Headaches are commonly categorized as tension, migraine or sinus in origin. They may also be caused by a pathological disease process that is far less common than the other three causes.
Tension headaches are typically caused by physical or emotional stress. This includes factors such as eyestrain, poor posture, a neck injury like whiplash, or even conditions such as temporomandibular joint dysfunction. Migraine headaches, while vascular in origin, are often triggered or exacerbated by hypertonic soft tissue in the cervical region. Sinus headaches arise from increased pressure in the sinus cavities around the nose and eyes. It is not uncommon to find myofascial trigger points in the suboccipital and posterior scalenes region that refer to the sinuses and either initiate or aggravate a sinus headache.
Tension headaches are the most common type of headaches. Quite simply, tightness in the neck and shoulder muscles seems to be the most direct cause. In our experience, myofascial trigger points in any of the muscles of the neck and shoulders can “trigger” pain in the head, whether it is behind the eyes, at the base of the skull, toward the back or side of the head or that “tight band” around the head. Deactivating these trigger points and relieving tension in the muscles through therapeutic massage can frequently decrease the frequency and intensity of tension headaches.
Aggravating factors. Headaches can also be initiated by certain foods and food additives (chocolate, nitrates, aspartame, etc.), medication interactions, lack of adequate water intake, skipping meals, smoking and drinking alcohol.
Self-health Measures. The most obvious, yet the most difficult measure to decrease or eliminate headaches is to slow down and have regular periods of rest and relaxation. Quite simply, try to eliminate one of the elements in the stress-tension-pain cycle.
Tension headaches also can be decreased or eliminated through a number of methods:
- Implementing a regular and moderate exercise program
- Utilizing meditation
- Reducing caffeine intake
- Eating more whole foods and fewer fast or processed foods
- Sitting quietly to eat meals, avoid eating on the run
- Increasing flexibility in the neck and shoulder muscles
- Cessation of smoking and tobacco use
- Improving workplace ergonomics
- Establishing regular sleep and wake patterns
- Making time for relaxation, hobbies and varied recreational activities
- Receiving periodic therapeutic massage or bodywork
- Developing a trusting, emotional support outlet with friends, family or a therapist
A frequent complaint, neck pain can result from a variety of factors. It can be acute or chronic. The most predominant cause of pain is damage to the soft tissue of the neck and can occur because of overuse, or injuries such as whiplash. Pain can also be due to abnormalities such as birth defects, structural trauma (i.e. fractures), degenerative and inflammatory diseases, or prolonged wear and tear resulting in cervical disc degeneration or protrusion (herniated disc). With various postural stresses, the disc degenerates as we grow older (typically age 40 and up), creating less space between the bones and more friction. Less frequently, neck pain can be caused by tumors or infection. Emotional stress is also an important contributing factor. Neck pain often causes, or is a major contributor to headaches, shoulder, arm and back pain. The longer a person has pain, the more effort is needed to correct it.
Aggravating Factors. Inactivity is one of several aggravating factors for neck pain. As soft tissue becomes more stiff and inflexible through lack of activity, the circulation to the area is decreased. Dysfunctional biomechanics is another factor, with the prime contributor being the head-forward, rounded-shoulder posture. Fatigue directly affects our sense of well-being and is a contributor to pain. We are less prone to continuing our supportive postural habits and more inclined to slouch and have contracted posture when we’re tired. Further tightness in the soft tissues can be caused by emotional stress. Stress can also worsen existing neck tension. Environment is something many of us forget when assessing pain. Consider this — a cool draft on the neck can cause stiffness and discomfort, just as allergies, fumes or odors from smoke, paint or some household cleaning products can irritate the respiratory system and eyes, thereby causing surrounding soft tissue to tense as a defensive mechanism. Other elements, such as fibromyalgia and temporomandibular dysfunction, can also be aggravating factors in neck pain.
Self-health Measures. Neck pain can be decreased or eliminated through a number of methods. If the pain does not subside or you experience tingling, numbness or sharp, shooting pain referrals to other areas of your body, then schedule an appointment to see a medical professional.
- Maintain supportive postural habits. Practice bringing your sternum up and contracting your lower abdominal muscles to bring your head and neck into better alignment while sitting or standing.
- If you wear eyeglasses, be sure your prescription is current or is adequate for your needs. If you spend large amounts of time at the computer, you may need special computer glasses.
- Computer monitors should be 18″ to 24″ away and the top line should be approximately at eye level
- Strategically use pillows to adequately support your neck while sleeping
- When reading, be sure to keep your light well-positioned to avoid undue neck rotation or strain
- Keep your neck warm. In cooler weather this may mean wearing a turtleneck shirt, even to bed
- Use of ice or heat or both to alleviate the pain and discomfort
- Maintain gentle movements of the neck. Modify any stretching or other activities involving the neck to stay within your tolerance
- Get some exercise, even if it is just a walk around the block. The increased circulation and endorphin level will help reduce the pain and bring much-needed nutrients and oxygen to the area. Consult with a qualified professional for appropriate strengthening exercises when you are ready
- Find ways to manage stress. Mental and physical flexibility is a key factor here
- If your pain is related to conditions such as arthritis or fibromyalgia, there are support groups which may have information and tips on how to manage your pain
Stretching Suggestions. Doing the neck and shoulder routines daily can create considerable relaxation and flexibility in the neck muscles, thereby producing an improvement in frequency, duration and intensity of headaches.
Plan to do stretching exercises two times each day for about 20 minutes per session. Do stretches slowly so you feel a normal sensation of stretching, but not pain. Hold the stretch for five seconds, relax for five seconds, and then repeat each stretch about three to five times. You can do many stretching exercises while standing or sitting. You can use them as stress-releasers when sitting in a long meeting and in the car, or while waiting in line at the store or standing in the shower. Many people include stretching exercises with their favorite daily TV show to make sure they keep these exercises as part of their daily routine. Other people do stretching exercises before bedtime to help them sleep.
Stretches that help relieve headaches are listed below. Add these to a whole body stretching program and use them when headaches first start:
- Neck range of motion: Tip your chin forward to your chest, upward to the ceiling, and then turn your chin to touch each shoulder.
- Shoulder shrugs: Shrug shoulders up, then up and forward, and then up and back.
- Neck isometrics: Place your palm on your forehead and press your head against it. Be very still and don’t move your head or hand as you press one against the other. Repeat with your hand on each side of the head.
- Head lift: Link the fingers of your hands together and hold then behind your neck at the base of your head. Pull your elbows forward and up so you can feel your head lifting up slightly from your neck.
Tips for Successful Stretching
Stretch twice daily, in the morning and before bed
- Begin stretches after taking a warm shower or using a heating pad over your most painful area for 15 minutes
- Listen to music or watch your favorite TV show while you do your exercises
- Do each stretch slowly. Stretch until the first sensation of stretching is reached, then hold the stretch for five seconds. Relax and repeat three to 10 times.
- If you feel more pain after stretching, wrap ice in a towel and place it on your most painful area for 10 minutes
- If your pain is usually aggravated by stretches, reduce the amount of stretch and talk to your therapist about your exercise program
And of course, massage therapy can greatly relieve soft tissue tension. If pain is due to disc degeneration or herniation, decreasing muscle tightness will help alleviate pain caused by the pain-spasm-pain cycle.
By Jill Bielawski and Jerry Weinert
Originally published in Massage & Bodywork magazine, February/March 2000.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.