Headache and Neck Pain Clinic - Increased sensitisation - poor sleepLow back pain is the most common disorder in the world. 82.5% of people who suffer chronic headaches also suffer low back pain, which is significantly higher than the general population (65.7%). Headaches are also commonly associated with neck pain and dysfunction.

Research has shown that manual treatments, specific exercises and natural medicine are effective at reducing the frequency, intensity and duration of headaches, as well as reducing medication use. Medication overuse headache is the 3rd most common headache in the world. It frequently occurs when people try unsuccessfully to control their headaches. This causes a second headache in addition to the original headache.

Different types of headaches require different treatment strategies. Some respond well to manual treatments and exercises, others respond better to natural medicine, and others respond to a combination of both. Chronic headaches can be prevented by early treatment of the cause, and not by masking the symptoms with medications.

There are many different types of headaches. These are some of the most common:

Headache and Neck Pain Clinic - Increased sensitisation - Who Gets TTH?

Tension-Type Headache

Commonly called a tension headache, this is the most common neurological condition in the world, and the 2nd most common disorder affecting women. 78% of people will suffer this headache during their lifetime, and it is the most common chronic and recurring headache.

  • 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.
Headache and Neck Pain Clinic - Increased sensitisation - Neck Muscles

What causes tension headaches?

The cause is unknown but it was once thought to be caused by tension in the muscles of the neck, shoulders and upper back, which is common in people who suffer tension headaches. Tension headaches involve many of the same nerves and parts of the brain and brainstem implicated in migraines. These become hypersensitive in people who suffer tension headaches. They may be triggered by poor sleep, bright light, stress, fatigue, or prolonged or poor posture.

What are the symptoms of a tension headache?

These headaches are associated with:

  • Stiff neck joints
  • Tight muscles
  • Tenderness

Tension headaches are commonly described as:

  • Pressure, squeezing or a tight band-like tension around the head that is usually felt on both sides of the head
  • Headaches that last 30 minutes—7 days
  • Headaches that are present on waking up, or soon after

Pain may be experienced over the:

  • Forehead and temples
  • Jaw (temporomandibular joint or TMJ)
  • Around or behind the eyes
  • Neck
  • Shoulders
  • Upper back

How are tension headaches treated?

These headaches respond well to evidence-based manual treatments to the neck, shoulders and upper back, combined with prescribed exercises to reduce the frequency, severity and duration of relapses.

If they are not properly treated they may become more frequent. This causes your brain and brainstem to become hypersensitive to pain, leading to chronic tension headaches that may be unremitting.

References for further information:

Aguila MR, Rebbeck T, Pope A, Ng K, Leaver AM. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches. Cephalalgia. 2018;38(10):1672-1686

Ashina M, Stallknecht B, Bentsen L, Pedersen JF, Galbo H, Dalgaard P, et al. In vivo evidence of altered skeletal muscle blood flow in chronic tension-type headache. Brain 2002;125(part 2):320-326

Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia. 2015;35(3):211-9

Ashina S, Lipton RB, Bendtsen L, Hajiyeva N, Buse DC, Lyngberg AC, et al. Increased pain sensitivity in migraine and tension-type headache coexistent with low back pain: A cross-sectional population study. Eur J Pain. 2018;22(5):904-914

Benito-González E, Palacios-Ceña M, Fernández-Muñoz JJ, Castaldo M, Wang K, Catena A, et al. Variables associated with sleep quality in chronic tension-type headache: A cross-sectional and longitudinal design. PLoS One. 2018;13(5):e0197381

Boline PD, Kassak K, Bronfort G, Nelson C, Anderson AV. Spinal manipulation vs amitriptyline for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther. 1995;18(3):148-154

Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of Spinal Manipulation for Chronic Headache: A Systematic Review.  J Manipulative Physiol Ther. 2001;24(7):457-66

Bronfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev 2014;8:CD001878

Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Clinical practice guidelines for the management of headache disorders in adults. Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory and Education Accrediting Boards, Clinical Practice Guidelines Project, Jan 2012

Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. J Headache Pain. 2014;15(1):67

Castien R, van der Windt DA, Grooten A, Dekker J. Effectiveness of manual therapy for chronic tension-type headache: A pragmatic, randomised, clinical trial.  Cephalalgia. 2010;31(3):133–143

Chen WT, Chou KH, Lee PL, Hsiao FJ, Niddam DM, Lai KL, et al. Comparison of gray matter volume between migraine and “strict-criteria” tension-type headache. J Headache Pain. 2018;19(1):4

Chen Z, Chen X, Liu M, Liu S, Yu S, Ma L. Magnetic Resonance Image Texture Analysis of the Periaqueductal Gray Matter in Episodic Migraine Patients without T2-Visible Lesions. Korean J Radiol. 2018;19(1):85-92

Côté P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, et al. Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2019;23(6):1051-1070

Courtney CA, Fernández-de-las-Peñas C, Bond S. Mechanisms of chronic pain – key considerations for appropriate physical therapy management. J Man Manip Ther. 2017;25(3):118-127

Delaruelle Z, Ivanova TA, Khan S, Negro A, Ornello R, Raffaelli B, et al. Male and female sex hormones in primary headaches. J Headache Pain. 2018;19(1):117

Do TP, Heldarskard GF, Kolding LT, Hvedstrup J, Schytz HW. Myofascial trigger points in migraine and tension-type headache. J Headache Pain. 2018;19(1):84

Eidlitz-Markus T, Zolden S, Haimi-Cohen Y, Zeharia A. Comparison of comorbidities of migraine and tension headache in a pediatric headache clinic. Cephalalgia. 2017;37(12):1135-1144

Eller-Smith OC, Nicol AL, Christianson JA. Potential Mechanisms Underlying Centralized Pain and Emerging Therapeutic Interventions. Front Cell Neurosci. 2018;12:35

Espi-Lopez GV, Rodríguez-Blanco C, Oliva-Pascual-Vaca Á, Molina-Martinez FJ, Falla D. Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(4):447-456

Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol. 2018;9:254

Fernández-de-Las-Peñas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2016;36(12):1134-1142

Ferragut-Garcías A, Plaza-Manzano G, Rodríguez-Blanco C, Velasco-Roldán O, Pecos-Martín D, Oliva-Pascual-Vaca J, et al. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of the Tension-Type Headache: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2017;98(2):211-219.e2

Finan PH, Goodin BR, Smith MT. The association of sleep and pain: An update and a path forward. J Pain. 2013;14(12):1539–1552

GDB 2015 Neurological Disorders Collaboration Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017;16:877-97

GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-480

GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1789-858

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia 2018;38(1):1-211

Kahriman A, Zhu S. Migraine and Tension-Type Headache. Semin Neurol. 2018;38(6):608-618

Kraya T, Deschauer M, Joshi PR, Zierz S, Gaul C. Prevalence of Headache in Patients With Mitochondrial Disease: A Cross-Sectional Study. Headache. 2018;58(1):45-52

Liang Z, Galea O, Thomas L, Jull G, Treleaven J. Cervical musculoskeletal impairments in migraine and tension type headache: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2019;42:67-83

Lidegaard M, Andersen LL. Association Between Trapezius Muscle Tenderness and Tension-Type Headache in Female Office Workers: A Cross- sectional Study. J Manipulative Physiol Ther. 2018;41(6):483-487

Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia. 2016;36(5):474-92

Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornella R, Raffaelli B, et al. Headache and pregnancy: a systematic review. J Headache Pain. 2017;18:106

Palacios-Ceña M, Barbero M, Falla D, Ghirlanda F, Arend-Nielsen L, Fernández-de-Las-Peñas C. Pain Extent Is Associated with the Emotional and Physical Burdens of Chronic Tension-Type Headache, but Not with Depression or Anxiety. Pain Med. 2017;18(10):2033-2039

Simpson N, Scott-Sutherland J, Gautam S, Sethna N, Haack M. Chronic exposure to insufficient sleep alters processes of pain habituation and sensitization. Pain. 2017;159(1):33-40

Stovner, LJ, Nichols E, Steiner TJ, Abd-Allah F, Abdelalim A, Al-Raddadi RM, et al. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018;17:954–76

Vivekanantham A, Edwin C, Pincus T, Matharu M, Parsons H, Underwood M. The association between headache and low back pain: a systematic review. J Headache Pain. 2019;20:82

Zheng N, Chi YY, Yang XH, Wang NX, Li YL, Ge YY, et al. Orientation and property of fibers of the myodural bridge in humans. Spine J. 2018;18(6):1081-1087

Headache and Neck Pain Clinic - Increased sensitisation - Cervicogenic Headache

Cervicogenic Headache

Cervicogenic headaches are caused by a problem in your neck (cervicogenic means ‘beginning in the neck’). Sensory nerves in your neck join up with nerves that innervate your face and head, and the outer layer around your brain called the dura mater. When this sensory signal reaches your brain it has trouble determining where the signal came from, so it inaccurately perceives the pain from your neck as a headache. This is known as referred pain. Cervicogenic headache is neck pain referred to your head as a headache.

What causes cervicogenic headaches?

Cervicogenic headaches are caused by problems in the joints, ligaments, discs, muscles or tendons, or nerves in your neck. They are not caused by problems with your head or brain. Problems include strains to muscles and tendons, muscle spasms and trigger points, and sprains to ligaments and joints. Injury, overuse and inflammation increase pain sensitivity resulting in higher levels of perceived pain and headache.

Common causes include:

  • Prolonged poor postures
  • Repetitive neck and head movements
  • Joint dysfunction
  • Muscle fatigue
  • Stress
  • Trauma such as car accidents, sports injuries or whiplash

What are the symptoms of cervicogenic headaches?

  • Pain or tenderness over the base of the skull (occiput).
  • Pain or tenderness may refer to the temples or forehead.
  • Headache felt on one side of the head (but may affect both sides).
  • Mild—severe pain intensity.
  • Dull diffuse pain to neck, shoulder or arm.
  • Restricted movement of the head and neck.
  • Worsened by head or neck movement, prolonged awkward postures or pressure applied over the upper neck and occiput.
  • Lasts days—weeks.

The brain relies on sensory nerves in the joints, discs, muscles and tendons in your neck to control balance, posture and movement. Problems with these can cause dizziness, unsteadiness or imbalance, in addition to the headache and painful neck.

How are cervicogenic headaches treated?

These headaches respond poorly to medications, but they respond well to evidence-based manual treatments and prescribed exercises. The aim is to relieve your headache and neck pain, and to reduce the probability of future episodes.

References for further information:

Aguila MR, Rebbeck T, Pope A, Ng K, Leaver AM. Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches. Cephalalgia. 2018;38(10):1672-1686

Bogduk N. The anatomical basis for cervicogenic headache. J Manipulative Physiol Ther. 1992;15:67-70

Bronfort G, Haas M, Evans R, Meininger B, Triano J. Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat. 2010;18:3

Bryans R, Descarreaux M, Duranleau M, Marcoux H, Potter B, Ruegg R, et al. Evidence-based guideline for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther. 2011;34(5):274-89

Bryans R, Decina P, Descarreaux M, Duranleau M, Marcoux H, Potter B, et al. Clinical practice guidelines for the management of headache disorders in adults. Canadian Chiropractic Association, Canadian Federation of Chiropractic Regulatory and Education Accrediting Boards, Clinical Practice Guidelines Project, Jan 2012

Chaibi A, Russell MB. Manual therapies for cervicogenic headache: a systematic review. J Headache Pain. 2012;13(5):351-359

Chaibi A, Knackstedt H, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for cervicogenic headache: a single-blinded, placebo, randomized controlled trial. BMC Res Notes. 2017;10(1):310

Côté P, Yu H, Shearer HM, Randhawa K, Wong JJ, Mior S, et al. Non‐pharmacological Management of Persistent Headaches Associated with Neck Pain: A Clinical Practice Guideline from the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2019;23(6):1051-1070

Dunning JR, Butts R, Mourad F, Young I, Fernandez-de-las Peñas C, Hagins M, et al. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord. 2016;17:64

Fernández-de-Las-Peñas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2016;36(12):1134-1142

Fredriksen TA, Antonaci F, Sjaastad O. Cervicogenic headache: too important to be left un-diagnosed. J Headache Pain. 2015;16:6

Garcia J, Arnold S, Tetley K, Voight K, Frank RA. Mobilization and Manipulation of the Cervical Spine in Patients with Cervicogenic Headache: Any Scientific Evidence?. Front Neurol. 2016;7:40 

Gross A, Langevin P, Burnie SJ, Bédard-Brochu MS, Empey B, Dugas E, et al. Manipulation and mobilisation for neck pain contrasted against an inactive control or another active treatment. Cochrane Database Syst Rev. 2015;23(9):CD004249

Haas M, Bronfort G, Evans R, Schulz C, Vavrek D, Takaki L, et al. Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine J. 2018;18(10):1741-1754 

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia 2018;38(1):1-211

Jaeger B. Are cervicogenic headaches due to myofascial pain and cervical spine dysfunction? Cephalalgia 1989;9(3):157-164

Jull G,Trott P, Potter H, Zito G, Niere K, Shirley D, et al. A Randomized Controlled Trial of Exercise and Manipulative Therapy for Cervicogenic Headache. Spine 2002;27(17):1835–1843

LeFebvre R, Peterson D, Haas M. Evidence-Based Practice and Chiropractic Care. J Evid Based Complementary Altern Med. 2012;18(1):75–79

Luedtke K, Allers A, Schulte LH, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine-systematic review and meta-analysis. Cephalalgia. 2016;36(5):474-92

Malo-Urriés M, Tricás-Moreno JM, Estébanez-de-Miguel E, Hidalgo-García C, Carrasco-Uribarren A, Cabanillas-Barea S. Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2017;40(9):649-658

Mingels S, Dankaerts W, Granitzer M. Is There Support for the Paradigm ‘Spinal Posture as a Trigger for Episodic Headache’? A Comprehensive Review. Curr Pain Headache Rep. 2019;23(3):17

Mingels S, Granitzer M. Pericranial Tenderness in Females With Episodic Cervical Headache vs Asymptomatic Controls: A Cross-sectional Study. J Manipulative Physiol Ther. 2018;41(6):488-49

Nilsson N, Christensen HW, Hartvigsen J. The effect of spinal manipulation in the treatment of cervicogenic headache. J Manipulative Physiol Ther. 1998;20(5):326-330

Rennie C, Haffajee MR, Ebrahim MAA. The Sinuvertebral Nerves at the Craniovertebral  Junction: A Microdissection Study. Clint Anat. 2013;26(3):357-66

Sremakaew M, Sungkarat S, Treleaven J, Uthaikhup S. Impaired Standing Balance in Individuals with Cervicogenic Headache and Migraine. J Oral Facial Pain Headache. 2018;32(3):321–328

Uthaikhup S, Assapun J, Watcharasaksilp K, Jull G. Effectiveness of physiotherapy for seniors with recurrent headaches associated with neck pain and dysfunction: a randomized controlled trial. Spine J. 2017;17(1):46-55

Zheng N, Chi YY, Yang XH, Wang NX, Li YL, Ge YY, et al. Orientation and property of fibers of the myodural bridge in humans. Spine J. 2018;18(6):1081-1087

Menstrual-Cycle-Graphic

Premenstrual Headache

Premenstrual syndrome (PMS) is a spectrum of symptoms experienced during the luteal phase of the menstrual cycle, which is the second half of the cycle between ovulation and your period. Up to 40% of women experience PMS, typically between 15–35 years of age, but it may affect older women. Premenstrual headache is one of many symptoms that may be experienced.

What is the cause of premenstrual headache?

Your central nervous system and endocrine (hormone) system are responsible for the natural fluctuations in hormone levels across your menstrual cycle. These systems also interact with your gastrointestinal (digestive) system and immune system, which is why PMS has such a broad range of symptoms. Premenstrual headaches are caused by the interaction between your endocrine and central nervous systems.

As your oestrogen levels decrease during the luteal phase your immune system increases activity. This leads to inflammation and constriction of blood vessels in the dura mater around your brain, resulting in a headache. This headache occurs before your period. Headaches that start after your period are caused by other factors, such as decreased iron levels due to blood loss, or migraine.

What are the symptoms of premenstrual headache?

Premenstrual headache commonly occurs as part of PMS, which includes a wide range of signs and symptoms that are a result of the different systems interacting with each other. These symptoms can vary between cycles, and between women. PMS may worsen pre-existing disorders such as migraines and back pain, and symptoms can be intensified by stress and emotions.

  • Increased appetite
  • Cravings for carbohydrates
  • Weight gain
  • Fatigue due to low blood sugar levels
  • Poor concentration and confusion
  • Poor memory
  • Mood swings
  • Hostility
  • Nervous tension
  • Social withdrawal
  • Anxiety
  • Depression
  • Skin conditions such as acne
  • Insomnia
  • Headaches
  • Migraines
  • Heart palpitations
  • Dizziness
  • Difficulty verbalising and incoherence
  • Abdominal bloating and discomfort
  • Constipation or diarrhoea
  • Breast congestion and pain (mastalgia)
  • Swelling of face and extremities
  • Pain and reduced pain tolerance
  • Musculoskeletal and back pain
  • Painful periods (dysmenorrhoea)

How is premenstrual headache treated?

PMS and premenstrual headaches respond well to evidence-based natural medicine. Prescriptions need to be formulated specifically for you due to the different systems involved and the variations between women. Only a qualified and experienced Naturopath has the necessary skills to formulate specific nutritional and herbal prescriptions for you that are supported by scientific evidence, and prescribed in a safe and effective manner.

References for further information:

Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia 2018;38(1):1-211

O’Donohue S. Gynaecology – Approaches to Treatment with Natural Therapies. Melbourne: self-published. 2001

Trickey R. Women, Hormones and the Menstrual Cycle. Sydney: Allen and Unwin. 1998

Paranasal-Sinuses

What is the cause of a sinusitis headache?

You have four pairs of paranasal sinuses which are innervated by the same nerve involved in migraines and tension-type headaches. Inflammation of these sinuses (sinusitis) can cause headaches felt over your forehead, face or the base of your skull (occiput). It can even mimic a toothache. Sinusitis is caused by acute, chronic or recurring inflammation of the mucous membranes lining your nose or sinuses (rhinosinusitis) due to infection, allergy or a migraine attack. In fact, many migraines are misdiagnosed as sinusitis. Tension-type headaches and jaw (temporomandibular joint, or TMJ) pain can also cause sinus pain.

What are the symptoms of a sinusitis headache?

  • 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

How do you treat sinusitis headache?

Sinusitis headaches respond well to evidence-based natural medicine. Prescriptions need to be formulated specifically for you because treatments vary depending on the different causes, such as infections or allergies, and migraine attacks. Only a qualified and experienced Naturopath has the necessary skills to formulate specific nutritional and herbal prescriptions for you that are supported by scientific evidence, and prescribed in a safe and effective manner. If the cause is migraine, tension-type headache or TMJ dysfunction then evidence-based manual treatments and exercises may be an appropriate treatment option.

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