Headaches are so common in our world that they have a colloquialism associated with them: “Oh, what a headache it is doing this or that.” It’s seriously no fun to have an aching head. Headaches can be gnawing or sharp, aching, throbbing, or dull. The World Health Organization (WHO) reports that 70% of adults have 15 or less head aches a month, and 3% of people have more than 15 head aches a month. Over 40 million Americans report having one or more headaches annually. According to WHO, “In the Global Burden of Disease Study, updated in 2013, migraine on its own was found to be the sixth highest cause worldwide of years lost due to disability (YLD). Headache disorders collectively were the third highest [cause of disability].”
There is a saying in natural circles that the powers that be don’t make junk. While headaches may be common, they are not normal or within the realm of health. While an occasional headache may be no big deal, if headaches are a recurrent problem, it’s time to look for a root cause.
Headaches are broadly divided into two categories: primary and secondary. This is to say, they are a problem onto themselves or they are caused by some physiologic or disease process. Primary headaches include tension headaches, migraine, and cluster headaches and make up 90% of all headaches. Primary headaches are not originating due to an underlying organic disease condition, though they very well can be the result of our choices, habits, and injuries. The most common causes of primary headaches are due to dehydration, stress leading to muscular tension, poor posture, hormonal fluctuations, and food sensitivities.
Secondary headaches result from other conditions such as an infection or increased pressure in the skull. Sinus infections and meningitis are examples of causes of secondary headaches, as well as alcohol consumption. Secondary headaches comprise less than 10% of all headaches. Other causes of secondary headaches include concussion, tumors, and more and more commonly, Lyme disease. Lyme disease is an illness that has 300,000 new diagnoses a year, and is especially prevalent in the Driftless region of Wisconsin and Iowa. Lyme disease can leave people with chronic headaches that have seemingly no cause. Because of the difficulty in obtaining accurate Lyme disease testing and the fact that the most accurate tests are not covered by insurance and can be upwards of $650, in addition to a lack of accurate information and consensus in the established medical community about Lyme etiology and effective treatment, Lyme induced headaches are often misdiagnosed and mistreated.
According to WHO, however, the most common cause of secondary headaches is the “medication-overuse headache,” the rebound effect of painkillers often used to treat both primary and secondary headaches. There is a growing epidemic in our country that is just emerging in consciousness surrounding addiction to opioid pain killers which experts say is leading to a market increase in the use of street heroine. In 2012, the CDC announced that prescription drug addiction in the U.S. is an epidemic. Addiction specialist and CFO at the Malibu Cliffs Addiction recovery center in California, was recently quoted on HBO’s Real Time with Bill Maher, to have said that in 2005 5% of all admissions were due to prescription drug addiction. He said in 2016 90% of all admissions are for prescription drug addiction.
Because of this and concerns about medication overuse headache, it behooves us to look at other options in treating headaches.
Cervicogenic headaches are considered secondary headaches because rather than pain originating in the head, the pain originates in the neck and refers into the head, being perceived as a headache. Evidence suggests that the source of these headaches is 1st-3rd peripheral cervical nerves and the structures they enervate including the muscles of the neck and the diaphragm starting at C3. These are usually induced by sustained awkward head position or repetitive neck movement like looking up or down for a prolonged period, such as when painting a ceiling or washing a floor. The headaches that follow often are accompanied by a loss of normal range of motion and pain in the neck, shoulder, or into the arm.
Cervicogenic headaches as well as tension headaches can also occur as a result of certain abnormal postures. For example, anterior head carriage is an abnormal posture that is becoming endemic in our device driven world. In normal healthy posture, the middle of the ear should line up over the middle of the shoulder. If the middle of the ear is forward the middle of the shoulder this is abnormal posture. Because the weight of the head is so large relative to the neck and upper back muscles, anterior head carriage is akin to holding a watermelon out in front of your body. It takes much more effort and strength to hold it away from your body than it does to hold it close. So imagine the work that your neck and upper back muscles are having to do to keep gravity from pulling your head to the ground. Moreover, when the head is forward, the muscles at the base of the skull (the sub occipital muscles) have to contract even more to keep your chin from dropping to your chest. This puts pressure on the three suboccipital nerves which can cause suboccipital and frontal headaches that can mimic a sinus headache.
There is a large body of evidence to support chiropractic treatment of headaches of many kinds. In particular, the evidence strongly supports chiropractic treatment of cervicogenic and migraine headaches. In a June 2011 Journal of Manipulative Physiological Therapy, authors conducted a literature review of 21 relevant studies and concluded, “Evidence suggests that chiropractic care, including spinal manipulation, improved migraine and cervicogenic headaches.”
In April 2011, the Journal of Headache Pain reported that, “The RCTs [random clinical trials] suggest that massage therapy, physiotherapy, relaxation, and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine.”
Finally, according to the American Chiropractic Association, in 2001, “researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.”
As dehydration is the most common cause of primary headaches, if you are considering whether to seek treatment, rule out dehydration first by drinking at least two liters of water a day for women and three liters a day for men (one liter is the size of a large water bottle or little more than a quart). If you do physical work or exercise, add another half liter for every half hour of vigorous (sweating) exercise. If you rule out dehydration and you’re still having headaches, it’s time to seek some professional help.