Conditions & Advice: Head Pain & Migraines
As osteopaths, we are trained to treat the whole body, not just painful backs. Headaches are caused either by a problem inside of the head (intra-cranial) or referred from a structure outside of the head (extra-cranial) Intra-cranial headaches are caused by a structure in the head or scalp becoming enlarged, swollen, inflamed, tightened, stretched or squashed. Migraine headaches, for example, are due to the blood vessels enlarging and then hurting when they contract again. The head pain of meningitis is from the tightening of the membranes that line the skull and spinal canal.
In contrast, extra-cranial headaches are caused by problems with sinuses, neck joints, jaw, teeth, ears or eyes. Wear and tear (spondylitis) in the small joints of the neck often causes tension in the muscles around the base of the skull. Many tension headaches are due to prolonged stress tightening the muscles of the neck and shoulders. Similarly, long hours working at a computer can tighten the structures of the head, neck and shoulders, combined with eye strain this can cause throbbing 'band-like' headaches.
One of the most worrying things for patients with headaches is that their pain might be due to a brain tumour. For this reason, one of the first tasks of the osteopath is to make an assessment, deciding which structure is causing the pain and whether it is something we can help with or whether we need to to refer the patient back to their GP, optician or dentist. Usually, after taking a full case history and examining the affected area we can be quite reassuring about the cause of the problem.
The membranes containing the brain and spinal cord form a continuous tube from the head to the back of the pelvis at the base of the spine. Being very sensitive to pain they can cause headaches, especially if they become too tight. This tightening of the membranes can be caused by infection, one of the most serious being meningitis, but also by dehydration from fevers, sunstroke or hangovers. They can be tightened by scarring after spinal surgery in the low back or neck, or by the needle passing through them during an epidural. During a car accident, the 'whiplash' effect of the head being thrown forwards and backwards puts traction on these membranes which can then cause headaches even months after the actual impact.
Surprisingly, if the joints in the very low back get 'locked up' for any reason, the dural membranes can get anchored at the lower end of the tube, causing a pull and resultant headache right at the opposite end. The osteopathic treatment of these dural membranes can be done very gently because usually, once they start moving again, the body naturally causes them to rehydrate and soften. We achieve this movement with gentle hand or finger pressure over specific areas of the skull, neck or low back.
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The three most important aspects for the therapist and patient to consider when treating migraine headaches are:
- Ensure that the diagnosis is correct.
- Ensure that the medication is appropriate and being used correctly.
- Ensure that the patient's lifestyle helps, rather than hinders recovery.
The most common types of long standing, periodic head pain are tension headaches, cluster headache and migraine . It is important for your GP to rule out any other problems that can cause head pain, then to make a correct diagnosis between these three.
Migraine has many features that do not occur in tension or cluster headaches:
- It often causes pain on one side of the head
- There may be visual disturbances, such as flashing or coloured lights, that occur before the headache begins.
- There may be nausea or vomiting
- There may be pins and needles or weakness in one half of the body.
- There may be sensitivity to bright light.
The patient may be pale, sweating and eventually only able to lie down in a darkened room. Tiredness is common and some people feel weakened for a day or so after the attack. Migraines frequently occur during periods of relaxation, so weekends and the first few days of a holiday are common times for attacks.
Most prescribed medication aims to relieve the symptoms by addressing the blood supply, either trying to prevent attacks or reduce the severity of symptoms once they occur. Initially, these drugs can be very helpful but they sometimes lose their effectiveness after a period of use. When this happens, sufferers tend to increase their dose. Unfortunately, this can make the problem worse, since headaches are one of the main side effects of many of these drugs.
Migraine sufferers often exhibit other imbalances associated with digestion, hormones or the liver. Subtle variations in the symptoms can indicate where these imbalances lie, giving a clue as to how the lifestyle can be changed to reduce the severity and frequency of attacks.
- If the headaches are triggered by foods, such as red wine, chocolate or shellfish and if there is nausea or vomiting during an attack, then there is likely to be an underlying digestive imbalance.
- If migraines occur during times of stress or emotional upset and are accompanied by irritability or visual disturbances, there is likely to be an imbalance in liver function. These headaches can also be aggravated by the contraceptive pill or may occur during menstruation.
Neck stiffness and jaw joint dysfunction can also contribute to migraine. As well as lifestyle changes, consider seeing your osteopath to help identify and correct any underlying imbalances that are causing your headaches.
One of the most frequent type of headaches, the tension headache, is due to a tightening of the muscles of the shoulders, neck and scalp causing a ‘tight band' sensation. Often there is a sense of pressure behind the eyes and throbbing or bursting sensations over the head. Causes of tension headaches include worry, noise, depression, fumes and concentrating for long periods (especially on close visual work, computer screens etc.) Minor head injuries, whiplash injury and neck problems, including arthritis can also induce headaches as muscles contract restricting blood and nerve supplies. Patients often describe a deep ache in the upper neck and back of the head where the neck and shoulder muscles attach then radiating over the head to the eye or temple area where the scalp muscles join.
Because the face is such a complex structure with such a range of functions, each requiring delicate and highly sensitive nerve supplies, problems in this area can cause intense pain. Sinus infection or ‘sinusitis' occurs when the lining membranes become infected, congested and swollen, causing acute pain, throbbing and pressure over the affected area. Facial bones can be restricted in adults by accidents, falls, fighting and injuries from sports, such as rugby and boxing. Babies can have their faces and sinuses squashed by being born ‘back to back‘, also a common cause for sticky eyes. Gentle work to the delicate structures can help the body to restore normal function.
Jaw Joint Dysfunction & Teeth
The jaw, or temporo-mandibular joint, not only has very strong muscles to allow for chewing and talking, but it can become arthritic, inflamed or dislocated, so it has plenty of scope for joint and muscle pain to arise. People who grind their teeth through the night (Bruxism) may awake with their head and face clamped and aching. Ironically, they are often unconsciously trying to decompress jammed areas in the bones forming the roof of the mouth and skull.
From jaws we inevitably move on to teeth, particularly teeth abscesses, which not only cause pain but also allow septic matter into the blood stream, making patients feel thoroughly unwell too. Tooth roots can be very long and upper tooth roots can even find their way into the sinus spaces behind the cheek bones. An abscess here, or an impacted wisdom tooth, is very painful and brings us rapidly to the care of a dentist. Dental treatment, by its very nature, involves having ones head tilted back and mouth wide open. This combination can affect not only the jaw joint but the upper neck joints too. A long session of dentistry sometimes exacerbates pre-existing headaches (if you already had a bad neck for example) or can induce them, especially if one is nervous and gripped into the chair. Brace work in adolescents can increase headaches, especially after appliances are adjusted, so we often work in conjunction with the dentist to help children through their brace work and support adults who are having a series of dental procedures. Even babies can be helped using very gentle osteopathic techniques to ease them through the discomfort of teething.
Ears can also cause children and their exhausted parents much distress. Because the ear and throat are connected by the eustacian tube a child may get repeated earaches, sore throats and coughs as an infection moves back and forth along the tube. Infections are usually treated with courses of antibiotics but if this is unsuccessful, the child may go on to develop Glue Ear, which can lead to hearing loss, slowed speech development, as well as pain. Cranial osteopathy aims to regain movement in the temporal bones and to help the throat, chest, and airways. Any child can develop ear problems but we often find that those delivered by forceps are particularly susceptible.
Eye strain is especially prevalent now that so many people spend hours looking at screens so that the eye muscles do not have to refocus between long and short distances. Also the neck and shoulders are usually set in one particular posture too and this leads to muscle fatigue, stiffness and aching as blood and nerve pathways to the eyes get congested. Exercise, massage, swimming, yoga, etc. will all help, but get your eyes checked and make sure your sitting posture at the computer is correct. Glaucoma is a more serious eye condition occurring when there is increased pressure of fluid behind the cornea. This may radiate pain to the forehead ears and teeth as well as behind the eye. Usually this builds up slowly and can be controlled, but if there is ever any sudden onset of eye pain, redness and changes to your vision, you must go straight to your doctor or optician since there are a few emergency situations where, without rapid medical attention, sight can be lostBack to top