Headaches Coming From Your Neck?
There are a whole range of headache and migraine types, characterised by everything from severity, to associated symptoms, to other contributing medical conditions, and more. What a lot of people don’t realise, is that some of the most common forms can be headaches coming from your neck – including issues in your shoulders, jaw, and upper back as well. This is great news for some, because it means the issue is no longer just about the headache symptoms, but about something that can be addressed in a way that is going to be more than just a symptomatic band-aid fix.
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Headaches that typically respond to changes in the your joint and muscle function include tension, migraine, and exertional vascular type headaches. These might be types of their own, but can come under the umbrella term of “cervicogenic” (cervico- pertaining to neck) if they are secondary to or exacerbated by issues stemming from the neck.
There are 3 main ways that your neck, shoulder, and upper back function can cause headaches, and depending on which one is the most detrimental to you, this can influence what type of headache you get.
Most people who are aware of cervicogenic headaches mostly associate them with tight muscles around their neck and head, particularly their upper trapezius and levator scapulae that many people know to be loaded during desk work and hold a lot of stress. These can be tight or overactive, usually paired with underactive or weak muscles elsewhere. This in and of itself can generate pain and tender points within the muscle, and create tension on their attachments around your upper neck and skull, and refer pain even further as well. Some muscles like your suboccipital, temporalis, and frontalis muscles that wrap around your skull can create superficial pain and ache around the head, and often create tight, pincer-like sensations at their attachments that can feel like someone is constantly squeezing your head.
This almost always underlies muscle dysfunction, and can be a big factor in preventing muscle-focused therapy from resolving the issue. There can be pain coming from irritation to the ligaments that hold the joint together, or from the joint surfaces themselves that refer into the head. This is particularly the case with the upper neck joints and the base of the skull (occipital plate) that can be compressed onto each other, putting pressure through the plates of your skull and throughout your head.
Additionally, there are a huge number of nerves in your neck, particularly the upper neck, that are responsible for proprioception – that is telling your brain where your head is in space relative to your body. These proprioceptive nerve fibres are most dense in the ligaments and connective tissue capsules around the joints. When these are compromised, the information your brain receives about your head position from your neck becomes different to the information it receives from your eyes visually and from the balance centres in your ears. These mixed messages create confusion for your central nervous system and can cause headaches as well.
This dense collection of nerves from your upper neck also contains nerves responsible for sensation around your head and face, sensation and secretions in your sinuses, secretions in your eyes, and pupil dilation, amongst other things. Issues with any of these can create symptoms resembling visual disturbance, sinus pain and blockage, and facial sensation changes.
This often comes as a secondary complication arising from the first two issues. Your brain requires an extremely large amount of blood flow to function normally (about 15% of your entire bodily blood flow), and if this isn’t delivered in full, problems occur quite quickly.
Lack of oxygen to the brain can create a toxic build up of carbon dioxide and waste products in your brain cells and nervous tissue that surrounds them, much like it does in muscles when they get fatigued. This toxicity can create low grade inflammation and bring on pain itself, but additionally, if parts of the brain start to function less optimally because of the lack of oxygen, other complications with information processing and coordinating automatic actions like balance, movement, vision, and much more can arise and contribute to headache. Improper blood flow to and within the brain is thought to be one of the major drivers for migraine occurrence.
The blood to your brain travels mostly through the carotid arteries in the front/sides of your neck, and the vertebral arteries that travel through the bones of your neck. When you have muscular tightness, poor joint movement, and any swelling or inflammation around these structures, compression of these blood vessels can occur and limit the flow to and from your brain.
What can you do about it?
There are many things that can be done to address each of these problems individually, but in almost all cases it’s a combination of these that are driving your symptoms.
The best way to approach treatment is to work in an order of priorities that best suits your body and the most underlying cause.
Most the time, this means addressing the structural issues first – fixing any movement and joint irritation issues not only in your neck, shoulders, and upper back, but lower down as well, particularly around the foundation of your whole spine and upper body that is made up of your hips and pelvis. This ensures any compensatory stress is found and eliminated, otherwise there is usually a high chance of reoccurrence.
Doing just this will solve a lot of muscular issues by itself, as joints have nerve endings directly to muscle that cause them to tighten and guard when they are irritated, so keeping them happy allows the muscles to relax as well. Any residual muscle issues can then be addressed, by identifying faulty muscle patterns (e.g. certain muscles overworking for other weak muscles), and then releasing the tightness in the overactive muscles and strengthening the underactive ones, usually involving rehab exercises to do out of clinic as well.
Addressing these two issues will reduce any vessel compression by joint or muscle structures and resolve any biomechanical blood flow issues as well. In fact, adjustments in the neck to improve joint function have been shown in studies to significantly increase the rate of blood flow to the brain just by themselves!
What if it’s not my neck?
Particularly if it’s an acute condition, or has a very long history, sometimes symptoms have to get worse for a short time before they get better as your body has to take on board some major changes to work back through that history. While there is certainly a chance of having your headache symptoms temporarily aggravated by treatment, despite being uncomfortable, this actually reveals a clear link between what is being treated and your headaches. Especially for patients who have had lots of other investigations done with no clear cause, this is actually a very good sign that we may have found the mark.
The worst case scenario in having your neck function assessed is no change in symptoms, but you end up with a looser, better moving, and healthier musculoskeletal system, and go away knowing that your headache isn’t coming from your neck. This way, you may have just helped prevent your neck from becoming a contributor to future headaches!