• Matthew Corbin D.C

Thud,Throb And Sob, The Definitive Guide To Headaches.


Today’s blog post is to give you an overview of the different types of headaches that claim millions of people’s sanity worldwide. My aim is to try and explain a complex topic into an easy to understand and digestible read! It is also my aim to give you the information on how to help yourself and when it’s time you should really seek some professional advice.


They come in many forms, they affect us in different ways. Whatever way you see headaches, unless you are one of the lucky ones that has never been burdened with such an infliction, you know how debilitating they really are. A tingly face on one side, another side throbbing like you have been hit in the face by a freshly pumped up basketball, a thud behind your eye that seems to throb in time with the rhythm of your heart, a foggy head with that feeling of a thunderstorm striking at the back of your eye like a red hot poker, pain that feels like your whole head is being clamped by a vice getting tighter by the minute, waking up with the most miserable head you’d think it was aunt betty’s wedding again, and the list could continue into a whole encyclopaedia! Working as a chiropractor I see many patients complaining of headaches and no one person is ever the same! Yes we spend years learning about the different signs and symptoms, treatments, categories of headaches, when to refer to a specialist and so on, but life is not a text book and headaches are one of the hardest conditions to get an accurate diagnosis.

We are going to talk about the 5 main classifications of headaches, give yourself a head start to get some precious skills for the next time you feel like your head is on a collision course to thud, throb and sob!

  • Tension headaches

  • Cervicogenic headaches

  • Migraine (classic and common)

  • Trigeminal neuralgia

  • Cluster headaches

  • Red flags

Tension Headaches

Tension headaches are the most common type with about 30% to 80% of adults having the joy of this kind of headache. They are less common in men but much more prevalent women. Tension type headaches are often called stress related headaches, muscle contraction headaches, daily headaches, or chronic non-progressive headaches. They usually begin slowly and gradually and often occur in the middle of the day. A tension headache may occur on an episodic basis (less than 15 days per month) or on a chronic basis (daily or more than 15 days per month). Most people with episodic tension headaches have them no more than once or twice a month, but the chronic headaches can occur more frequently, how nice!

What Causes Tension Headaches?

The cause can be multifactorial, it is not the type of headache that is familial (runs in the family) but is most commonly caused by tight muscles from poor posture resulting in tension in the back of the neck and scalp. Sometimes this is not the cause and is most likely due to the stresses of life, whether moving house, financial, relationships and other reasons to send cortisol rushing through your body. Long hours sitting at the computer may also be an important causative factor with modern living driving us into a more sedentary lifestyle.

Symptoms?

These headaches are generally mild to moderate rarely getting to the levels of a migraine, they often feel like and band of pressure or pain equal over the forehead head lasting from 30 minutes to a whole day. You will also feel one or more of the following

  • Muscle aches (base of skull, forehead)

  • Trouble sleeping

  • Chronic fatigue

  • Irritability

  • Hard to concentrate

  • Mild sensitivity noise or light

  • Mild occasional dizziness

Treatment?

This depends on the severity but most people will be given over the counter pain medication such as paracetomol and ibuprofen. But the good news is chiropractic may help by reducing muscle tension with soft tissue techniques and spinal manipulation. In severe cases pain management clinics may be appropriate with stress relief techniques and counselling.

Cervicogenic headaches

Cervicogenic headaches are unilateral in nature (one side) but in rarer cases both sides and originate in the neck and not the head. This may seem strange but a quick anatomy lesson will make things clearer! In the spinal column lies the spinal cord containing millions of

nerve fibres innervating all of our structures from muscles to organs, in the neck some of these nerves can refer pain from the upper, mid and lower neck up into the head as seen in this diagram. Chiropractic is great for these types of headaches because it is often a misalignment in the spine putting pressure on these nerves causing the pain. The headaches can be associated with depression but more often than not it is from spinal and muscle dysfunction, from poor posture, heavy sporting activities or injury to the area such as whiplash. With treatment cervicogenic headaches can clear up much quicker than if left on its own devices. Symptoms?

  • Unilateral (one side of the neck)

  • Made worse by neck movement

  • Cervical joint tenderness (upper 3) (feel the base of your spine)

  • Trigger points and tight muscles around the neck and shoulders

  • Weakness of certain muscles in the neck, usually from poor posture

  • Pain can last up to 3 months and is usually a dull and achy pain

  • Less commonly pain can be felt around the eyes and forehead

Treatment?

This headache is more of a structural problem with the bones, nerves and muscles that responds well to chiropractic or physical therapy relieving these unwanted aches and pains.

  • Spinal manipulation

  • Cervical traction

  • Soft tissue work

  • Acupuncture

  • Ultrasound

  • Sport taping

  • Anti-inflammatories

  • Specific exercises

  • Roll matt

  • Posture correction and advice

Migraine Classic and Common

These headaches are the most spoken about, most documented and one of the most debilitating. They are split into two categories classic and common. In both cases they can be acute, sudden or gradual in nature. There is a familial link more so with females. Symptoms typically start at puberty, with the menopause, menstruation and the pill all being trigger factors. Food triggers such as tyramine foods, red wine, cheese, nuts. Histamine, citrus juice, coffee, tea, alcohol, niacin, processed foods, preservatives can all be triggers too.

Migraines typically occur in four phases which are, prodrome, aura, attack, and postdromal. It is important to know about the phases of migraine so to take action and avoiding going through all of these miserable phases. Unfortunately even if you do take the steps it might not always help but as I always say knowledge is power!

Phase 1. Prodrome: Before a migraine fully kicks in there are often early warning signs usually a few hours before or even up to a day before a migraine sets in fully. These are sensations that you would not normally feel which include increased tiredness and yawning, increased urination, increased irritability and increased thirst. Drink plenty more water to keep hydrated, have a sleep in a dark room, stay away from bright computer screens and try and lay off of the sugar.

Phase 2. Aura: Before the headache pain starts an aura may come into fruition, it is reported that 1 in 5 experience these other changes in sensations and may not occur with every headache that you get. Changes in vision is the most common of aura’s, this can include flickering lights in different shapes and forms in the corner of the eye, a temporary loss of vision due to the flickering lights, and hallucinations sometimes from the past. No this is not someone on psychedelic drugs these are real signs from migraines! Other sensations are pins and needles in the body usually on the face, hands and feet, numbness is also reported. There are also reports of communication deficits, problems with speech and trouble concentrating and this is all before the real pain sets in.

Phase 3. Attack: Having had migraines myself I understand the attack phase all too well. The pain usually starts around the top of the eyes (in the socket) and usually on one side of the head either in the temporal area or one side of the forehead. In some cases the attack phase can strike the whole head with pain being felt around the front of the neck with a tight throat area. The pain is dull and throbbing often causing nausea and in severe cases vomiting. Exercising or anything increasing the heart rate can make a migraine worse as too bending over to pick something up. The sufferer may feel increased pressure with the simplest of tasks. Less commonly changes in sensation and light headedness may occur but are less common in the attack phase.

Phase 4. : Postdromal: after the attack phase most sufferers will feel wiped out, sluggish, a sense of confusion and head pain when bending over. Not every attack includes all of these phases and some cases are a lot worse than others, but the key is trying to recognise when an attack is about to happen and take the steps to try and get relief before any other phases kick in, and kick you. below is a list with the differences between common and classic migraines.

Classic

· Associated with prodromal aura, (a transient visual, motor or sensory phenomenon)

· Unilateral or pulsating

· Preceded by prodrome

· May persist 1-2 days

· Mild to severe pain

Prodrome symptoms may be severe & produce transient hemiplegia, aphasia or hemi sensory deficits

Classic

· Not associated with prodromal aura

· Unilateral or bilateral & intense

· Pain affects eye, frontal regions & temples

· Lasts a day or longer

· Begin in adolescence or early adulthood associated with vomiting

In children abdominal pain may replace headache as prominent feature

Treatment?

The treatment may vary from case to case but the following are the gold standard: (Always ask your Doctor before taking any medication)

  • Rest in a quiet dark room and initially treat with aspirin

  • Medication with ergotamine & caffeine combination

  • Sumatriptan

  • Subcutaneous injection where above drugs ineffective

  • Calcium channel blockers (nifedipine)

  • Avoid triggers/change in contraceptive pill/manage stress/quit smoking

  • Chiropractic care may help reducing stress and improve joint mechanics

The causes of migraines is still up for discussion, many years of research and money has been put into finding the cause but because neurobiology is so complex it is still at a theoretical stage. What we do know is there is a disruption in the communicating pathways between the brains nucleus and vascular system, a genetic defect making the neurovascular system hyper excitable. A large nerve called the trigeminal nerve may be the biggest find in migraine headaches as it is believe to release certain brain chemicals that cause a cascade of events, mainly dilating blood vessels and sending faulty signals to the brain which in turn is processed as pain e.g. the throbbing sensation of an artery does not normally hurt but because of the failure in neural signaling the pulse is perceived as pain. I won’t go into further detail as its complex stuff but if you would like to find out more information check out the link at the bottom of this blog.

Trigeminal neuralgia

We hear of this trigeminal nerve again, this is a big player in the world of headaches and deserves its own category of headache. This headache is a neuropathic disorder that causes intense fascial pain, the trigeminal nerve senses pain, temperature and pressure and also controls the muscles of mastication (chewing). One theory is believed that dilated blood vessels in close proximity to the trigeminal nerve cause damage to the myelin sheath (like the skin of a nerve) which cause local inflammation and irritability to the nerve causing the intense pain. Again this is a theory and is yet to be solidified. It can be caused more seriously by an aneurism or intracranial tumour but is much less common. It affects women in their 50’s most commonly, pain is usually felt on one side of the mouth that radiated to the ear and eye on the same side. Pain can be made worse by touching the area, wind and even just movement can send those neurons into frenzy. Attacks and episodes seem to increase with frequency and are sometime caused by trigger points. Attacks are usually short and frequent lasting a couple of seconds to a couple of minutes, it is not unusual to have hundreds of attacks a day. The pain usually goes into remission often disappearing for a few months and even years only to return and raise its ugly head again.

Treatment?

  • Get professional help as there are many causes

  • Try not to move the jaw too much and stay inside if it is a stormy day

  • See a chiropractor as it could be a jaw problem (temporomandibular disorder)

  • See your GP if you feel like you need medication

  • Sometimes surgery is needed

Cluster headaches

Imagine being poked in the eye with a red hot poker? It’s going to hurt right? Well this is what patients often report of with cluster headaches. It is probably the most painful type of headache that would scare even the bravest of folks. They are the least common and can accompany migraines, and are believed to be a disorder of the hypothalamus (a nucleus in the mid brain). The pain is a sharp, intense stabbing sensation that can last up to 30 minutes and occurs multiple times a day (1-3 times in 24 hours) and always on the same side of the head.

  • Occurs over periods of weeks & months, followed by periods of no headaches. This is the less severe form

  • It affects middle age men (50’s) the most with history of heavy smoking & drinking

  • They last from 30 minutes to 2hours

  • Pain is usually on one side around/behind eyes

  • Horner’s syndrome may be present

  • Associated nasal congestion/rhinorrhoea

  • Pain radiates to the same side on the neck or jaw

  • Alcohol can be a trigger

Treatment?

  • Inhalation 100% oxygen for 15mins

  • Ergotamine tartrate aerosol

  • Amitriptyline for prophylaxis

  • Always consult your doctor before taking any medication that is not over the counter

  • Spinal manipulation of upper neck

  • Soft tissue stretches, cold packs, neck pillows, neck traction

  • Ensure sleep levels are kept to at least 8 hours a night

  • Relaxation therapy and stress management

  • Avoid food triggers, do not skip meals

Finally I am going to talk about red flags. Red flags are used in the medical world to give us reason to believe something potentially serious is afoot. The use of red flags saves people’s lives and generally indicates a pathological process. It is not always the case but puts safety first by referring the patient to the appropriate specialist to rule out anything serious. Next are the kinds of signs and symptoms you should never leave and see a Doctor.

  • Sudden high blood pressure

  • Abrupt onset with very severe pain e.g. heavy pain within seconds

  • New headaches in an older patient that they have not experienced before

  • Trauma/cancer/alcohol or drug dependency

  • Neurological problems such as loss of vision

  • Cognitive changes such as forgetting name, or not remembering what day of the week it is

  • Seizures and vomiting without aura

  • Persistent and progressive headaches in children

  • Waking up with “the worst headache” you have ever had.

And that’s us at the end of the definitive guide to headaches, and I say this is a guide; this information in no way replaces the advice of your doctor. But I really hope you have learnt something new and realise that chiropractic can help a lot of these problems. Headaches cause so many upsets, it is not just about the pain but about the affect it has on the whole of a person’s life from the workplace to relationships. Take control, get informed and live the life you love.

Until next time stay healthy while I write the next blog which will be on leg pain and all that it entails.

Yours in Health

Corbin’s Chiro Blog

http://www.nhs.uk/conditions/headache/pages/introduction.aspx http://www.migrainetrust.org/factsheet-cluster-headache-10908 http://www.achenet.org/resources/types_of_headaches/


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