Did you know that it is thought that headaches are the most common complaint of mankind? 

There is much confusion about the cause of headaches and therefore the best way to manage them. I am often asked ‘how do I treat my headache?’ and in my opinion, the correct and most helpful answer cannot be given without thorough assessment.

The majority of headaches do not actually require medical management, as you would know with almost all of us having had several in our lifetimes. A few paracetamol does the trick. However, persistent or acute headaches, accompanied by any of the following symptoms really should be checked out:

• Headaches with a stiff neck
• Headaches with neurological signs such as drowsiness, dizziness, numbness of the limbs, weakness
• Headaches that increase over a few days
• Sudden and abrupt headache onset
• Headaches that wake the sufferer from sleep

Headaches can have many a varied cause, from dehydration to common ailments and viruses, to sinusitis, drug or medicine-induced and injury or trauma such as concussion. Today I will explain the difference between the often confused vascular headaches (migraines) and cervical headaches (originating and referring from the neck). Both types present to physios and doctors with similar presenting symptoms, so confusion regarding the actual cause can sometimes be quite common. 

Vascular headaches.

Migraines usually occur episodically and are often associated with a warning sign such as visual or sensory symptoms (the ‘aura’). Nausea and vomiting are common also and often follow the headache onset. Migraines have a finite duration, when cervical headaches last for days or more. Migraines can have any associated neck tenderness, pain or stiffness, but neck movements do not typically make the headache worse. Migraines ‘throb’ and the pain is often felt at the front or temporal sides of the head. Sleep and anti- migrainous drugs are the only things that relieve the pain.

Migraines are generally not understood that well and are also under-diagnosed. They first afflict people from 10-40 years in age and 75% of all diagnosed migraine sufferers are women. It is thought that migraines occur from a complex reaction in the brain between the nerve pathways and the blood vessels, causing a change in the brain’s chemical balance. Neural pathways in some parts of the nervous system and brain are over sensitised, causing the associated visual disturbances, nausea and sensitivity to light and noise.

Physiotherapy, massage, postural exercise, correction and awareness such as with Pilates don’t really make a difference to these kinds of headaches. 

Cervical headaches.

These headaches can be just as severe as vascular headaches but there are a few differing definers. These headaches are usually slow in onset, building over days. They can last for days to weeks and neck movements or tender points on the neck can really irritate the headache. There is rarely any associated visual or sensory disturbances and infrequently any vomiting. Any or all of dizziness, neck stiffness and symptoms such as numbness, tingling or pain down the arms can be present. The headaches are usually felt on one side of the head – the same side as the neck stiffness and tenderness.

Cervical headaches are caused by pain that is referred to the head from the neck region. This can include from one or more muscular, nerve, bony, upper spinal joint, or vascular structures in the neck. Common causes for these headaches are accidents such as falls, head knocks, whiplash injuries, or postural causes such as poke chinned and slumped postures.

Physiotherapy, massage and exercises to strengthen and support the spinal posture work amazing well for both treatment and prevention of these types of headaches. 

Headaches at a glance.

Features

Vascular headaches

Cervical headaches

Onset

Fast

Slow

Site

Frontal or temporal

Occipital

Type of pain

Throbbing

Dull aching

Frequency

Episodic

Constant

Time course

Hours

Days to weeks

Triggers

Food, drugs, stress

Posture, accidents

Treatment

Avoid triggers, stress reduction

Physio, massage, posture correction

Remember that your physio or doctor know how best to diagnose your headache and its cause. And diagnosing the correct cause will allow for the best treatment.

Nerves as a part of the danger alarm system

Pain is a highly sophisticated alarm system that is designed to warn the body of danger. We all need it to keep ourselves and our tissues safe.

Nerves conducting messages from our muscles, skin and joints are only a part of the system. Today we will explore why there is no such thing as ‘muscle or joint pain’.

Take the example of a paper cut on the end of your thumb. Sensors on the end of the nerves that supply the skin of that thumb will detect some damage to the skin. Alarm bells will ‘ring’ at these sensors and an electrical impulse travelling at 150km per hour will tell the brain “there’s something going on at my thumb.” The brain will take this message and will use that with other pieces of information to produce (or not) an experience of pain. Such other information could include the intensity of the alarm signal, visual inputs of the sight of the blood, visual impact of realising the deepness of the cut, memories of this happening before and really hurting etc.

This alarm system from the tissues (skin, muscle, joint) to the spinal cord and brain is called ‘nociception’, which means ‘danger message’. From the example above, it can be seen that nociceptive messages along the nerves does not always result in pain. You may have experience this yourself when noticing much later that you have a little cut on your thumb with the presence of dried blood, but can’t recall when you had cut yourself.

Nociception is only one small part of the pain experience.

We all have nociception going on all of the time- quite often beyond our consciousness. However most of us do not feel pain all the time. The brain has not thought there needed to be any concern to worry or alert you that you are or your tissues are actually in danger.

Even more interesting is that pain can be experienced without any nociception at all. Take emotional pain. Or strange tales of husbands experiencing ‘labour like’ pains when their wives are giving birth, or twins who feel the pain of the other.

So it can be said that pain does not ‘live’ in your muscles, skin or joints. It is nerve sensors that do - alerting the brain and consciousness that danger is about. Pain is the complex construction as your brain evaluates these danger messages with other information relevant.

You can impress your dinner party guests that what you hear about targeting ‘muscle and joint pain on the Panadol and Voltaren ads on TV is not entirely true from a physiological view!

More on nerves, their sensors and nociception next time.

Want your pre-baby bodies back sooner?

Fix now stock the famous SRC Recovery Shorts for our post-natal mums.

SRC Recovery shorts offer compression and support around the pelvis an abdominal area after you have your baby. The benefits include:

- reducing caesarean and episiotomy pain

- supporting the abdominal muscles while healing after separation of pregnancy

- assisting in supporting your back and pelvis as you go about looking after your new little family addition

- giving you confidence when lifting, bathing an carrying your baby

- providing support to your pelvic floor region to support and speed wound recovery

- helping with the loss of your ‘jelly belly’.

Measure for your correct size at 36 weeks pregnant and have them ready to go as soon as you have baby.

RRP $189 and attract a private health fund rebate from most insurers. Call CBD or St Leonards branches to purchase.