Headaches

Tension-type headache (also called tension headache) is the most common chronic and recurring headache. The Global Burden of Disease studies published in The Lancet rank it the most common neurologic condition in the world, and the 2nd most common disorder affecting women. Three quarters of people will suffer this headache during their lifetime.

• Tension headaches affect 67% of men, but more than 80% of women
• 68.4% of people suffer neck pain each year, but this increases to 88.4% of people who suffer tension headaches
• 23% of people who suffer tension headaches also suffer migraines
• 89.3% of people who suffer both tension headaches and migraines also suffer neck pain

It is a primary headache, so the cause remains unknown. It was once thought to be caused by tension in the muscles of your neck, shoulders and upper back. Research has shown that this is not the cause, but it is common in people who suffer these headaches. While the cause is not known, they are triggered by poor sleep, bright lights, stress, fatigue, and prolonged postures.

Poor sleep, stress, fatigue and prolonged postures are associated with tight muscles in the neck, shoulders and upper back. These are commonly experienced by people sitting at work computers for several hours every day, resulting in a stiff neck and tight muscles. These muscles may develop trigger points which are tender to touch. The research shows that prolonged postures are a significant risk factor for developing neck pain and headaches.

Bright light is known to trigger migraines as well as tension headaches. Migraine research has found changes in the cells of the retinas at the back of your eyes that leave your eyes more sensitive to bright light. When exposed to bright light, the retinas and the visual cortex at the back of your brain becomes overactive. The brain perceives this as a painful stimulus and a headache results. Researchers think that this may be similar to the process that triggers a tension headache in response to bright light.

Tension headaches involve similar neural pathways and brain regions as migraines and cervicogenic headaches. Poor sleep, stress, fatigue and prolonged postures all affect your upper neck, between the base of your skull and the top three vertebrae in your neck (C1—3). The result is neck joint dysfunction, where joints no longer function accurately and smoothly, and muscles fatigue and become tight. The joints, ligaments, muscles and tendons in your upper neck have sensory nerves that connect to the nerves that innervate the outer layer around your brain and spinal cord, called the meninges.

The sensory nerves from your upper neck (C1—3) connect to the trigeminal nerve in your brain stem and upper spinal cord. This is called the trigeminocervical complex. The trigeminal nerve innervates the meninges around your brain. When your C1—3 sensory nerves detect painful stimuli from your neck it sets off inflammation in your neck, and also in the trigeminal nerve. This inflammation reaches the meninges around your brain, which sensitises the sensory nerves of the meninges. This is what your brain perceives as pain in your head — a headache. Your trigeminal nerve also innervates the skin around your ears and temples, your forehead and around your eyes. This is why you can also feel headache pain to these areas when triggered.

Tension headaches commonly occur at the same time as migraines and cervicogenic headaches. This results in symptoms of both headaches occurring simultaneously. Migraines and cervicogenic headaches commonly involve only one side of your head, whereas tension headaches are felt on both sides of your head. This is one of the distinguishing features of tension headaches.

Recent research has identified an anatomical structure in the neck called a myodural bridge. It is a connection from a group of small, deep neck muscles collectively called the suboccipital muscles. These muscles connect your skull to the top two vertebrae (C1—2). These bridges run forward from these muscles, between the vertebrae, and attach to the dura mater (the outer layer of your meninges) surrounding your upper spinal cord. When you move your neck these muscles and bridges stop the spinal cord and dura mater from buckling. Repetitive movements, prolonged postures and trauma can cause these muscles to become dysfunctional, resulting in the spinal cord and dura mater buckling. Sensory nerves in the dura mater signal pain to your brain, which you perceive as a headache.

• Stiff neck joints
• Tight muscles
• Tenderness
• Pressure, squeezing or a tight band-like tension around the head. It is usually felt on both sides of the head (unlike migraines and cervicogenic headaches that are usually felt on one side only)
• Headaches are moderately severe
• Pain is dull and diffuse, not throbbing like a migraine
• Headaches that last 30 minutes—7 days
• Headaches that are present on waking up, or soon after
• You may be averse to light (photophobia) or loud sounds (phonophobia), but not both like a migraine

Your practitioner will take a detailed history and perform a physical examination to determine what type of headache(s) are causing your problem. They will assess your posture and movements, including other areas of your body that can affect your kinetic chain, looking for painful or dysfunctional postures and movements. They may also perform orthopaedic and neurologic exams, and check neurologic and vascular structures in your neck that may be affected. There are no blood tests or imaging biomarkers that are useful for diagnosing tension headaches, but you may be referred for these if there is an underlying cause such as trauma.

You will be given a diagnosis, and presented with recommended treatment options. The recommended treatments will be tailored specifically to you, and will be discussed with you so that you are comfortable with the treatment approach. Manipulation (also called adjustment) may be recommended, but if you are not comfortable with this then other techniques can be used.

Research shows that these headaches respond well to manual treatments and exercises, such as joint manipulation (adjustments), mobilisation, dry needling, soft tissue treatments, muscle energy and neuromuscular inhibition techniques, and stretches. The treatments and exercises aim to reduce tight muscles, stretch short muscles, and strengthen weakened muscles or muscles that need more endurance. The treatments and exercises will also strengthen muscles essential to neck and head stabilisation, and restore correct and accurate movement to joints that are not moving correctly.

Your brain controls balance, posture and co-ordinated movements. It relies on accurate sensory input from the nerves in your upper neck to do this. The same problems that are associated with tension headaches can also cause problems with these functions, resulting in dizziness, unsteadiness and imbalance, and clumsiness due to poor movement control. If these signs and symptoms are also present they will be addressed with treatments and exercises specifically tailored to you.

Headaches don’t only affect the parts of your brain associated with the perception of pain. They also affect other areas that regulate your emotions and mood, cognition (your ability to concentrate and remember things) and your social and professional interactions. Every person is different — it affects some people more than others. This is known as the biopsychosocial framework, which considers the biological, psychological and social effects of the headache on you, as a whole person. This is also taken into account with your treatments.

Analgesic (painkiller) and anti-inflammatory medications have a mixed track record, working for some but not others. Importantly, medications won’t fix your underlying functional, stability, postural or proprioceptive problems. Rehabilitation exercises and stretches are prescribed specifically tailored to you. You will also be given occupational and lifestyle strategies. All of these are designed to get you out of pain, improve function of your neck, and reduce the probability of recurrence.

Treatments are focussed on the underlying cause and not simply providing short-term relief. Some people are headache-free within a few treatments. The research, and experience shows that other people may take between 6—12 weeks. This is common with tension headaches, and is common if the underlying contributors have been present for a long time. Strengthening and retraining muscles and restoring correct, accurate function to the neck takes time. There are no quick fixes. Some people only want to get out of pain, and we respect that decision. We will always recommend treatments and exercises that are specifically tailored to you and your needs, with the aim of getting long-term, lasting results for you.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download a Headache Diary here.

Cervicogenic means “beginning in the neck”. These headaches are caused by prolonged postures, repetitive movements and trauma that affect your neck. They are caused by sprains, strains, muscle fatigue and inflammation affecting the joints, ligaments, muscles and tendons in your neck. The neck will usually feel stiff, the muscles tight and tender to touch, and certain postures and movements will make it feel worse. They are common daily presentations in our clinic.

Yes; these are called cervicogenic headaches. The most common causes are prolonged postures, repetitive movements of your head and neck, and stress. This is commonly experienced by people sitting at work computers for several hours every day, resulting in a stiff neck and tight muscles. These muscles may develop trigger points which are tender to touch. The research shows that the amount of time you spend in a given posture is a significant risk factor for developing neck pain and cervicogenic headaches.

Cervicogenic headaches can also be caused by trauma to your neck. Car crashes and sports collisions can cause whiplash to your neck, resulting in traction, compression and rotational injuries. This can sprain ligaments and injure the joints in your neck. It can also tear muscles and strain tendons that stabilise and move your head and neck. The result is neck joint dysfunction, where joints no longer function accurately and smoothly, and muscles fatigue and become tight.

Cervicogenic headaches can be caused by prolonged postures, repetitive movements or trauma that affects your upper neck, between the base of your skull and the top three vertebrae in your neck (C1—3). The joints, ligaments, muscles and tendons in your upper neck have sensory nerves that connect to the nerves that innervate the outer layer around your brain and spinal cord, called the dura mater. Your C1 sensory nerve also innervates the dura mater around the back or your brain near the base of your skull (your occiput). When this part of your neck is affected you will feel the headache at the back of your head.

If the joints, ligaments, muscles and tendons that are innervated by C2 or C3 are affected you may feel the headache above your ear and into your temple, or even towards your forehead and around your eye. The sensory nerves from your upper neck (C1—3) connect to the trigeminal nerve in your brain stem and upper spinal cord. This is called the trigeminocervical complex. The trigeminal nerve innervates the dura mater around your brain. When your C1—3 sensory nerves detect painful stimuli from your neck it sets off inflammation in your neck, and also in the trigeminal nerve. This inflammation reaches the dura mater around your brain, which sensitises the sensory nerves in the dura mater. This is what your brain perceives as pain in your head — a headache.

Your trigeminal nerve also innervates the skin on your face, over your temples, forehead, and around your eyes. This is why you can also feel headache pain to these areas.

If one side of your upper neck is affected, then you will feel the headache on the same side of your head; if both sides of your neck are affected you may feel the headache on both sides of your head.

Recent research has identified an anatomical structure in the neck called a myodural bridge. It is a connection from a group of small, deep neck muscles collectively called the suboccipital muscles. These muscles connect your skull to the top two vertebrae (C1—2). These bridges run forward from these muscles, between the vertebrae, and attach to the dura mater surrounding your upper spinal cord. When you move your neck these muscles and bridges stop the spinal cord and dura mater from buckling. Repetitive movements, prolonged postures and trauma can cause these muscles to become dysfunctional, resulting in the spinal cord and dura mater buckling. Sensory nerves in the dura mater signal pain to your brain, which you perceive as a headache.

• • • • • Pain or tenderness over the base of your skull (occiput)
        • Pain or tenderness may refer to your temples or forehead
        • Headache felt on one side of your head (but may affect both sides)
        • Mild—severe pain intensity
        • Dull diffuse pain to your neck, shoulder or arm
        • Tight or stiff neck
        • Made worse with specific head and neck positions and movements, and pressure applied over your upper neck and occiput
        • Lasts days—weeks
        • Rarely causes nausea and vomiting
        • May be associated with dizziness and clumsiness

Your practitioner will take a detailed history and perform a physical examination to help rule out other types of headaches, such as tension headaches and migraines. They will assess posture and movements of your head, neck and shoulders, looking for specific painful or dysfunctional patterns. They may also perform orthopaedic and neurologic exams, and check neurologic and vascular structures in your neck that may have been injured. There are no blood tests or imaging biomarkers that are useful for diagnosing cervicogenic headaches, but you may be referred for these if there is an underlying cause such as trauma.

You will be given a diagnosis, and presented with recommended treatment options. The recommended treatments will be tailored specifically to your neck, and will be discussed with you so that you are comfortable with the treatment approach. Manipulation (also called adjustment) may be recommended, but if you are not comfortable with this then other techniques can be used.

Research shows that these headaches respond well to manual treatments and exercises, such as joint manipulation (adjustments), mobilisation, dry needling, soft tissue treatments, muscle energy and neuromuscular inhibition techniques, and stretches. The treatments and exercises aim to reduce tight muscles, stretch short muscles, and strengthen weakened muscles or muscles that need more endurance. The treatments and exercises will also strengthen muscles essential to neck and head stabilisation, and restore correct and accurate movement to joints that are not moving correctly.

Your brain controls balance, posture and co-ordinated movements. It relies on accurate sensory input from the nerves in your upper neck to do this. The same problems that can cause cervicogenic headaches can also cause problems with these functions, resulting in dizziness, unsteadiness and imbalance, and clumsiness due to poor movement control. If these signs and symptoms are also present they will be addressed with treatments and exercises specifically tailored to you.

Headaches don’t only affect the parts of your brain associated with the perception of pain. They also affect other areas that regulate your emotions and mood, cognition (your ability to concentrate and remember things) and your social and professional interactions. Every person is different — it affects some people more than others. This is known as the biopsychosocial framework, which considers the biological, psychological and social effects of the headache on you, as a whole person. This is also taken into account with your treatments.

Analgesic (painkiller) and anti-inflammatory medications have a mixed track record, working for some but not others. Importantly, medications won’t fix your underlying functional, stability, postural or proprioceptive problems. Rehabilitation exercises and stretches are prescribed specifically tailored to you, and the problem with your neck. You will also be given occupational and lifestyle strategies. All of these are designed to get you out of pain, improve function of your neck, and reduce the probability of recurrence.

Treatments are focussed on the underlying cause and not simply providing short-term relief. Many people are headache-free within a couple of treatments. The research, and experience shows that other people may take between 6—12 weeks. This is common if the underlying cause has been present for a long time. Strengthening and retraining muscles and restoring correct, accurate function to the neck takes time. There are no quick fixes. Some people only want to get out of pain, and we respect that decision. We will always recommend treatment and exercises that are specifically tailored to you and your needs, with the aim of getting long-term, lasting results for you.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download our Headache Diary.

Premenstrual syndrome (PMS) includes a wide range of symptoms. These may occur during the luteal phase of the menstrual cycle. This is the second half of the cycle occurring between ovulation and the start of the period. Up to 40% of women experience PMS. This usually occurs between the ages of 15 to 35 years, but it can also affect older women. A common symptom during this phase is premenstrual headache.

Hormones are produced by the organs of your endocrine system. Your central nervous system monitors and changes levels throughout your menstrual cycle. These systems interact with your gastrointestinal (digestive) and immune systems. , contributing to the diverse range of symptoms experienced during PMS. Premenstrual headaches result from the interplay between these systems.

Oestrogen levels decrease during the luteal phase. Oestrogen is a natural anti-inflammatory. When levels decline, the immune system becomes more active. This leads to inflammation and constriction of cerebral blood vessels. This leads to premenstrual headaches. Headaches that arise after your period have different causes. These include decreased iron levels due to blood loss, or migraines. Research has found that oral contraceptive pills increase the likelihood of headaches.

Premenstrual headaches are often seen with PMS. This syndrome manifests with a diverse range of symptoms. These vary between women, and between cycles. They involve dysfunctions within one or more systems. PMS may exacerbate pre-existing conditions like migraines and back pain. In fact, menstrual-related headaches are more common in womenen who also experience migraines. Stress and emotions can increase the severity of symptoms.

PMS and premenstrual headaches respond well to evidence-based natural medicine. Personalised prescriptions are essential. This is because of the various systems involved, and different manifestations. Naturopaths have the necessary expertise to formulate bespoke evidence-based nutritional and herbal prescriptions.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download a Headache Diary here.

You have four pairs of paranasal sinuses. They are all innervated by the trigeminal nerve. This also innervates your forehead, face, TMJs and teeth, as well as the meninges around your brain. It is also involved in migraines and tension-type headaches. Sinusitis is the inflammation of the mucous membranes lining your sinuses. This inflammation results from infections, allergies or migraine attacks. Sinusitis headaches cause pain over your forehead or face, and can mimic a toothache. Tension-type headaches and TMJ pain can also cause sinus pain.

• • • • • tenderness, swelling or pain over the involved sinus
        • referred pain to the forehead, face or occiput
        • low-grade fever and chills
        • malaise
        • inflamed and red nasal mucous membranes
        • mucous present on rising or in the evening
        • runny nose
        • congestion causing a nasally voice
        • teary eyes (lacrimation)
        • post-nasal drip that may cause a dry, unproductive cough

Sinusitis headaches respond well to evidence-based natural medicine. Treatments vary based on the underlying causes. Common causes include infection, allergy, or migraine attacks. Personalised prescriptions are essential. Naturopaths have the necessary expertise to formulate bespoke evidence-based nutritional and herbal prescriptions. Manual treatments are also effective when the cause is migraine, tension-type headache, or TMJ dysfunction.

You can book an appointment online or call The Headache and Neck Pain Clinic today to make an appointment.

You can also download a Headache Diary here.