Headache is the most common cause of neurological consultation in clinical practice for doctors, and many of my patients come because they are afflicted by them. Most people will suffer from what we call a primary headache, that is, headache not the result of another medical condition such as a tumour or aneurism, etc. However, correctly diagnosing the cause of a headache is vital. since a headache may be a ‘red-flag’ pointing to a secondary or underlying condition that may be serious & possibly life-threatening. For example:

1. Sudden onset, severe (thunderclap) headaches could be due to a
   1. haemorrhage or intracranial haemorrhage,
   2. vertebral artery dissection,
   3. cerebral venous thrombosis or
   4. reversible cerebral vasoconstriction syndrome.
2. A headache worse for coughing, straining or sneezing may signal raised intracranial pressure or if they’re provoked by posture, such as stooping, then imaging is required as the cause may require emergency intervention.
3. Headaches with neurological features: sensory changes, weakness, double vision (including sixth cranial nerve palsy), Horner’s Syndrome or visual field defects also need investigation.
4. Headaches worsening with eye movement and/or impaired vision may suggest inflammation of the optic nerve (retrobulbar neuritis).
5. Enlarged blind spot suggests papilledema (selling of optic nerve at the back of the eye) or raised intracranial pressure.
6. Headache with stiff neck, nausea and vomiting, recent onset of confusion, altered consciousness and/or fever raises concerns of infection, such as meningitis or encephalitis, and requires hospital admission and lumbar puncture.

Thankfully such secondary causes for headaches are generally rarer. Most people get primary headaches. These fall into three main types: Tension-type, migraine, and cluster headaches. 38% of the population suffer tension headaches, 10% migraines and <1% cluster headaches, and almost all migraine suffers will also have tension headaches.

A Danish study found that risk factors for migraine were familial disposition, no vocational education, a high work load, and frequent tension-type headache. For tension-type headache, risk factors were poor self-rated health, inability to relax after work, and sleeping few hours per night. Many of these risk factors may lead directly to increased stress levels, which can affect muscles.

Egilius Spierings, a neurologist on the staff at the ‘Tufts Craniofacial Pain Center’, states that ‘Tension headache is thought to be caused by a lack of sleep, stress, hunger, thirst, eye strain or strain on the muscles of the shoulders, head and neck, usually due to bad posture – think sitting at your desk all day’, while migraine ‘occurs when blood vessels in the head dilate’, but ‘just as with tension headache, stress on the muscles in the neck, jaw and shoulders may also play a role, especially in people who have frequent or long-lasting migraine headaches’.

Given this you might be surprised that Spierings says ‘in the headache world, there is no attention being paid to the muscles’, as approaches to headache prevention or treatment generally focus on pharmacological intervention.

Experience shows that remedial work to head neck & shoulder muscles provides considerable benefit for people suffering primary headaches including migraine & tension headache. We’ll take a closer look at these in the coming months. In the mean-time if you’re suffering from migraine or tension headaches why not call us at the clinic.