Neck Pain and Headache

Head and neck pain is the second most common area of chiropractic practice, after back pain.

Head and neck pain is the second most common area of chiropractic practice

The most important step for a headache sufferer is to initially obtain a correct diagnosis. There are many types of headache, but the International Headache Society (IHS) has classified and defined them under the following major categories:

  • Migraine
  • Tension-type headache
  • Cervicogenic headache (arising from the neck).

There are now controlled trials supporting the effectiveness of chiropractic management for each of these forms of headache.1-6

While the evidence for tension type headache and cervicogenic headache has been available for a longer period, some further consistent findings have appeared to show the effectiveness of chiropractic for migraine sufferers. In 1998, a study of 218 patients with migraine found that while amitriptyline (a well-established effective drug for migraine) reduced headache scores by 24% at a 4 week follow-up, spinal manipulation reduced the headache score by 42%.3

Macquarie University has also completed a trial of chiropractic spinal manipulative therapy for migraine in 2000. They found that a high proportion of people report a significant improvement in migraines (reduction in pain, reduction in light sensitivity, decreased nausea and less likely to need a dark quiet area) after chiropractic.6

In a study, published in 2001, of 105 patients with cervicogenic headache it was found that cervical manipulation increased active range of motion of the neck.7 It has also been found that there is a sustained benefit.8

Once anatomical pathologies are ruled out chiropractors, and an increasingly large number of medical specialists, argue that dysfunctional structures in the neck frequently play a major role in these headaches.

Two recent discoveries relating to the neck or cervical spine are of particular interest:

  1. The facet joints of the cervical spine are a source of head and neck pain.9
    • The facet joints, found in pairs on the back of the cervical vertebrae, are rich in pain receptors. Chiropractic cervical manipulation is aimed primarily at gapping these facet joints to restore normal mechanics or movement.
  2. The existence of bridges of connective tissue between the muscles and ligaments of the upper cervical spine and the dura of the base of the skull. This discovery by dental researchers in the U.S.10 and chiropractic researchers in the U.K.11 in 1995 and 1998 provides a much clearer anatomical basis for tension in the cervical spine as a cause of headache. The dura (thick covering of the brain and spinal cord) encloses the central spinal cord and is extremely pain sensitive. It is now known to be directly connected to muscles and ligaments in the neck.

Obviously there are also many lifestyle and behavioural factors that may also play a role and can even trigger neck pain as well as headache. Your chiropractor is trained to help you identify possible factors that may be involved in your headaches. Some examples include:

Physical

  • Repetitive posture
  • Prolonged activity
  • Clenching of teeth (jaw problems)

Chemical

  • Food allergies or sensitivities (e.g. chocolate, sugar, orange juice, coffee, smoking, milk, wheat, gluten, alcohol)
  • Sinus related problems
  • Constipation
  • Menstrual cycle

Emotional

  • Stress related to work or home
  • Tension

To understand how pain medication may actually increase head pain click here. It is now known that medication over-usage headache (MOH) is a significant cause of frequent headaches. This article also describes a pattern of headache where the sufferer has frequent tension-type headaches with occasional migraine headaches. It describes the two types of headache as fitting on the one spectrum.

    References

    1. Parker, G., Tupling, H., Pryor, D. (1978) A controlled trial of cervical manipulation for migraine. Aust. NZ. J. Med. 8: 589-593.
    2. Parker, G.B. et al. (1980) Why does migraine improve during a clinical trial? Further results from a trial of cervical manipulation for migraine. Aust. NZ. J. Med. 10: 192-198.
    3. Nelson, C.F., Bronfort, G. et al. (1998) The efficacy of spinal manipulation, amitryptiline and the combination of both therapies for the prophylaxis of migraine headache. J. Manip. Physiol. Ther. 21: 511-519.
    4. Boline, P., Kassak, K., Bronfort, G., Nelson, C., Anderson, A. (1995) Spinal manipulation vs amitryptiline for the treatment of chronic tension-type headaches. J. Manip. Physiol. Ther. 18: 148-154.
    5. Nilsson, N., Christensen, H.W., et al. (1997) The effect of spinal manipulation in the treatment of cervicogenic headache. J. Manip. Physiol. Ther. 20: 326-330.
    6. Tuchin, P.J., Pollard, H., Bonello, R. (1999) A randomised controlled trial of chiropractic spinal manipulation therapy for migraine. Proceedings of the 5th Biennial Congress of the World Federation of Chiropractic. 183-184, Abstract.
    7. Whittingham & Nilsson (2001) Active range of motion in the cervical spine increases after spinal manipulation (toggle recoil). J. Manip. Physiol. Ther. 24: 552-555.
    8. Chapman-Smith, D. (2002) Notes for state association; Jan: 4.
    9. Lord, S.M., Barnsley, L. et al. (1996) Chronic cervical zygapophyseal joint pain after whiplash. A placebo controlled prevalence study. Spine 21: 1737-1745.
    10. Hack, G.D., Koritzer, R.T. et al. (1995) Anatomic relation between the rectus capitus posterior minor muscle and the dura mater. Spine 20: 2484-2486.
    11. Mitchell, B.S., Humphreys, B.K., Sullivan, E. (1998) Attachments of the ligamentum nuchae to posterior to cervical posterior spinal dura and the lateral part of the occipital bone. J. Manip. Physiol. Ther. 21: 145-148.