A headache is the symptom of pain anywhere in the region of the head or neck. It occurs in migraines, tension-type headaches, sinus headaches, cervical headache, temporal mandibular joint (tmj), cluster and dangerous headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe and reoccurring headaches.

There are over 200 causes of headaches. We will briefly discuss the ones common to our office.

TENSION HEADACHES

A tension headache is caused by postural and muscular problems in the upper spine. It is common for them to start at the base of the skull and pull over the head and up to behind the eyes. Common causes include, poor sleep habits, forward head posture, poor pillow support, excessive computer work, eye strain and imbalance in the neck muscles. These are the most common headaches we see. They commonly respond well to chiropractic, muscle trigger point work, medication, stress reduction and exercise.

TEMPORAL MANIBULAR HEADACHES (TMJ)

A temporal manibular (or TMJ) headache is pain in the jaws and over the temple or of the side of the head. They are commonly worse with eating, especially hard candy, steak, and chewing gum. There are several causes including muscle imbalance of the jaw muscles, degenerative joint disease (Osteoarthritis of the jaw), dental malalignment, and slipped articular disc of the tmj. These respond well to low level laser (Pain Res Manag. 2018 May 10;2018,) mobilization, exercise, electrical therapy and occasionally a dental splint. We commonly co-manage these with your dentist.

CERVICAL HEADACHES

Cervical headaches are a very common type of headache that arises from the cervical spine. It occurs in about 4 percent of the population. Most of the pain starts in the neck and runs up over the head. They are more common in women and those who have experienced whiplash injuries and concussions. These headaches can start from any cervical or neck structure, but the most common cause is the facet joint. These respond well to mobilization, adjustments, (Front Neurol. 2016; 7: 40) exercise and trigger point work.

SINUS HEADACHES

With sinus headaches, most of the pain is in the front of the head. The most common causes are allergies, inflamed or blocked sinus cavity, viral and bacterial infections and referred pain from the cervical nerves to the front of the head. Sometimes the patient will feel sinus congestion with continuous flow or blockage. Bacterial infection should always be checked first and treated with antibiotics if present. At times none of these are present and you just have pain in the front of the head. This is most common in sinus headaches that are referred through the cervical trigeminal nerve. The nerves in the head share a common nerve pool with those of the neck. (See diagram below) That is why some patients respond well to neck treatment. These headaches respond well to medication, chiropractic, diathermy, and acupuncture.

CLUSTER HEADACHES

A cluster headache is a rare type of headache that affects about 1 to 2 people in every 1,000. The pain is usually centered over one eye, one temple or the forehead. Usually the pain is episodic. It occurs and lasts between 30 minutes to 3 hours for most cases. They are more common in men and in smokers. It can be triggered by alcohol. Most common treatment is oxygen. Sumatriptan and zolmitriptan nasal sprays can be used in chronic sufferers.

MIGRAINE HEADACHES

A migraine headache is a condition marked by recurring moderate to severe headache with throbbing pain that usually lasts from four hours to three days, typically beginning on one side of the head but may spread to both sides. It is often accompanied by nausea, vomiting, and sensitivity to light or sound, sometimes preceded by an aura, often followed by fatigue. Many of our patients will have to lay down in a dark room when these occur, and they are often debilitating. Elimination of alcohol and food high in nitrates like ham, bacon, and smoked meats can be helpful to prevent migraines. Caffeine can be of benefit, but it has side effects in some. (J Headache Pain. 2017; 18(1): 107). They respond well to acupuncture, medication, nutritional changes and exercise.

Migraines affect three times as many women as men. -The Journal of the American Medical Association

DANGEROUS HEADACHES

There are several kinds of dangerous headaches. They are epidural hematoma or bleeding on the brain. They are most common after trauma to the head. Subdural hematoma bleeding is usually spontaneous due to rupture of blood vessels. Described as incredibly sharp pain in the head for no reason, like a knife in the head. Pain with swelling on the temple can be Temporal Arteritis. Temporal arteritis is inflammation of the temporal artery at the side of your head. Acute glaucoma pain is behind the eye secondary to increased pressure in the eye. All these are medical emergencies and should immediately be evaluated by the emergency room. Pain that wakes you up at night in a previous cancer patient should have a complete diagnostic work up. Headache with numbness or weakness on one side of the body is a great concern for stoke. Trouble speaking, smiling, facial drop, dizziness, double vision or loss of consciousness are reasons for an immediate emergency room visit. Any sudden pain in the head for no apparent reason is concerning enough for an immediate emergency room visit.

TREATMENT

Our office offers several types of treatment for headaches. These treatments include acupuncture, mobilization, low level laser, trigger point work, medication – both anti-inflammatory and migraine, exercises, several types of adjustments (manipulation) and diet /nutritional advice. Each case is evaluated separately, and an individual program is prescribed.