Headache or Pain in the Neck?

Headache or Pain in the Neck?

By: Jennifer Gordon, MSPT, CLT

Have you ever noticed the tension in your head and neck at the end of a long week at the office? It may start as some soreness in your upper shoulders or the neck, or it may start as a headache. You grab an Advil which helps temporarily, but you can’t help but notice that your neck feels sore to the touch and your upper back feels stiff. What is going on here?

You may be suffering from cervicogenic headaches, migraine, or tension headaches. Cervicogenic headaches originate in the musculoskeletal structures of the cervical spine (neck) and may radiate into the head, face, shoulder, shoulder blade and arm. These headaches may be further complicated by symptoms of dizziness, lightheadedness, nausea and weakness. Conversely, migraine headaches are due to a disorder involving the nerves and vessels of the brain and spinal cord, yet sufferers tend to also present with muscle tightness, weakness, and trigger points in the muscles of the neck. Tension headache, the most common type of headache affects an astounding 1 in 3 adults and is generally located at the back of the head. Tension headaches are caused by body tension from stress or overwork, and present as a band around the head spreading into or from the neck musculature.

Recurrent headache disorder is a common disorder affecting 1 out of 2 people according to the World Health Organization and is the third highest cause worldwide of lost time due to disability. Patients may avoid seeking treatment due to the financial cost of relying only on over-the-counter medications. So what to do?

First, you need to determine the underlying cause of the headaches. You need to talk to your doctor about your general health, the medications you are taking, and the activities that bring on your symptoms. Headaches may be caused by gradual aging changes in the body, poor posture (especially computer use), or due to trauma/injury and can dramatically affect your quality of life. Headaches can interfere with concentration, and tolerance to external stimuli (noise, light), and may result in withdrawal or avoidance of social situations. You may experience decreased quality of life and disability due to fear of the next episode, or you may experience other secondary conditions, namely anxiety, and depression.

Your health care provider can refer you to Physical Therapy for examination of the soft tissue structures (muscles and nerves) of the head, neck, and jaw to determine functional loss of range of motion or flexibility, and decreased willingness to move the head and neck. You will be assessed for joint mobility, muscle strength, and the presence of trigger points (muscle contraction that refers to pain in a typical pattern) to determine the underlying cause of the headaches. Your posture during work and daily activity will also be considered to develop the most efficient intervention for decreasing your symptoms.

Treatments may include exercises to reduce postural stresses on affected musculature and to improve postural control. Mobilization of the cervical spine joints, trigger point massage, dry needling, myofascial release, and traction may be implemented to reduce symptoms. Education regarding daily prolonged positions that may be contributing to the condition and reduction of screen time may be recommended. Modalities particularly heat and ice may also complement your treatment program.