Headaches and Migraines are still not well understood, or classified.
The myofascial headache (tension headache) is a lot more prevalent than previously thought. Especially when associated with TMJ disorders, bruxism and cervicogenic headaches.
People with headaches do not often present with one simple musculoskeletal source. It is usually more complex combination of factors and a combination of therapies can be needed to relieve the symptoms.
People with headaches, orofacial pain and bruxism provide a complex ‘story’ as there are so many structures which can be responsible for their symptoms/pain.
Many headache people suffer different types of headaches, most likely 2 different types.
Any chronic sufferers of headaches can also develop secondary anxiety or depressive features compounding (making worse) the clients symptoms/presentation.
Research shows that if a human body is in pain for 6 months or longer, you will show signs of depression, because it is just not normal to be in pain for that long.
Interestingly enough, jaw pain/TMD often presents to the sufferer as anxiety first, instead of actual pain. So once the area is treated and the pathology/sore bit is healing or healed, the anxiety goes quickly.
Some headaches if left to continue (i.e no medication, rest, therapy, postural change) can worsen and progress into migraine type pain (non aura).
Popular theory as to why, to date:
Majority of headaches (if you ask any hands on therapist, from physio, chiro, osteo, massage therapist etc) will say it is due to cervicogenic origin (i.e. the neck).
Physio has some great research showing the benefit of hands on treatment and exercise for cervicogenic headaches.
2002 Therapy & exercise for cervicogenic headaches
The only study to stand up to stringent criteria for diagnosis of primary headaches of all potential sources of cervicogenic headaches is the cervical zygopophyseal joint (neck joints). (Dwyer et al 1990).
Medicine has classified them into 4 catagories as of 2004:
- Tension-type headaches - Cervicogenic
- Cluster & Other autonomic cephalgias
- Other primary headaches
With relief of headaches supported by injection of local anaesthetic into lateral atlantoaxial joint (Aprill et al 2002) or by third occipital nerve block for head pain coming from C2-3 zygopophyseal joint (Lord & Bogduk 1996), thus supporting the former. Other structures are muscle tension, joint capsules and loose areolar tissue (richly innervated by nociceptive and mechanoreceptive nerve endings (McLain 1994). And the principle of convergence (International Association for the study of of pain 1994).
In plain speak – neck joints appear to be the origin for most of the cervicogenic headaches. Then muscle tension and the nervous system. The nervous system can then behave in a ‘tricky’ fashion and remember previous trauma or pains. A new small injury can restart an old pain pattern.
New research into diet and repeated use of anti-biotics as a child are showing alteration in gut biomes, which can cause an over activity of nitrate producing bacteria which in turn produce nitric oxide, which causes vaso dilation of blood vessels and can create head pain.
Usually occur on waking in the morning. And can be due to; poor sleeping position (lack of sleep), poor pillow, and lots of grinding during the night. Talk to your physio about the best pillow position and type for some relief. Often people complain of headache at the end of the day from poor posture at the computer and talking a lot at work. Morning headaches can also be due to sleep apnoea, if your still tired after a full night’s sleep, seek sleep studies.
When does clenching/grinding become a problem and aggravate/cause headaches?
Most of the population clench or grind their teeth at night. An increase in the intensity of this phenomenon can lead to you waking up with a headache, or creating inflammation and swelling in your jaw joint area, which then sensitises other structures and can refer in a headache pattern.
Clinically we are noticing triggers for increased clenching at night (bruxism):
Gastrointestinal problems (leaky gut, IBS, anaemia etc), Respiratory blockages (deviated septums, rhinitis, polyps etc), Change in hormones (teenage years, menopause, pregnancy etc), Changes in medication, Alcohol usage, and more.
We are also noticing clinically, triggers which increase your day clenching;
Increased use of computer screen use, poor posture, concentrating, stress.
Lack of Sleep and headaches:
It is important to note that headache may also be associated with respiratory sleep disorders such as limitation of airflow (upper resistance syndrome, UARS), or cessation of breathing (sleep apnea)
(Gold et al 2003).