Headaches are a headache for not only those who suffer them, but also for the medical profession as a whole. The primary reason is because there is so much complexity surrounding the nomenclature let alone the pathology, so let us try and make things simple and understandable, knowledge being empowering.
Headache is a title, rather like ‘motor vehicle.’ What do you travel to work in? A 50cc electric scooter, a Humvee, Range Rover, Swift, what horsepower, fuel, electric, LPG, CNG, petrol or diesel, colour, seating formation, number of doors, you see the picture.
Headache means an ache in the head — always unpleasant, but hugely differing diagnoses and treatments, so let us start splitting headaches into various categories.
Headache 1: Trauma headache
If you are hit on the head with a bottle of whisky you will have a headache.
Headache 2: Chemical headache
If you drink a bottle of whisky you will have a headache.
Headache 3: Disease headache
Meningitis, leptospirosis, Covid, influenza, and many other diseases can cause headache.
Headache 4: Tumour headache
Cancers, tuberculosis, benign tumours and other growth in the brain or cervical spine may be a cause of headache.
Headache 5: Blood vessel headache
Strokes are the most common blood vessel headaches, but aneurisms or blockages can occur, all which can be first noted by the onset of a headache.
Headache 6: Mechanical headache
Small spinal joints in the neck can impinge on various structures within the spine and cause headache. It has been estimated as much as 70% of headaches come from the cervical spine.
Headache 7: Stress headache
Surprisingly low cause of headache, but we will expand later in this article.
Headache 8: Unknown
Atmosphere radio waves, loud music, eyesight strain, and “the medical profession just does not know” fall into this category.
When a patient presents at a medical clinic with a headache, the provider will usually consider a worst-case possibility and work backwards. This is the safety plan for patients, and while it may frustrate patients that the medical provider seems too cautious, severe and lasting consequences can arise with misdiagnosis of headache than most pathologies. For example, while it may seem simple to diagnose a trauma headache, the most difficult events do not leave obvious skull lesions. The brain sliding forward within the skull creating internal damage can be far more devastating than an open obvious trauma injury resulting in headache.
A similar problem can arise from chemical headaches. The sudden ingestion of alcohol may be obvious as a precipitating factor for headache, not so much the slow accumulation of chocolate, breathing in fumes of chemicals adverse to the human body, lead or other poisoning from using paints, sprays, and even explosives, (both civilian and military use) with poor protocols. Carbon monoxide is another headache producer that we are exposed to daily, yet we have no measure in normal circumstances. Also, there is the matter of smoking, which not only creates carbon monoxide, but nicotine can also be the cause of headache. There are even headaches caused by a disgruntled spouse eliminating his or her headache as read in a crime novel. Opposite, in a loving relationship blood vessel headaches may be apparent — not all headaches have to be sinister pathologies. Sex can trigger a headache, genuinely, not always a “sorry darling”.
In broad terms traumatic headaches require treating the trauma, chemical headaches balance the chemical imbalance, disease invoked headaches treat the disease, etc.
The majority of headaches are at least in part postural exacerbated for some people who have genetically thicker blood vessels in the neck, where the vessels travel within a boney canal and any impingement can create headaches — rather like watering the garden and the hose becoming kinked thus reducing the amount of oxygen to the brain. There’s enough to provide and survive, but quality of life is diminished. Often when these arteries are impeded in blood flow the posture of the headache sufferer is poor and the joints of the cervical spine become locked onto the artery. Physiotherapy can often help as a first choice of treatment for these types of headaches. If physiotherapy is the best form of treatment, the most important treatment is the follow-up when all symptoms have settled. The spine can be reviewed when asymptomatic and a Gold Star Prevention Programme can be implemented. Think of a headache as a neck attack, just like a heart attack. The best treatment is three months post-episode when a clear review by your provider can then set a programme while healthy, not debilitated.
Stress headaches are often an overused excuse for a person having a headache. While stress seldom causes a headache, stress can add to an existing pathology, but must not override any other cause. Take, for example, being told your house is on fire, the dog has run away, your spouse or partner has just been fired from work, and Johnny/Jenny has just received a D for English. That is stress, but few people choose to suddenly have a headache over sorting the problems presented. Stress does cause a bunching of the shoulder girdle muscles, which caused loss of movement in the neck, which can cause blood vessels to reduce oxygen to the brain. The stress is not the cause, it’s just a contributing factor.
So, short of seeking a medical diagnosis, what prevention and good health regimes can be applied?
Look to the worst being eliminated first.
Unilateral one arm exercises above the head loosen the shoulder girdle.
Neck slides, doubling the chin, and also sliding sideways, both sides assist.
Sitting upright with the chin on the bent elbow, make a fist with your hand (the Thinker’s posture, except without the slump).
One pillow, not two, when sleeping at night. Tilt your bed slightly, not your neck for seven hours.
Watch out for two main potential sinners: alcohol and smoking.
Make a loose circle thumb and forefinger — at the base of the circle in the web of the thumb find the tender point and massage. That spot is the acupressure point and can reduce headaches.
Most of all see a primary medical provider who is interested in headaches and has read outside the script. This point alone will take the heartache out of a headache that might otherwise be a blight on your quality of life for more than a single episode. Headaches are not normal and fortunately, despite the gaps in our knowledge, most headaches can be successfully treated and not cause the bewilderment, fear, and apprehension they currently can do.
Keep fit
Malcolm and Rebecca.
Thanks to Doctor Mike Bowen, Former All Black Sports Medicine GP. for peer review.