Headaches can be very debilitating and have a huge impact on your quality of life. Many headaches originate in the neck. These are called cervicogenic headaches. They are a result of dysfunction within the top three vertebral segments of the spine. They are also associated with poor activity in the deepest muscles of the neck and can often result in impairments with balance and sensations of dizziness.
Dysfunction in the neck causes head pain in two distinct ways:
1. Convergence of nerves in the brain – the upper cervical spine (neck) and one of the sensation nerves of the head (Trigeminal nerve) both send messages to a common origin in the brain: The Trigemino-Cervical Nucleus.
This gives a neuroanatomical explanation for how ‘danger messages’ from the neck can be felt as pain anywhere in the head.
This includes areas like the forehead, behind the eyes, nose, jaw, and anywhere on the scalp or back of the skull.
This diagram shows you the breakdown of which nerves supply which area. When there is dysfunction in the upper cervical spine (ie. the joints are stiff) the brain will refer pain to areas that are innervated by the upper cervical spine.
2. Sensitisation of the brainstem –
the more often “danger messages” (pain) get sent, the more efficient your brain becomes at sending these messages. When your brain becomes efficient at doing something, it takes less and less stimulus to create a response. This is how you can become sensitive to lights, sounds, smells, and environments. Your brain may create an association between certain things and your headaches, and then when you are exposed to these things it can trigger the headache.
What can we do about it?!
Step 1: We need to desensitize the structures that are sending these ‘danger signals’ to your brain. We do this by re-creating your headache by applying pressure to certain areas of the upper neck. Breathing through this headache tells your brain that the pain that you’re feeling is not associated with any threat, and eventually you will feel it resolve.
Step 2: We need to assess the deficit of the muscles deep inside your neck. These muscles are responsible for holding your head up – when they aren’t working properly, the larger muscles in your upper back try to do this instead. As upper back muscles can’t do this efficiently, they can become tired and tight and will contribute to the stiffness in the upper neck.
Step 3: If your brain has poor accuracy of determining the position of your neck (we call this joint position sense), you can develop symptoms of dizziness or unsteadiness. We can retrain the brain to become more accurate at positioning your head appropriately using specific exercises.
These three steps are the foundation of a good headache management plan. A useful adjunct to treatment is the use of acupuncture which has been shown to be very effective at reducing headache frequency, intensity, and duration compared to medication. Your brain makes its own versions of opioids (very strong painkillers), called endogenous opioids. These chemicals act just like opioid drugs, attaching to opioid receptors in your brain. Endogenous opioids help your body control pain. When an acupuncture needle sits in the affected areas causing headache for a certain amount of time, the brain releases endogenous opioids into these affected areas. Other mechanisms by which acupuncture works involve the release of certain hormones that affect your immune and circulatory systems. The use of a headache diary can be an effective tool to identify patterns and environmental triggers which your brain has associated with headaches. This way you can avoid these triggers to help reduce the incidence of headaches.
Typically, there is a significant reduction in either headache frequency or intensity within the first 4 treatments which are 3-4 days apart. As the frequency of headaches goes down, the time between treatments increases. Ultimately once we have reduced the sensitivity of the structures in the neck and created an exercise program to target the deficits which are contributing to headaches, treatment will cease and you will be able to manage your headaches on your own.
Deshane Deenoo
Physiotherapist
MPthy, BSc Kin., APAM, AHPRA
