Chronic headaches, migraines, and neck pain
Ross Hauser, MD . This article will concentrate on the role of the cervical ligaments and treatments that include Prolotherapy for stabilizing the neck and possibly providing a cure for chronic headaches.
Let’s look at four new research studies.
In the first study from a diverse team of Canadian researchers from medical universities and hospitals throughout Canada, doctors explored treatments for managing patients who suffered from chronic tension-type headaches with constant neck pain and muscle spasm. The muscle spasms should have been a clue that the headaches were being caused by cervical neck instability. Muscles spasm in unstable joints because they are being overworked trying to help or replace the function of damaged ligaments and tendons in stabilizing the joint.
This is shown by the Canadian doctor’s suggestion that treatments should include exercise (to help stabilize), relaxation training with stress coping therapy (to reduce spasm) and perhaps manual therapy (chiropractic) to help get the neck back in its natural position. 1
- Quick summary: Doctors found that headache had a neck instability component and the treatments offered were symptom management techniques, not curative techniques.
The connection and problems of headache and neck pain in the work place has also found recommendations from University of Turin doctors for relaxation techniques to help manage muscle spasms and tension. The doctors noted a muscle relaxation program could significantly reduce the high rate of work disability.2
Again, the researchers point to system suppression, at least in these papers attempts are made to get away from pharmaceutical management of chronic headache and do seek to find the problems of headache routed in neck pain and instability and muscle spasm.
In the third study from doctors at University of São Paulo in Brazil, researchers concluded: “We cannot assume that physical therapy promotes additional improvement in migraine treatment; however, it can increase the cervical pressure pain threshold, anticipate clinically relevant changes, and enhance patient satisfaction.”3
- Quick summary: Why increase pain threshold? Why not get rid of headache pain?
Lastly, the fourth paper doctors examined the 4th phase of a migraine cycle – The migraine postdrome – that is the physical aftermath after the migraine episode has dissipated. In this study of 120 patients, 81% reported at least one non-headache symptom in the postdrome.
Postdrome symptoms, in order of frequency, included feeling tired/weary and having difficulty concentrating and stiff neck. Many patients also reported a mild residual head discomfort.4
One notable characteristic of the patients was noted by the doctors:
There is a striking underestimation of the frequency of neck stiffness and sensitivity to light and noise.
Prolotherapy and the neck element in headaches
Do weakened ligaments in the neck cause an unnatural head posture which can cause headaches? Can strengthening these neck ligaments resolve the problem of chronic headaches and migraines by resolving the problem of cervical instability?
In our own research published in the medical journal Practical Pain Management, we showed the mechanism by which Prolotherapy effectively treated tension and migraine headaches in fifteen patients by stimulating cervical ligament repair.
Our study followed patients, on average, 22 months after their last Prolotherapy treatment and all 100% still had benefit.
Clinically significant improvements were reported including:
- decreased headache intensity level,
- number of associated symptoms and light sensitivity in patients with tension and migraine headache pain.
While our research is much more indepth, it is not a new claim. As far back as 1962, doctors reported good to excellent results in 90 percent of patients with neck and/or head pain treated with Prolotherapy.5
Typical areas treated during Prolotherapy sessions for chronic headaches and neck pain are the base of the skull, cervical vertebral ligaments, posterior-lateral clavicle, where the trapezius muscle attaches, as well as the attachments of the levator scapulae muscles. Because there is an anesthetic in the solution, generally the neck or headache pain is immediately relieved. This again, confirms the diagnosis both for the patient and the physician.
Are you a candidate for Prolotherapy for headache pain?
1. Varatharajan S, Ferguson B, Chrobak K, et al.. Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J. 2016 Feb 6.
2. Rota E, Evangelista A, Ceccarelli M, Ferrero L, Milani C, Ugolini A, Mongini F. Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study. Eur J Phys Rehabil Med. 2016 Jan 8.PubMed PMID: 26745361.
3. Bevilaqua-Grossi D, Gonçalves MC, Carvalho GF, Florencio LL, Dach F, Speciali JG, Bigal ME, Chaves TC. Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2015 Dec 21.
4. Giffin NJ, Lipton RB, Silberstein SD, Olesen J, Goadsby PJ. The migraine postdrome: An electronic diary study. Neurology. 2016;87(3):309-313
5. Hackett GS, et al.Prolotherapy for headache. Pain in the head and neck, and neuritis. Headache. 1962 Apr;2:20-8.