chronic neck pain and chronic headaches

CHRONIC NECK PAIN
AND CHRONIC HEADACHES

TWO COMMON PROBLEMS THAT GO TOGETHER LIKE A HAND IN A GLOVE

Chronic Neck Pain

Kai Kalhh – Hamburg/Deutschland – Pixabay

“Headaches account for 1-4% of all emergency department (ED) visits and are the ninth most common reason for a patient to consult a physician. Tension-type headaches (TTH) are common, with a lifetime prevalence in the general population ranging between 30% and 78% in different studies. They affect approximately 1.4 billion people or 20.8% of the population.  TTH onset often occurs during the teenage years and affects three women to every two men.”   Dr. Michelle Blanda, Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine, in an article written just a couple of months ago for MedScape (Tension Headaches).

“Tension headache A tension headache is the most common type of headache. It is pain or discomfort in the head, scalp, or neck, and is usually associated with muscle tightness in these areas.  Tension headaches occur when neck and scalp muscles become tense, or contract. The muscle contractions can be a response to stress, depression, a head injury, and anxiety.”  From the NIH’s MedlinePlus Medical Encyclopedia (Tension Headaches)

“A cervicogenic headache is, by its definition, any headache which is caused by the neck. The term ‘cervicogenic’ simply refers the cervical area, which is a part of your spine located right near the base of the skull. Common symptoms of a cervicogenic headache include a steady, non-throbbing pain at the back and base of the skull, sometimes extending down to the neck and between the shoulder blades. The pain can also be located behind the brows and forehead. Because of the location, most of the pain is felt in the head, even though the problem is originating from the spine.  Along with head and/or neck pain, symptoms may include nausea, vomiting, dizziness, blurred vision, becoming very sensitive to light or sounds and feeling pain down one or both arms. The neck also becomes very stiff and the patient may have trouble moving.”  From the Department of Anesthesiology (Division of Pain Medicine) at New York University’s Langone Medical Center (Cervicogenic Headache)

“With over 50 million cases per year, in the United States alone, headaches top the list of the most common afflictions in humans.  More than 70% of headache sufferers never consult a doctor because they assume that little can be done to help them….  There is evidence that chiropractic treatment is effective in the management and  alleviation of headache pain.  A reason for this effectiveness seems to be that stiffness and pain in the cervical (the neck area) spine is a frequent and major factor of headaches.”  Dr. Carlos P. Zalaquett of he University of Southern Florida (Headaches)

How many people in America suffer from CHRONIC HEADACHES and / or CHRONIC NECK PAIN?  As you can see above, the numbers are staggering.  This post is not so concerned with the headaches that we all have a tendency to get once and a while.  I am interested in those people who have regular / frequent / daily / chronic headaches — and particularly those people whose headaches involve neck pain or SPASM as well.

Although these have been known forever as “Tension Headaches”, this moniker is falling by the wayside and being replaced by the more descriptive “Cervicogenic Headache”.  What’s the difference and why does it matter?  With a “Tension Headache” doctors tend to blame the headache on things that cause ‘tension’ (whatever the word ‘tension‘ really means).  They will tell you that you don’t relax well, or that you have too much stress in your life, or more likely that your tension is caused by ANXIETY or DEPRESSION —- the main reason that antidepressant medications are so commonly prescribed for headaches along with the other drugs we’ll get to in a moment. 

The term “Cervicogenic” is much more descriptive because it implies (and rightly so) that the headache is originating (being generated or “birthed”) in the Cervical Spine — otherwise known as your neck.  If you ever get to take a look at the anatomy of the neck, you will see that it is made up of 7 vertebrae, the discs between (none between your skull and C1 or C1 and C2), as well as the nerves that emanate from tiny windows (Intervertebral Foramen) between said vertebra.  And let’s not forget the MUSCLES and FASCIA.   Interestingly enough, these nerves not only travel down into your arm, but perform numerous vital bodily functions as well.  This is simple to understand once you realize that your nerves are what connect your body to your brain (HERE).

TREATMENT OF CERVICOGENIC HEADACHES

Knowing a lot of facts about neck pain and headaches are worthless unless one has an idea of how to resolve the underlying “generators” or cause(s) of the pain.  Let’s first take a look at some of the things that the medical community suggests.  Despite the fact that things like MRI and BRAIN SCANS are the most common starting point, there is ample evidence saying that this should never be a first-line procedure (HERE is a study on the matter from earlier this year) in the war against neck pain and headaches.    Once brain tumors or aneurysms (rare occurrences) have been ruled out, doctors start using you as a guinea pig.   I am not being harsh here, but simply telling something you already know — that besides the drugs mentioned a couple of paragraphs previously, there is an array of things that will potentially be used on you.  And just remember that even if one of these treatments happens to work, it likely won’t work forever because it’s covering symptoms without addressing the underlying cause of those symptoms.

The article from the Langone Medical Center at the top of the page lists several treatments to try for Chronic Cervicogenic Headaches (I have listed them in order).  The first group is listed under “Pharmacological Management“.  Be aware that this warning is given concerning several of the drugs listed below:  [These drugs are] often prescribed but cannot be recommended, given the potential for residual and rebound effects“.   When used in relationship to headaches, the term “REBOUND” simply means that while it may bring some temporary relief, the drugs you are taking are actually causing or at least contributing to your headaches.

  • NSAIDS:  This class of drug can work like magic.  Unfortunately, they are also one of the more dangerous classes of drugs on the market today (HERE and HERE).  Add CORTICOSTEROIDS (cortisone) to the mix and the problems get that much worse.
  • ASPIRIN:  If you are still taking regular doses of ASPIRIN because of headaches or because your doctor told you it was good for your heart, take a moment to read THIS.
  • ACETAMINOPHEN:  Although one of the biggest manufacturers used to have a slogan that read, “Ty_ _ _ _ _, nothing safer,” this is not exactly true.  Follow these links to learn more (HERE and HERE).
  • CAFFEINE:  Caffeine is an interesting substance because for many people, it can be both a cause and cure for headacheCan anyone say “Rebound”?
  • SUSTAINED RELEASE OPIOIDS:  This would be Oxycontin

This next group is listed under “Invasive Procedures”.

  • TRIGGER POINT INJECTIONS:  Any number of things are injected into TRIGGER POINTS.
  • NERVE BLOCKS:  This is done with Corticosteroids and hardcore drugs
  • NERVE ROOT BLOCKS:  Ditto (or maybe via R.F.A. — Radio Frequency Ablation)
  • FACET JOINT BLOCKS:  The injection is guided via CT into the FACET.
  • DISCOGRAPHY:    The website Spine-Health (a medical site) touches on how bad this test sucks for the patient in their article Lumbar Discography for Back Pain Diagnosis.  “This diagnostic procedure – also called a discogram – is a controversial one. This article does not extol the use of discography; rather it addresses some aspects of the procedure that may make a patient more at ease with what is an uncomfortable exam.”  If you talk to someone who has been through a Discogram, don’t be surprised if they tell you that they will put a gun in their mouth before they do another.
  • BEHAVIORAL APPROACHES:  I talk about them in the next paragraph.
  • SPINAL MANIPULATION:  Yep; as crazy as it seems, this is the last thing listed under “Invasive Procedures”. 

Behavioral approaches such as eating an ANTI-INFLAMMATORY DIET, PROPER EXERCISE, throwing away the CIGARETTES, HAVING MORE SEX, TAKING WHOLE-FOOD SUPPLEMENTS, WATCHING YOUR POSTURE, WATCHING YOUR WEIGHT (it’s true; several studies have tied headaches to Obesity) and any number of others, can make all the difference in the world as far as stopping or reversing headaches are concerned.   But what about dealing with underlying mechanical problems that are at the root of many people’s Chronic Pain?  Here are my “Big Three”.

  • DEAL WITH SUBLUXATION:  Although the other two bullet points below technically fall under this category (Subluxation is defined as vertebrae that have lost their normal alignment and motion in relationship to each other), for our purposes, we will give it its own category.  Generic (simple and uncomplicated) subluxation can almost always be dealt with via CHIROPRACTIC ADJUSTMENTS

 

  • DEAL WITH SCAR TISSUE:  When people get only temporary relief of their symptoms with adjustments (particularly if they are not getting large restorations of joint motion with said adjustments), it’s usually because there are ADHESIONS OF THE FASCIA in play.  If these are not dealt with, there will be little or no long-term benefits from treatment.

 

  • DEAL WITH YOUR ABNORMAL CERVICAL CURVE:  Although I have written several articles on this topic, I really beat this drum loudly in the LAST ONE.  One of the points was that not only do abnormal front-to-back curves of the neck cause a multitude of problems, repeated adjustments by themselves do little or nothing to solve (correct) this problem.
All to often, Chiropractors are hung up on the first bullet point.  In other words, everything is about the adjustment.  You don’t have to go very far to grasp the fact that I believe adjustments can be amazing (HERE and HERE).  However, skipping the bottom two points is a not only a mistake that will probably leave you wanting as far as results are concerned, it leads to DEGENERATION.   Most other practitioners want to skip all of this and go straight to stretches and strengthening exercises.  Unfortunately, this is putting the cart ahead of the horse.  If you want to understand why STRETCHING can actually make you worse if you have not dealt with the two top bullet points above, just click the link.  And while strengthening is important, needs to be done after the issues above have been dealt with. 
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