Headaches are very common, especially tension headaches. The World Health Organization estimates 33 percent of men and 50 percent of women are affected by tension headaches, and one in 20 adults gets a headache every day.
They rarely are signs of a serious or life-threatening problem, especially chronic headaches. But despite being so common, they typically are misunderstood.
The “tension” in a 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 in the neck are major contributors to the production of headaches as well.
In order to understand how a neck problem causes headache, you need to understand how referred pain works. Referred pain is caused in one location but felt in another. Other common examples of this include pain in the arm caused by heart disease as well as 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 the chart several times a day, especially for headache patients who are skeptical the pain across their forehead actually stems 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. Typically the patient had no idea there was such a tender spot in his or her 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 if these types of neck problems are the cause of a patient’s pain, no medication 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.
They are known as rebound headaches, also called medication overuse headaches, and are caused by the most commonly prescribed headache medications, including Fiorinal; Tylenol; all NSAIDs, including aspirin, Zomeg and Imitrex; and any painkiller that has caffeine in it. 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 is misdiagnosed — is because of the fact that much of the referred pain from the neck is felt over the sinuses. This type of headache is often mistaken for a sinus headache, and I have seen patients endure years of sinus treatment without much success. They typically do not come to the office for the headache, because 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.
Some patients with chronic sinus congestion leave the office after a neck treatment with their sinuses draining for the first time in years. 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 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. They often respond very well to treatment of the neck, though for complete recovery sometimes the patient needs 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, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.