Tension-Type Headaches
At some point, everyone will have a headache, whether it’s from stress, lack of sleep, hormonal related or even self-induced after having way too much fun the night before! In fact, 9 out of 10 Americans suffer from headaches. For the most part, headaches are not indicative of a dangerous underlying condition, but they can be (…a topic for a future “Health Update”). The focus of this Health Update is to discuss the most common form of headache – the tension-type headache or, TTHA.
Tension-type headaches (TTHA) are defined by the Mayo Clinic as “a diffuse, mild to moderate pain that’s often described as feeling like a tight band around your head.” Ironically, even though this is the most common form of headache, the causes of TTHA are not well understood. These are sometimes described as muscle contraction headaches but many experts no longer think muscle contractions are the cause. They now feel that “mixed signals” coming from nerve pathways to the brain are the cause and may be the result of “overactive pain receptors.”
Regardless of the cause, the triggers of tension headaches are well known and include stress, depression/anxiety, poor posture, faulty awkward work station set-ups, jaw clenching and many others. Risk factors for TTHA include being a woman (studies show that almost 90% of woman experience tension headaches at some point in life) and being middle aged (TTHA’s appear to peak in our 40s, though TTHA’s are not limited to any one age group). Complications associated with TTHA’s may include job productivity loss, family and social interaction disruption, and relationship strain. The diagnosis is typically made by excluding other dangerous causes of headaches and when all the test results return “normal,” the diagnosis of TTHA is made.
Treatment utilizing over the counter medications are often effective so long as side effects of stomach irritation and/or liver and kidney issues don’t arise. The use of heat and/or cold is often helpful as some prefer one over the other. Alternating between ice and heat is sometimes most effective. Controlling stress by trimming out less important duties or “…taking on less” can help. Yoga, meditation, biofeedback and relaxation therapy are also great! An “ergonomic” assessment of a workstation and how it “fits” the headache patient can also yield great results. Other highly effective therapies include acupuncture, massage therapy, behavior and/or cognitive therapy as well as of course, chiropractic! Chiropractic is a GREAT choice compared to standard medical care, especially when side effects to medications exist. This is because manipulation of the cervical spine addresses the cause of the headache and doesn’t just try to “cover up” the pain. In 2001, Duke University reported compelling evidence that spinal manipulation resulted in almost immediate improvement for those with headaches that originate in the neck with significantly fewer side effects and longer-lasting relief compared to commonly prescribed medication. Chiropractic treatment approaches include (partial list): spinal manipulation, trigger point therapy, mobilization techniques, exercise training, physical therapy modality use, dietary and supplementation education / advice, lifestyle coaching and ergonomic assessments. >>> Back to top
Headache – What Is It and What Can I Do About It?
“I woke up this morning with an excruciating headache. I thought the top of my head was going to blow off!” “I notice as the day goes on, tightness in my neck worsens and I get a headache usually by 2-3pm.” “I don’t know if I can do my work with my headaches.”
These are common patient history entries we frequently receive at our clinic. Headaches are one of the most common complaints prompting patients to visit a health care provider. Many patients ask, “...what is a headache?” The National Institutes of Health (NIH) describe four types of headache: vascular, muscular contraction or tension, traction, and inflammatory.
The most common form of a vascular headache is migraine. Migraine sufferers usually complain of severe pain on one or both sides of the head, nausea or vomiting and sometimes visual changes. There is often a heightened sensitivity to light or noise prompting migraine sufferers to lay in a dark, quiet room until the migraine passes. Women are more likely to suffer from migraines than men and the severity of symptoms can be so extreme that all activity must be stopped until it passes.
The next most common type of vascular headache is the toxic headache produced by a fever. Other vascular headache types include “cluster” headaches, which are characterized by repeated episodes of intense pain that start in one spot and spread out from that spot. These may only last a few minutes to an hour but carry a very high level of pain and activity intolerance. Another common type of vascular headache is that resulting from high blood pressure.
Muscle contraction or tension headaches involve tightening of the facial and neck muscles. These often start in the neck and radiate over the top or to the sides of the head. The muscles in the neck are usually extremely tight and tender and often, moderate pressure applied with the finger or thumb to these muscles will prompt radiating pain into and/or over the top of the head. This can also result in significant activity intolerance but usually not as severe as migraine or cluster headaches.
Traction and inflammatory headaches result because of other conditions that range from a sinus infection to a stroke. These types of headaches can serve as a warning sign of a more significant or serious condition. Another example is meningitis as well as other conditions affecting the sinuses, spine, neck, ear, and teeth.
The NIH suggests, when headaches occur ≥3 times a month, that “… preventive treatment is usually recommended.” Certainly, in some cases, medication may be indicated but only after ruling out a more serious condition and after exhausting less invasive treatments that carry fewer side effects.
The American Chiropractic Association recommends: 1) avoid long time periods of staying in one position (computer, sewing machine, reading, etc.) and take stretching/neck range of motion exercise breaks every ½ to 1 hour; 2) Exercise – walking, low impact aerobics; 3) Avoid teeth clenching (due to straining the temporomandibular – TMJ, or jaw joint); 4) Drink lots of water – stay hydrated.
Chiropractic care may include spinal manipulation (adjustments), nutritional advice (dietary suggestions, vitamin/mineral options such as a B complex), exercise, posture retraining, and relaxation techniques. If you, a family member or a friend require care, we sincerely appreciate the trust and confidence shown by choosing our service. If headaches are a problem, doesn’t a trial of chiropractic make sense prior to utilizing a more risk oriented treatment option? We look forward in serving you and your family.
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Health Update: Headaches
Chiropractic Care and Headaches
“I can’t believe how much my head hurts! I’ve been laid off from work for the last 3 weeks and worried about making my mortgage payment this month – I think the stress is getting out of control! Pain starts in my neck and radiates into my head, eventually making my whole head hurt, especially behind my eyes. There are times I feel like my head might explode! I can’t stand loud noises or even normal noise. Over-the-counter medications aren’t touching it and I can’t drive if I take some of the medications my doctor prescribed. I don’t know what to do next.”
This history is classic for the diagnosis of a tension-type of headache. As unemployment rates reach new highs and stress levels climb, it is no wonder more and more people are presenting with this condition. Even prior to the recession, tension headache was the most common type of headache experienced by adults, affecting 10-65% of the population. The impact on daily living by tension headache is significant as it disrupts daily activities, quality of life, and work. These types of headaches, according to the International Headache Society, can last from 30 minutes to 7 days, do not include nausea/vomiting but may include increased sensitivity to light or noise (rarely both at the same time). The most common frequency is less than 15 tension headache’s/month.
Medication has been the primary medical form of treatment and some patients require the regular use of certain medications, even when headaches are not present - - as is sometimes the case, it’s too late to start meds once the headache starts. In these cases, Amitriptyline has been the most frequently prescribed medication and it’s considered the drug of choice for tension headache. Chiropractic care has been reported to be helpful in a number of prior studies. One reported equal benefit to Amitriptyline with 6 weeks of treatment.
A recent publication conducted a study using a new design in which tension headache sufferers with more than 10 headaches per month were randomly assigned to one of four groups: 1) cervical spinal manipulation (CSM) + amitriptyline, 2) CSM + placebo (fake) amitriptyline; 3) sham CSM + real amitriptyline; or 4) sham CSM + placebo amitriptyline. That way, one can determine which of the two or, whether the combination of both is most beneficial. An initial period of 4 weeks was followed by a 14 week treatment period. A headache diary was used to track headache frequency in the last 28 days of the treatment period. Nineteen completed the study, and the combination of CSM and amitriptyline carried the most statistically significant result, with CSM alone a close second. A larger sample size was recommended for a more statistically powerful evaluation.
This study is important as CSM by itself was found to be at least as (if not more) effective than Amitriptyline alone, which is the medication of choice for tension headache. Hence, if CSM or Amitriptyline alone are not found to be satisfying, the combination of the two is strongly supported by this study.
If you, a family member or a friend suffer from tension headaches, we may be able to help. >>> Back to top
To schedule a FREE Consultation with Dr. Falkenroth, simply call (831) 475-8600.
Health Update: Headaches
Different Headaches and Chiropractic Care
Adults may experience many different kinds of headaches. A primary headache is a headache that is not a part of another disease process. Secondary headaches can come from a poor eyeglass prescription, diabetes, the flu, or even a brain tumor. The most common primary headaches are tension-type, migraine, and cervicogenic (from the neck).
Tension type headaches feel like a tight band around your head. Stress seems to aggravate them and women tend to get this type of headache more frequently. Females are also more affected by migraine headaches.
There are two types of migraine: classical and common. The classical migraine headache may start with nausea or sickness in the stomach and proceed to an intense throbbing pain on one side of the head. The common migraine lacks this nausea and is more common than the classical type.
In cervicogenic headache, neck function is prominently disturbed. In addition to neck pain, there are usually tight neck and shoulder muscles, and a limited range of motion.
Recent research has shown that the three above described headaches can also overlap with one another. In chiropractic, we look to the spine as an often-overlooked factor in headache treatment. By objectively analyzing spine function, the doctor will identify the joints that are restricted in their range of motion or show abnormal posture and alignment. Many patients on x-ray, or through external postural analysis from the side, can show forward head posture. This is where the neck seems to arise from the front of the chest rather than back over your shoulders. The head is very heavy and with this poor posture, the muscles at the back of the neck must work hard to restrain this heavy load.
Chiropractic care has an excellent safety profile and several studies have shown that patents with headaches positively respond to chiropractic care without the side effects often seen with other treatments.
If you know someone with Headaches, give them the enclosed new patient flyer and have them call our office at (831) 475-8600 to schedule their appointment.>>> Back to top
For more information go to www.RepairMyBack.com or call our office at (831) 475-8600.
