We all get them. In fact, 47% of adults around the world are dealing with an active headache disorder. FORTY-SEVEN PERCENT!! That’s way more significant than I would have ever thought, and that’s with me currently sitting here typing this with a headache (albeit self-inflicted from falling a bunch trying to snowboard yesterday.). In fact, migraines are listed as the 6th most disabling illness in the world. So If you’re reading this, there’s a high likelihood that you or someone around you is dealing with one right now.

And as many of you have likely dealt with headaches before, this will probably resonate with you: it’s more than just the pain. It can cause you to be more sensitive and reactive to everything around you, causing extra stress. It’s hard to feel motivated and personable when you feel like your head is a pressurized tin can. And because it’s “invisible” to others, it’s easy to worry about what assumptions they are making - “Do they think I’m a slacker because I couldn’t handle the bright lights at the meeting?” “What will people think if I miss another day of school?” You can also end up holding yourself back from things…”I would love to take that trip, but what if I get a headache the entire time and it’s all ruined?” “That would be an amazing networking opportunity, but I just can’t focus through the pain and I have no energy”

I alluded to simliar stuff in the last 2 weeks with jaw pain, and as someone who has experienced both, I have to say the mental, emotional, and social tolls are about on par for both - and neither are good no matter how hard you try to just “fake it” for others.

So is there something you can do about it? Depending on the type of headache, absolutely!! Specifically if you have the type I’m going to focus on discussing today.

Oh, and just to make it more confusing, you can have more than one type overlapping each other at the same time. So make sure to read all the way through!

Ok, I’ll kinda touch on headaches referred from jaw pain for a sec, but for the most part, I talked about those pain patterns in the last 2 weeks. If you have a headache that feels like pressure just behind the eye (one side or both but one side more so), that could be referred from lateral pterygoid or another jaw muscle and will respond really well to dry needling, like I talked about.

Bear with me while I go through some of the background info…I know, I know. Not as exciting and not the bottom line info. Read on if you like to have back ground info, but if you prefer the bottom line, scan ahead for relavent bolded words.

Primary Vs Secondary Headaches (HAs):

Per the International Classification of Headache Disorders (ICHD): These 2 broad categories are pretty straight forward. Primary HAs have NO structural or metabolic abnormality and are not a symptom of or caused by another disease or condition. They are often chronic (>15 days/month) and episodic (flare ups <14 days/month) depending on which kind. Secondary HAs, however, ARE a symptom of or caused by an underlying issue and do have a structural or metabolic abnormality. They generally occur in one single episode or are of a new onset later in life.

A lot of people know about some of the primary ones: tension type, migraines, and trigeminal neuralgias. The type referred from the jaw counts as a secondary headache. There are several other types, but less common. Some do require immediate medical attention though. For example, if you have sudden headache onset with double vision and confusion, go to the ER. But if you have a history of migraines and visual changes are standard for your aura, then an ER visit isn’t warranted unless there something very different about this episode compared to past ones. Here’s a very generalized guideline of the red flags that may warrant more immediate medical screening/intervention, especially if more then one of these is present.

2 types that are common that are worh mentioning are Tension Type - the most common HA in the US - which feels like you have a tight band or vice grip around your head, they’re constant, and affect both sides equally. The underlying cause can vary, and sometimes things like PT can help decrease the muscular tension and help some. Then there’s migraines. There are several specific type, and like I’ve mentioned, they can have some neuro symptoms, but those symptoms shouldn’t last longer than 60 min each. Migraines are one sided (though you can have both sides get one at the same time, but be different intensities), pulsating, and last 4-72 hours when untreated. Migraines are mod to severe, can get aggravated by physical activity, and can be paired with nausea and/or light or sound sensitivity. Note that I bolded the duration for a reason. I’ve had multiple patients talk about having migraines that last way longer than that - and I typically find that they aren’t actually having migraines, or at least not primarily (like I mentioned, you can have more than one type, so they would be getting occasional migraines on top of another type that would continue in between)

So what type am I talking about?

Cervicogenic Headaches

This is a secondary type of headache. It make up about 15% of all chornic headaches and about 20% of ALL headaches…pretty high prevalence!

Pain is usually one sided (again, you can one on each side at the same time, but typically one will be worse) and starts in the neck/back of head and can wrap up into the head, as shown in the picture. Often, certain neck movements or long static positions (desk work, driving, etc) will aggravate or initiate pain. Your neck muscles may feel very tender and possibly feel like they have more tension than usual. You also may have some limited motion, ie you can’t look over your shoulder as easily in at least one direction.

Note that, like I said, it can occur on both sides with different levels of intensity/severity, so just becuase it’s not one sided doesn’t mean it isn’t this kind. And it is possible for it to occur along with a migraine (I’ve had a case recently where a cervicogenic headache would start, and then trigger a migraine)

I’m gonna skip the anatomy behind these headaches, because it is the exact same pathways as discussed last week. In fact, this pain pattern is almost the exact same as what you can see with referred jaw pain. And like I mentioned then, there’s almost always neck stuff going along with jaw issues. Though neck pain + headaches doesn’t automatically mean you have a cervicogenic headache. It could be from the jaw. Or both as they sometimes go hand in hand. But either way, the process behind the headache pain pattern is the same. It’s just that the input can come from jaw pain or impaired movement, versus a cervicogenic headache where the signal originates from C1/2 (the uppermost part of your spine). Both enter the same nerve pathway - go back to this blog post if you want a refresher on this anatomy.

How do I know if my HA is cervicogenic?!

The quickest and easiest way involves someone passively moving your neck to check for C1/2 movement. It’s actually a super easy under 5 min screening process IF your medical provider knows the Cervical Flexion Rotation Test. But that’s a big if. It is something that I have never seen a primary physician do, nor an ER doc, nor any other MD/DO/NP/ND. For that matter, I learned it in school, but not in a way that was precise enough. Now that I know a better way, it makes me wonder how many false negatives I’ve gotten on past patients. I’m sure there are others who know this version and use it, but I don’t have a great way to tell you how to find them. But if you have a provider do this (becuase I know any of you that think you may be dealing with these headaches just googled that test) and they don’t have the back of your head resting against their stomach, then they’re doing the way that may not be 100% accurate.

The good news is, if you’re positive on this test and you have a good PT or chiro that can perform upper cervical manipulations/mobilizations and properly strength train and educate, your cervicogenic HA symptoms will be resolved in about 4 visits.

There are benefits to getting PT for other types of headaches as it can reduce frequency and/or intensity of migraines, tension headaches, and other kinds. But I wanted to talk about cerviogenic in this post because PT is just SO EFFICIENT at treating them! Yet those people are often not seeking out PT and instead going to a physican who may not have adequate time to tease out the headache type and may not know the screening test I mentioned. So all they get is more tests and no answers. In fact, the average time it takes to get an accurate diagnosis after onset is 16 months! Can you imagine going through 16 months of pain when it could have been gone in 4?! Physical therapy has been shown to be highly effective, including long term results.

If the description of cervicogenic headaches sounds like it may be what you have going on, hit me up! Even if you’re not in my area, I’ll do my best to help you find someone nearby