Headaches

Headaches are a common ailment which varies in intensity, pain and location. Although the majority of headaches are a temporary nuisance some can be more serious, concerning and disruptive.

One common patient complaint is occipital headaches which can signify an underlying condition that can be treated with massage and bodywork techniques.

Occipital headaches also known as occipital neuralgia is a non life threatening disorder that is located at the back of the head and can arise from a variety of causes. It is a soft tissue injury whereby it develops tension within the myofascial system which creates stress onto the skeletal system. From this misalignment of muscles results and there is an imbalance of the musculoskeletal system and poor habitual body techniques which consequently causes pain or an occipital headache. The occipital headache develops from sustained contraction of semispinalis capitis. The semispinalis capitis can entrap the greater occipital nerve leading to pain, numbness and burning from the occipital region to the top of the head.

The location of the occipital nerves arise from the upper spinal cord and branch out over the back of the head to the scalp, supplying sensation to the region. The majority of patients with this disorder experience pain originating at the base of the skull and radiating to one side of the back of the head. Other experiences felt can include throbbing, aching or burning pain; even shooting or shock-like pain.

Causes of Occipital Neuralgia

Occipital neuralgia is the result of compression or irritation of the occipital nerves due to injury, entrapment of the nerves, or inflammation of the muscles and nerves and lastly bone and blood abnormalities.

Medical Conditions

• Trauma to the back of the head
• Neck tension and/or tight neck muscles
• Osteoarthritis
• Tumours in the neck
• Cervical disc disease
• Infection
• Gout
• Diabetes
• Blood vessel inflammation

Symptoms of Occipital Neuralgia

• Aching, burning, and throbbing pain that typically starts at the base of the head and radiates to the scalp
• Pain on one or both sides of the head
• Pain behind the eye
• Sensitivity to light
• Tender scalp
• Pain when moving the neck

Diagnosing Occipital Neuralgia

• If you think you may have occipital neuralgia, make an appointment with your doctor.
• MRI Scan
• Physical Examination
• Blood test
• For treatment to work, it is very important that you receive an accurate diagnosis.

Treatments for Occipital Neuralgia

• The type of treatment depends on what is causing the inflammation or irritation of the occipital nerves. There are a number of things you can try to get relief, including:
• Apply heat to the neck
• Rest in a quiet room
• Massage tight and painful neck muscles
• Take over-the-counter anti-inflammatory drugs
• Surgery may be considered if pain does not respond to other treatments or comes back.

What is a cervicogenic headache?

A cervicogenic headache is simply another name for a headache which originates from the neck and is one of the most common types of headache.

During certain neck movements or sustained postures, stretching or compression force is placed on the joints, muscles, ligaments and nerves of the neck. This may cause damage to these structures if the forces are beyond what the tissues can withstand and can occur traumatically due to a specific incident or gradually over time. When this occurs pain may be referred to the head causing a cervogenic headache.

Cervicogenic headache typically occurs due to damage to one or more joints, muscles, ligaments or nerves of the top 3 vertebra of the neck. The pain associated with this condition is an example of referred pain (i.e. pain arising from a distant source – in this case the neck). This occurs because the nerves that supply the upper neck also supply the skin overlying the head, forehead, jaw line, back of the eyes and ears. As a result, pain arising from structures of the upper neck may refer pain to any of these regions causing a cervicogenic headache.

Although cervicogenic headache can occur at any age, it is commonly seen in patients between the ages of 20 and 60.

Causes of cervicogenic headache

• Activities that place excessive stress on the upper joints of the neck (traumatic/repetitive).
• prolonged slouching
• poor posture
• lifting or carrying
• excessive bending or twisting of the neck
• Working at a computer or activities using the arms in front of the body (e.g. housework).

Signs and symptoms of cervicogenic headache

Patients with this condition usually experience a gradual onset of neck pain and headache during the causative activity

• Pain and stiffness after the provocative activity
• Pain and stiffness upon waking the next morning.
• constant dull ache, normally situated at the back of the head, although sometimes behind the eyes or temple region
• Pain is usually felt on one side, but occasionally, both sides of the head and face may be affected
• Difficulty turning their neck
• Pain, pins and needles or numbness may also be felt in the upper back, shoulders, arms or hands
• Dizziness
• Nausea
• Tinnitus
• decreased concentration
• an inability to function normally

Diagnosis of cervicogenic headache

• subjective and objective examination from
• X-ray, MRI or CT scan

Contributing factors to the development of cervicogenic headache

There are several factors which can predispose patients to developing cervicogenic headache. These need to be assessed and corrected where possible with direction from a physiotherapist. Some of these factors include:

• poor posture
• neck and upper back stiffness
• muscle imbalances
• muscle weakness
• muscle tightness
• previous neck trauma (e.g. whiplash)
• inappropriate desk setup
• inappropriate pillow or sleeping postures
• a sedentary lifestyle
• A lifestyle comprising excessive slouching, bending forwards or shoulders forwards activities.
• stress
• dehydration

Migraine:  Migraines are a common and distressing disorder which can limit the person’s quality of life. Studies have shown the incidence of migraine to be 9-10%, about 17% of the female population and 6% of the male population. So, about 2 million Australians can be expected to suffer from migraine, about 1.5 million women and about 500,000 men. It is thought that more women suffer migraine than men due to hormonal factors. Migraines are common in the 20’s and 30’s but the onset can occur in childhood. Migraines become less frequent in the 40’s.  Migraines may occur recurrently over many years or even decades. Frequency may vary greatly in the same person over time, from a few years up to several weeks.

Causes:

• Inherited.
• Certain parts of the brain employing monoamines, such as serotonin and noradrenaline, appear to be in a hypersensitive state, reacting promptly and excessively to stimuli such as emotion, bombardment with sensory impulses, or any sudden change in the internal or external environment
• Cortical changes
• Interaction between the brain and the cranial blood vessels
• Dietary Triggers
• Environmental triggers
• Hormonal triggers
• Physical and Emotional Triggers

Symptoms

The International Headache Society classifies a headache as a migraine when:

(a) The pain can be classified by at least two of the following;

• one sided
• moderate to severe
• throbbing
• aggravated by movement

(b) There is at least one of the following associated symptoms:

• nausea
• vomiting
• photophobia (sensitivity to light)
• phonophobia (sensitivity to noise)

(c) The headache lasts for between 4 and 72 hours.

Other symptoms that may be experienced include:

• osmophobia (sensitivity to smell)
• aura (visual disturbances such as bright zigzag lines, flashing lights, difficulty in focusing or blind spots lasting 20-45 minutes)
• difficulty in concentrating, confusion
• a feeling of being generally extremely unwell
• problems with articulation or co-ordination
• diarrhoea
• stiffness of the neck and shoulders
• tingling, pins and needles or numbness or even one-sided limb weakness
• speech disturbance
• paralysis or loss of consciousness (rare).

Stages of Migraine

Migraine can be divided into five distinct phases:

1. Early Warning Symptoms (prodromol)

Usually people experience warning symptoms 24 hours before the migraine. These symptoms include:

• changes in mood, varying from feeling elated, on top of the world and full of energy, flying through the day’s work and accomplishing twice as much as usual, to feeling depressed and irritable
• gut symptoms, nausea, changes in appetite (intense hunger or sugar craving: may consume a whole packet of biscuits or chocolates), lack of appetite, constipation, diarrhoea
• neurological changes, drowsiness, incessant yawning, difficulty finding the right words (dysphasia), dislike of light and sound, difficulty in eye focus
• changes in behaviour, hyperactive, obsessional, clumsy, lethargic
• muscular symptoms, general aches and pains
• fluid balance changes, thirst, passing more fluid, fluid retention.
• All these symptoms arise in the hypothalamus, the deep-seated part of the brain.

2. Aura

Visual disturbances are the most common symptoms. These include difficulty focusing on one spot, bright zigzagging lights and flashing lights. Aura affects the visual field of both eyes despite often seeming to affect one only and lasts 5-60 minutes then the vision normally restores itself. Aura less commonly affects speech or sensation.

3. Headache

The headache phase can last up to three days. It is often throbbing and on one side of the head, but can affect both. It can be on the same or opposite side to the aura. Movement makes it worse. The most common accompanying symptoms in this phase are nausea, vomiting and sensitivity to light, sound and smell. Eating can help especially starchy foods. The symptoms can be more distressing than the headache itself.

4. Resolution

In some cases sleep is restorative, in children being sick can make them feel much better. For others effective medication can improve attacks. For a few nothing works except the headache burning itself out.

5. Recovery (postdromol)

A feeling of being drained may exist for about 24 hours; others may feel energetic or even euphoric.

Types of Migraine

Lower-half Headache or Facial Migraine

The term applies to common migraine that covers one-half of the face involving the nostril, cheek and jaw.

Migraine Aura without Headache

This is when the attacks are referred to as migraine aura without headache. This type of migraine is rare thus a doctor should be consulted if this develops for the first time when over 50.

Status Migrainosus

This term describes migraine that may last longer than 72 hours. Symptoms of nausea and light sensitivity resolve after a couple of days but the headache persists.

Basilar Artery Migraine (with loss of balance and fainting)

Symptoms include visual disturbances, giddiness, loss of balance, slurred speech followed by aching mainly in the back of the head. Fainting can occur at the height of the attack.

Hemiplegic Migraine (with weakness on one side of the body)

Symptoms resemble a stroke and may progress until the arm and leg on one side are completely paralysed for a few hours. Repeated attacks may leave a residual weakness. Familial hemiplegic migraine occurs where there is a family history of hemiplegic migraine.

Ophthalmoplegic Migraine (with double vision)

Symptom is paralysis of one or more of the muscles moving the eyes resulting in the eyes moving out of alignment and the person seeing double.

Retinal Migraine (with loss of vision in one eye)

Symptom is loss of sight in one eye and normal vision in the other. The sight clears leaving an ache behind the eye or a generalised headache.

Migrainous Infarction

Symptoms range from permanent blind spots to a full stroke occurring during a typical migraine attack. An infarct is the death of tissue due to an inadequate blood supply.

Treatment of Migraine

Each individual needs to develop their own migraine management plan that will improve their lifestyle such as modifications, medication and therapies.

Postural Headaches: The next time you get a headache, check your posture. Poor posture causes muscle strain, changes in your breathing patterns and leads to a host of problems, including headaches. Without being conscious and taking positive steps to get your posture back in line, neck pain and an occasional headache can easily become chronic. Headaches caused by poor posture can include tension and neck-related headaches. Tension headaches, brought on by muscle tension in the back of your neck and/or your scalp, are the most common type of headache.
Neck related headaches are more nerve-related and occur when stress leads to straining or inflammation of the discs and facet joints in the middle and upper parts of your neck. Neck related headaches could also occur as the result of inflammation in the joints where your skull and neck meet.

Factors

• Factors that contribute to poor posture and posture-related headaches include poor muscle tone, obesity, stress, pregnancy and high-heeled shoes. Personal habits and environmental concerns can also be contributing factors. These factors include an incorrectly set up computer workstation, carrying heavy backpacks, working on counter tops set too low or too high and even the way you hold and carry an infant or small child.

Symptoms

• The symptoms tension and neck-related headaches create can help you distinguish the type from which you suffer. Symptoms typical of tension headaches include mild to moderate pain, usually on both sides of the head or neck. In contrast, neck-related headaches are usually on one side of the head or neck. The pain associated with neck-related headaches can be severe.

Consequences

• Poor posture can lead to more than just the occasional tension or neck-related headache. These headaches can become chronic and result in additional problems. Risk factors include prolonged poor posture and the overuse of pain medication. Taking too much pain medication to cure a headache can have the opposite result and cause you to suffer from “rebound headaches.”

Prevention/Solution

• You can take steps to prevent or reduce the occurrence of posture-related headaches. The most important step you can take is to improve your posture. Make a conscious effort to stand, sit and lie down properly. Strength training that targets your back muscles and hamstrings is also beneficial. Instead of continually taking pain medication to lessen headache pain, try alternative therapies such as getting a massage, relaxation therapy, acupuncture or chiropractic care.