Persistent headaches can be one of the most debilitating conditions for those who suffer from them. They can prevent enjoyment of even the simple things in life and often the suffering is in silence.
Contributors to headaches can include structures inside the skull, chemical influences on the brain and upper neck dysfunction. All of these may be present with your headache.
Understanding the different categories of headaches can help us make informed decisions about when to seek appropriate care.
As a starting point, understanding what we call Red Flags – those signs which may have serious medical consequences – is vitally important.
Red Flags for headaches
The most important consideration when suffering a headache is that nothing catastrophic is happening. Headaches can be very severe and frightening, but the Red Flags we most commonly look for include:
- Is it a brand new headache that you haven’t experienced before?
- Is it very severe, or the worst headache you have ever had?
- Are there any Neurological symptoms present, such as:
- Numbness or tingling in your hand or limbs
- Slurred or impaired speech
- Drooping face
If you have any of these symptoms you should be assessed immediately by a medical doctor.
Previous research into headache types have largely focused on symptoms that were occurring in the head.
This only tells parts of the story. New research is showing that the neck is a key factor in how headaches and migraines begin, because your neck can sensitise your Brainstem.
The Brainstem is a transitional area in the body between the spinal cord and the brain. It is located right at the bottom of your skull, at the very top of your neck.
Also known as the the Headache Hub, there are many signals that pass through the Brainstem. If these signals are heightened, the Headache Hub goes into overdrive.
The Diagram below illustrates some of the inputs that go through the Headache Hub.
The upper part of the neck plays a crucial role in minimising signals that can sensitise the Headache Hub.
The role of the Multifidus
Weakness in the deep spinal muscles (Multifidus) that stabilise and support movement in the upper spine can cause pain and stiffness in the neck joints.
When other superficial muscles contract to compensate for this lack of stability, tension in ligamentous structures supporting the vertebrae can sensitise the Brainstem / Headache Hub.
As deconditioned Multifidus muscles progressively provide less support, sensitivity is increased in the Headache Hub.
It only takes small changes in this delicate balance to promote Headaches. Changes related to diet or hormonal changes, for example, can be enough to cause severe Headaches.
Other triggers can occur when the neck is irritated while acting as the primary structure. For example:
- working longer hours
- spending time at a different workstation
- a few nights of poor sleep
- more exercise than usual
- more or less hormones than usual
- more or less serotonin than usual
- red wine or chocolate
These small changes can magnify any existing sensitivity in the neck and result in a Headache or Migraine.
It can be hard to fully comprehend underlying causes when you feel you haven’t done anything much different, but the sensitivity of the system can make it react to small changes.
As a general rule, if your Headaches vary in intensity, duration, frequency or part of the head you experience them, the neck is the first place to treat.
Make sure you present for treatment when you are in remission. Treating your neck and restoring strength and mobility will form a good first line of defence to minimise sensitivity from sometimes-unavoidable triggers.
Over time these triggers may further ‘turn-off’, providing greater stability and relief.