At TPM Chiropractic Townsville, a common concern presented is the debilitating pain people witness with a Cervicogenic Headache – or as they describe it stress headache or tension headache.
Blinding Pain
Often, we have patients that come to TPM Chiropractic presenting with what is known as a Cervicogenic headache. For those of you playing at home, this is a common complaint relating to pain radiating from one side of the head, clinically known as a hemicrania continua, which people refer to as stress headache or tension headache.
What is known about cervicogenic headaches is that they are caused by a musculoskeletal dysfunction within the cervical spine region (upper neck area), sometimes causing neck pain. Over the years it has become common for western medicine to treat this pain with a non-steroidal anti-inflammatory drug (NSAID), however this can often leave the patient with additional effects such as varying levels of gastrointestinal distress, nausea, dizziness and even an increase in blood pressure and exacerbation of pain through the extremities. Multiple NSAID’s are also not suitable for pregnant women and have even found to negatively influence infant birth weights. It is because of this; a growing number of people are turning to the evidence based practice of modern day chiropractic care and it multi-faceted modalities to help alleviate their neck pain, tension head pain and general headaches.
Understanding the pain.
Often the patient will present with severe pain through the frontal lobe, behind the eye or even through a large portion of the front half of their scalp. While it is easy to try and target these exact areas, as western medicine often attempts to do, it’s important to understand that this pain is simply the outlet of a problem stemming from the fact that the nerves in our neck, head and face all work together. It has been well documented the cervical nerves heavily interact with the 12 Cranial Nerves as well as smaller nerves like the Lesser Occipital Nerve which innervates the rear of the scalp behind the ear. The interaction we will look at more closely is that of the Cervical Nerves and the fifth cranial nerve known as the Trigeminal Nerve. It’s this interaction which is most important as the Trigeminal Nerve continues to branch off into three separate divisions, most notably, for this subject, into the Opthalmic division. Within this division are the innervation points for the front of the Scalp, eyes and frontal lobe. With this information in mind, it is easy to see the benefits of chiropractic care when dealing with what can be often be a debilitating concern for sufferers.
What can be done in the clinic
Now we have established a strong connection between the large groupings of nerves in the cervical region, known as the Dorsal Horn, and the complex nerve structures and formations within the head itself. We can talk about the strong evidence to suggest the cross wiring of these areas and the chiropractic stimuli given to it can aid in an almost immediate modulation of pain. This is most likely easiest explained by the Dorsal Horn’s direct link to a section at the base of the brain known as the trigeminocervical nucleus. It is this section, which is within a part of the brain known as the Medulla, pain signalling is received from not only the Trigeminal Nerve but three other cranial nerves as well. Given that pain can be received from one of the four cranial nerves into the Medulla, it is easy to see how the same can also happen from the cervical end, producing pain at the sensory end of the ophthalmic nerve, causing a headache.
By using quick motions and stimulating the vertebrae C1, C2 and C3 of the cervical region we can help to modulate the central neurology that is producing the perceived head pain and associated autonomic changes. It is not uncommon for this to have an almost immediate effect on the patient’s pain response.
Moving Forward
We can help to assess if chiropractic treatment would suit your needs and after we complete your treatment, can help to create ways to improve your cervical core stability and devise any rehab that may be required. While this is a great way to help alleviate pain, if you are prone to this style of headache, we can help you move forward by modulating the excitability of the circuits within the brainstem which will help to control the tendency for head and neck pain.
TPM Chiropractor Dr. Shae.
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References:
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https://www.tga.gov.au/sites/default/files/auspar-indocid.pdf
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“INDOMETHACIN”. Hazardous Substances Data Bank (HSDB). National Library of Medicine’s TOXNET. Retrieved April 4, 2013.
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“The International Classification of Headache Disorders 2nd Edition (ICHD-2)”. the Headache Classification Subcommittee of the International Headache Society. Retrieved 2012-09-22
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Goadsby, P. J., & Bartsch, T. (2008). On the functional neuroanatomy of neck pain. Cephalalgia, 28 Suppl 1(s1), 1–7. http://doi.org/10.1111/j.1468-2982.2008.01606.x
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Hall, T, Briffa, K, Hopper, D. Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. The Journal of Manual & Manipulative Therapy. 2008.16(2), 73-80
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Jerome A. Barakos Peter G. D’Amour William P. Dillon T. Hans Newton University of California, San Francisco San Francisco, CA 94143-0628 “Trigeminal Sensory Neuropathy Caused by Cervical Disk Herniation”
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George Paxinos (2004). The Mouse Brain in Stereotaxic Coordinates. Gulf Professional Publishing. ISBN978-0-12-547640-9. Retrieved 16 August 2013
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James R. Dunning, Raymond Butts, Firas Mourad, Ian Young,
Cesar Fernandez-de-las Peñas, Marshall Hagins, Thomas Stanislawski, Jonathan Donley, Dustin Buck, Todd R. Hooks and Joshua A. Cleland “Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial” (2016)
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Linda Hanson, Mitchell Haas, Gert Bronfort, Darcy Vavrek, Craig Schulz, Brent Leininger, Roni Evans, Leslie Takaki, and Moni Neradilek Chiropractic and Manual Therapies “Dose–response of spinal manipulation for cervicogenic headache: study protocol for a randomized controlled trial” (2016)
