In order to help treat headaches, practitioners such as Osteopaths understand that there are so many potential causes, meaning they’re not all the same.
Some headaches require urgent medical attention.
Some are solved by simply doing a few mobility stretches.
Some are related to your Jaw, and how you grind your teeth.
There are many possible solutions to them – and it all depends on WHY you’ve got the headache in the first place.
1. Headache Causes
There are many, many causes of headaches.
The most common reasons that we see are:
- Muscular Causes of Headache
- Nerve Causes of Headache
- Joint Causes of Headache
- Brain Causes of Headache
- Vascular Causes of Headache
- Stress Causes of Headache
In order to figure out what type of headache you have you must start by giving your practitioner a decent history.
The most common causes are in fact muscular.
Temporalis and Masseter are common culprits, reacting to how your Jaw is aligned, dental work and if you’re stressed!
Clenching your jaw is a common cause of headaches with many people doin this a lot during the day and night (without realising it).
Trapezius is the big shoulder muscle that is often over worked in people that have poor posture – especially desk bound workers.
Just underneath trapezius are smaller Suboccipital muscles that can cause headaches, reacting to stiffness in the upper neck joints.
There are small nerves that come out underneath these muscles – and can cause one sided head pain into your temple.
The above muscles are certainly the most common that we find in daily practice – and there are a number of reasons why they’d be like this, tight enough to cause headaches.
The most common reasons we see are:
- Dental or Jaw issues
- Muscular weakness
And often it’s a combination of these things!
Nerves can be entrapped as they come out of the spine, or pass through/near muscles of the spine and face.
As you can see in the diagram, the small Suboccipital muscles are quite small, but they’ve got a very big job to do.
As you can also see – there are lots of small nerves that arise from this region, and are very commonly associated with headaches, especially headaches closer to the skin.
If your headaches are related to these small muscles of the upper spine, typically it’s very easy (and gentle) to remove the headache, and show you a few things to stop them coming back.
Painkillers might stop the actual headache, but won’t necessarily stop the “reason” the headache is there in the first place.
An Osteopath can quickly help you identify the potential reason the headache is there, and potentially help you remove it, fast.
This is very common.
Most of the time, the joints responsible for contributing to headaches are your upper neck (C1/C2) and your Temporomandibular (TMJ) joint in your Jaw.
The upper neck can become very stiff for a variety of reasons, including things that manual therapy cannot help.
The Osteopath can feel which joints are causing issues, and has a number of different ways to potentially help, including (but not limited to): Massage, stretching, joint manipulation, dry needling, and exercise/mobility.
Many times these joint stiffness actually contributes to the muscular tension, which then makes the pain even worse!
So, we attempt to safely free up any restrictions in these joints, which usually will give a positive effect in the surrounding muscles, and your headache may subside.
Often this relief is immediate – but of course, really depends on the cause.
When we say “Brain” causes of headache, we mean inside the skull, which can actually be vascular (blood vessel) related (still inside the skull) and of course things like brain tumours and other space occupying lesions.
Of course all are actually “felt” by the brain in someway – hence painkillers can modify pain by acting at pain receptors to inhibit the pain signals.
So many people get them, assume the worst, and consult “Doctor Google” – only to come across all the reasons why they think their pain is a brain tumour!!
It’s so common for people to think this, only to discover it’s a really simple cause, and easy to fix.
Osteopaths are trained to ask specific questions about your headache to gain as much information from you as possible.
This enables them to quickly decide if they think they can help you, or if you need referring for imaging, MRI, Xray, or any other tests.
Vascular = “Blood vessel”.
The number one on this list would have to be a “stroke” which is a blood vessel breaking inside the brain.
The location of the break determines the symptoms, but if there’s a lot of blood lost (i.e. haemorrhage) it can cause a headache, which may be severe.
One of the reasons is that the “dura” (a protective membrane around the brain) can become irritated as a result of the bleeding.
Usually there are other symptoms associated with a stroke – not “just” a headache.
If you have a head pain that is the worst you have EVER felt and painkillers do not change it – you really need to get checked out.
Especially if there are strange symptoms like facial weakness or voice changes.
You can also get headaches related to the blood supply located in the upper neck.
It is the number one issue that we see on a day to day basis.
There are so many forms of stress, with causes including financial, relationship, and workplace stress.
Why does stress cause headaches?
Stress does several things, one of which is increase your systems cortisol levels.
This is a normal reaction, and you want this to occur – but when the stress is happening repeatedly and it’s “out of your control” then you really have to looks at ways of changing it.
Stress and the cortisol response negatively affects your ability to SLEEP and therefore recover from your day.
Stress changes the way you BREATHE – making you breathe shorter and faster breaths, in the upper chest – making you potentially use some of the upper chest muscles a bit more than you should.
It also increases muscle tension – especially in the shoulders, neck and lower back.
And – stress can decrease your ability to cope with pain.
We always suggest ways of helping you calm your stress response if you present with head and neck tension.
Of course there are random causes of head pain, that don’t fit the norm – things like being allergic to preservatives in e.g. ham. Remove the ham, stops the pain.
Symptom: Headache after eating ham, Symptom not present when not eating ham, reproducible every single time.
Does this mean EVERYONE gets headaches from ham? No! It’s just we do see some very random cause and effect situations in some people.
2. Headache Assessment
All headache assessment is carried out in the same way that other pain causes are carried out:
- Active range of motion
- Passive range of motion
- Special tests
It’s vital that we get a good history!
Not all head pain has the same cause/origin – and the answers you give will help guide us towards other questions, that will help us decide if we can help you or not.
These are questions like:
- How long have you had them?
- Where in your head do you feel them?
- How strong are they?
- Can you do anything to relieve them? i.e. do painkillers work (they often don’t)
- Do you have visual symptoms such as flickering, sensitivity to light?
- Are they worse with certain neck positions?
- Do they wake you at night?
There are many other questions, but unless your practitioner gets a good history, they’ll struggle to help you.
3. Headache Diagnosis
There are a number of different “causes” of headaches, some of which an Osteopath isn’t able to “diagnose” without diagnostic imaging.
Thankfully, most of the time, the “cause” of most peoples headaches are purely structural – and have a simple muscular or joint related “cause” which is (usually) very easy to treat.
Depending on the history and assessment – there are several types of headache that clinicians like Osteopaths, Physiotherapists & Chiropractors need to be aware of, and will/should refer for diagnosis.
- Vascular causes
- Infection causes
- Medication causes
- Trauma causes
Sometimes a headache will “seem” serious, but actually isn’t.
Pain sensations can be quite different in different people – and what some people say is a “mild” headache – could be excruciating for others.
Some people very rarely get headaches, and others get them on a daily basis.
4. Headache Exercises
The only time exercises or stretches will possibly help a headache is if the cause is musculoskeletal, and is diagnosed as such.
When the cause is stiffness of the upper neck (otherwise known as “cervicogenic” headache) most of the time basic mobility of the upper neck will help.
Basic mobility will include movements like:
Upper neck traction, nodding actions to mobilise the muscles and joints of the upper neck as in this video:
And then, you need to look at other reasons WHY that region is “tight”
Very often, we find there’s a combination of:
- Tight upper/back of neck
- Weakness of the front neck muscles
- Tight chest muscles
- Weakness of the glutes/hips
Of course, there are multiple variables with this – but the above four are super common!!
The reason for this – is that we SIT so much of our days – in front of a computer or device, using our shoulder and neck muscles a LOT in one place (i.e. not moving the neck much).
Add to this the fact that when we sit – we basically turn all muscles of, except the ones that hold up our heads… No wonder they start complaining after a while!!
If you see an Osteopath, they’re never going to ONLY look at your neck, as the cause of ALL headaches…
If its muscular, or skeletal – there’s almost always something else contributing to the headache and upper neck tension!
So – we generally recommend:
- Mobilise/stretch upper back neck
- Strengthen front of neck
- Stretch front of chest and help improve rotation and
- Strengthen glutes/hip region
- Look at your desk/sitting posture set up.
5. Headache Relief
Relieving headaches can be extremely simple, if the cause is something that a manual therapist can treat.
We generally don’t recommend taking a painkiller, unless the pain you’re experiencing is affecting your sleep.
Getting sleep is super important – and it’s worth masking pain for this.
We don’t usually recommend it in other circumstances, because painkillers simply mask the pain.
When you’re masking your pain, you brain isn’t getting the feedback it should be getting, and you “think” you’re fine, when in actual fact, the problem is still there, you just can’t feel it as much.
Like we said – this can be really really important – especially if it’s affecting things you need, like sleep.
If your sanity is being tested by pain, then sure – minimise it somewhat. But always expect that pain to come right back – and sometimes worse, when you’re throwing down painkillers…
We don’t think it’s possible to prevent all reasons for headaches unfortunately!!
However, if the cause of the headache is largely “structural” then the solution is often very very simple.
You prevent headaches by maintaining strength, and mobility.
You cannot have too much of EITHER though!! As to much strength/tension causes headaches, and too much mobility (there is such a thing!) can also cause headaches…
What you need is a combination of the above.
7. Osteopathic Treatment For Headaches
Typically – the treatment centres on making sure you’re mobile where you need to be, and stronger where you need to be.
There are so many ways we can do this, and the exact style and pathway that the practitioner chooses, is really dependent on the reason why the pain is there in the first place.
Generally, Osteopaths use the following techniques to help improve mobility:
- Soft tissue techniques
- Joint manipulative techniques
- Stretch techniques
And then – they give you a few things to do yourself.
Sometimes there’s an additional “indirect” or “cranial” approach which may be of benefit.
How many treatments do you need?
This really depends on the severity, and other factors like degenerative change etc.
Sometimes it’s very easy to get full resolution very quickly. Sometimes it’s not quite that easy.
But it’s always best to consult us, to make a plan for you to not only get rid of headaches, but keep them away!