Headaches are common; often disregarded and attributed to dehydration or stress, but there is often more to them and much that can be done if the correct cause is identified.
Tension Headaches
The most common type of headaches are Tension Headaches. In simple terms pain in the muscles in the neck can cause a referral of pain to the head. These referral sources in the muscles are are called trigger points.
Tension headaches are usually caused by poor posture and/or stress, and can last from a few hours to several days. It is usually very responsive to acupuncture or manual therapy. NICE (The National Institute of Clinical Excellence) has approved Acupuncture for the treatment of Tension Headaches. Manual Therapy aims to reduce the muscle spasm, mobilise the underlying joints and enable better neck posture to prevent recurrence.
In the diagram below the large whitened circles show the trigger points in the muscle and the coloured dots show where the pain is referred to.
Cervicogenic Headaches
Often headaches can be caused by problems in the cervical spine which either refers pain to the head directly, or causes local muscle spasm and therefore a secondary tension headache. Treating or managing the underlying neck condition will improve the headache. Jaw pain is often associated with clenching and grinding of teeth, and poor bite patterns. Your dentist can prescribe a mouth guard to prevent too much pressure being applied through the teeth.
Migraines
Migraines are often easier to recognise. They are characterised as one-sided throbbing headache around the temple. In approximately 75% of cases there is a trigger which include stress, menstruation, noise, odours, heat, neck pain, and certain foods. 25% of migraines seem to have no known trigger. Classically there are often preceding symptoms called Aura which might include changes in vision or smell, but sometimes none at all.
Interestingly neck pain is reported as an important feature in 69% of Migraines, and there is often a significant overlap between tension headaches and migraines. This means that by treating the associated Tension Headache and/or neck pain an important trigger of the migraine can be removed.
The old theory was that Migraine was caused by inflammation of blood vessels in the brain, but this has been shown to be incomplete. A newer perspective suggests that some migraine sufferes may have a genetic channelopathy. A channelopathy is a malfunction in ion channels. These are proteins that regulate the flow of ions across cell membranes and are vital for normal nerve function. In the case of migraines, channelopathies may cause changes in the excitability and responsiveness of neurons in the brain, leading to increased sensitivity to triggers that can trigger migraine attacks.
One specific type of channelopathy that has been linked to migraines is a mutation in the CACNA1A gene, which encodes a subunit of a calcium ion channel. This mutation can lead to an increase in the flow of calcium ions into neurons, causing them to become more excitable and prone to firing abnormally.
Research has shown that people with this CACNA1A mutation are more likely to experience migraines with aura, which are migraines accompanied by visual disturbances, such as flashing lights or zigzag lines. This suggests that channelopathies may play a role in the development of certain types of migraines.
Other ion channels and genes have also been implicated in migraines, and ongoing research is uncovering more about the complex interplay between genetics, ion channels, and migraines.
Medication overuse headaches
These are also called Rebound Headaches and caused when people take painkillers too often. They are more common than you might think… 5-10% of people with headaches get them because they are taking painkillers too often. This type of headache is manifested as frequent or daily headaches that develop over several months of taking painkillers (for migraines or headaches). If you take painkillers for your headaches more than twice a week for more than three months see your pharmacist or GP.
Other less common causes of headaches
The most serious headaches are bleeds on or in the brain, or masses in the brain. These types of headaches are accompanied by other symptoms which may include: fever, sudden neck stiffness, changes in cognition or movement or personality changes, or headaches which worsen when coughing and sneezing, or with exercise.