Dr. Mario Awwad, D.C.

Common Headache Types




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.

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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:

  1. cervical/neck misalignments and faulty neck biomechanics
  2. previous neck/upper back injury- not properly rehabilitated
  3. poor posture
  4. Excessive emotional stress
  5. anxiety or depression
  6. prolonged sitting or driving
  7. 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.

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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.

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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:

  • aspirin
  • Tylenol
  • Excedrin
  • Anacin
  • Demerol
  • Vicodin
  • Percocet
  • Darvon
  • Xanex
  • Fiorinal
  • oral contraceptives
  • tetracycline
  • heart medications
  • anticoagulants
  • Dilantin

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.

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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.

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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.

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