The headache treatment world is a weird place when it comes to headache causes and cures. On the one side you have neurologists who focus on vascular headaches known as migraine and throw drugs at the problem. On the other side you have musculoskeletal (MSK) practitioners like chiropractors, physical therapists, acupuncturists, massage therapists and the like who treat the cause. Who’s right? Well, after more than two decades spent treating headaches, the MSK folks are more often right than the med pushers. Most headaches have a MSK origin, yet since your family doctor is more likely to only have been exposed to the neurology view, the real causes of headaches are often missed. So what are the most common missed MSK causes of headaches?
1. Upper neck joints– Your neck has joints just like your fingers called “facet joints”. The upper neck joints (C0-C3) can cause headaches when they get injured. How can they get injured? In a car crash or when you fall and hit your head (or something hits your head). Regrettably, there’s a very low likelihood your family doctor has ever heard of these type of headaches. What do you do to treat them? Manipulative therapies through chiropractors , osteopaths, or physical therapists can often help. When this doesn’t last, injecting concentrated platelets into the joints under precise x-ray guidance may help heal the damage. Be a bit careful here, as while a C2-C3 facet injection is commonly performed with steroids (which is bad for the joint) finding a practitioner with considerable experience to inject the higher joints (C0-C2) can be difficult. As an example, there are likely less than 50 providers in the U.S who have injected more than 100 patients at C0-C1 (our clinic has performed >1,000 of these procedures).
2. Loss of Cervical Curve– Your neck needs to have a c-shaped curve so that 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 get irritated (see below for enthesopathy). How do you fix this? Find an experienced chiropractor who knows how to restore the curve. Check out www.idealspine.com to find someone in your area. When this fails, prolotherapy in the neck to tighten the ligaments in the back of the spine can be helpful.
3. Instability– The upper neck has ligaments that hold it together just like any other joint or part of the body. 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 can be easily diagnosed with a technology known as DMX, which is a video x-ray while you move. You can help treat this with exercises, although frankly strengthening usually wont solve the issue. Another method is highly precise injections of concentrated platelets into the damaged ligaments (see discussion above on upper cervical facet injections, as these must be performed under highly specialized imaging guidance).
4. Irritated Nerves– There are nerves at the back of the head that can cause headache. The two most commonly involved are the greater and lesser occipital nerves which can cause pain in the back of the head. These can be irritated by bad posture, loss of neck curve, instability, etc… The nerves can often be treated via precise injection under ultrasound guidance using a regenerative nerve procedure like our advanced 3rd generation platelet lysate.
5. Weak Muscles– The most common weak muscles that lead to headaches are the deep neck flexors (DNFs) 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. DNFs can be strengthened with a very specific protocol developed by physical therapists at the University of Queensland in Australia. The other muscles can be strengthened with specialized machines like a BTE multi-cervical unit. For the high upper neck muscles, we’ve developed an iPhone accelerometer based strengthening protocol that provides instant feedback to the patient.
6. 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. Regrettably the identification and treatment of trigger points has become a lost medical art due to changes in reimbursement for trigger point injections >10 years ago. However, one of our old physical therapists has been able to spread the IMS trigger point dry needling technique across the country, so many well trained physical therapists are now out there who can treat these issues. See http://www.kinetacore.com/.
7. Posture– Last, but certainly not least. Postural issues like a forward head and rounded shoulders can lead to enthesopathy. This means that the muscles at the back of the head which attach to the skull via tendons get overworked because they’re exceeding their design specifications by being used to hold up the head. The tendons get degenerated and develop micro-tears. Early on in this disease cycle, a postural physical therapy program can help. One of the best we’ve ever seen can be found at www.egoscue.com. If that doesn’t work, then concentrated platelet injections into the tendons may be needed.
The upshot? Most headaches shouldn’t be treated by popping Motrin or throwing a lifetime of migraine drugs at the problem. Figure out which of the 7 causes you might have and then take action for a life free of nasty and disabling headaches!