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Headaches & Migraine

Headaches & Migraine

Headaches affect a large number of us through our lives and are one of the most common causes for visiting the GP. Seeing your GP is a sensible first step to take but only very rarely does medical investigation tell us that something is wrong.

This is reassuring enough but at the same time leaves lots questions unanswered. Most patients go on to rely on a life time of medication that masks the problems rather than solves them.

It is well documented that headaches can be caused by pain referred from disorders in the upper part of the neck. We call these types of headaches cervicogenic i.e. coming from the cervical spine. At first this is not something that most people would normally consider but actually the nerves in the upper part of the neck link directly to a part of the brain that we know is sensitised in people with headaches, the trigeminocervical nucleus.

Cervicogenic headaches are acknowledged by the International Headache Society (IHS), but in our clinical experience the role of the neck as both a cause and a trigger for many types of headache including migraine has been considerably underestimated. Without expert assessment of the joints and soft tissues in the upper part of the neck a cervicogenic headache cannot be ruled out especially given that lots different types of headaches including migraine present in very similar ways.

90% of the patients who have come to see us complaining of headaches (including migraines) have been successfully treated. Accurately stressing stiff tissues in the upper part of the neck temporarily reproduces the patients head pain and this is one of the key diagnostic criteria set by the IHS to differentiate cervicogenic headache from other types. Once the exact location in the neck has been confirmed carefully aimed, gentle manipulation of these stiff spinal segments is used to then ease the symptoms and most patients find that generally their pattern of headaches starts to change very quickly.

If on examination there are no relevant disorders to be found in your neck or upper back, treatment would not be recommended and we would refer you back to your GP. We also work closely with Consultant Neurologists so that the medical aspects of various types of headaches are also managed effectively.

“I suffered daily headaches for over 10 years before a neurologist referred me to HFS. Gentle manipulation of my neck started to ease the pain almost immediately. I was also shown how to correct my posture and set up my work station properly and I have not had a headache for over a year” (Stephanie – Insurance Broker)

Common underlying causes of cervicogenic headaches include poor sitting posture (especially head/neck position), an adverse workstation / desk environment, and altered muscular control of the shoulder blade. Treatment therefore involves managing these underlying causes with manual therapy to loosen joint and soft tissue restrictions, posture correction, and specific exercises to improve muscular control of the head/neck and shoulder blades. The majority of people with cervicogenic headaches tend to work at desks and as such optimising this environment through ergonomic assessment is often the key to successful management of this problem.

Greg Ryan

Director of Human Resources & Musculoskeletal and Sports Physiotherapist

Qualified from Guy’s Hospital.

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