3. Take a look around you at work, on the train or bus, at school with yourself or your children - and tell me with a straight face that we all have good posture that isn't causing stress in the top of the neck.
The fact is, since we start sitting, we sit badly. Whether its on the floor at school craning up to look at your teacher, head down looking at the desk, sitting on poorly fitted chairs/desks, sleeping on your side curled up, or on your back with a big pillow pushing your head forwards............from the earliest of ages we are spending an overwhelming majority of our waking and resting day with our head positioned forwards of the spine - either chin poked out or head pointed down.
This constant stress creates changes in the top of the neck which manifest themselves over years. Everyone is different as to how much of an issue this can become, just like not all people with fallen arches or 'flat feet' get shin, knee, hip and/or back pain from them, but others most certainly do and that needs to be addressed.
In the same way not everyone with bad posture gets headaches or migraines - otherwise we would all be suffering (actually, 97% of the population will suffer a headache at some point in time and we know that 60% of those can have their infrequent and mild headache reproduced by pushing on the neck).(3)
In those who are suffering, especially when a simple solution has not presented itself (as it rarely does) we whole heartedly echo the sentiments of a growing community of headache and migraine specialists calling for a skilful examination of the neck.
At the recent Migraine World Summit Dr Joel Saper (Neurologist - Michigan Head & Neurological Institute) called for action:
“It’s essential that we consider the neck very carefully. These (difficult) cases need to be with someone who can treat the neck and put it all together” .(4)
But what type of investigation do you do? Who should you see?
Not surprisingly many people with migraines have already tried neck treatment (due to the symptoms) and not had success. Why is this the case and why try again where so many have failed?
The problem is that traditional treatments have focussed on the neck without testing, or treating the way in which it is connected to the headaches. What results is people having an assessment, finding (not surprisingly) that they have a sore neck, and then treatment begins.........working on the assumption that if we just treat the pain in the neck or restore normal movement that this will result in the headaches or migraines improving.
Clinical trials in Physiotherapy, Chiropractic and Osteopathy have failed to show that we can have a significant impact using those methods.(6)
This along with variable results and a history in some areas of over servicing has seen a manual therapy or 'hands on' approach shunned.
This is a mistake. Throwing the baby out with the bath water.
Instead what is needed is an approach that is designed specifically to treat the relationship between the neck and your symptoms. An approach that before you commence treatment can show clearly whether there is a relationship between your neck and your symptoms. It is also an approach that sets high expectations about results. We will not be telling you "You've had this for 10 years - it will take months and months to see changes"
We know that if our treatment is going to work for you, then we will see significant changes within the first two weeks.
It's time to use the right tool for the right job, and seek a highly skilled examination of your neck using techniques designed to identify and treat the role of the neck in headache and migraine.
Call today and try the only hands on technique shown to lower brainstem sensitivity, and treat the underlying issue in primary headache.
(1) Ashina, S., Bendtsen, L., Lyngberg, A. C., Lipton, R. B., Hajiyeva, N., & Jensen, R. (2015). Prevalence of neck pain in migraine and tension-type headache: A population study. Cephalalgia. 35 (3): 211-219 https://doi.org/10.1177/0333102414535110
(2) Kerr, F. W. L. (1961). Structural relation of the trigeminal spinal tract to upper cervical roots and the solitary nucleus in the cat. Experimental Neurology. https://doi.org/10.1016/0014-4886(61)90036-X
(3) Watson, D. H., & Drummond, P. D. (2012). Head pain referral during examination of the neck in migraine and tension-type headache. Headache, 52(8), 1226–1235. https://doi.org/10.1111/j.1526-4610.2012.02169.x
(4) Saper, J (2018) Concussions, Brain Injuries, and Migraine. Migraine Word Summit Keynote Video - Day 3 - Risks.https://migraineworldsummit.com/talk/concussions-brain-injuries-and-migraine/
(5)Cerritelli, F., Ginevri, L., Messi, G., Caprari, E., Di Vincenzo, M., Renzetti, C., … Provinciali, L. (2015). Clinical effectiveness of osteopathic treatment in chronic migraine: 3-Armed randomized controlled trial. Complementary Therapies in Medicine, 23(2), 149–156. https://doi.org/10.1016/j.ctim.2015.01.011
‘The RoB-tool was also applied by Cerritelli and colleagues with all included studies showing unclear or high risk of bias. According to the authors, methodologic quality is poor due to limitations in randomization and incomplete reporting of outcome data. Additionally, the strength of the treatment effect cannot be evaluated based on the available evidence.’
(6) Chaibi, A., Benth, J., Tuchin, P. J., & Russell, M. B. (2017). Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology, 24(1). https://doi.org/10.1111/ene.13166
The effect continued in the CSMT (Chiropractic Spinal Manipulative Therapy) and placebo group at all follow-up time points, whereas the control group returned to baseline. The reduction in migraine days was not significantly different between the groups (P > 0.025 for interaction).
Roger O'Toole is the Director and Senior Clinician of the Melbourne Headache Clinic and has over 10 years experience as a physiotherapist.