tension headache

Top 3 Causes of Tension Headaches

The Headache Dilemma

Just about everybody has experienced a headache of some sort in their lifetime.  Maybe you get them after a long night of drinking.  Or, they pop up during stressful times at work.  Whatever the scenario, headaches are a common problem in our society.  According to WebMD, 80% of Americans suffer from tension headaches from time to time and women are twice as likely to have them.  3% of the population suffers from daily, chronic tension headaches (a number that I believe is under reported).  The key term here is “tension”.  Tension headaches are typically labeled as “cervicogenic”, meaning they generate from the cervical spine.  However, there are many more sinister reasons for pain around the head.  For the sake of this write up, we are excluding things such as head trauma, vascular issues, and migraines.

What Triggers Tension Headaches?

As mentioned above, I believe the reporting of chronic tension headaches is vastly understated.  Basically, people tend to accept them as “normal” and are unaware of their effects.  That is, until they feel relief for the first time!  Based on my training and clinical experience, I have come to find that there are three main triggers for the classic tension based headache.  They consist of upper cross posture, poor breathing patterns, and TMJ/jaw dysfunction.

Posture and Headaches

Poor posture
Janda's Postural Syndromes

The obvious one is poor posture.  Specifically, upper cross posture.  Click here to read about the effects of technology on our posture.  It’s not that poor posture directly causes headaches.  It’s the adaptations of the muscles and joints as a result of prolonged and repetitive poor positioning.  For example, a forward positioned head often leads to excessive rounding, or hyperkyphosis, of the upper back.  This adaptation often results in subsequent muscle tightening as well as locking up of vertebral joint segments.  There is a high likelihood that when I evaluate a patient that works at a computer for a living that I will find trigger points and muscle tightness in various muscles of the upper thoracic spine and cervical spine.

In addition, their upper thoracic and lower cervical joints move like a brick compared to the segments above and below.  For these patients, treatment is centered towards these dysfunctions.  In addition, some sort of rehab program is implemented to offset the over usage of these muscles and joints.  One rule of thumb is that if there is a muscle that is being overworked, there tends to be a muscle, or muscles, that aren’t doing enough hence the implementation of strengthening.

Below are some diagrams by Dr's Travell and Simons outlining the common trigger points in the head and neck as well as their referral patterns.

Pain patterns and trigger points
Travell and Simons Trigger Points of the Head and Neck

An Exercise in Futility?

Individualized treatment and rehab is crucial to success.  However, an attempt to correct work stations and postural habits may be the most important factor.  Simply getting treated or doing a handful of exercises will not overturn years of bad habits. A diligent effort must be made to break these habits which usually involves constant reminder of postures throughout the day.  Typically, the more I show you how much you really struggle, the more likely to facilitate a change.

Posture Reminder
Sit Up Straight!

We recommend that you use some kind of reminder system to keep you in check throughout the day.  This can include stickers to place on things you look at the most, i.e. computer, rear view mirror, or phone.  Or, setting alarms on your cell phone will do the trick.  The point of constantly reminding you is to create awareness.  The more awareness, the more actions can be taken to create better postural habits.

Breathing and Headaches

The second component related to tension based headaches is poor breathing mechanics.  When most people think of the respiratory system, they picture the lungs.  However, we must understand the contribution of certain muscles in assisting the process of getting air in and out of the lungs.  I group the muscles into two categories, primary and accessory.  The primary muscle of respiration is called the diaphragm.  The accessory muscles consist of muscles in the neck (SCM and scalenes), ribs (obliques and intercostals), as well as muscles that affect the spine and scapula (levator scapulae, erectors, upper trapezius, etc).  The accessory muscles are meant to kick in during times that require more assistance such as during exercise.  While at rest, we should primarily use our diaphragm to breathe.  Instead, I find that most people rely on the accessory muscles all of the time.  A concerted effort should be made to remedy this dysfunction.  A quick drill for you to evaluate your breathing is to place one hand on your chest and another on your belly.  As you breathe, your bottom hand should push outwards with minimal movement of the top hand.  You can also place both hands around your neck to feel whether or not the neck muscles are contracting when you breathe.

Diaphragm breathing
"Belly Breathing"
Diaphragm breathing
Accessory muscles of breathing
Accessory Muscles
Neck muscle tension with breathing
Too much tension in accessory muscles

When evaluating one’s ability to use the diaphragm, we typically get one of two types of patients.  The first patient has little issue with breathing correctly; they just need to make it more of a habit.  The second patient, on the other hand, cannot grasp the concept.  These patients tend to need some TLC to help get them going in the right direction AND THEN they need to make it a habit.   I have seen so much success with simply pointing out that proper breathing is in fact a real thing.  A drastic change is seen when a concerted effort is made to decrease the activity of the accessory muscles.  Once diaphragm activity is normalized, an effort can then be made to teach proper core activation which we will discuss at a later time.

Jaw Tension and Headaches

The third reason for tension headaches may be the most prevalent of them all.  Temporomandibular dysfunction, or TMD for short, involves excessive jaw clenching, grinding, and tensing.  One thing that needs to be pointed out is that TMD is different than TMJ.  TMJ refers to the temporomandibular joint.  Humans have two of these joints.  TMD is simply the dysfunction of that joint.  If I had a dollar for every time that a patient stated that they have "TMJ" I would be, well you know!  Anyways, those that grind their teeth at night most likely are aware of it.  Whether a dentist told them, or their significant other has complained about it, it is not news to them.

Lockjaw and headaches

What these people don’t realize is that they most likely hold excessive tension in and around their jaw throughout the day as well.  The real kicker is that people can have TMD without having any issues with grinding their jaw.  They simply hold tension in their jaw like most people hold tension in their traps and neck.  Long standing TMD can result in tension headaches, TMJ degeneration and disc issues, and varying degrees of "lockjaw".  Lockjaw occurs when the muscles of the jaw become spastic, or the disc located within the TMJ becomes "stuck".  Symptoms can involve an inability to open or close the jaw fully.

Trigger points of the head and jaw.
Travell and Simons Trigger Points of the Head and Jaw

When I began to dive into assessing and treating the jaw, I found that TMD often coincides with poor breathing.  Some studies have correlated a relationship of jaw clenching and poor breathing with anxiety and stress.  So the next time your kids are giving you a fit, take a moment to see if your jaw is tightening up and how you are breathing (if you are at all).  Treatment of the jaw and head region, as well a home stretching program, can yield results so enormous that the patient is usually dumbfounded.  Like breathing, correcting the overarching habit is crucial for sustained benefits.

 

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