What’s the first thing you do to try to relieve an irritating headache? Swig down an extra cup of coffee? Raid the medicine cabinet and pop a couple of ibuprofen? Rub your throbbing temples? Migraine sufferers rely on neurologist-prescribed triptans, antihistamines, anti-seizure drugs, or antidepressants. In extreme cases, even sedatives may be prescribed to help sufferers sleep off the pain. Do any of these things actually cure your headache?
While all of these things may provide some headache and migraine relief, the relief is only temporary. If you want to cure your headaches and migraines, you have to find their source.
Neurologists and other traditional doctors focus on diagnosing and treating vascular headaches (migraines), and they traditionally throw drugs at the symptoms. Their approach is reactive. They are reacting to your current pain by “fixing” it with the temporary relief provided by prescription drugs. They know your headache will come back; that’s why they write you a prescription with refills.
Musculoskeletal practitioners such as chiropractors, physical therapists, acupuncturists, and massage therapists are focused on finding and treating the cause of your headaches. Despite their best efforts, sometimes they can only provide short-term relief. When that happens, you need to find a physician who understands where headaches originate.
Despite the fact that most headaches stem from a musculoskeletal issue, it’s unlikely your family doctor or neurologist has ever heard of the following seven most common headache causes:
- injured neck joints—Your neck has joints, just like your fingers, called “facet joints.” When injured, the upper neck joints (C0–C3) can cause headaches. Injuries can occur in a car crash, fall, or other blow to the head, and joints also can become arthritic without injury.
- loss of cervical curve—Your neck needs to have a C-shaped curve so the weight of your head is distributed evenly between the discs in the front and the facet joints in the back. When you lose the curve, the neck muscles that attach to the back of the skull can become irritated, and this irritation can activate nerves that send pain into your head.
- laxity of neck ligaments causing instability—The upper neck has ligaments that hold it together. When these are injured and stretched, the nerves, discs, and facet joints can become irritated or damaged, and the muscles get overworked trying to stabilize the area. This problem is most commonly caused by car crashes and is easily diagnosed using a technology known as DMX, which is a video X-ray of your movements. In addition, when the discs in the neck degenerate with age, the ligaments can get stretched leading to sloppy movement. This then has the same effect.
- irritated nerves—There are nerves at the back of the head that can cause headaches. The two most commonly involved are the greater and lesser occipital nerves. These can be irritated by bad posture, loss of neck curve, and instability. In addition, there are small muscles at base of the skull that connect to the covering of the brain called the dura. When these muscles spasm they can yank on the dura, leading to headaches.
- weak muscles—The most common weak muscles that lead to headaches are the deep neck flexors in the front of the neck. However, weak muscles can also be found in the upper neck or even at each level in the back of the neck. These lead to areas that are unstable, and the extra wear and tear on discs, joints, and tendons can also lead to headaches.
- trigger points—Trigger points are areas in the muscle that are tight and weak and cause pain. Many different muscles in the neck (and a few in the head) can cause headache. This is referred pain, where a spot in the muscle shoots pain to the head.
- poor posture—Postural issues, like a forward head and rounded shoulders, can cause the muscles at the back of the head that attach to the skull with tendons to become overworked. The resulting tendinopathy can lead to pain at the back of the head. Over time, the tendons can degenerate and develop micro tears.
cures and treatments
As the song goes: “The back bone’s connected the neck bone…the neck bone’s connected to the head bone….” The musculoskeletal system is all connected, so you may need one or several of these treatments to help your headaches.
- repair injured neck joints—Manipulative therapies by chiropractors, osteopaths, or physical therapists often can help. Injecting concentrated platelets into the joints under precise X-ray guidance also may help to heal the damage. Be careful here: While a C2–C3 facet injection commonly is performed with steroids (which is bad for the joint), finding a practitioner with considerable experience to inject the higher joints (C0–C2) that also can cause headache can be difficult. As an example, there are likely less than 50 providers in the United State who have injected more than 100 patients at the C0–C1.
- restore your cervical curve—Find an experienced chiropractor who knows how to restore the curve. Prolotherapy in the neck to tighten the ligaments in the back of the spine can be helpful if curve restoration only provides temporary relief.
reinforce ligament stability—If the sole cause of your instability is weak muscles, specialized exercises may help. If the problem flares with exercise, then the other half of the stability equation is ligaments. Another treatment method focusing on this system is precise injections of concentrated platelets into the damaged ligaments.
- chill out irritated nerves—The nerves often can be treated via precise injection under ultrasound guidance using a regenerative nerve procedure, like the Regenexx advanced third-generation platelet lysate.
- strengthen weak muscles—Deep neck flexors can be strengthened using a very specific protocol developed by physical therapists at the University of Queensland in Australia. The other muscles can be strengthened with specialized machines such as a BTE multi-cervical unit. For the high upper-neck muscles, an iPhone accelerometer-based strengthening protocol can provide instant feedback to the patient.
- eliminate trigger points—Regrettably, the identification and treatment of trigger points has become a lost medical art due to changes in reimbursement for trigger-point injections. One physical therapist has been able to spread a trigger-point dry-needling technique across the country, so many well-trained physical therapists now can treat these trigger-point issues with an acupuncture needle. Don’t confuse this technique with traditional Chinese acupuncture, as most acupuncturists aren’t trained to treat muscle trigger points.
- reset proper posture—Early on, the effects of poor posture can be helped by a postural physical-therapy program.
While Motrin or Excedrin or triptans may relieve your headache or migraine, no drug is a safe long-term solution. Find the cause of your headaches and seek out treatments to cure or at least manage them long-term. By being proactive, you can stop that next headache before it starts.
“Seven Headache Causes and Cures” first appeared as a post on the Regenexx blog.
Like all medical procedures, Regenexx procedures have a success and failure rate.
Not all patients will experience the same results.