the sinuses cannot break this cycle; a major cause of the pattern will be left in place until the neck is treated.

I often tell my patients that their headaches are not “all in their heads” but actually start a few inches lower, in the neck. This is true of tension headaches, sinus headaches, even migraines. (More on migraine headache next week.) They often respond very well to treatment of the neck, although for complete recovery sometimes the patient has to improve their diet, control stress, and begin to exercise regularly. But all these lifestyle changes are made a lot easier when chronic headache is relieved with proper treatment of the cause of the pain.

Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.

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