It is estimated that between 75-90% of the population experience one or more headache every year. Most of these will be benign and mildly annoying, however, some will be debilitating and have a significant impact on wellbeing. Fortunately very few headaches will be the result of a sinister cause and in these cases, chiropractors are well trained to recognise the red flags and refer appropriately.
Headaches are so common; most people think getting a headache is a normal part of everyday life. This is simply not true. Headaches are a sign that something is wrong. While some people may just pop a pill, chiropractors would encourage addressing the cause and not just covering up the symptom.
In 2007 the International Headache Society agreed upon an updated classification system for headache1. Headaches were classified into: 1) Primary; 2) Secondary; or 3) Cranial Neuralgias and other headaches.
How does Chiropractic Help?
Chiropractic is a recognised health choice for headaches because one of the most common headache triggers is Cervicogenic, which literally means ‘from the neck’.
In one Macquarie University study the approach of correcting spinal imbalances in the neck and upper back with chiropractic care was tested in patients with chronic migraines 2. The results showed that specific chiropractic adjustments decreased the severity of migraines in 72% of patients. The frequency, duration, disability and amount of medication also reduced.
Your chiropractor will also be interested in how your lifestyle may be affecting your headaches. Stress reduction, breathing exercises, improving diet, certain supplements and drinking plenty of water may all be helpful.
These are the most common type of headache. They are often described as ‘hatband’ tightness around the forehead, temples and back of head. It is thought that tension headaches are brought on by fatigue and stress as well as tightness in the neck and jaw region.
Migraine can begin as a dull ache that develops into a constant throbbing pain felt in the temple or retro-orbital (behind the eye) area. The pain is often accompanied by sensitivity to light (photophobia) and sound (phonophobia). Often there is a prodromal period before the actual headache when the patient may experience blurred vision or ‘zig zig’ lines in the vision, pins and needles or numbness. This is known as an ‘aura’ and is a part of Classic Migraines. When the headache is experienced without the aura it is called a Common Migraine.
Some of the triggers for migraines include family history, stress, a lack of sleep or over-sleeping, missing a meal, certain medications, caffeine, chocolate, alcohol and hormonal changes.
These are characterised by clusters of short-lived attacks of severe pain, usually around the eye. They are more common in men and there may be many months in between clusters.
Secondary headaches are those that can be attributed to another disease, disorder or trauma. This may include:
- Head or neck trauma
- Space occupying lesion of the brain – such as tumour or haemorrhage
- Systemic disorder – dehydration can give you a headache
- Substance withdrawal – cutting out coffee can give you a headache!
- Disorder of the eye, ears, mouth, sinus, etc
- Medication overuse – this is often seen with migraine individuals where their medication can actually cause headaches
- Psychiatric disorder – headaches are common among individuals that experience depression
Of course the goal with secondary headaches is to treat the attributing factor causing the headache rather than just the symptoms.
The most common form of cranial neuralgia is Trigeminal Neuralgia, which affects the fifth cranial nerve (Trigeminal Nerve). This condition is also known as Tic Douloureux.
The trigeminal nerve is the largest cranial nerve and receives sensation from the entire face as well as controlling motor functions such as biting, chewing and swallowing.
Individuals with Trigeminal neuralgia experience severe electric-shock-like pain that shoots into the face along the distribution of the trigeminal nerve or one of its branches. Pain usually affects one side of the face.
Pain typically lasts for a few seconds or a few minutes, but is usually frequent and re-occurring, and at times constant. Pain is often debilitating and can be bought on by simple activities such as chewing, shaving, brushing teeth or even wind blowing onto face.
Trigeminal neuralgia is often seen in patients with Multiple Sclerosis. Other causes include pressure or irritation to the nerve due to a swollen blood vessel or tumour. However, most commonly there is no clear cause of the neuralgia.
An individual that presents with trigeminal neuralgia will likely need a MRI, CT scan and blood tests to determine the cause of the face pain.
This may include medications such as anti-seizure drugs, muscle relaxants and anti-depressants. Various surgical procedures (depending on the cause of the neuralgia) may also be used.
To date there a no large studies investigating the effectiveness of chiropractic care with trigeminal neuralgia. There are, however, case studies that show chiropractic care may improve outcomes for these patients. 3
Often the upper cervical or temporomandibular (jaw) joints show dysfunction that can cause pressure and irritation and act as a trigger for the neuralgia.
It has been our experience that these patients may improve with gentle chiropractic care and TMJ pacification exercise.
Temporomandibular Joint (TMJ) Dysfunction
The TMJ is the joint formed between the temporal bone and the jaw bone (mandible). If you place your finger immediately in front of you ear and open and close your mouth you will feel the TMJ move.
The TMJ has an articular disc within the joint. The design of the joint allows it to rotate during the initial part of mouth opening, then translate forward as the mouth opens wider.
Symptoms associated with TMJ Dysfunction include:
- Pain and stiffness in the jaw that may radiate to the ear, into the temporal bone, down the jaw or into the back of the neck
- Limited movement or locking of the jaw
- Painful clicking when opening the jaw
- An uneven bite (mal-occlusion)
In some cases a dental device to improve occlusion may be required, but most straightforward cases respond well to simple chiropractic care that will include cranial adjustments and TMJ exercises.