Headaches, like back pain, are one of the most common of all physical complaints and can be one of the most frustrating to manage. Pain of any type that occurs in any part of the head is called a headache. Tension-type headaches (also called muscle-spasm headaches) are the most common types of headaches in adults. They may be the result of a neck or jaw problem, poor posture, fatigue, or stress.A problem in the neck, head, or jaw–such as an injury or arthritis–can lead to tension in the muscles at the back of the head and to increased pressure on the nerves to the face and head. Poor posture can cause these muscles to become overworked, which can trigger a headache.
Where does it hurt?
In most cases of neck pain with a headache, patients report constant achy and stiff neck with pain on either both sides or one side of the neck. Every case is different, but usually the neck pain is in the upper and middle neck area. Usually on the side of the neck pain there is a referred headache either in the back of the head or radiating on one side of the head starting in the back, radiating around the same side of the head and into the area of the forehead or behind the eye. This is called cervicogenic headache. Your nervous system is a lot like a tree, with the ‘base’ of the tree near your neck and the ‘branches’ running through the rest of your body. Because of this, it’s possible to feel the effects of a pinched nerve or headache in other parts of your body besides your neck. For example, upper trap pain can also cause a headache. Understanding the root cause of your pain is fundamental to treating your pain in the long run and will decrease your dependence on painkillers or treatment that only addresses the symptoms.
What are symptoms of headaches from neck pain?
A tension-type headache typically begins at the back of the head and spreads to the top of the head and the eyes. You might feel an increase in facial pain along the cheeks near the jaw bone (temporomandibular joint dysfunction). People often describe a tightness, a sensation of someone tugging on their hair, or a feeling of wearing a tight cap. These headaches can worsen with specific positions–such as sitting at a desk–and may ease with rest.
Can headaches from neck pain be treated?
Yes, headaches and neck pain can be treated and with great results. Even better, many times it can be treated conservatively without needing injections, pain medications, or surgeries. The key to treatment is to solve the root cause of your pain so you can get the best results and a long term outcome.
Some root causes of headaches and neck pain can be:
- Forward head posture
- Upper neck hypomobility
- Rounded shoulders
- Weak mid back and shoulder blade muscles
- Overload to the upper trap muscles
- Tight neck and mid back
- Use manual therapy to evaluate the mobility of the joints and muscles in your neckPoor work posture and ergonomics
- Poor sleep and high stress
Some root causes of headache and neck pain, especially after major medical red flags are ruled out:
- Sleeping in an awkward neck position
- Being in an auto accident with whiplash
- Poor sitting posture at your computer or desk
- Improper heavy-lifting techniques
- Turning your neck to the side with poor posture
- Prolonged watching TV in a bad position
- Flying in an uncomfortable seat on an airplane
- Sport injury
- Sleeping with a bad pillow
If you have failed multiple treatment approaches already, your clinician missed the real root cause of your pain and was just chasing the symptoms. The pain or symptom is the effect, not the cause. What do I mean by this? Say your fire alarm goes off in your house. Its purpose is to protect you and make you aware that something is wrong, i.e., that there is a fire in your house. The “alarm” is like your pain (your body’s way of telling your something is wrong) and the “fire” is the root cause. When the fire alarm goes off, you don’t run upstairs and just turn it off, right? You run through the house with the fire extinguisher, trying to find the room where the fire is at. You try to find out what caused the alarm to go off so you can put it out. Once the fire is out, then the fire alarm can go off. Solve the “root” cause of your pain, and then the pain (“the effect”) eventually goes away.
Additionally, there is a common root cause for headache and neck pain which many clinicians misdiagnose. They treat the headache and neck pain with a cookie cutter approach, hoping it will work, and treat it as a simple muscle problem. They tend to rely on stretching, ultrasound, massage, and focus treatment directly on the headache and neck muscle. However, often the root cause is missed and the symptoms return. So many healthcare clinicians treat pain like this and thus show poor treatment outcomes which results in the pain coming back. Why? They missed the root cause of your headache and neck pain. This is also the case when patients turn to injections, nerve blocks and other surgeries which are still not effective because the actual problem still is not solved, their treatment was just chasing the pain.
The first step in treatment is to identify the root cause of your pain. A specific and individualized treatment approach for your type of pain can lead to a successful outcome for you and resolve your symptoms for the long term. This is why you can’t rely on a standard cookie cutter approach; you need a customized and individualized treatment approach specifically for your type of headache and neck pain.
What happens if it goes untreated?
Minor case – If it is a minor case of neck pain and headache, research shows that many acute cases of pain may spontaneously go away in 4-8 weeks. But who wants to wait 8 weeks to get pain free? Let’s try to solve the root cause of your pain in 2-3 weeks and address all of the risk factors present (so it never returns!) and get you back to your favorite activities faster! We still recommend that you get it checked out by a one of our board-certified physical therapists to ensure that it is just a minor case, to solve all risk factors, and to get the optimal outcome in the fewest visits needed. Most minor cases resolve on their own in time, or get better with some stretching and strengthening. But, the sooner you take action, the sooner you are pain free. (And research supports this!)
Severe case – If it’s more of a severe and chronic case of neck pain and headaches, your pain will probably start to worsen and increase because the root cause of the pain is not being treated. Headaches can be caused from many different pathologies too. Many people turn to pain medication at this time but this only blocks the pain for short term. You may not feel the pain when taking pain medications, but the underlying problem is still there. Many people say after the pain medication is stopped, then usually the pain returns and sometimes it returns even worse. This is when you may experience chronic neck muscle pain, radiating pain into your, shoulder blade, or shoulder, and the headaches start becoming worse. You may even begin to experience a migraine. At this point the trigger points in the neck muscle become painful to touch and commonly cause increased neck pain and worsening headaches. Many people overlook this as the cause of the headache. Sometimes in severe cases, it can happen on both sides of the neck. Even though it’s more chronic now, we can still help. Once the root cause is addressed, then we can start decreasing your pain, regardless of how chronic and severe the pain is. This is the crucial first step. It just may take more time to recover from a chronic case. Usually with chronic and severe cases, the longer you have your pain and injury, the longer it takes to resolve.
What outcome can you expect from treatment?
As we’ve discussed, the first step is to solve the root cause of your headaches and neck pain. This is the most essential step to plan a treatment specialized for you and your unique type of pain. Your root cause will guide your treatment and dictate what is the best way to treat your pain. This, along with identifying risk factors that may
be predisposing you to have your pain and injury, will allow you to start getting pain free again. The next step is to start decreasing pain, modifying activities, and start addressing all of the impairments causing your pain which
we discovered during your evaluation. With each session, pain should start to decrease and you should start to regain range of motion with less pain and symptoms. Any radicular and referred pain should resolve fast as well. At this
point, we begin light and basic strengthening only if it does not increase pain. Treatment will consist of a lot of manual therapy and light exercises.
The next step is to achieve full range of motion, (which should correlate to being pain-free) and now we can start progressive strengthening. Strengthening the muscles is crucial and research shows that this gives you the best long-term outcome! As you start to get stronger and maintain your mobility, your pain will continue to decrease if it is not already gone. Your increased strength will allow you to perform more activities and prevent flare-ups. This usually does take up to 4 weeks. As you clear our goals, then we can start easing you back into sport, golf, running, and whatever your favorite activities are. This is when we start winding down treatments and getting you back into functional strengthening, sport specific training, return to run programs, golfing, and whatever your goals are. In the end, we reassess everything, making sure we achieved all of our goals, your goals, that all risk factors are gone, and finalize your long-term home exercise program. There are many factors which can influence your outcome, but 85-90% of our patients respond well to our treatment approach and achieve a successful outcome when completing their plan of care.
How is it diagnosed?
when you seek help for a headache and neck pain, we will perform a comprehensive evaluation and ask questions about your pain and your daily activities.
These may include:
- How and when the pain started: Did the pain begin spontaneously or was there any trauma or injury experienced in the area?
- Where are the symptoms located, and have they changed location or intensity since the onset?
- What things make the symptoms better or worse?
- What type of work do you perform?
- What hobbies or household activities do you regularly perform?
- What is the worst your pain gets throughout the day?
- What activities throughout your day make your pain worse?
One of our board-certified physical therapists will perform a thorough assessment at your evaluation, testing: movement, the range of motion, joint mobility, strength, muscle activation, nerves, and functional movement. The therapist will also check your reflexes, do a medical screening (to rule out medical red flags and serious pathologies), and conduct special tests on your primary area of pain to determine what specifically may be involved and to rule out other conditions. The key to getting an accurate and correct diagnosis is reproduction of your pain during the evaluation. We want to find out if we change (or even decrease) your pain during the evaluation. This is the key! To provide a definitive diagnosis, your therapist may also collaborate with an orthopedist or other healthcare provider. The orthopedist may order further tests, such as magnetic resonance imaging (MRI) or electromyography (EMG) if medical red flags are present. After the evaluation, you will know exactly what your diagnosis is and what exactly is causing your pain. You will have plenty of time to ask questions to ensure that you fully understand what is going on. The next step, then, is to determine what is the best way to treat it.
Do you need an X-ray and MRI imaging for neck pain with a headache?
The average cost of care for a case of spine pain in the US is $1800-$6600. This high price is due to many factors: the over-inflated cost of healthcare, the over expensive cost of unwarranted imaging (x-rays, CT scans, and MRIs) that is not needed, over-utilization of care (which increases the number of visits needed to be treated, requiring multiple visits to different doctors and physical therapists for the same diagnosis), and getting billed for unnecessary and unproven treatments that you don’t even need. All of these factors increase cost and this is why healthcare is so expensive. We strive to end that unnecessary, expensive cycle. In fact, we are currently publishing our first-year data with the University of Central Florida that shows the cost-effectiveness of our treatment approach.
This year, the average cost of our care was shown to be $814-$1141. Some of our patients get even as low as $315 for the full treatment! So if you have a deductible of $3,000-$10,000 and you have to pay out of pocket for your treatment, we can save you lots of money.
Remember, every case of pain is different and not all a headache and neck pain is the same. It is hard to predict exactly how much your treatment is going to cost you. But after a thorough evaluation, we can tell you exactly what is causing your pain, how long it is going to take, what the best way to treat it will be, and exactly how much it is going to cost. We have no hidden fees, no co-pays, and no miscellaneous bills that you will be surprised by 3 months after you receive treatment. Your pain, your diagnosis, your goals, and what is best for you dictate your treatment and how much it will cost, and while it varies for every patient, treatment at Pursuit is still much more affordable than standard healthcare.
How can a Physical Therapist treat it?
Your physical therapist will conduct a thorough examination that includes a review of your health history. Your therapist will ask you questions and will perform tests to determine the most likely cause of your headaches. For example, your therapist might:
- Ask you to recall any previous injuries to your neck, head, or jaw
- Ask you the location, nature, and behavior of your pain and other symptoms
- Ask you to draw your areas of pain on a body diagram
- Perform tests of muscle strength and sensation
- Examine your posture when sitting, standing, and performing various activities
- Measure the range of motion of your neck, shoulders, and other relevant parts of your body
- Use manual therapy to evaluate the mobility of the joints and muscles in your neck
If it appears that you do have tension-type headaches, your physical therapist will work with you to design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache–such as sinus, migraine, or cluster headache–your physical therapist likely will refer you to another health care professional for additional diagnostic tests and treatment.
Your physical therapist will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes in your posture and lifestyle:
Improve neck mobility. Physical therapists use a specialized technique called manual therapy to increase movement and relieve pain and to stretch the muscles of the back of the neck.
Improve your strength. Your physical therapist will teach you exercises to increase the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance and make it easier for you to sit or stand for longer periods of time without discomfort.
Improve your posture. Physical therapists will teach you to ways to improve your posture. Whether it is simply pushing your chest out or pulling your shoulder blades backward and together, slight modifications to everyday living can make a vast improvement in posture.
Modify your workstation or home office. Tips may include:
- using a headset instead of a regular phone
- adjusting your computer screen so that it is no lower than the level of your eyes
- finding an appropriate desk chair
- adjusting the position of your computer mouse