Headaches effect most people at some times during their life. Generally a headache will effect the back of the neck but may spread into the face, forehead and behind the eyes. Headaches maybe classified into several categories- migraine or vascular headaches, neck headaches, headaches related to drugs, exertional headaches related to exercise or headaches related to increased pressure within the skull (tumor ). I will discuss the first headache types as they are the mostly commonly treated by your general practitioner or physiotherapist.
Vascular Headaches:
These include migraines effecting about 20% of the population at some time during their lives. They are associated with opening of the blood vessels in the head ( vasodilation ) which causes the throbbing sensation. The opposite may occur the onset of the headache with closing down of the blood vessels (vasoconstriction ) producing an “aura” characterised by bright or coloured lights.
Characteristics: throbbing, younger patients( 10-40 years) fast onset lasting hours. Associated symptoms include nausea, vomiting or dizziness.
Causes:
These may vary and sometimes controversial. Precipitating factors may include, certain foods (chocolate, cheese or nuts) blood pressure changes, too little or too much sleep. Migraines maybe related to noxious input from the upper 3 neck vertebra although the pathophysiology of migraines remain unclear and is open to further research .
Treatment: A first choice, consult your general practitioner. Very often sleep reduces the headache in conjunction with medication.
Cervical Headaches:
( neck headaches or cervicogenic headaches )
Neck headaches are causes by abnormalities arising from the upper 3 joints /vertebra in the neck. Noxious information is transferred to the brain (trigeminocervical nucleus) and this is interpreted as pain in the neck or head.
Characteristics: Generally a slow onset taking days, worse in the morning but may vary during the day depending on activity. The patient is 20-60years. Very often but not always reduced range of neck movement is evident. Like vascular headaches dizziness, vomiting or nausea may occur.
Causes: Include degenerative changes (arthritis) in the cervical vertebra, postural stresses (sitting for long periods at a computer, long periods of driving ) or trauma ( whiplash or sporting injuries). Sometimes it’s a combination of factors.
Treatment: Consult your general practitioner who may order x-rays or other tests to eliminate non-mechanical factors. Physiotherapy may offer relief by mobilising the upper 3 vertebra. This reduces the noxious input to the brain. The therapist may also look at causative factors such as workplace or home office ergonomics. Upper cervical exercises can help maintain movement gained during the treatment sessions.
Conclusion:
The causes, treatment and management of headaches are many and varied. Vascular headaches and neck related headaches may be separate entities but future research may show they share the same pathophysiology.
References:
D. Watson The Upper Cervical Spine and Headache.
April C Dwyer A Bogduk N Cervical zygapophyseal joint pain patterns.II
A clinical evaluation. Spine 1990;15: 458-461
Bogduk N. the role of the neck in headache; the neck is important Proceedings 8th
Congress of the International Headache Society. Amsterdam 1997 Cephalalgia 1997a; 17: 224
Bruker and Khan’s Clinical Sports Medicine.
Jenson S. Neck related causes of headache, Aust. Family Physician 2005;34 (8) : 635-9
Jull G, Trott P Potter H et al. Arandomized control trial of exercise and manipulation therapy for
cervicogenic headache . Spine ( phila Pa 1976 )