We’ve all seen people working on laptops in airports, airplanes, coffee shops, on the train, walking down the street…you name it! So how does this affect one’s neck, and does it contribute to headaches?
A 2016 study compared females with posture-induced headaches vs. healthy, age-matched female control subjects to see if there was any significant difference in their head-tilt and forward head position during laptop use.
The research team measured angles for maximum head protraction (chin-poking forwards), head-tilt, and forward head position at baseline (neutral resting) and while using a laptop. Essentially, they measured how “slumped” the participant’s posture was at rest vs. while working on a laptop.
The results showed that the headache group demonstrated an increased head protraction of 22.3% compared to the control group at rest. When comparing the ratio of forward head position during habitual sitting to the maximum head protraction, the researchers found a significant difference, which was also worse in the headache group. Similarly, laptop work head position was worse in the headache group.
The researchers concluded that the headache group showed worse posture at rest in the two measurements as well as more forward head posture during the laptop task than the control group. They recommended that management/therapy for patients with headaches and/or neck pain include posture retraining exercises as an important aspect of obtaining long-term successful outcomes.
This study illustrates the importance of that and the need to include exercises like chin-retractions, conscious head re-positioning, cervical traction (in some cases), deep neck flexor muscle strengthening, managing scapular stability, and more.
When looking at a person from the side, imagine a perpendicular line that passes through the ear canal should pass through the shoulder, hip, and ankle. In cases of forward head posture, that line will pass forwards of these bony landmarks.
Previous research shows that the head weighs an average of 12 pounds (5.44 kg), and for every inch of forward head positioning, the neck and upper back muscles are burdened with an extra 10 pounds (4.53 kg) of load to keep the head upright. That means a five-inch forward head position adds 50 pounds (22.67 kg) of weight to the neck and upper back area. It’s no wonder this faulty posture leads to chronic neck and headache complaints!
Spinal joint manipulation is one of the most patient-satisfying, fast-acting remedies for neck pain and headaches of several types offered by doctors of chiropractic. But when manipulation is combined with exercise training, studies show this combined approach results in the best long-term benefits or outcomes!
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“Migraine” is a complex, chronic neurologic disorder characterized by recurrent debilitating headaches. Over 30 million Americans suffer at least one migraine headache each year. (1) The condition affects 18% of females and 6% of males and is the leading cause of “severe” headaches. (1) Over 80% of migraineurs miss work as a result of their headaches, with an average of 4-6 absences per year. (2)
Early explanations for the genesis of migraine focused on cerebrovascular vasoconstriction with subsequent vasodilation. (3) Migraine is now recognized as a more complex series of neurologic and vascular events wherein vasodilation may or may not be present. (4-8) Evidence suggests that a migraineur’s brain is hyperexcitable and uniquely predisposed migraine headaches in much the same way that an epileptic is susceptible to seizures. (8,9) The hyperexcitable migraineur brain is susceptible to various “triggers”. Migraines develop when the number of triggers exceeds a critical threshold for a given patient.
Migraine treatment is subdivided into “abortive” therapies that seek to stop or reverse the progression of an existing headache and “prophylactic” treatments, which seek to prevent or reduce the frequency of future attacks. Abortive treatments are most effective when given within the first minutes of an attack. (10) Unfortunately, once the migraine brain has been “triggered”, conservative therapy may not always abort that particular episode. However, prophylactic management directed at controlling migraine triggers is often helpful.
Spinal manipulation is a useful tool in migraine prophylaxis. One study demonstrated a “significant reduction” of migraine intensity in almost half of those patients receiving spinal manipulation. Nearly ¼ of migraine patients reported greater than 90% fewer attacks. (11) Spinal manipulation has demonstrated similar effectiveness but longer lasting benefit with fewer side effects when compared to a well-known and efficacious medical treatment (amitriptyline). (11,12,13,14)
Conservative care should also include evidence-based dietary and nutraceutical recommendations. An excellent literature review by Orr, provides the following recommendations for migraine prophylaxis (15):
1. Lose Weight
Weight loss may decrease the frequency of migraine and other primary headaches (tension, cluster). (16-18) “Migraine has a specific association with obesity. Furthermore, obese individuals appear to be more likely to suffer from chronic migraine as compared to their peers. There is increasing evidence to suggest that migraine and obesity may be linked through inflammatory mediators released by adipose tissue.” (15)
2. Limit Fats
Dietary fats trigger synthesis of prostoglandins which are known migraine triggers (19). Low fat diets have been shown to play a role in migraine prophylaxix. (20,21)
3. Drink Water
Increased hydration may produce subjective improvement in headache disability and intensity, however no difference in frequency. (22)
4. Decrease Sodium
Patients on a low sodium (DASH) diet report a decrease in headache frequency vs those on a high sodium diet. (23)
5. Feverfew (125mg)
Feverfew may be a useful tool for preventing migraines. (24,25,26) Dosage recommendations vary, however the average dose used in the studies was 125mg/day.
Adding ginger to feverfew may provide relief for acute migraine. (27,28) The proprietary ginger preparation used was (LipiGesic™ M)
7. Riboflavin (400mg)
Riboflavin (Vit B2) may help prevent migraines. (26, 29-38) Dosage recommendations vary, however the average dose used in the studies was 400mg/day.
8. Magnesium (400-600mg)
Magnesium may provide migraine prophylaxis. (26, 39-42) Dosage recommendations vary, however the average dose used in the studies is
400-600mg/ day for the prevention of migraine in non-pregnant patients.
9. CoEnzyme Q10 (100mg TID)
CoEnzyme Q10 may be effective in migraine prophylaxis. (26, 43-46) Dosage recommendations vary, however the average dose used in the studies was 100mg TID.
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Everyone, well at least almost everyone, has had headaches from time to time, and we all know how miserable they can make us feel. In fact, at some point in time, 9 out of 10 Americans suffer from headaches that range between mild and dull to throbbing, intense, and debilitating, sometimes to the point of requiring bed rest in a dark, quiet room.
The common reflex is to reach for that bottle of pills and pray the headache subsides so you don’t have to call in sick and lose another day of productivity when you have so much to do. Unfortunately, between the side effects of many medications designed to help headaches and the pain associated with the headache, this approach is frequently NOT the answer. So what is?
The good news is that many studies have identified spinal manipulation therapy (SMT), the main type of care utilized by chiropractors, as being very effective for popular types of headaches—in particular tension-type headaches that arise in the neck. An important 2001 study reported that SMT provided almost immediate relief for headaches that arose in the neck with SIGNIFICANTLY fewer side effects and longer-lasting results compared with commonly prescribed medications.
Another interesting study that found similar results included tracking the prevalence/frequency of headaches after treatment stopped. The authors of the study reported the patients receiving SMT had continued to experience sustained benefits throughout the following weeks, and even months, in contrast to those in a medication treatment group where headaches came back almost immediately after they discontinued treatment.
The most commonly prescribed medication for tension-type headaches are non-steroidal anti-inflammatory drugs (NSAIDs). Common over-the-counter options include ibuprofen (Advil, Nuprin, etc.) and Aleve (Naproxen). For those who can’t take NSAIDs because of blood thinning and/or stomach-liver-kidney problems, doctors commonly prescribe acetaminophen (Tylenol), but it can be hard on the liver and kidneys, especially when taken over time.
So, what can you expect from a visit to a chiropractor for your headaches? The typical approach begins with a thorough history and examination with an emphasis of evaluating the neck and its associated function. Your doctor of chiropractic may also perform tests designed to reduce pain and some that provoke a pain response to identify the “pain generator” or cause!
Because each patient is unique, the type of care provided will be individually determined based on the findings, the patient’s age, comfort, and preference of both the provider and patient.
So, the next time you find yourself reaching for pills because of headaches, remember that there are better options! Give chiropractic a try. You’ll be GLAD you did!!!
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Most likely, everyone reading this article has had a headache at one time or another. The American Headache Society reports that nearly 40% of the population suffers from episodic headaches each year while 3% have chronic tension-type headaches. The United States Department of Health and Human Services estimates that 29.5 million Americans experience migraines, but tension headaches are more common than migraines at a frequency of 5 to 1. Knowing the difference between the two is important, as the proper diagnosis can guide treatment in the right direction.
TENSION HEADACHES: These typically result in a steady ache and tightness located in the neck, particularly at the base of the skull, which can irritate the upper cervical nerve roots resulting in radiating pain and/or numbness into the head. At times, the pain can reach the eyes but often stops at the top of the head. Common triggers include stress, muscle strain, or anxiety.
MIGRAINE HEADACHES: Migraines are often much more intense, severe, and sometimes incapacitating. They usually remain on one side of the head and are associated with nausea and/or vomiting. An “aura”, or a pre-headache warning, often comes with symptoms such as a bright flashing light, ringing or noise in the ears, a visual floater, and more. For migraine headaches, there is often a strong family history, which indicates genetics may play a role in their origin.
There are many causes for headaches. Commonly, they include lack of sleep and/or stress and they can also result from a recent injury—such as a car accident, and/or a sports injury—especially when accompanied by a concussion.
Certain things can “trigger” a migraine including caffeine, chocolate, citrus fruits, cured meats, dehydration, depression, diet (skipping meals), dried fish, dried fruit, exercise (excessive), eyestrain, fatigue (extreme), food additives (nitrites, nitrates, MSG), lights (bright, flickering, glare), menstruation, some medications, noise, nuts, odors, onions, altered sleep, stress, watching TV, red wine/alcohol, weather, etc.
Posture is also a very important consideration. A forward head carriage is not only related to headaches, but also neck and back pain. We’ve previously pointed out that every inch (2.54 cm) the average 12 pound head (5.44 kg) shifts forwards adds an EXTRA ten pounds (4.5 kg) of load on the neck and upper back muscles to keep the head upright.
So, what can be done for people who suffer from headaches? First, research shows chiropractic care is highly effective for patients with both types of headaches. Spinal manipulation, deep tissue release techniques, and nutritional counseling are common approaches utilized by chiropractors. Patients are also advised to use some of these self-management strategies at home as part of their treatment plan: the use of ice, self-trigger point therapy, exercise (especially strengthening the deep neck flexors) and nutritional supplements.
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Headaches can arise from many different causes. A partial list includes stress, lack of sleep, allergies, neck trauma (particularly sports injuries and car accidents), and more. In some cases, the cause may be unknown.
A unique common denominator of headaches has to do with cervical spine anatomy, in particular the upper part of the neck. There are seven cervical vertebrae, and the top three (C1-3) give rise to three nerves that travel into the head. These nerves also share a pain nucleus with the trigeminal nerve (cranial nerve V), which can route pain signals to the brain.
Depending on which nerve is most irritated, the location of the headache can vary. For example, C2—the greater occipital nerve—travels up the back of the head to the top. From there, it can communicate with another nerve (cranial nerve V or the trigeminal nerve), which can refer pain to the forehead and/or behind the eye.
When C1—the lesser occipital nerve—is irritated, pain travels to the back of the head, while irritation to C3—the greater auricular nerve—results in pain to an area just above the ear. When a nerve is pinched, the altered sensation can include pain, numbness, tingling, burning, itching, aching, or a combination of these sensations.
These are classified as cervicogenic headaches (CGH), and as the name implies, the origin of pain/altered sensation arises from the neck.
A 2013 study reviewing the literature on CGH found that manipulation and mobilization improved pain, disability, and function. The most effective approach included manipulation combined with neck-upper back strengthening exercises.
But what about migraine headaches? Migraines are vascular headaches, and some (but not all) are preceded by an aura or a pre-headache warning that may include blurry vision, tingling, strange olfactory sensations, etc. One study of 127 migraine sufferers reported fewer attacks and less medication required by those who received chiropractic care.
The good news is that spinal manipulation is very safe, and a trial is often very rewarding for many types of headaches.
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Headaches are REALLY common! In fact, two out of three children will have a headache by the time they are fifteen years old, and more than 90% of adults will experience a headache at some point in their life. It appears safe to say that almost ALL of us will have firsthand knowledge of what a headache is like sooner or later!
Certain types of headaches run in families (due to genetics), and headaches can occur during different stages of life. Some have a consistent pattern, while others do not. To make this even more complicated, it’s not uncommon to have more than one type of headache at the same time!
Headaches can vary in frequency and intensity, as some people can have several headaches in one day that come and go, while others have multiple headaches per month or maybe only one or two a year. Headaches may be continuous and last for days or weeks and may or may not fluctuate in intensity.
For some, lying down in a dark, quiet room is a must. For others, life can continue on like normal. Headaches are a major reason for missed work or school days as well as for doctor visits. The “cost” of headaches is enormous—running into the billions of dollars per year in the United States (US) in both direct costs and productivity losses. Indirect costs such as the potential future costs in children with headaches who miss school and the associated interference with their academic progress are much more difficult to calculate.
There are MANY types of headaches, which are classified into types. With each type, there is a different cause or group of causes. For example, migraine headaches, which affect about 12% of the US population (both children and adults), are vascular in nature—where the blood vessels dilate or enlarge and irritate nerve-sensitive tissues inside the head. This usually results in throbbing, pulsating pain often on one side of the head and can include nausea and/or vomiting. Some migraine sufferers have an “aura” such as a flashing or bright light that occurs within 10-15 minutes prior to the onset while other migraine sufferers do not have an aura.
The tension-type headache is the most common type and as the name implies, is triggered by stress or some type of tension. The intensity ranges between mild and severe, usually on both sides of the head and often begin during adolescence and peak around age 30, affecting women slightly more than men. These can be episodic (come and go, ten to fifteen times a month, lasting 30 min. to several days) or chronic (more than fifteen times a month over a three-month period).
There are many other types of headaches that may be primary or secondary—when caused by an underlying illness or condition. The GOOD news is chiropractic care is often extremely helpful in managing headaches of all varieties and should be included in the healthcare team when management requires a multidisciplinary treatment approach.
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Headaches are a very common problem that can have multiple causes ranging from stress to trauma. To make matters worse, there are MANY different types of headaches. One such type is the “cervicogenic headache” (others include migraines, cluster headaches, etc.).
The main distinction between the symptoms associated with cervicogenic headaches and those associated with migraine headaches are a lack of nausea, vomiting, aura (a pre-headache warning that a headache is about to strike), light and noise sensitivity, increased tearing with red eyes, one-sided head, neck, shoulder, and/or arm pain, and dizziness. The items listed above are primarily found in migraine headache sufferers. The following is a list of clinical characteristics common in those struggling with cervicogenic headaches:
Infrequently, the cervicogenic headache sufferer can present with migraines at the same time and have both presentations making it more challenging to diagnose.
The cause of cervicogenic headaches can be obvious such as trauma (sports injury, whiplash, slip and fall), or not so obvious, like poor posture. A forward head posture can increase the relative weight applied to the back of the neck and upper back as much as 2x-4x normal. Last month, we discussed the intimate relationship between the upper two cervical vertebra (C1 & C2) and an anatomical connection to the covering of the spinal cord (the dura) as giving rise to cervicogenic headaches. In summary, the upper three nerves innervate the head and any pressure on those upper nerves can result in a cervicogenic headache. Doctors of chiropractic are trained to examine, identify, and treat these types of potentially debilitating headaches.
Cliff Atwell, B.S., D.C.