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Headaches and/or migraines affect just about everyone at some point and they can present themselves in many different ways. Some people only experience pain in one part of their head or behind their eyes, some people experience a pounding sensation inside their whole head, and some people even experience nausea, while others do not. The pain itself may be dull or sharp and may last for anywhere from a few minutes to a few days. Fortunately, very few headaches or migraines have serious underlying causes, but those that do require urgent medical attention.
Although headaches can be due to a wide variety of causes, such as drug reactions, temporomandibular joint dysfunction (TMJ), tightness in the neck muscles, low blood sugar, high blood pressure, stress and fatigue, the majority of recurrent headaches are of two types: tension headaches (also called cervicogenic headaches) and migraine headaches. There is a third, less common, type of headaches called a cluster headache that is a cousin to the migraine. Let's start out by taking a look at each of these three types of headaches.
Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers. Most people describe a tension headache as a constant dull, achy feeling either on one side or both sides of the head, often described as a feeling of a tight band or dull ache around the head or behind the eyes. These headaches usually begin slowly and gradually and can last for minutes or days, and tend to begin in the middle or toward the end of the day. Tension headaches are often the result of stress or bad posture, which stresses the spine and muscles in the upper back and neck.
Tension headaches, or stress headaches, can last from 30 minutes to several days. In some cases, chronic tension headaches may persist for many months. Although the pain can at times be severe, tension headaches are usually not associated with other symptoms, such as nausea, throbbing or vomiting.
The most common cause of tension headaches is subluxations in the upper back and neck, especially the upper neck, usually in combination with active trigger points. When the top cervical vertebrae lose their normal motion or position, a small muscle called the rectus capitis posterior minor (RCPM) muscle goes into spasm. The problem is that this small muscle has a tendon which slips between the upper neck and the base of the skull and attaches to a thin pain-sensitive tissue called the dura mater that covers the brain. Although the brain itself has no feeling, the dura mater is very pain-sensitive. Consequently, when the RCPM muscle goes into spasm and its tendon tugs at the dura mater, a headache occurs. People who hold desk jobs will tend to suffer from headaches for this reason.
Another cause of tension type headaches comes from referred pain from trigger points in muscles such as the trapezius, sternocleidomastoid (SCM) or levator scapulae muscle on the side of the neck. These are much more common in people who suffer a whiplash injury due to the muscle damage in the neck region.
Each year, about 5 million people in the UK experience migraine headaches, and about 75% are women. Migraines are intense and throbbing headaches that are often associated with nausea and sensitivity to light or noise. They can last from as little as a few hours to as long as a few days. Many of those who suffer from migraines experience visual symptoms called an "aura" just prior to an attack that is often described as seeing flashing lights or that everything takes on a dream-like appearance.
Migraine sufferers usually have their first attack before age 30 and they tend to run in families, supporting the notion that there is a learned behaviour to them. Some people have attacks several times a month; others have less than one a year. Most people find that migraine attacks occur less frequently and become less severe as they get older.
Migraine headaches are caused by a constriction of the blood vessels in the brain, followed by a dilation of blood vessels. During the constriction of the blood vessels there is a decrease in blood flow, which is what leads to the visual symptoms that many people experience. Even in people who don't experience the classic migraine aura, most of them can tell that an attack is immanent. Once the blood vessels dilate, there is a rapid increase in blood pressure inside the head. It is this increased pressure that leads to the pounding headache. Each time the heart beats it sends another shock wave through the carotid arteries in the neck up into the brain.
There are many theories about why the blood vessels constrict in the first place, but no one knows for sure. What we do know is that there are a number of things that can trigger migraines, such as lack of sleep, stress, flickering lights, strong odors, changing weather patterns and several foods; especially foods that are high in an amino acid called 'tyramine'. You can reduce the likelihood of migraine headaches by making some lifestyle changes.
Cluster headaches are typically very short in duration, excruciating headaches, usually felt on one side of the head behind the eyes. Cluster headaches affect about 200 thousand people in the UK and, unlike migraines, are much more common in men. This is the only type of headache that tends to occur at night. The reason that they are called 'cluster' headaches is that they tend to occur one to four times per day over a period of several days. After one cluster of headaches is over, it may be months or even years, before they occur again. Like migraines, cluster headaches are likely to be related to a dilation of the blood vessels in the brain, causing a localised increase in pressure.
Numerous research studies have shown that spinal adjustments are very effective for treating migraines and tension headaches, especially headaches that originate in the neck.
A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that "spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than commonly prescribed medications." These findings support an earlier study published in the Journal of Manipulative and Physiological Therapeutics that found spinal manipulative therapy to be very effective for treating tension headaches. This study also found that those who stopped spinal care after four weeks continued to experience a sustained benefit in contrast to those patients who received pain medication.
Each individual's case is different and requires a thorough evaluation before a proper course of spinal care can be determined. However, in most cases of tension headaches, significant improvement is accomplished through adjustments of the upper two cervical vertebrae, coupled with adjustments to the junction between the cervical and thoracic spine. This is also helpful in most cases of migraine headaches, as long as food and lifestyle triggers are avoided as well.
Trigger point therapy for headaches tends to involve four muscles: the splenius muscles, the suboccipitals, the sternocleidomastoid (SCM) and the trapezius. The splenius muscles are comprised of two individual muscles - the splenius capitis and the splenius cervicis. Both of these muscles run from the upper back to either the base of the skull (splenius capitis) or the upper cervical vertebrae (splenius cervicis). Trigger points in the Splenius muscles are a common cause of headache pain that travels through the head to the back of the eye, as well as to the top of the head.
The suboccipitals are actually a group of four small muscles that are responsible for maintaining the proper movement and positioning between the first cervical vertebra and the base of the skull. Trigger points in these muscles will cause pain that feels like it's inside the head, extending from the back of the head to the eye and forehead. Often times it will feel like the whole side of the head hurts, a pain pattern similar to that experienced with a migraine.
The sternocleidomastoid (SCM) muscle runs from the base of the skull, just behind the ear, down the side of the neck to attach to the top of the sternum (breastbone). Although most people are not aware of the SCM trigger points, their effects are widespread, including referred pain, balance problems and visual disturbances. Referred pain patterns tend to be deep eye pain, headaches over the eye and can even cause earaches. Another unusual characteristic of SCM trigger points is that they can cause dizziness, nausea and unbalance.
The trapezius muscle is the very large, flat muscle in the upper and mid back. A common trigger point located in the very top of the Trapezius muscle refers pain to the temple and back of the head and is sometimes responsible for headache pain. This trigger point is capable of producing satellite trigger points in the muscles in the temple or jaw, which can lead to jaw or tooth pain.
Physical examination and self-reported pain outcomes from a randomized trial on chronic cervicogenic headache. Darcy Vavrek, ND, MS, Mitchell Haas, DC, MA, and Dave Peterson, DC. J Manipulative Physiol Ther. 2010 Jun;33(5):338-48.
Dose response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. Mitchell Haas, DC, Adele Spegman, PhD, RN, David Peterson, DC, Mikel Aickin, PhD, Darcy Vavrek, ND. Spine J. 2010 Feb;10(2):117-28.
Recurrent neck pain and headaches in preadolescents associated with mechanical dysfunction of the cervical spine: a cross-sectional observational study with 131 students. Sue A. Weber Hellstenius, DC, MSc. J Manipulative Physiol Ther. 2009 Oct;32(8):625-34.
Diagnosis and chiropractic treatment of infant headache based on behavioral presentation and physical findings: a retrospective series of 13 cases. Aurélie M. Marchand, MChiro, DC, Joyce E. Miller, BS, DC, and Candice Mitchell, MChiro. J Manipulative Physiol Ther. 2009 Oct;32(8):682-6.
Short-term effects of manual therapy on heart rate variability, mood state, and pressure pain sensitivity in patients with chronic tension-type headache: a pilot study. Cristina Toro-Velasco, PT, Manuel Arroyo-Morales, MD, PT, PhD, César Fernández-de-las-Peñas, PT, PhD, Joshua A. Cleland, PT, PhD, and Francisco J. Barrero-Hernández, MD. J Manipulative Physiol Ther. 2009 Sep;32(7):527-35.
Reduction in high blood tumor necrosis factor-alpha levels after manipulative therapy in 2 cervicogenic headache patients. Gábor Ormos, MD, J.N. Mehrishi, PhD, FRCP, and Tibor Bakács, MD, DS. J Manipulative Physiol Ther. 2009 Sep;32(7):586-91.
A randomized, placebo-controlled clinical trial of chiropractic and medical prophylactic treatment of adults with tension-type headache: results from a stopped trial. Howard Vernon, DC, PhD, Gwen Jansz, PhD, MD, Charles H. Goldsmith, PhD, and Cameron McDermaid, DC. J Manipulative Physiol Ther. 2009 Jun;32(5):344-51.
Improvement in Radiographic Measurements, Posture, Pain & Quality of Life in Non-migraine Headache Patients Undergoing Upper Cervical Chiropractic Care: A Retrospective Practice Based Study
James Palmer, Ph.D & Marshall Dickholtz Sr, DC. J. Vertebral Subluxation Res. June 4, 2009.
Non-invasive physical treatments for chronic/recurrent headache (Review). Brønfort G, Nilsson N, Haas M, Evans RL, Goldsmith CH, Assendelft WJJ, Bouter LM. The Cochrane Library 2009, Issue 1.
Frequency & Duration of Chiropractic Care for Headaches, Neck and Upper Back Pain. John K. Maltby, DC, Donald D. Harrison, PhD, DC, MSE, Deed E. Harrison, DC, Joseph W. Betz, BS, DC, Joseph R. Ferrantelli, BS, DC, Gerard W. Clum, DC. J. Vertebral Subluxation Res. August 21, 2008.
The effectiveness of physiotherapy and manipulation in patients with tension-type headache: a systematic review. Marie-Louise B. Lenssincka, Le ́onie Damena, Arianne P. Verhagena, Marjolein Y. Bergera, Jan Passchierb, Bart W. Koes. Pain. 2004 Dec;112(3):381-8.
Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. Mitchell Haas, DC, Elyse Groupp, PhD, Mikel Aickin, PhD, Alisa Fairweather, MPH, Bonnie Ganger, Michael Attwood, Cathy Cummins, DC, and Laura Baffes, DC. J Manipulative Physiol Ther. 2004 Nov-Dec;27(9):547-53.
Efficacy of spinal manipulation for chronic headache: a systematic review. Gert Bronfort, DC, PhD, Willem J.J. Assendelft, MD, PhD, Roni Evans, DC, Mitchell Haas, DC, and Lex Bouter, PhD. J Manipulative Physiol Ther. 2001 Sep;24(7):457-66.
Cervicogenic headaches: a critical review. Scott Haldeman, DC, MD, PhD, Simon Dagenais, DC. Spine J. 2001 Jan-Feb;1(1):31-46.
A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. Tuchin PJ, Pollard H, Bonello R. J Manipulative Physiol Ther. 2000 Feb;23(2):91-5.
Evidence Report: Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-based Practice Center Center for Clinical Health Policy Research 2200 W. Main Street, Suite 230 Durham, NC 27705.
Chiropractic care of a pediatric patient with migraine-type headaches: a case report and selective review of the literature. Joel Alcantara, BSc, DC, and Kyle J. Pankonin, DC. Explore (NY). 2010 Jan;6(1):42-6.
Intractable migraine headaches during pregnancy under chiropractic care. Joel Alcantara, Martine Cossette. Complement Ther Clin Pract. 2009 Nov;15(4):192-7. Epub 2009 May 2.
Chiropractic care of a 6-year-old girl with neck pain; headaches; hand, leg, and foot pain; and other nonmusculoskeletal symptoms. Jan Roberts DC, Tristy Wolfe MA. J Chiropr Med. 2009 Sep;8(3):131-6.
A case of chronic migraine remission after chiropractic care. Tuchin PJ. J Chiropr Med. 2008 Jun;7(2):66-70.
Chiropractic management of a patient with migraine headache. Stacy Peters Harris DC, DACRB. J Chiropr Med. 2005 Winter;4(1):25-31.
Treatment of bipolar, seizure, and sleep disorders and migraine headaches utilizing a chiropractic technique. Erin L. Elster, DC. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):E5.
Upper Cervical Chiropractic Care for a Patient with Chronic Migraine Headaches with an Appendix Summarizing an Additional 100 Headache Cases. Erin L. Elster, D.C. J. Vertebral Subluxation Res., August 3, 2003.
Chiropractic/rehabilitative management of chronic headaches: A retrospective case report. Steven D. Novicky, D.C., DACRB. J Chiropr Med. 2003 Summer;2(3):96-101.
Upper Cervical Chiropractic Care For A Nine-Year-Old Male With Tourette Syndrome, Attention Deficit Hyperactivity Disorder, Depression, Asthma, Insomnia, and Headaches: A Case Report. Erin L. Elster, D.C. J. Vertebral Subluxation Res., July 12, 2003.
Chronic migraine and chiropractic rehabilitation: A case report. R. Clark Davis, DC, CCRD. J Chiropr Med. 2003 Spring;2(2):55-9.
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" ... it's just amazing!"
Malcolm & Pat Pete
Atlas Wellness Centre (Atlas): Can you tell me your names, please?
Malcolm: Yes, Malcolm James Pete.
Pat: Pat Pete.
Atlas: And what made you want to come and see us in the first place.
Malcolm: Well, I’ve been suffering with severe pain in lower back and legs for two, three years really. I had several hip operations which supposedly were designed to cure the problem. But they had absolutely no effect and I would say in desperation, I saw your advertisement in the local paper. It sounded very good. So I thought, “Let’s give this a try.”
Atlas: And how would you say that having the health problems affected your life before you came in?
Malcolm: It stopped me doing most things that I enjoy doing. I couldn’t walk. I couldn’t go for walks. I couldn’t garden. Found it extremely difficult to do any jobs around the house and was virtually confined to a wheelchair.
Atlas: And how would you say things have changed since you started having the care here?
Malcolm: Since I’ve had the care, I’ve lost 95 percent of all the pain that I was suffering with. I rarely use the wheelchair now unless in fact I’m – got a lot of walking to do and I can rely on a walking frame and now I can get about comfortably with a walking frame. My only problem now is that it has been so long since I’ve walked that I’ve got to build up my stamina and balance before I can really try to walk without any support at all.
Atlas: And Pat, would you say you noticed changes with Malcolm?
Pat: Definitely. He’s not taking any painkillers now. He was on quite a lot of painkillers. Within about three weeks to a month, he had dispensed with all the painkillers. It’s so good for both of us. He’s much more independent. I don’t have to push him around in a wheelchair, so it has made a lot of difference to my life too. Yeah, it’s just amazing!
Atlas: Excellent. What would you say to someone who’s maybe a bit worried, a bit – about coming here for the first time?
Malcolm: I would tell them to come along without any concerns at all. I found the people – all of the people I’ve come in contact with to be very helpful. They explain what’s going to happen and there’s absolutely nothing to worry about. But the benefits can be immense.