According to the latest research, 9% of men and 12% of women in the U.S. experience at least 1-2 headache episodes per month. And, more than 4% of the U.S. population suffers from frequent headaches, defined as headaches that occur at least 180 days a year. Needless to say, headaches have become a social and economic burden in the United States, as well as other parts of the world.

Scientists have identified over 300 causes for headaches. Various pain-sensitive structures and tissues including the skin, subcutaneous tissue, muscles, arteries, periosteal bone covering, and the upper cervical and facial nerves produce headaches when irritated or injured. Fortunately, only a handful of causes are responsible for the majority of headaches.

The most common of these headaches include:
Cervicogenic- problems within the neck
Muscle-tension- neck and upper back muscular spasms
Post-traumatic- following head/neck trauma, i.e. whiplash
Drug-induced- from analgesic overuse
Doctors of chiropractic successfully help thousands of individuals everyday obtain safe, effective, long-term relief from their headaches. This is because most headaches have a spinal, muscular, or habitual component which the chiropractor has been trained to identify and treat. In fact, surveys show that 10-25% of patients initiate chiropractic care for the relief of headaches.

To learn more about specific headache types, headache treatments, prevention tips, or to view various articles related to headaches, choose from the links menu above.

Common Headache Types

Cervicogenic Headaches
Muscle Tension Headaches
Post-Traumatic Headaches
Drug-Induced Headaches
Migraine Headaches
Cluster Headaches

Cervicogenic Headaches
Cervicogenic headaches refer to headaches which originate from tissues and structures in the cervical spine or neck region. The headache is generally a very constant, strong, yet dull pain. The most common location of pain is around the orbital (eye) region and upper neck area but may also include other areas of the face, head and neck. The headache will typically last for one to three days and reoccur ever one to four weeks until properly treated. The headache may also be accompanied by nausea, vomiting, dizziness, ringing of the ears, and sensitivity to light and sound – similar to migraine headaches.

Cervicogenic headaches are caused by irritation or injury to the structures of the upper neck region, resulting in local neck pain as well as referred pain to the temporal and facial regions. This headache is often precipitated or aggravated by head and neck movements and by applying deep pressure to the muscles of the upper cervical area.

Chiropractic management of cervicogenic headaches is the best way to eliminate these headaches. Without addressing the problems in cervical spine the headache will continue to persist and worsen. Individuals should be warned that relying on analgesics to remedy cervicogenic headaches does nothing to correct the cause of the headache and generally worsens the headache in what’s known as the “rebound effect”. See “Drug-Induced Headaches” below for more information.

Muscle Tension Headaches
Tension headaches are the most common headache type, representing approximately 60% of all headaches. These headaches are caused by the sustained contraction of the muscles in the neck and head region. The sustained muscle contraction is usually a result of a combination of the following:

cervical/neck misalignments and faulty neck biomechanics
previous neck/upper back injury- not properly rehabilitated
poor posture
Excessive emotional stress
anxiety or depression
prolonged sitting or driving
improper sleeping habits
Characteristically, these headaches are generally mild to moderate in intensity and can last from hours to days. There is a constant tight or pressure sensation, generally feeling like a tight band is wrapping around the head. There is commonly pain and tightness in the area of the neck and shoulder. Pain generally starts in the base of the skull or temporal regions of the head and spreads outwards to affect other areas of the head and neck.

Chiropractors have great success treating muscle tension headaches. By utilizing spinal adjustments, therapeutic exercises and stretches, soft tissue techniques such as trigger point work and massage, and by counseling on lifestyle modification, tension headaches can become a thing of the past. Individuals should be warned that relying on analgesics to remedy tension headaches does nothing to correct the cause of the headache and generally worsens the headache in what’s known as the “rebound effect”. See “Drug-Induced Headaches” below for more information.

Post-Traumatic Headaches
Post-traumatic headaches are headaches initiated from head or neck injury, such as in a whiplash-type injury or blow to the head. The resulting headache varies from person to person. Most commonly, the resulting post-traumatic headache is one of the following:

post-traumatic cervicogenic headache
post-traumatic muscle tension headache
post-traumatic migraine headache
post-traumatic cluster headache
post-traumatic vascular headache
The most favorable outcomes are seen with those who seek early treatment. It’s also important immediately following any head trauma to rule out subdural hematoma, a potentially fatal condition caused by intracranial bleeding. Chiropractors frequently treat post-traumatic headaches and do so with success.

Again, individuals should be warned that relying on analgesics to remedy post-traumatic headaches does nothing to correct the cause of the headache and generally worsens the headache in what’s known as the “rebound effect”. See “Drug-Induced Headaches” below for more information.

Drug-Induced Headaches
Experts have claimed that as many as 60% of chronic headaches are drug-induced. It’s quite ironic that the abuse or frequent use of medications used to relieve the symptoms of a headache can actually end up perpetuating the headache or cause new headaches. In addition, physical dependency and organ damage are also extremely common complications associated with chronic analgesic usage.

Drug-induced headaches are usually dull, diffuse and non-throbbing affecting both sides of the head. They are frequently present first thing in the morning and persist throughout the day.

Medical experts say that analgesic medications (over the counter or prescription) should not be used more frequently than 1 to 2 days per week. Using medications beyond this period will gradually increase the frequency of the headaches and will further increase their intensity of the pain. Unfortunately, although there is extensive documentation on drug-induced headaches, many medical physicians fail to pay attention to this fact or are simply unaware. Worse yet, the many tv drug commercials are made to make us feel as though pain relievers are a safe effective means of relief for headaches. However, taking pain medication for chronic headaches without seeking corrective care is like unplugging the flashing oil light in your car dash, instead of adding oil to the engine.

The most common medications which lead to the development of drug-induced headaches include:

oral contraceptives
heart medications
Simply eliminating or limiting the use of analgesic use will resolve most if not all of the headaches. However, most individuals are unaware that the drugs they’re taking can sometimes do them more harm than good.

Migraine Headaches
Migraines account for approximately 10% of all headaches. Researchers have found that 3.4 million females and 1.1 million males suffer from 1 migraine attack per month. Migraines follow a hereditary course, with 70% of migraine sufferers having other family members who are also affected. Migraine headaches often have coexisting muscle tension and cervicogenic factors which contribute to the frequency and intensity of migraine attacks.

The pain generated by migraines has a throbbing quality and usually involves one side of the head initially. The headache tends to reach its peak intensity after about 30 minutes. Migraines are commonly accompanied by nausea and vomiting. During severe attacks, sensitivity to sound and light may occur forcing the individual to seek a dark and quiet room mandatory. The duration of the headache can vary from a few hours to 1 to 2 days.

Migraine headaches are categorized into either “common” or “classical” migraines.

Classical Migraines differ from common migraines in that the actual headache is preceded by neurologic disturbances which indicate a migraine attack is about to take place. These include alterations in the visual field (zigzag lines, blind spots, etc.), numbness or tingling of the lips or hand, problems with balance and even loss of consciousness. These neurologic disturbances generally last 15 to 30 minutes and resolve before the headache begins. In some cases, the neurologic disturbances may persist several days after the headache has resolved.

Clinical trials conducted on chiropractic’s effectiveness in the management of migraine headaches have shown remarkable improvement in many cases.

Cluster Headaches
Cluster headaches are most common in middle-aged male smokers and are among the most painful of all headaches. The individual is often awaken 1 to 3 hours after sleep with the headache in its full-blown state. The headache lasts about 1 hour and attacks occur frequently over several days to weeks – thus their name “cluster”. The headaches will then disappear for periods of months to years before returning. The pain in cluster headaches is deep, nonthrobbing and severe located behind the ear and may radiate to the forehead and temple regions. There is also tearing of the affected eye, nasal congestion, and nasal drip.

Smoking, alcohol ingestion and napping often precipitate attacks. Immediate administration of oxygen (100% at 7 liters for 15 minutes) has been shown to provide some relief. It has been suggested that immersing the hand in ice water to the point of pain and elevating the bed may also provide some relief.

Chiropractic Treatment of Headaches

Chiropractors successfully treat thousands of headache sufferers everyday. According to surveys, as many as 25% of the individuals seeking chiropractic care do so for the treatment of headaches.

Chiropractic has such good success in the treatment of headaches because most headaches are either soft tissue or neurologic in nature. Also, a significant portion of headaches originate in the tissues of the neck. And since chiropractors focus their treatment on the soft tissues of the spine, which includes the neck, the majority of headaches can be successfully managed with appropriate chiropractic care. Best of all, chiropractic treatments consist of only safe, natural, and noninvasive therapies that focus on correcting the cause of headaches, and not simply the short-term masking of symptoms.

Chiropractic treatment for headaches has been compared with other forms of treatments and in most cases, has excelled. To see the results of studies evaluating the effectiveness of chiropractic care in the treatment of different headache types, select the “Articles” link from the table above.

Headache Prevention Tips

Regular spinal checkups. Regular spinal checkups allow you to correct any structural misalignments, faulty biomechanics and spinal nerve irritation within the upper spine before serious problems develop. Practicing a “preventative” approach as opposed to a “crisis” approach is the most effective way to stay healthy.

Practice proper posture and ergonomics. Proper posture and ergonomics keeps stress to the cervical and upper thoracic spine to a minimum. Proper body biomechanics keeps irritation and injury to the pain sensitive spinal tissues to a minimum.

Avoid analgesic use. While occasional short-term analgesic use is appropriate in some cases, analgesics are not a cure and should not be used as a long-term solution to managing headaches. Proper headache management deals with correcting the cause of the headache and not simply the masking of symptoms. Furthermore, excessive analgesic use frequently has a rebound effect, ironically increasing the frequency and intensity of the headaches they are meant to treat. FYI- research has shown that 60% of all chronic headaches are drug-induced.

Proper stress management. Stress is a major trigger of headaches. If you find your stress levels are excessive, contact our office. We can assist you in appropriately managing your stress levels.

Regular exercise. Routine physical activity keeps the body and mind strong, healthy and happy. A minimum of 3 times per week for 40 minutes should be your goal. Involve friends and family, mix up the activities, keep it fun and stay consistent!

Proper diet and nutrition. Providing your body with the proper fuel through proper diet and nutrition allows the body to fight off disease and function at a higher level.

Also, if you suffer from migraines be sure to avoid foods that trigger attacks – chocolate, caffeine, nuts, MSG, foods containing nitrates, and alcohol are some to avoid.

Headache Related Articles and Research

The Effect of Spinal Manipulation on Cervicogenic Headaches
A Controlled Trial of Cervical Manipulation for Migraine
Spinal Manipulation vs. the drug “Amitriptyline” in Chronic Tension Headaches
Study Comparing Manual Therapy (manipulation) and Cold Packs in Post-Traumatic Headaches
Anxiety and Depression Linked To Chronic Headaches

The Effect of Spinal Manipulation on Cervicogenic Headaches

In this study, researchers set out to determine the effectiveness of spinal manipulation in the treatment of cervicogenic headaches (headaches caused by disorders within the cervical spine). 53 patients were placed into one of two groups which received either,

1 chiropractic spinal manipulation 2X/week for 3 weeks, or,
2 deep friction massage and low-level laser treatments in the upper back and neck region 2X/week for 3 weeks.
After the 6 weeks researchers found that those receiving the chiropractic spinal manipulation:

1 decreased their use of analgesics by 36%, compared with 0% in the no-spinal manipulation group
2 decreased their number of hours they experienced headaches during the day by 69%, compared with 37% in the no-spinal manipulation group
3 decreased their headache intensity per episode by 36%, compared with 17% in the no-spinal manipulation group

A Controlled Trial of Cervical Manipulation for Migraine

The efficacy of cervical manipulation for migraine was evaluated. In a six-month trial, 85 volunteers suffering from migraine were randomly allocated to three treatment groups. One group received cervical manipulation performed by a medical practitioner or by a physiotherapist, another received cervical manipulation performed by a chiropractor, while the control group received mobilization performed by a medical practitioner or by a physiotherapist. For the whole sample, migraine symptoms were significantly reduced. No difference in outcome was found between those who received cervical manipulation, performed by chiropractor or orthodox therapist, and those who received the control treatment. Chiropractic treatment was no more effective than the other two treatments in reducing frequency, duration or induced disability of migraine attacks, but chiropractic patients did report a greater reduction in pain associated with their attacks.

Australian-New Zealand Journal of Medicine 1978; 8:589-593. From the University of New South Wales, Sydney

Spinal Manipulation vs. Amitriptyline in Chronic Tension Headaches

This randomized controlled trial compared the effectiveness of spinal manipulation and amitriptyline for the treatment of chronic tension-type headache. This study consisted of a 2 week baseline period, a 6 week treatment period and a 4 week post-treatment follow-up period. Of the 150 patients who were enrolled in the study, 24 (16%) dropped out, 5 (6.6%) from the spinal manipulative therapy and 19 (27%) from the amitriptyline group. During the treatment period both groups improved at very similar rates in all primary outcomes.

In relationship to baseline values at four weeks after cessation of treatment, the spinal manipulation group showed:

a 32% reduction in headache intensity,
a 37% reduction in headache frequency,
a 37% reduction in over-the-counter medication usage, and
a 16% improvement in functional health status.
The amitriptyline group showed improvement from baseline values in the same four major outcome measures of 6% or less.

Controlling for baseline differences, all group differences at four weeks after cessation of therapy were considered to be clinically important and were statistically significant. This sustained therapeutic benefit may reduce the need for self-administered analgesic medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.

Boline, DC. APT 1995;18(3):148-15.

Manual Therapy vs. Cold Packs in the Treatment of Post-Traumatic Headache

One year after head trauma, 23 patients with post-traumatic headache entered a prospective clinically controlled trial to find out if specific manual therapy on the neck could reduce the headache. The study was completed by 19 patients (83%). Ten patients were treated twice with manual therapy and nine patients were treated twice with cold packs on the neck. The pain index was calculated blindly. Two weeks after the last treatment, the mean pain index was significantly reduced to 43% in the group treated with manual therapy (manipulation) compared with the pre treatment level. At follow-up five weeks later, the pain index was still lower in this group compared with the group treated with cold packs, but this difference was not statistically significant. The pain index for all 19 patients was significantly correlated to the use of analgesics as well as to the frequency of associated symptoms (number of days per week with dizziness, visual disturbances and ear symptoms). It is concluded that the type of manual therapy used in this study seems to have a specific effect in reducing post-traumatic headache. The result supports the hypothesis of a cervical mechanism causing post-traumatic headache and suggests that post-traumatic dizziness, visual disturbances and ear symptoms could be part of a cervical syndrome.

Cephalgia 1990; 10:241-250. From the County Hospital of Aarhus, Denmark.

Anxiety and Depression Linked to Chronic Headaches

According to new research from Ohio University, almost half of chronic tension headache sufferers also suffer from anxiety and depression. In this study, 245 chronic headache sufferers completed questionnaires which assessed their psychological status. Surprisingly, 45% admitted to feeling anxious, depressed or hopeless on almost a daily basis. Researchers were unable to determine whether the psychological problems actually preceded the onset of the headaches.

According to researcher Lipchik, “A lot of people have a difficult time separating ‘their headaches from their anxiety and depression’ and many of the people don’t acknowledge that they have psychological problems or problems managing stress. It’s easier for them to discuss it as a consequence of their headaches.”

Annual Meeting of the American Association for the Study of Headache. San Francisco, California. 1998.