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There are over 100 different types of headaches, most of them secondary to other causes. The two most common primary headaches are tension headache and migraine. Surprisingly, little is known about the cause of headaches and although theories exist, none are proven. Medications used to treat headache try to intervene in the biochemical chain that results in the symptoms.


Migraine is thought to be caused by a cycle of vasoconstriction then vasodilation of the blood vessels of the head. This may be caused by the release of vasoactive substances by the trigeminal nerve. Other theories include the existence of blood shunting vessels that divert arterial blood directly to the veins without ever reaching the head, and also a slowly moving wave of neural activity traversing the cortex of the brain, causing the aura.


  • Severe throbbing head pain felt usually unilaterally
  • 0-30 minutes before attack there are focal neurologic symptoms (aura) in 'classic' migraine
  • 20% have feelings of depression, irritability, restlessness or nausea
  • 20% see jagged, or shimmering lights, or lose vision in a specific area (scotoma)
  • Hypersensitivity to light, sound or smell is common
  • Lasts from 4 to 72 hours

Many triggers have been identified, including:

  • Dietary - e.g. cheese, red wine
  • Emotional - e.g. stress, depression
  • Physical - e.g. fatigue, over-exertion
  • Systemic - e.g. oestrogen cycles
  • External stimuli - e.g. flashing lights

Soft Tissue manipulation can help release any impediments to blood flow. Massaging the temples can help abort an attack. Some forms of migraine are caused or aggravated by restrictions to vertebrae in the neck. We have all experienced neck pain and stiffness tracking up to the head and causing a headache. A subnucleus of the trigeminal nerve is found at C2/3 level in the neck. Irritation at this level causes the trigeminal nerve to release vasoactive substances which cause the vasoconstriction/vasodilation cycle causing the migraine. Dysfunction of the upper cervical vertebrae can be treated by articulation or manipulation of the neck. Home mobility and postural exercises together with avoiding migraine triggers are also helpful in management. Lymph drainage techniques may also aid in relieving any congestion in the head.

Tension Headache


  • Begins morning or early afternoon, getting progressively worse
  • Pain felt over the eyes, at the back of the head, or as a band around the head, sometimes spreads to the neck and shoulders
  • Pain is usually bilateral, constant , 'tight', and never throbbing in nature
  • Lasts from 15 minutes to 1 week

Muscle tension is believed to restrict blood flow and there also appears to be a reduction in pain suppression. Stress and depression may contribute to the cause.

Pain at the back of the head may be due to compression of the 2nd Cervical nerve, often due to poor posture with the head held forward of the shoulders and then being held in extension.

Soft tissue treatment to the neck can improve blood flow by releasing tight muscles. Articulation or manipulation to the OccipitoAtlantal joint can improve posture and help prevent compression to the 2nd Cervical nerve, making Osteopathic treatment an effective treatment for headache of a cervicogenic nature.

Hitchin Osteopathic Clinic, Old Park Dental Surgery, 72 Old Park Road, Hitchin, Hertfordshire SG5 2JT 01462 432609