Headache

By: Gareth Sneath, Registered Physiotherapist

Headache is an extremely common symptom, a bit like a cold or low back pain. Most of us will experience headaches at some time. There are many reasons/causes of the headache symptom, ranging from benign reasons such as tension or stress, both physical and mental to more serious pathology such as an aneurysm. One potential source of headache is the upper part of the neck just below the base of the skull particularly the joints, ligaments, nerves and muscles of the first three segments (C1,2,3). Researchers have established that the pain sensitive structures in this area if inflamed, irritated or injured can refer pain into the head. The daily effort involved in moving and balancing the weight of the head (approx 12-15 lbs) is considerable and relies on a complex system of joints and muscles. The neck is the most mobile part of the spine enabling us to position the eyes in a number of positions for sustained periods of time i.e. sitting watching a movie, typing at a keyboard or for more dynamic activates such as tennis or swimming. All of these require muscle activity to support the weight of the head in the desired position against the force of gravity. It is not surprising that these activities can potentially “upset” the neck and cause both local (neck) and referred pain into the head.

If the headache is severe, persistent or associated with other symptoms, medical advice should be sought in order to confirm the diagnosis. For those patients with headaches, unrelated to more serious pathology, a careful history and physical examination of the neck may establish that the problem is related to a postural or faulty movement in the neck. For example, if the headache is aggravated (or eased) by prolonged posture or applying certain stretches the problem is likely related to the neck.

Australian researchers found that in a group of headache subjects poor posture (forward head position) and weakness of muscles at the front of the neck (deep neck flexors) were more common. These small muscles, attached directly to the front of the vertebral bodies, play an important role in controlling and supporting the neck. They can be activated by gently and slowly nodding the head when lying down but you should not raise your head off the pillow. We tend not to use these muscles very much so don’t be surprised if it takes some practice to develop their endurance.

Clinical experience indicates that working on postural correction, mobility and muscle control of the neck is a useful strategy in treating headache when the neck is the source. The techniques are simple and safe and ultimately can be incorporated into a self-directed program to maintain control of symptoms.