Headaches, Migraines, Facial Pain, and their Relationship with Neck Pain.
The two most common types of headaches have one thing in common, Neck Pain.
Tension-Type headaches and migraines are the most prevalent types of headaches and often times the individuals that suffer with these headaches also have neck pain.
There are many different treatments options for headaches and migraines; ranging from self-management to surgery and prescription drugs. One thing that we know is that for many individuals that suffer with migraines and headaches, neck pain is often there as well and for many of these individuals once their neck gets addressed the headaches and migraines start to be less painful, less frequent, or all together go away.
What is it that causes our neck to be so closely tied to the most prevalent types of headaches?
Before we go down that rabbit hole lets dive a little deeper into the numbers on migraines, headaches and neck pain.
Some numbers for you.
Up to 88% of individuals with tension headaches have neck pain.
Up to 76% of individuals with migraines have neck pain.
Up to 89% of individuals that have tension headaches and migraines have neck pain.
Why is it that so many individuals with headaches also have neck pain? Well it has to do with an area or rather group of parts of the neck and head that make up the Trigemino-Cervical Complex.
Quick synopsis. Essentially many headaches and migraines are caused by referred pain from the neck causing one to feel like the pain is coming from the head or inside their head when in actuality it is due to an issue in the neck and the pain is due to referred pain because of the neurological connections and overlap between the head and the neck.
Let's get back to it.
What is the trigemino-cervical complex?
A section of the brainstem and spinal cord that starts at the medulla and extends down towards the second bone in the neck. You can see a full representation below, depicted by the yellow lines.
What makes this area of the spinal cord and brainstem so important is that information is being sent in and out of these areas from multiple parts of the head and neck and information is also being processed in these areas to a certain extent.
Take a look at the area on the bottom of the picture that says, "Spinal Nerve C2"
The C2 spinal nerve controls multiple muscles, specifically two muscles at the back of the neck called the rectus capitis anterior and rectus capitis lateralis.
The C2 spinal nerve also gets sensory information, meaning it conveys to the brain what we are feeling in an area, from the side of the face (orange on the picture below) and the back of the head and neck (green area on the picture below).
It receives all this information and sends it to an area of the Trigeminal Cervical Complex (TGCC) called the Pars Caudalis. Before reaching the pars caudalis though this information goes to an area called the trigeminal ganglion. The Trigeminal ganglion also receives information from the blue and pink areas of the picture to the left.
Essentially you have a lot of information coming from the head and neck and converging in one area, the trigemino-cervical complex.
When there is altered alignment of the neck and head it causes uneven pulling on the muscles, tendons, ligaments, and fascia that surrounds these tissues. This then puts pressure on/inflames the structures that send signals to the trigemino-cervical complex leading the body to perceive pain in an area(head and face) when it actually is coming from that a different spot the neck. When pain is felt somewhere else rather then where the damage is occurring this is called referred pain.
Due to how the body develops there is an overlap of information coming from the head and face and information coming from the neck. Therefore when there is abnormal alignment of the neck the pain in that area can cause pain in the head and face. For many individuals this results in migraines, headaches, and/or facial pain.
What's the solution?
History first. Migraines are complex and while the neck can directly cause migraines, facial pain, and headaches to occur, for some individuals that's not the case. That makes a thorough history and evaluation key to making sure that an individual who is experiencing migraines, facial pain, or headaches have indications that it is coming from the neck.
If there is a problem in the neck that's causing or contributing to the headaches and migraines that is where we come in. During our evaluation we look at how the neck is functioning measuring how well it moves(range of motion) and if that's normal or it causes pain, if movement of the neck into different position causes the body to become off balance. (The picture on the bottom right shows the distance someone sways when holding their head in 10 different positions, if the path length gets longer, more instability/imbalance, it means there is dysfunction of the neck in that position).
We then also look at how well the neck is functioning by performing a test called the Joint Position Error Test. Essentially this test is looking at how well our neck knows where it is at by bringing it to a position with eyes open then closed. (We've talked previously about how the eyes and neck are connected and you can read more about that here.) We then also look at how well the body is coordinating balance using a test called the modified Clinical Test of Sensory Integration and Balance, mCTSIB. The combination of this information give us an idea if the neck is a contributing factor or possible cause of the facial pain, headaches, or migraines and to what extent.
If the data-driven exam has led us to the conclusion that the headaches, migraines, or facial pain is being caused or worsened by abnormal function and alignment of the neck we then move forward with care at our office. Our care includes data-driven chiropractic care, and any rehab that is necessary, whether that is strengthening the muscles of the neck, improving the coordination between the eyes and the neck or retraining the muscles of the neck.
If you or someone you know suffers with headaches, migraines, or facial pain and they're looking for a in-depth look and solution to what could be causing their pain have them call us at 614-769-7831 to schedule your or their complimentary consultation or click the link below to reach out to us via email.
As always if you have any questions about this blog or would like another topic covered in depth you can email me at drcoffman@optimizecolumbus.com
Have a great day!
-Dr. Jake
References
Castien René, De Hertogh Willem; A Neuroscience Perspective of Physical Treatment of Headache and Neck Pain. Frontiers in Neurology, VOLUME 10, 2019: https://www.frontiersin.org/article/10.3389/fneur.2019.00276 DOI=10.3389/fneur.2019.00276
Goadsby PJ, Bartsch T. On the functional neuroanatomy of neck pain. Cephalalgia. (2008) 28 (Suppl. 1):1–7. doi: 10.1111/j.1468-2982.2008.01606.x
Johnston MM, Jordan SE, Charles AC. Pain referral patterns of the C1 to C3 nerves: Implications for headache disorders. Ann Neurol. (2013) 74:145–8. doi: 10.1002/ana.23869
Luedtke K, Starke W, May A. Musculoskeletal dysfunction in migraine patients. Cephalalgia. 2018 Apr;38(5):865-875. doi: 10.1177/0333102417716934. Epub 2017 Jun 22. PMID: 28641450.