It can be difficult for us to determine what is causing our headache. Chiropractors are trained to find misalignments in the cervical spine that put pressure on the nerves which can cause pain and headaches. They can also help identify forward head posture, or tech neck which is a leading cause of tension headaches.
Could you start us off by explaining what a cervicogenic headache is, what causes it, and what it feels like when you have one?
Dr. Gregg Rubinstein: That’s a really good question. A lot of headaches, they call them or brand them vertebrogenic or cervicogenic headaches. It’s a common term used by medical doctors to describe headaches that are usually related to issues in the cervical spine or the neck. Typically, when the upper cervical vertebrae are out of alignment, they can put pressure on the delicate spinal nerves that recur and go back into the head, or even put pressure on the brainstem area. Those upper cervical nerves contribute to migraine headaches, tension headaches, and sometimes things called cluster headaches.
Many types of headache can be related to misalignments in the spine. The vascular type or the migraine headaches are very common, and it has an important relationship to the cervical spine because the vertebral arteries, which are primarily the main feed of blood supply to the brain, is actually housed and contained inside of some of the vertebrae. So, if there’s misalignments, it’s kind of like putting a kink in the hose and that can alter the flow of blood to the brain. Since nerve system controls vasodilation or vasoconstriction, typically that’s the mechanism involved in many migraine headaches.
So, by correcting the alignment, you can actually eliminate that and improve blood flow to the brain and stop those pulsing headaches that people associate with migraines. And also improving the blood flow to the brain helps get rid of the visual disturbances, the photosensitivity, all that, because primarily migraines seem to be the vascular type of headaches.
Now tension headaches are a little bit different and that’s when a lot of the muscles in the neck and in the back of the neck at the base of the skull tighten up. And when they start to get really tight, they can pull the bones out of alignment and irritate the nerves that exit between the vertebrae. And again, since some of those nerves in the upper cervical spine recur and go back and affect structures in the head, we can go and we can see these headaches as well.
The other thing that we see is that forward head posture is going wild today. Everyone’s leaning forward, looking at their computer screens, looking at their iPhones, looking at their iPads. So, the forward head posture pushes the head forward. And then the muscles have to kind of pull the neck back or hold it up almost like reins with a horse. And then those muscles get tight and start to spasm, and again can contribute to the headaches as they start to squeeze a lot of the structures, the blood supply, and the nerves all up in the head. So, there’s a lot of sensitivity to forward head posture and misalignment that can contribute to headaches. And that’s what they call cervicogenic or vertebrogenic headaches.
What exactly is a pinched nerve in the neck and what causes it? Is a stiff neck considered the same thing, or is that a different issue? And can those issues cause headaches?
Dr. Gregg Rubinstein: Wow, three-part question. I hope I can remember it all and get through it.
RC: I’m sorry!
Dr. Gregg Rubinstein: No, it’s okay. A pinched nerve is really just a lay term for what we call a chiropractic subluxation. And a subluxation defined is really a vertebrae that’s misaligned, it’s fixed or stuck in that abnormal position and they’re pinching or irritating the nerves that they’re usually designed to protect. So, when those misaligned bones irritate the nerves, they alter the function of the nerve and distort the messages that are being carried through these nerves, which are called action potentials. And that distortion can contribute to inefficient communication and maybe even cause dysregulation in the body, since your nerve system not only senses pain and move muscles, but it runs and regulates your entire body, including your stomach, your heart, your liver, your kidney, your spleen, your intestines are all regulated by that nerve system.
That’s why chiropractors always put the nerve system first. And why clearing pressure off this nerve system could help alleviate symptoms of many different things. Neck pain is one thing, but also a host of other issues, like TMJ problems, all kind of respond well to cervical adjusting. So, when we have these misalignments or pinched nerves that can happen. Also, when there’s irritation to the nerves the muscles can tighten up and that can cause neck stiffness. But on the flip side of that, when those muscles tighten up from stress and tension, they can also pull the bones out of alignment and contribute to a subluxation. So, a stiff neck can often be related, but you can also have a stiff neck from an accident and it doesn’t necessarily have to be from a subluxation.
And yes, those issues, as we mentioned before, can all contribute to headaches because any misalignment that affects the neck and the upper cervical spine have a high likelihood of contributing to headaches. A lot of headache sufferers get great relief when they see a chiropractor. And the best part about chiropractic is you’re not taking drugs, you’re not taking aspirin repeatedly. And all these medications do have somewhat of a negative effect on your overall body’s health, which they call side effects. But sometimes they’re really just direct effects of taking the medications.
Can you explain how muscle tension in the neck can result in a tension headache and what that feels like for a patient?
Dr. Gregg Rubinstein: So, again, lately we got a lot of people spending a lot more time in front of their computers and using their phones for work. And they’re developing that forward head posture, or what’s lately been called tech neck. And as the head starts to move forward, it puts a lot of strain on the muscles in the neck. And you’re always trying to hold your head and neck upright, and when these muscles fatigue, they’re going to tense up, eventually can even spasm. And when these spasms occur then they’re tightening up, squeezing, you’re getting less blood supply to those muscles in the area. So, they’ll start screaming out for oxygen. And that can cause like that tension, achy feeling at the base of the skull. Tension headaches can kind of be related to a lot of that. And just that feeling of stiffness at the base of the neck and those nerves will kind of even make the pain kind of radiate forward, some people get that pain behind the eyes. So, it’s really interesting.
When those bones are out of alignment, a chiropractor can make an adjustment and change that pattern of alignment, get the pressure off the nerves. And when you make an adjustment, you break up the fixation, you also provide a quick stretch and any time you stretch a muscle a muscle should relax. That’s how chiropractors can help people deal with these tension headaches and tight neck syndromes with limited range of motion.
You talked about tech neck, but can tech neck cause headaches?
Dr. Gregg Rubinstein: Wow. I always seem to be just one step ahead, but like I said, great minds think alike. And if I stole your thunder on your last question, I’m sorry. But yeah, my previous answer about tech neck or text neck is common now.
What’s interesting is that the generations now are being raised with technology. I see six-year-olds with iPhones and iPads, right? I don’t think I even had my first cell phone till I was 30. And I don’t think I had my first smartphone till I was 35. And my first computer, I think I got in my late twenties so we didn’t grow up with these technologies.
And I’m certainly seeing a change when I x-ray some of the younger people now, because when I first started practicing 29 years ago, it was not that common to see a lot of loss of the cervical curve, or reversal of the curve, or that forward head posture. Now, when I routinely x-ray people under 30, I see it very often, especially in the generation that grew up with the cell phones and the computers. So, it’s much more common. This forward head posture has really been studied a bit, and it shows with people with lost cervical curve and forward head posture have headaches much more frequently. And there’s even a couple of studies out there that suggest that people with these forward head postures don’t live as long, and were nowhere near as healthy as people with proper alignment and proper curves in the neck.
That’s why chiropractic is so important today in restoring the curve, improving mechanics, and getting better alignment. Because if the mechanics are not restored, we limit how much flow of nerve energy. And also, when things aren’t lined up, we can see an increased amount of degenerative change or arthritic change, bone spurs, disc height loss. Because when things aren’t mechanically smooth, we’ll start to see more wear and tear because there’s more grinding and more pressure on these nerves.
We’ve all seen that 70-year-old guy all hunched over and he didn’t just wake up one day, look in the mirror and say, “What happened to me?” These things happen slowly over time and develop. And that’s why it’s important for periodic checkups for adults, and children as well, to prevent tech neck and limit and mitigate the effects of tension headaches and these problems in your life.
Are there any other problems in the neck that could cause headaches that we haven’t discussed?
Dr. Gregg Rubinstein: Well, there are a lot of different causes of headaches. Very often they are vertebrogenic or caused by misalignments and problems in the neck. But something that’s very important to talk about is, you need to rule out other serious causes of headaches.
There are some space occupying lesions, tumors that can grow in the brain that can cause headaches. It’s very important if you have intractable headaches that are not going away and not responding to chiropractic care, that very often we’ll refer that patient out for maybe a CAT scan or an MRI. Sometimes when we come across cases like that is very important. There are headaches related to cardiovascular issues, particularly if someone’s having a stroke, they’ll have headache, dizziness and other signs and symptoms.
It’s very important to be diligent and not just say, “Oh yeah, it’s just another routine type of headache.” There are additional studies that can be done to make sure that we rule out any more significant complicating factors and other significant or serious types of disease processes that can cause headaches. Just know that every chiropractor is trained to do a proper examination and to determine if it’s a chiropractic case or if it needs to be referred out.
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To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call (212) 977-7094 to schedule an appointment.
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