There are no fun headaches, and yet the range of possible headache pain severities and types is vast. The pain of neuralgic (nerve pain) headaches is a pain so severe that most of us will thankfully go our whole lives without exeperiencing a pain that intense. At the other end of the spectrum there is the kind of mild tension headache that many of us experience regularly in relation to a wide range of triggers.
You and I can both have the exact same strain of virus and exhibit fundamentally similar but differing symptoms during its course. I used to get a bad cough after every virus that came along as a kid, it didn’t mean I had a different virus the one my friends and family had though. It just meant that my general constitution was different to theirs so the virus effected me differently. Could it be that the same principle holds true for different types of headache? Different symptoms but same basic underlying cause?
Many of the people who come to my office looking for help with headaches have multiple headache diagnoses. It is quite normal to find that a person suffers with tension type headaches, cervicogenic headaches and migraine headaches for eg.. Given these 3 are so common and account for more than 95% of all the headaches that show up at my clinic let’s take a quick look at these 3 in turn.
Tension type headaches are somewhat poorly understood and are also the most commonly diagnosed headache.
Tension type headache is very common, with an estimated lifetime prevalence in the general population ranging in different studies between 30% and 78%. Tension headaches are known to have a major socio-economic impact made up largely of missed work hours and inflated healthcare costs.
The very nature of tension type headaches has made them completely baffling from the perspective of traditional medical thought. Medicine does extremely well with things that it has the technology to measure, like broken legs and malaria. There is currently however no blood test or scan that can diagnose or explain a tension headache. This has meant bizarrely that it is only a relatively recent development that medical ‘science’ has acknowledged they might actually be a real physical complaint; as opposed to purely psychosomatic.
The official medical line on tension headaches is in it’s essence ‘we don’t really know what they are’. And yet, medicine does have a name for them and a genuinely helpful list of diagnostic tick boxes to help with identifying them.
So basically the only way we have of distinguishing tension headaches from other headache types is by the type of symptoms. And in this case symptoms are not much to go by. Remember after all, as I child I had the same virus as my family but different symptoms.
Cervicogenic headaches are extremely common. Many have experienced them and yet very few people have even heard of them in medical terms. The International Society For Headache Classification define cervicogenic headaches roughly as follows… ‘
‘Headache caused by a disorder of the cervical spine and its bony, disc and/or soft tissue elements, often accompanied by neck pain’.
So, unlike the good old migraine and tension type headaches, the cervicogenic headache does have some more substantial theory behind it. We know that these type of headaches are caused by or at least closely associated with pain and stiffness in the neck. There is no scan or blood test for neck tension but you can manually test for it if you have the training to do so.
There are no reliable stats on the prevalence of cervicogenic headaches. Two observations I have for you are however that in twenty years of managing headaches on a daily basis I have yet to meet someone who’s doctor had diagnosed them with cervicogenic headache, despite the fact that most of my patients in that time have easily fit the official international diagnostic criteria. This is a clue that while cervicogenic headaches are out there, they are not being diagnosed.
Migraine headaches are extremely common and are generally much more severe than regular headaches. A giant heap of studies have documented migraines high prevalence and its socio-economic and personal impacts. In the Global Burden of Disease Study in 2010 (GBD2010), it was ranked as the third most prevalent disorder in the world.
Like tension type headaches migraines have baffled medicine for as long as they have been diagnosed. There is no scan or test to diagnose migraine, we know they are a physical thing but they are not a thing we have much ability to capture or measure.
There have been some small ‘migraine footprints’ identified in the form of alterations in blood flow around the brain and changes in brain chemistry but that’s about it. It is worth bearing in mind that these blood flow alterations are most likely just a symptom of whatever is really causing the migraine, in the same way that changes in blood flow around an injury are not the actual injury.
So, if you ask your medical doctor what causes migraine they will most likely mumble something about blood flow to the brain. This isn’t really based on much. It is not my intention to criticise the fact that medicine hasn’t cracked the case you understand, I am just making sure we’re clear that it hasn’t. Officially, we don’t really know what migraine is!
Needless the say we have all been taught to think that a migraine headache is a separation condition to any other type of headache. This is kind of the original idea behind giving them all different names. There can be no doubt whatsoever that there are many forms of headache and that there are numerous different physical processes that can lead someone to suffer with headaches.
If you peruse the International guideline for headaches diagnosis, what you see at first glance is an intimidatingly long list of headaches with long names. At second glance it also become apparent that there is a good deal of overlap. Common headaches with different names are frequently listed underneath one another and acknowledged to be connected, at least in some patients.
This fact points to our blossoming truth… many seemingly different headaches are actually different forms of the same headache with a shared underlying cause. Some people have cervicogenic tension headaches, some people with tension headaches sometimes get one that spills over into a migraine, and a fun list of other possible combos.
The Cause Of Headaches
My experience with successfully helping more people with headaches than I could ever recall or recount has lead me to an unusual belief. I believe that something like 90% of headaches have the same basic cause, the same way I believe that 90% of toothache has the same basic cause.
I believe that the common headache varieties are caused by a swirling and complex mixture of 4 key lifestyle factors..
- Emotional Stress
- Postural issues
- Old injuries
If we take these 4 areas and combine them under the heading of ‘headache lifestyle’ then we have the cause of migraines, we have the cause of tension type headaches and we have the cause of cervicogenic headaches.
Your specific and unique cocktail of lifestyle factors and your specific and uniques cocktail of headache types are all tied up together in a neat parcel. The unique combination of ‘headache lifestyle’ factors you carry will explain why you might have the same headache as your neighbour but with different diagnosis.
You may have genetic factors that come into play, you may have triggers that don’t fall under the headings above, yet if you can deal with the factors above you have an excellent chance your headaches will stop.
I hope this has at least loosened your grip on what you think it means to have a certain type of headache or another. The truth is there is so much we don’t understand about headaches that an open mind is the only logical conclusion.
My theories are based on experience but nonetheless they are still just theories. Don’t take them at face value though, try them out and see if there is any truth to what I am saying. Have you always been able to feel tension in your neck when your migraines come on? Do you get fewer headaches when you avoid dairy and gluten? Have you got an old whiplash injury in your neck that was never dealt with? Do you always get more headaches when you are stressed? These are the real questions, and if the answer is yes to some of them maybe some of my theory applies to you.
I write these blogs out of a desire to help people think more deeply about their pain, in ways that open up the wide world of possible fixes. The overwhelming majority of stubborn pain conditions can be resolved with the right tools and understandings. And that’s good news because living with persistent pain is a really basic part of what makes up a happy healthy life.