You say migraine, I say headache…

In a car accident 20 years ago, Ramesh suffered from back sprain and whiplash. More recently he has also developed persistent headaches, neck and shoulder pain. He says that all of these make it impossible for him to think straight.

Janet has had severe headaches for several months and on occasion they have lasted for several days at a time making it impossible for her to sleep. She has dark circles under her eyes and looks exhausted.

Richard has a history of chronic migraines from childhood. Since a riding accident a few years ago where he hit his head, he has also started to suffer from silent migraines. He is aware of chronic tension in his neck and jaw, and often feels depressed about the fact that he can no longer exercise because of his condition.

The headache condition

Despite the variation in these diagnoses, symptoms and histories, all of these people are suffering from what is collectively termed as ‘headache condition’. According to a study conducted by the Eurolight Project (a collaborative pan-european data collection project) in 2010, more than 50% of us suffer at least one headache a year. The most frequently diagnosed types of headaches are tension headaches (60-70%) and migraines (15%).

Not only are headaches (and here I include migraines) commonly painful, they can be disabling, seriously affecting the individual’s ability to work or carry out normal day to day life. People with chronic headaches live in fear of their next headache and describe their headaches as ruling their life. As with many chronic pain conditions, this can lead to further medical situations such as anxiety and depression.

Typical headache symptoms

Headache and migraine pain can vary from a mildly annoying dull ache to debilitating intense pain.  People describe these as an ice-pick through their eye or an unbearably tight band squeezing round their head. People often tell me that headaches are the worst type of pain because the pain is so close to them, ie in their head, unlike a pain in their foot which is more bearable.

The pain felt in headaches does not come from the brain itself. Instead the pain signals come from nerves which are activated around the skull, blood vessels, and soft tissues in the head and neck.

Some unlucky sufferers can have symptoms without a headache, called silent migraines. Typical symptoms can include nausea and vomiting, digestive upsets, dizziness, disturbed vision and flashing lights, neck and jaw pain, tingling, numbness, inability to speak or think properly. Often the person is not even aware they are having a migraine as these symptoms are also indicative of other medical conditions.

The problem with headaches

Many people never get a medical diagnosis of their condition and just live with the symptoms, self-medicating with painkillers when things are bad. Or they may end up with an incorrect diagnosis and on a cocktail of medication.

According to the World Health Organisation, headaches have been underestimated, under-recognised, and under-treated throughout the world. This is in part because, worldwide on average, only 4 hours of undergraduate medical education are dedicated to instruction on headache disorders. This creates a clinical barrier to correct diagnosis and effective treatment for many.

Despite the medication prescribed, there is no effective medical “cure” for headaches. People may also undergo various procedures such as botox or anaesthetic injections in their neck or head, or they may be sent on mindfulness courses to help them manage their pain.

Undoubtedly there are physical, mental and emotional triggers for headaches and these vary from person to person. For many, the cause is muscle spasm and fascial restriction which can be exacerbated by stress, food, drink or environmental triggers.

The myofascial approach to headaches

As a myofascial therapist, I have treated many people suffering from headaches, including our three case studies mentioned above. The causes of their headaches are as individual as they are and have involved us piecing together the pieces of the jigsaw that is their condition.

What is common to all of them is the fact that they have fascial restrictions that are causing postural imbalance and strain on their nerves and other pain sensitive structures. Sometimes the source of their symptoms is obvious, such as tension in their neck and shoulders, for others it is less obvious.

For example, Ramesh had an imbalance in his pelvis which was creating a twist all the way up his spinal cord into his head. As we corrected his pelvis, so his headaches disappeared.

For Janet the cause of her persistent headaches was severe tension in the fascia of her back. Once this was loosened, her headaches went immediately and she was able to sleep again.

For Richard the main source of his problems were in his neck and jaw. Once we had released these restrictions and, combined with some simple relaxation exercises to help calm his mind, his symptoms started to dissipate and he was able to contemplate starting a gradual return to exercise.

In many cases, there may not be a “cure” as such for headaches, but by taking a holistic mind-body approach to the individual, it is possible to help people reduce their symptoms to the point that they can take back control of their lives and no longer live in fear of their headaches.

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