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Headaches

Headaches are very common and arise from different sources within the head and neck. Across the globe, 46% of people experience one or more type of headaches. In the United States, migraine headaches affect 12% of the population, including 18% of women, 6% of men, and 10% of children. This affects 1 in 4 households. Headaches arising from the neck affect over 4% of the population.

Sensory nerves from both the head and upper neck bring pain information into the upper spinal cord. This is why problems in the upper neck can be felt as headache, and problems in the face or head can be felt as also neck pain. The Denver Spine and Pain Institute providers can diagnose the source of your headache pain and direct treatment accordingly. We commonly work with neurologists and primary care providers to diagnose and manage headaches, especially when there is an upper neck problem that leads to aggravation or increased frequency of primary headaches such as migraine. We make use of careful history, physical exam, and imaging to arrive at a diagnosis and to create an individualized treatment plan, often teaming up with physical therapy, manual therapy, the use of medications, relaxation training, and other psychological approaches as part of our Connected Care Approach.

Headaches can be broken down by source into the following categories:

Headache Red Flag Emergencies

There are some headaches that require immediate medical attention. Headaches that arise along with the following symptoms should all be assessed quickly:

Similarly, if the onset of the headache is sudden and severe, or the onset is in someone greater than 40 years old, these also should not be ignored. If a prior headache history is different or progressive from the current headache, these should also be evaluated by your medical provider or your local emergency room department.

Headaches Arising from Structures of the Face and Neck

Central Neuropathic Pain (MS, stroke) and Facial Neuralgias (Nerve Pain)

Central neuropathic pain is a neurological condition caused by damage to the brain, brain stem or spinal cord. It can be caused by stroke, multiple sclerosis, tumors, epilepsy, trauma, or Parkinson’s disease. The pain is often described as prickling, tingling, pressing, piercing, aching, burning or brief but severe episodes of sharp pain. It can be felt in any part of the body, including the head, face, and neck.

Post-radiation treatments for cancer or other radiation exposure may cause injury to nerves and neuropathic pain, sometimes years after the exposure. This would be treated like other forms of neuropathic or neuroinflammation related pain.

Primary Headache (migraine, cluster, others)

Migraine headaches can occur with or without an aura and can be chronic or episodic. The mechanism for migraine headache occurs through a dysfunction of the trigeminovascular system within the brain, which causes activation and stimulation of the nerves, and dilation of the blood vessels through chemicals such as calcitonin-gene related peptide (CGRP), substance P, and neurokinin A. The result is inflammation and pain, called neurogenic inflammation. Many of the treatments for migraine headache target this neuroinflammation, and some of the newer medications specifically target the CGRPs.

Headaches Arising from the Neck (Cervicogenic Headache)

Anatomy

The nerves of the upper neck merge with the nerves coming into the upper spinal cord from your head and face (convergence) before sending pain signals to your brain. Your brain has trouble deciding whether the pain is from your neck, head and face, or both. These types of headaches are called cervicogenic headaches, as they come from the neck (cervical spine). Injury, mechanical stress causing irritation, or inflammation of joints, discs or nerves of the upper neck can cause these headaches.

Prevalence

These cervicogenic headaches effect over 4% of the general population and up to one third of all patients with headaches have cervicogenic headaches. They can also occur along with other types of headaches, including migraine headaches. When this is the case, the headaches from the neck often spark migraine headaches, leading to higher frequency and severity of the migraine problem. Treating the neck problem can not only alleviate the headaches from the neck but also help reduce the severity of the migraine or other headache problem.

Diagnosis

The providers at The Denver Spine and Pain Institute are frequently asked to diagnose and treat headaches, especially looking for headaches that come from the neck. We often treat these in conjunction with neurologists, primary care doctors and other physicians. The diagnostic process begins with a careful history, physical examination, and the use of imaging to assist, as well. When needed, diagnostic injections can be performed to pinpoint the source of the neck pain and headaches. Physical therapy and medication treatment responses can also sometimes be helpful in determining your specific diagnosis. We gather information from all sources and use this to make a specific diagnosis and create an individualized treatment plan for you.

Headache Treatment

Physical Therapy

Whether your headaches are arising from injury or inflammation of the structures of the upper neck, or these structures are reacting to headaches from another source, the mechanics, joint movement, and muscular balance of the neck must be addressed as part of your overall treatment plan. The physical therapists at The Denver Spine and Pain Institute are skilled at treating upper neck and headache problems, and we can also assist in finding other skilled physical therapists near your home, if you are outside of our area.

We also work with other manual therapists who treat the joint dysfunctions, although we believe that addressing the muscular balance and proper firing patterns of the muscles is also very important and requires skilled physical therapy.

Ergonomics

The positions and methods used during work, including desk or labor type work, recreation, such as bicycle riding, or positioning for other daily activities like working in the kitchen, sleeping, or reading can have an impact on your pain. Attention to the way in which things are done, the positions for activities, and modifications made to certain activities is known as ergonomics. We believe that proper instruction or help with modifications which may allow you to better enjoy your favorite activities is an important part of our treatment plan.

Medications

There are many medication options available to assist in the treatment of headache pain. Your provider will give you education regarding the most appropriate medication options for the treatment of your headaches and assist in making a mutual decision regarding the appropriate choice for you. This will be done by discussing the pros and cons as well as side effects of certain medication options. We may also suggest newer medication options, such as those for migraine headache, and often work in conjunction with your other medical providers in the coordination of care.

Injections

Injections or upper spine procedures can be very helpful in making the diagnosis as to the source of your upper neck and headache symptoms. This treatment may include injection of corticosteroids, or procedures may take away the sensation from injured joints or areas that have been diagnosed as the problems (radiofrequency ablation). In rare cases, spinal cord stimulation or other neuromodulation techniques can be utilized. When muscular problems are a key component of the pain (myofascial pain/trigger points) trigger point injections can be performed in the office. This is often combined with massage therapy, physical therapy, or dry needling efforts. The providers at The Denver Spine and Pain Institute will help you choose the right procedure option for you, always taking into consideration the pros and cons of the procedure, as well as any financial and corticosteroid exposure concerns that you may have.

Psychology

Tension and postural issues often play a role in aggravating upper neck and headache symptoms. Muscle tension, including muscle tension headaches, can be addressed through programs that include frequent stretching, proper ergonomics, as well as relaxation training. We may recommend biofeedback or relaxation training with a psychologist, such as Joy Simpson, LPC, at MindYourPain, to assist you in mastering relaxation techniques that can have a positive impact on alleviating your headaches.

Lifestyle

As we learn more and more about pain, we realize the importance of regular exercise, stress management, proper sleep, proper diet and use of supplements to assist in the treatment of your headache pain. Managing these aspects of your lifestyle can directly reduce inflammation, promote relaxation, and have other positive benefits that reduce your pain.

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Exceptional Headache Care

At the Denver Spine and Pain Institute, we have seen firsthand how headaches can significantly impact your life, making it difficult to participate in your favorite activities and even perform routine daily tasks.

We have specifically designed our exclusive Connected Care Approach™ to get you back to enjoying your life faster. This approach involves:

  • A full spectrum of care, including physician treatments, physical therapy, massage, diet and lifestyle education, behavioral health, research, and state-of-the-art treatment options.
  • Mobilizing an experienced team to coordinate your care.
  • Discussing options and offering guidance to help you make an informed decision.
  • Developing caring and therapeutic relationships to address your individual needs.

Schedule an Appointment

Please contact us today to schedule an appointment. The Denver Spine and Pain Institute serves patients in Denver and the surrounding areas of Colorado.

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