HEADACHES: A PREVENTABLE ILLNESS
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A common disorder
Headaches are extremely common, with around 90% of the general population having experienced a headache in their lifetime and around 40% of the population affected by headaches globally, which amounted to 3.1 billion people in 2021 (1,2).
More than just a painful condition, headaches are also a leading cause of disability. In 2019, the Global Health Estimates found headache disorders to be the third highest cause of disability-adjusted-life-years (DALYs) worldwide after stroke and dementia (2). To be clear, one DALY equates to the loss on one year of full health. Headaches can have an impact on other areas of life – affecting family life, social life, and employment.
What many people don’t know however, is that the 3 most common types of headaches are extremely curable without the use of medications.
Types of headaches
Headaches are generally classified as either primary or secondary headaches. Primary headaches are not associated with an underlying condition and include migraine, tension-type headache, and cluster headache. Secondary headaches can be traced back to a local or systemic pathology, such as a trauma, infection or haemorrhage (3,4).
The most frequent types of headaches that Chiropractors come across include primary headaches such as tension type headaches and migraines, and secondary headaches such as cervicogenic headaches and medication overuse headaches (5). It’s important to know that headache types can overlap. For example, another cause of headache can overlap with migraine and either precipitate or aggravate a migraine attack (4).
Headache types can overlap, for example another cause of headache can overlap with migraine
Cervicogenic headaches
Cervicogenic headaches are secondary headaches that arise from a disorder of the head or neck (4). This is an extremely common presentation to Chiropractors as patients often complain of both neck and head pain. They are usually felt as mild to severe pain radiating from the neck and base of the skull into the head or face (5). The source of pain from cervicogenic headaches originates from structures in the upper neck, including joints, muscles, ligaments, joint capsules, and discs (6).
Risk factors for cervicogenic headaches include:
- Previous neck trauma
- Dysfunction of the cervical (neck) vertebrae
- Sustained or repetitive neck postures/positions
Cervicogenic headaches respond extremely well to standard Chiropractic care, because structures innervated by the upper branches of the spinal cord (C1-C3) are often found to be the painful source of the headache. The sensory information from this area converges on the same part of the spinal cord as sensory information from the face and back of the skull, leading to referred pain (6).
Previous neck trauma is a risk factor for headache
Migraines
One of the most common types of headaches, migraine affects around 1 in 7 people worldwide and around 10 million people in the UK (3). Migraine ranks as the seventh most common cause of disability worldwide, and the third most common cause of disability in people under 50. An estimated 3 million workdays are lost per year to people suffering from migraines (3).
Migraines are pulsating or throbbing, one-sided headaches, which can often last between hours to days. The headache is accompanied by nausea, sensitivity to light and sounds, and in around 1/3 of sufferers the onset of headache is preceded by an aura with visual, sensory or motor symptoms (2,3).
The cause of migraine is unknown, but it is thought to be related to the release of inflammatory substances around the nerves and blood vessels of the brain (2). It has also been described as a dysregulation in the brain which can cause the brain to perceive non-painful stimuli as noxious (3).
Migraines have common triggers such as:
- Stress
- Lack of sleep
- Caffeine or alcohol intake
- Certain foods
- Menstruation
Migraine treatment often involves analgesics, anti-emetics and certain specific anti-migraine and prophylactic medications to prevent migraines before they start. The WHO recommends lifestyle modifications such as maintaining sleep schedules, avoiding alcohol, healthy diets and staying hydrated to prevent migraines (2). Manual therapies, including those offered by Chiropractors, are also an effective way to reduce the frequency of migraines without the need for medications (7).
Did you know? Chiropractic treatment is shown to be helpful in the prevention of migraines
Tension type headaches
Tension type headaches are mild-to-moderate, pressing, tight, or vice-like headaches that can often feel like a band around the head, and sometimes spread into the neck. Women are affected 50% more than men (2). The cause of tension headache can usually be traced back to muscles in the neck that are tight or hyperactive. Muscle which are placed under too much load or repetitive strain develop painful muscle knots which refer pain into the head. This type of headache can overlap with cervicogenic headache and other types of headache, and can lasts from a few hours to a few days (1,5).
Over 70% suffer from the episodic type which occurs on less than 15 days per month. An unlucky few have chronic tension type headache which can be unremitting and far more disabling.
Tension type headaches appear to respond best to a multimodal approach to treatment including rehabilitation, re-education, as well as manual therapies, which are all offered at CH Chiropractic (5). Chiropractic can also reduce the likelihood of a tension type headache overlapping with a different type of headache such as cervicogenic headaches by addressing primary musculoskeletal dysfunctions.
Tension type headaches are caused by tight head and neck muscles
Medication Overuse Headaches
Medication overuse headache is a type of secondary headache which occurs on 15 days or more per month and can vary in location and severity. As the name suggests, they are characterised by the worsening of a pre-existing headache due to the regular use of medications used to treat headaches (2,5).
Certain medications, such as triptans, which are used to treat migraines and cluster headaches, are more likely to lead to medication overuse headache. The risk of getting medication overuse headache increases if you use triptans, opioids or combination analgesics 10 or more days per month, and simple analgesics like paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin 15 days or more per month. Fortunately, it usually resolves after the medication is stopped.
Medication overuse headaches occur on 15 or more days a month and are caused by the overuse of medications used to treat headaches.
The role of Chiropractors to treat headaches
Chiropractors, with their skill in manual therapies, as well as their intimate knowledge of anatomy and the nervous system, are well versed to treat patients with headaches. Scientific literature supports the use of manual therapies (including combinations of spinal manipulation, mobilisation, soft tissue therapies) as well as patient education and prescription of specific rehabilitative exercises to treat migraines, cervicogenic, and tension type headaches (5,7). In addition to manual therapies, Chiropractors can provide acupuncture which is recommended by the National Institute for Care Excellence for the treatment of migraine and chronic tension-type headaches (1,3). Chiropractic spinal manipulative therapy is demonstrated to be safe with few adverse reactions and can provide a drug-free alternative to those wishing to reduce or avoid medications. There is also some evidence to support that Chiropractic is helpful as a prophylactic treatment to prevent migraines (7).
My personal experience
When I was training as a baby Chiropractor in Bournemouth, I started to experience what I learned were ‘textbook’ cervicogenic headaches. This was caused by looong study sessions bent over a desk, which, with hindsight, was wreaking havoc on my neck and shoulders. The headaches became so frequent and so severe that I was having to interrupt daily study sessions to lay in bed with an ice pack and paracetamol, which was, well, not very nice.
Fortunately for me, I couldn’t have been in a better place to start having headaches. Thanks to the training clinic, I was able to start receiving treatment which immediately relieved a lot of the tension in my neck and nearly eliminated the headaches.
Now, I rarely have any headaches to speak of, and that is down in a HUGE part to receiving treatment and continuing to receive prophylactic treatments which prevent my headaches from coming back. I can vouch personally for the impact that headaches can have on your daily life, and I HIGHLY recommend having Chiropractic treatment. As I learned from researching this blog post, headaches are a major contributor to workdays lost and are a massive cause of disability worldwide – and they shouldn’t be. Not when the most common types of headaches can be relieved without medication and prevented from coming back with a proper treatment plan.
Headaches are one of my favourite topics and one of my favourite conditions to treat in the clinic – also because I know from years of experience that the treatment yields extremely satisfying results… and many happy patients!
Don’t suffer unnecessarily… click here to book an appointment and here to read more blog posts.
References:
- NICE CKS - headache https://cks.nice.org.uk/topics/headache-assessment/background-information/prevalence/
- WHO factsheet on Migraine and other headache disorders https://www.who.int/news-room/fact-sheets/detail/headache-disorders
- NICE CKS - migraine https://cks.nice.org.uk/topics/migraine/background-information/prevalence/
- International Headache Society The International Classification of Headache Disorders, 2nd Edition https://ihs-headache.org/wp-content/uploads/2020/05/1477_ichd-iir1final-1.pdf
- Royal College of Chiropractors, Chiropractic Quality Standard: Headache (2020)
- Clinical Chiropractic, Vizniak 2018
- Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. J Headache Pain. 2011 Apr;12(2):127-33. doi: 10.1007/s10194-011-0296-6. Epub 2011 Feb 5. PMID: 21298314; PMCID: PMC3072494.
- NICE CKS: Medication overuse headache https://cks.nice.org.uk/topics/headache-medication-overuse/background-information/causes/