What Causes Headaches and Migraines?
There remains a lack of clear diagnostic criterion for most headaches. There are over 300 different types currently recognised and most pathophysiology unproven/unknown. A commonly used term by Physiotherapists is cervicogenic headache/migraine (CGH). This is based on the involvement of several anatomical structures in the upper cervical region that are sensitive to pain. These structures include neck muscles, discs, nerves and the joints of C0-C3.
Headaches, migraines and the anatomy: Headache and Migraine are not separate entities – rather different expressions of the same condition. The trigeminocervical nucleus is found in the lower brainstem. This receives information from the trigeminal nerve as well as information from the top three spinal nerves of the neck (C1-C3).
There is a convergence of messages in the upper cervical spine (C1-C3) and this can result in pain being referred to anywhere in the head such as pain in the eyes, ears, nose and jaw. This is because the opthalamic, maxillary and mandibular nerves are branches of the trigeminal nerve.
More recently it has been found that misbehaviour of the central disc at levels C2-C3 is particularly responsible for headaches and migraines. The Nucleus (gel) of the disc is designed to move. When there is a trauma, or the neck is subject to sustained postures there is sideways deviation of the nucleus. This causes asymmetric distribution of pressure and results in local muscle spasm and increase afferent messages in the trigeminal nerve.
What is referred pain? This is when the brain assigns pain to an area that isn’t related to any nociception (danger message production). This kind of mechanism explains how a joint in the neck can reproduce headache or migraine pain when it is stressed – the brain mistakenly assigns the area of ‘danger’.
What are the Signs and Symptoms of Headaches and Migraines
+ Pain referring to the head/skull
+ Neck pain
+ Reduce range of movement of the neck
+ Pain below the neck
When Should you See a Specialist/Doctor
+ Rare – 3-4% headaches are indicative of Red Flags
+ 1st onset of headache > 50 years of age, especially without trauma/incident
+ Less than 3 month history without incident
+ Neurological signs: Increased/absent reflexes, bilateral symptoms into arms
+ Sudden onset vomiting with headache
+ During/Post exertion headache – Particularly females.
What is the treatment of a headache and migraine?
If the Physiotherapist can temporarily REPRODUCE the headache or migraine with manual techniques then cervical afferents are relevant. Manual therapy will then be performed, this involves massage, joint mobilisation and exercise. This is aimed at relieving pressure on the joints and desensitising the nerve.