Migraines and the Neck
Migraines are debilitating for millions of people. For those of you who suffer from migraines and have yet to find relief, this post likely is for you. If you have sought medical care from multiple doctors, just to end up with no real solution other than a heavy-hitting medication. Would I be safe in assuming that those meds either put you to sleep, make you like a zombie, or doesn’t do anything at all? People experience migraine symptoms differently and when people have migraines, trying to describe it to someone who doesn’t have them is like trying to tell a “you had to be there” joke to a person who wasn’t there. It is usually frustrating and you know the person you’re telling about your headache believes “it’s just a headache, whats the big deal?”. Makes you want to give THEM a migraine right? So next time, give them the following stats.
“1 BILLION PEOPLE worldwide suffer from migraines every year, and nearly 38 million people in the United States”(1) alone. This makes the migraine the “3rd most prevalent illness in the world” (1) and “1 in 4 households in the U.S. includes someone with a migraine” (1). For more stats click HERE . Seriously, click the link, it will blow your mind how common migraines are.
I have to preface this and say that in order to run with my recommendations, you need to seek out medical consultation as to rule out common non-orthopedic triggers of migraines that include, but are not limited to, sinus issues, sleep disturbances, over-exertion, smoke, air pressure changes, hormone changes (menstruation, menopause), over-use of pain medication, and certain foods.
Ok, so you’ve ruled out all of those triggers. So why are you still having these massive headaches?! Well, before my patients come to me, what I’ve often seen happening is the practitioners before me just “chase the pain” (which you’ll see as a theme is many upcoming posts). What I mean by “chase the pain” is to implement strategies, usually medication, that sole purpose is to address symptoms but often don’t remedy a solution as to the cause. What I propose, is the cause, not the symptom.
In the eyes of a good Physical Therapist, one cannot look at the head without evaluating the neck. The head is a bowling ball sitting on top of an extra-large golf tee supported by ligaments and muscles thats sole job is to support and move it. The symbiotic interdependence that these structures provide, gives us the ability to do a multitude of tasks ranging from deliberate movements (i.e. driving) to powerful multi-directional movements required for sport. Others just need the support to look down at their phone. 😉 Regardless of the demands we place on the head and neck, there are certain vital structures within the neck that can, when aggravated, create massive headaches like many migraine sufferers experience. In PT, we usually call those “cervicogenic headaches.” Which commonly, are misdiagnosed with the blanket diagnosis of “migraines”. The first thing I see in these evaluations is usually bad posture. The patient usually has a forward head, rounded upper back, and forward and rounded shoulders. What I see in my physical exam is usually a combination of tight and weak upper trapezius, levator scapula, pec major and minor muscles, along with weak muscles of the anterior neck and shoulder blades (rhomboids, mid/lower traps, serratus anterior, and the rotator cuff). Sometimes referred to as “upper crossed syndrome”.
This creates a large imbalance of forces on the head that usually takes a long time to develop any symptoms related to this dysfunction. So the onset of headaches/migraines can be very gradual in frequency and intensity. The region of the head called the sub-occipital triangle is where many of these headaches originate. It is a small region located directly below the bottom of the skull where C1 (Atlas) & C2 (Axis) meet and interact with the skull. When the shoulders round and the shoulder blades round up and forward, the thoracic spine (upper back) rounds, and the cervical spine must adapt in order to keep our vision aligned to the horizon. This chronic sequence ultimately produces narrowing of the sub-occiptal triangle of the cervical spine.
This narrowing causes impingement (pinching) of a very sensitive nerve bundle involving two primary sensory nerves called the Great Occipital nerve (GON) and the Lesser Occipital nerve (LON). The GON travels up and around the top of your head, while the LON runs up and to the side of your head usually terminating above your ear near the top of the jaw.
This is commonly called “occipital neuralgia” and can present as all the same symptoms as a standard migraine. Pain behind the eyes, on the top & side of the head, in your ear or jaw, and I have even had it described as the pain follicles of your hair. You will also be chronically sore to touch in the sub-occiptal triangle itself. Now if MDs discover the cause, they usually do something called an Occipital nerve block by injecting a pharmaceutical mixture in to the sub-occipital space essential numbing the nerve in order to “turn it off” and stop the symptoms. Get it? Chasing the pain, not attacking the cause.
As Physical Therapists, we implement a combination of manual therapy and exercise in order to stop the dysfunction of the tight and weak muscles and promote symmetry between right/left and front/back. We stretch the sub-occipital muscles, upper-trapezius, levator scapula, pec major and pec minor (future post about the pec minor), and concurrently strengthen the anterior neck muscles, mid/lower trap, rhomboids, serratus anterior, rotator cuff, deltoids, biceps, triceps, and pecs. The goal is to pull the shoulder-blade back and down, return the thoracic and cervical spine to normal position and alignment, while teaching you behavioral changes in order to promote chronic relief and prevention. Essentially just taking the “dys” out of dysfunction.
Now it took a LONG time for your headaches to get this bad, so it will take a while to fully eliminate the dysfunction. So don’t expect these improvements to happen overnight. So if you stick with the exercise program and change the behaviors that facilitated the bad posture, you will get relief. Many people suffer from debilitating headaches, I hope that this post gave you a possible strategy to ending your chronic headaches/migraines.
In the next post I’ll present simple exercises to treat this dysfunction and specific cues to minimize compensation in order to safely and efficiently be successful.
Thanks for reading! Stay healthy and stay active!
Brian Blevins PT, DPT
References:
- Migraine Facts – Migraine Research Foundation. (n.d.). Retrieved August 01, 2016, from https://migraineresearchfoundation.org/about-migraine/migraine-facts/