The goal of our Headache and Migraine Clinic here at PhysioHealth is to ensure all sufferer’s of headache and migraine have the opportunity to be assessed by a skilled practitioner to determine the potential input of the Upper Neck to their symptoms.
Often Migraine and Headache management revolves around medications, Neurology reviews, scans and injections. Over 80% of migraine sufferers complain of neck stiffness and pain and often seek some form of manual release, with varying degrees of success. Our aim is to take the guess work out of cervical (neck) involvement, provide a clear diagnosis and specific re-alignment techniques.
The medical facts…
There is a growing body of evidence that suggests primary headache and migraine are on a spectrum rather than separate diagnoses – a very different scenario to the 300+ diagnoses traditionally described under the medical model. Quality research studies show that the common disorder across this headache and migraine spectrum is sensitisation of the Trigemino-Cervico Nucleus (TCN), also known as the lower brainstem.
The TCN supplies neural input to the head, eyes, jaw and face as well as the blood vessels inside the skull. It makes sense then that a negative disturbance to this structure can cause pain in the head, on the face, behind the eye, or a throbbing or pounding sensation deep inside the skull. The combinations of pain and sensation capable of being caused by this important structure are very varied and wide reaching. Common symptoms include, but are not limited to:
- Head and/or face pain
- Visual Disturbances and Aura
- Nausea and Vomiting
- Light and sound sensitivity
- Sinus pain and tear duct leaking
- Confusion and/or dizzyness
Where does the neck come into it?
The sensitisation of the TCN that is present in all sufferers of migraine is likened to an amplifier with the sound turned way up – normal neural information passes through, but due to the sensitised state the information is hugely amplified and read by the brain as dangerous. Regardless of the trigger that pushes someone over the edge into a migraine state if we can determine that the sensitisation is caused by the neck then treatment has a great likelihood of improving pain, symptoms and regaining quality of life.
Quick anatomy lesson – this TCN – the lower brainstem sits in the dorsal horn of the spinal cord at the spinal levels of the first three cervical vertebra – i.e. the top 3 vertebra of the neck. If there is significant disturbance to the alignment of the vertebra or pressures of the disc at this level the neural input into the TCN will be greatly increased and can cause the sensitivity that leads to symptoms.
How does physio help?
The physiotherapy treatment approach at this clinic is to determine the specific alignment of the vertebral joints and to use sustained pressures in specific directions to re-align the upper spine and take pressure off the TCN. There is no high velocity cracking involved. Depending on the stiffness and mobility of the joints this may take some time to finely tune, but we should be able to notice a significant change to migraine and headache symptoms between 1-5 treatments.
Other manual release, dry needling or review of the lower neck, thoracic spine and general body mechanics may also be very beneficial to maintaining the upper cervical alignment and we always include deep neck flexor strengthening for stability of the neck to maximise the longevity of our treatments.
- Poor posture – particularly over a prolonged period of time with a chin poke position. This compressed position of the upper spine will increase pressure and increase any sensitivity of the TCN.
- Whiplash history – rotational high velocity forces through the upper neck have a high likelihood of upsetting cervical alignment.
- Concussions – similar forces to a whiplash injury and often poorly followed up, we have had significant success with treating “Post Concussive Syndrome” with gentle spinal re-alignment techniques.
- Family History – though there is no confirmed genetic component to migraine, you will inherit your neck peculiarities from your parents!
Please contact the PhysioHealth Headache and Migraine Clinic for any further information on 4207 9999, and keep up to date with hot tips for self-treatment techniques and extra information on our facebook page @PHheadacheclinic.