Health June 2014

Heading off pain

Steps to easing chronic neck-related headaches

  • Poor workstation set-up can cause neck strain
  • There are over 40 types of headache
  • Hands-on treatment, exercise and posture changes suggested

I recently treated a young executive who was referred to me with severe neck pain and muscle spasms. He felt the issue was related to his posture and long hours working in a demanding office role.

Clinically, his neck movement, joints and spinal muscles were tight and restricted. A poor workstation set-up resulted in unnecessary strain in his upper neck. We altered his desk and monitor height, and after a couple of visits the patient reported his neck pain resolved—better still, his regular headaches had ceased completely.

I was surprised, as he had not mentioned headaches at our initial session, having considered them unrelated to his stiff neck.

My client had never sought treatment for his distractingly painful headaches, believing them to be stress-induced and unrelated to his other complaints. He was not aware that a combination of hands-on treatment, posture changes and exercise could rid him of this long-term affliction.

A large proportion of the community suffers from headaches of various types. The UK-based International Headache Society lists over 40 different types of headache, and a great deal of research is being done to understand the pathophysiology, or functional changes, behind each disorder.

With cervicogenic (neck-related) headaches, the source of pain is the cervical spine, muscles or soft tissues of the neck, but the sensation is felt in the head. The pain is often episodic and unilateral, affecting the forehead, temple or eye area.

The neural networks from the cervical spine and head cross over in the upper spinal cord. Here, incoming and outgoing neural pathways converge with messages descending from the brain and central nervous system at what could be described as a sensory power terminal: the trigeminocervical nucleus.

The nucleus is the source of the trigeminal nerve, a cranial nerve that supplies the face, eye, head and internal skull, and the sinuses. This convergence means problems originating in the neck can cause pain in the head.

Occasionally, pain can be directly referred from the neck to the area at the back of the head. This is because the spinal nerves from the upper three levels of the cervical spine also supply the posterior skull.

As many headache types have common symptoms, a doctor or physiotherapist relies on a patient’s detailed account of their condition to help classify the type of headache they are suffering. A careful physical examination is performed to assess the motion of the neck, changes in soft tissues and any joint stiffness.

Manually reproducing the individual’s head pain—when mechanical pressure is applied to specific structures in the upper neck—helps confirm a diagnosis of a cervicogenic headache. Sometimes, however, further investigation is needed to establish the cause of pain.

A multidisciplinary approach to the treatment of cervicogenic headaches works best. Physiotherapy often includes massage, joint mobilisation, ergonomic correction and self-maintenance through exercises and postural education. A doctor may prescribe medication and further testing, or refer patients to a specialist.

If you suffer from headaches, seek professional help. It is vital to distinguish between neck-related headaches and other headache disorders. In migraine or tension-type headaches, there are often coexisting musculoskeletal symptoms.

Addressing these through hands-on treatment, exercise and postural correction may have an impact on the frequency or severity of attacks as an adjunct to pharmacological management.

Head pain can be worrying. Anyone suffering from recurrent, severe or persistent head pain should consult their doctor to determine if further investigation into the cause of their headaches is required.