Published March 2007

Headaches can be a real pain in the neck. They are an almost universal complaint with 90% of Americans saying they’ve experienced a least one bout of head pain in their past. But what if the headaches keep coming back or never really go away? Approximately 1 in every 6 individuals or 45 million people in the United States suffer from chronic headaches. Also known as “cephalgia,” headaches cost billions of dollars in treatment expense and lost worker productivity every year. Headache symptoms which persist and worsen call for a visit to your primary care physician to begin the process of diagnosis and treatment.

There are a number of different ways to classify headaches. They can be referred to as either secondary or primary. Secondary headaches occur as a result of some other condition such as a stroke, infection, brain tumor or head injury. Primary headaches, on the other hand, occur when the headache problem is the disorder. These can be further categorized as one of three main types: vascular, muscle tension and cervicogenic.

The most common type of vascular headache is migraine. Migraine headaches are usually characterized by throbbing pain on one or both sides of the head with a combination of nausea, vomiting and sensitivity to light and/or noise. About 15% of migraine sufferers experience an aura such as vision changes or disruption in taste, smell or touch as a precursor to an attack. While circulatory changes occur during a migraine, the cause is actually thought to be chemically mediated and neurologic in nature. According to nurse practitioner Penny Bernards, a headache specialist at the Neuroscience Group of Northeast Wisconsin, about 40% of migraines affect both sides of the head. Almost three times as many women as men are afflicted by migraines and 60% of the time there is also complaints of neck pain. Being alert to physical or environmental triggers such as certain foods, hormonal patterns and stress will help develop individualized treatment strategies and assist in determining if and what type of medication should be prescribed in your case.

Tension headaches are typified by a constricting sensation or “vice-like” ache felt in the head, neck and jaw musculature. Contributing factors may include anxiety, fatigue or unresolved anger. Caffeine and nicotine intake also may play a role. Tension headaches have been correlated with myofascial pain dysfunction in which one frequently experiences pain in the temples and in front of one or both ears which tends to worsen with chewing, yawning or talking. Mouth opening range of motion may be limited or out of balance. Treatment is aimed at identifying and extinguishing muscle guarding and faulty movement patterns. Inform your dentist or oral surgeon if you find yourself grinding and clenching your teeth. Massage, yoga and physical therapy may help with relaxation training.

Cervicogenic headaches (CGH) originate in the neck and involve the anatomical structures innervated by C1 to C3, the top three neck vertebrae. The International Headache Society has established criteria for diagnosing CGH: Pain is typically located at the base of the head and may project to the forehead, orbital (eye) region, temples, vertex (top of the head) and ears. These headaches are precipitated and aggravated by neck movements or sustained neck postures. Painful limitation or asymmetry in upper cervical motion along with changes in the neck muscle contour, texture, tone or response to stretching is commonly seen. 50% of CGH are related to trauma and may be accompanied by dizziness or difficulty swallowing. A skilled manual physical therapist is trained to find and treat movement restrictions associated with cervicogenic headaches. Studies have shown that manipulative therapy and exercise can reduce the symptoms of CGH and these positive effects are maintained over time.

Thankfully less than 5% of all headaches are considered potentially life threatening. The National Headache Foundation ( does advise you to consult your healthcare provider if your headache is sudden and severe, occurs with a fever or includes significant neck stiffness with uncontrollable vomiting. If you are over 50 years of age, your headache occurs after trauma or includes bouts of confusion or a loss of consciousness; prompt medical evaluation is strongly encouraged. Any headache that is accompanied by numbness, weakness or vision loss should be looked into. In general, any headache which clearly interferes with your ability to function normally at work, rest or play warrants further examination.

Mark Shropshire, MSPT is a licensed physical therapist and board certified orthopedic clinical specialist. He is the owner of Motion Synergy Physical Therapy, LLC in Appleton where he practices osteopathically based manual physical therapy. For additional information call (920) 730-9400.