Headache Cause & Classifications: there are many different types of headaches which can make management confusing for patients. At Mountain Health & Performance North Vancouver chiropractor clinic our doctors are experienced in the treatment of all types of headaches including: tension headaches, migraine headaches, cervicogenic headaches and cluster headaches. Continue reading to learn more:
What is a Headache? Headache Cause & Classification
Headaches involve pain in the head or face. Headache cause may include: nerve pain, blood vessel constriction or dilation, muscle tightness and brain injury. In many cases the true headache cause is unclear. The brain itself does not have pain receptors therefore it cannot be a source of pain. However structures around the brain including nerves, meninges, and dura can be a source of head pain.
The muscles of the face and neck can also cause head pain and headaches. Headaches can be classified as primary or secondary. A primary headache is a headache that is due to the condition itself while a secondary headache is due to another condition (i.e.: a sinus headache from sinusitis).
There are many categories of headaches that are defined by the international headache society (IHS). The four most common classifications include:
A migraine headache is a primary headache disorder. You must have a minimum of 5 headaches to be diagnosed with migraine headaches. Chronic migraines occur on 15 or more days per month for more than 3 months in a row.
Migraine Headache Symptoms:
Pain on one side of the face/head
Pain described as throbbing or pounding
Moderate to severe intensity
Associated nausea, vomiting, sensitivity to light and or sound
Aggravated by physical activity
Recurrent (may occur several times per week/month)
Last 4-72 hours but generally less than 24 hours
Migraine with Aura:
A migraine with aura involves neurological symptoms that start before or come on during the headache. The aura may be experienced as neurological symptoms that occur before the headache. Aura may or may not begin after headache pain has started. These neurological symptoms are typically short-term and go away once the migraine is over. One or more of the following symptoms may be present during a migraine aura:
Visual: zigzags, flashes of light, a blind spot, partial or total blindness.
Sensory: numbness or tingling.
Speech: trouble with words.
Motor: weakness in the limbs, trouble speaking.
Brainstem: trouble swallowing, vertigo, ringing in the ears, double vision, trouble with balance, decreased level of consciousness.
People with migraines often find it difficult to describe their aura symptoms. One or more aura symptoms may spread gradually over 5 minutes or they may occur one after the other. Each aura symptom lasts between 5-60 minutes. Usually a headache will start within an hour of aura symptoms.
Visual aura is the most common and occurs in more than 90% of migraine patients that have aura. Pins and needs in the body, face or tongue may also occur. Many people who have migraine with aura may also have migraines without aura. Pre-migraine symptoms may begin hours or a day or two before the other symptoms of a migraine which include: neck stiffness, sensitivity to light and or sound, nausea, blurred vision, yawning. These are not considered to be part of the aura symptoms.
Migraine without Aura:
Migraine headaches with the symptoms described above (pain on one side of the face, head, nausea, vomiting, sensitivity to light and or sounds etc.) without aura.
Migraine Headache Cause:
The underlying cause of migraine headaches is unknown but genetics and lifestyle appear to play a role. The most frequently associated causes of migraine headaches include:
Blood vessel constriction/diminished blood flow to the brain
Central nervous system dysfunction
Imbalance in brain chemicals – including serotonin which helps regulate pain in the nervous system.
Migraine Triggers: A number of factors may trigger migraines including:
Intense physical activity
Medications (birth control pills, nitroglycerin)
Lack of sleep
Hormonal changes (menstruation or menopause)
Environment (weather changes, high humidity)
Bright lights, sun glare, loud sounds.
Strong smells like perfume, paint thinner and smoke
Migraine headaches should be diagnosed by a primary medical provider (i.e.: chiropractor, physiotherapist & or medical doctor) based on a thorough history and physical examination. At Mountain Health & Performance North Vancouver chiropractor clinic our doctors have extensive experience diagnosing and treating migraine headaches. If we feel that our patients require further testing or care we will refer our patients back to their medical doctors or the correct specialist.
Headache diaries in which symptoms are recorded daily are important to help diagnose migraine headaches and can also be used for treatment purposes. Headache diaries are required to record information regarding pain and associated symptoms day to day for at least 1 month.
Migraine Headaches may also be associated with the following conditions:
Mountain Health & Performance North Vancouver chiropractor clinic (additional tips/information):
Create a consistent daily schedule/routine with regular sleep patterns and regular meals.
Control stress through meditation, mindfulness, self-care, and gentle exercise.
Reduce the effects of estrogen by decreasing medications that contain estrogen (if possible under doctor supervision).
Exercise regularly: regular exercise reduces tension and can help prevent migraines. Warm up slowly because sudden intense exercise can trigger migraines.
Complete a headache diary to determine common triggers and avoid these triggers when possible.
Regular treatment for joint and muscle dysfunction from a chiropractor.
At Mountain Health & Performance North Vancouver chiropractor clinic our doctors have experience diagnosing and treating tension-type headaches because they are primarily connected to muscle tension.
They are common headaches and may be classified as primary OR secondary headaches. They are considered a secondary headache if they occur for the first time in close proximity to another disorder that is known to cause headaches. Tension-type headaches may also be referred to as:
Muscle tension headache
Tension-Type Headache Symptoms:
Onset builds up over the course of the day with stress or tension.
No warning signs such as aura will come before the headache.
Pain on both sides of the head, and or face.
Described as dull and achy, a tight band or heavy weight on the head, pressing or tightening.
Mild to moderate intensity.
Last minutes to days.
Pain does not worsen with physical activity.
Headaches are not typically associated with nausea.
Sensitivity to light or sound may be present.
Tenderness to muscles around the head and face.
Tension-Type Headache Cause:
The exact causes of tension-type headaches are not known. The source of headaches may be related to decreased blood flow to the outer part of the brain. This can occur due to muscle contraction/muscle tension. Muscle tension can also cause irritation of the nerves that travel up the back of the head. Tension-type headaches can also be secondary headaches, which means they are secondary to other conditions such as overuse of medications.
At Mountain Health & Performance North Vancouver chiropractor clinic our doctors have a lot of experience treating cervicogenic headaches because they originate in the neck.
Cervicogenic headache pain is caused by dysfunction in the cervical facet joints and associated nerves. The nerve and joint irritation can present as pain in the back of the head/neck that may refer into the temples or behind the eye. The greater occipital nerve runs behind the skull from the back of the neck to the top of the head. It also curves around the upper cervical facet joints C2-C3 and through the suboccipital muscles at the back of the neck (which connect to the skull).
Signs & Symptoms of Cervicogenic Headaches:
May occur daily or at least 2-3x/week.
Slow increase in symptoms throughout the day.
Symptoms are typically on one side of the head, neck or face.
Symptoms typically start at the suboccipital region – connection between back of neck and head.
Symptoms may progress and radiate into the temples, forehead or behind the eye.
Symptoms described as a dull ache or boring pain.
May have stabbing or deep pain as well
Can be moderate-severe intensity.
May occur with: nausea, blurred vision, difficulty swallowing, or sensitivity to light/sound.
Cervicogenic Headache Cause:
Cervicogenic headaches are caused by dysfunction in the cervical spinal (neck) joints, discs or surrounding soft-tissues. Numerous pain-sensitive structures exist in the cervical (upper neck) and occipital (back of head) regions. The junction of the skull and cervical vertebrae have regions that are pain generating, including the lining of the cervical spine, the joints, ligaments, cervical nerve roots vertebral bodies.
Cluster headaches involve excruciating pain in bouts of 15 minutes to three hours. To be diagnosed with cluster headaches you must have at least 5 attacks to be classified as cluster headaches.
Signs and Symptoms of Cluster Headaches:
No true warning signs or aura occur prior to the onset of the headache. Some people will feel a shadow or dull ache prior to the headache. Symptoms are one side of the face in the areas of the temple or behind the eye. May be described as: severe burning, piercing, worst pain you’ve ever had. Includes at least one of the following symptoms on the same side of headache:
Tearing of the eyes
Slowed heart rate
Sensitivity to light
Mild neck symptoms
Sensation of fullness in the ear
Cluster Headache Cause:
The cause of cluster headaches is unknown but has been suggested that it involves abnormalities of the hypothalamus. The hypothalamus is a part of the brain that has various functions. It is responsible for the regulation of various aspects of the metabolism, of the autonomic nervous system, hormone release, sleep, hunger, body temperature and more. It is also believed that dilation of the blood vessels creates pressure on the trigeminal nerve. There is no familial history associated with cluster headaches, unlike migraine & tension type headaches.
Treatment for Cluster Headaches:
Medications are the main treatment for cluster headaches. When headaches occur increasing oxygen to the brain will often help to decrease the length of symptoms so exercise, oxygen treatment, caffeine, hot showers have also been used with varying results.
Headache Treatment at Mountain Health & Performance:
At Mountain Health & Performance North Vancouver chiropractor clinic our doctors are skilled in the diagnosis and treatment of all types of headaches.
The first step for successful treatment of any headache involves a correct diagnosis. Book in to see a chiropractor at Mountain Health & Performance to have your headache properly assessed and diagnosed. A specific plan of management will be created to treat the headache as well as the associated joint and soft-tissue dysfunction that may be contributing to your headaches. Depending on the cause of the headaches various treatments may be offered including: joint manipulation, mobilization, stretching, myofascial release, laser therapy, exercise and advice.
Migraine headaches can be treated by various medications that have been specifically designed to prevent or treat migraines. It’s important to discuss your migraine symptoms with your medical doctor to determine if preventative medication and or pain medication during migraine attacks is appropriate for you. In addition to medication several manual therapies have shown promise for the treatment of migraine headaches.
Spinal Manipulation for Headaches:
Current randomized control trial studies have shown that spinal manipulation and mobilization is effective in reducing the frequency of migraine headaches. Spinal manipulation affects the nervous system and helps to decrease pain and nerve irritation. It can also help to improve mobility and reduce muscle tension in the neck, which may be contributing to or worsening migraine headaches. A Cochrane review determined that manipulation of the spine may be effective for migraine and tension headache and that manipulation combined with neck exercises may be effective for cerivcogenic headaches. A systematic review by Vernon concluded that for headaches that are tension type or cervicogenic, spinal manipulation is an effective treatment for the reduction of symptoms. At Mountain Health & Performance North Vancouver chiropractor clinic our doctors use manipulation to treat joint dysfunction that may be contributing to various types of headaches including migraines. Some patients are not candidates for manipulation and for those patients we can offer mobilization (slower stretching of the joints) when manipulation is not indicated in order to improve joint motion and produce similar results.
Soft-Tissue Therapy for Headaches:
Studies have found soft-tissue therapy (i.e.: massage or myofascial release) helped to reduce migraine frequency and intensity. Soft-tissue therapy may also help to reduce muscle contraction and tension that can irritate neck and facial nerves. We can help to educate you on proper sitting position, computer and workstation set up to ensure ideal ergonomics at work and at home. At Mountain Health & Performance North Vancouver chiropractor clinic our doctors use various soft-tissue therapy techniques to treat headache disorders.
Rehabilitation & Exercise for Headaches:
Rehabilitation has proved effective at reducing the frequency of cervicogenic headaches.
At Mountain Health & Performance North Vancouver chiropractor clinic our doctors provide correct postural strengthening exercises and stretches to help strengthen the neck and back and reduce tension in the surrounding musculature.
Mountain Health & Performance is back open for non-urgent care as of May 19th 2020! We will be following COVID-19 guidelines in our clinic to ensure the safety of our therapists and patients. Please call 604-984-0014 to book or click on the "book an appointment" button to book online.