Ask the Osteopath:Primary Headaches

10 million people in the UK get headaches on a regular basis and it is something that I do see a lot. There are many causes of headaches but the majority of them can be managed and successfully treated. In this post I am going to go through primary headaches.

All headaches are causes by stimulation of the threat to the sensor in the nociceptive sensors and the network of nerves in the brain. They can be stimulated in many different ways the main four include blood vessels (arteries or veins), muscles, traction and inflammation. Headaches associated with blood vessels include cluster headaches and migraines. Headaches associated with muscles include cervicogenic and tension headaches. Traction and inflammatory headaches include a wide range of conditions from stroke, meningitis to sinus infections.

Age can play a factor in getting headaches as you get older there are changes to your blood vessels similar to other areas of your body these include decrease in elasticity and the size of the vessels themselves all affecting the blood pressure.

No surprise here but alcohol is often linked to headaches this is due to dehydration.

Types of Headaches:

There are two main types of headaches either Primary or Secondary.


Pain directly for example: migraine, tension, cluster, cervicogenic


Headache from an external cause such as a pathology or condition

Tension Headache:

This is the most common type of headache.

Prevalence: Very common affects 80% of the population with 60% between 20-50 years

Risk groups: X4 more in women than men

Pain frequency: Episodes and can occur up for up to 15 days a month.

Pain duration: Normally lasts 30 mins to continuous.

Pain Location: Bilateral (on both sides of the head), often across the whole head or forehead

Pain Intensity: Mild to moderate pain

Pain Quality: Pressure or tightness

Causes of Tension Headaches:

  • Tightness and increased tone of the muscles at the base of the skull including temporalis, master, sub-occipitals, Sternocleidomastoid and trapezius.
  • Pain or dysfunction in the jaw
  • Sensitivity to the trigeminal nucleus

What aggravates Tension Headaches?

  • Stress, depression and anxiety
  • Neck pain or tightness of the muscles in the neck
  • Drug and alcohol overuse
  • Normally found more in desk based people

How can you treat tension headaches?

  • Manual therapy: Including osteopaths and physiotherapy particularly if aggravated by neck pain
  • Acupuncture – NICE recommends 10 sessions over 5-8 weeks
  • Exercise
  • Medications: Aspirin, NSAIDs & Amitriptyline

Cluster Headache:

Prevalence: Rare – 0.05% of UK population

Risk groups: X4 in men than women, 20-40 years, smokers and alcohol abuse

Pain frequency: occur for 6-12 week cycles and can go into remission for months or years.

Pain duration: 15-180 minutes, normally occurs at the same point every day and can be 1-2 hours after falling asleep

Pain Location: Unilateral headache with excruciating pain often over one eye and spreads round the front of the head and around the side of the head by the ear

Pain Intensity: Severe or very severe pain- People often commit suicide its that painful.

Pain Quality: Sharp, burning, deep, throbbing or tightness

What other symptoms are associated with cluster headaches?

  • Horner syndrome: constricted pupil or drooping eye
  • Blood shot eye, watery eye
  • Swollen eyelid
  • Forehead or face swelling and sweating
  • Runny nose or blocked nose
  • Restlessness or agitation

What is the cause of Cluster Headaches?

Increase vasodilation of blood supply increasing the pressure on the trigeminal nerve. It is also possible that it affects the hypothalamic dysfunction due to the increase blood flow the grey matter is normally affected by the attack. It has also been suggested that melatonin can contribute to it.

What is the treatment for Cluster headaches?

  • Prophylatic drugs or deep brains stimulators
  • Often dealt with my a neurologist with interests in headaches
  • Oxygen treatments
  • Triptan through IV drip or nasal routes
  • Drugs: Verapamil

What causes cluster headaches?

Normally of a vascular cause due to increase dilation and blood flow through the vessels increases the pressure on the trigeminal nucleus. The actually mechanism that occurs is debatable and poorly understood.

  • Hypothalamic dysfunction: Activation of the grey matter in the brain during the attack.
  • Para symptomatic reflexes: in the brain are activated round the trigeminal nerve and cause dilation and increase blood flow to the cranial vessels it could also be affected by melatonin.


Prevalence: Common- 15% of UK population

Risk groups: Affects females X3 more than men, between the ages 12- 30 years.

Pain duration: 4-72 hrs – Adults, 1-72 hrs in 12-17 years

Pain frequency: up to X15 a month, chronic is considered for more than 3 mnths

Pain Location: Unilateral (one side of the head and normally radiated to the eye or bilateral (on both sides of the head) round the front of the head

Pain Intensity: Medium to severe

Pain Quality: Pulsating throbbing pain

What other Symptoms are associated with migraines?

  • Nausea & vomiting
  • Effects vision: flickering lights, spots or lines, partial loss of vision
  • Sensitivity to light and sounds
  • Changes to sensation: Numbness, pins + needles
  • Can affect speech
  • Aura – pre or post drome so a build up of symptoms before or after the actual headache. You can also get the feeling of the aura without the actual headache. They are often reversible They can take 5 minutes to develop and can last from 5-60 minutes
  • Pre-drome: Approximately 20 minutes before – 33-75% of patients
  • Pro-drome: Altered mood, irritability, depression, fatigue, food craving,

What can aggravated migraine?

  • Diet: Chocolate, cheese, alcohol, caffeine, MSG, lack of food
  • Bright lights or load noises
  • Stress
  • Hormones – particularly in women around menstruation and menopause

What causes migraines?

Again like other types of headaches the cause is debatable and there are several different theories:

  • Depolarisation: Irritation of the cranial and trigeminal nerves in the neck which produce inflammatory chemicals and decrease in neurological function to the area.
  • Vascular: Spasm of the blood vessels and increase blood flow normally to the occipital lobe of the brain. This can cause an inflammatory picture and reaction. The spasm of the blood vessels often causes the characteristic throbbing pain that you can feel.
  • Serotonin: Serotonin is a neurotransmitter and chemical that is found between the brain cells. It can cause spasm and dilation of the blood vessels which can trigger the headache.
  • Neural theory: Irritation of the nerves in the brain which leads to releasing of a chemical called CGRP (Calcitonin General Related Peptide) which again cause inflammation of the blood vessels in the brain and therefore pain. It can interfere with the pain pathways in the brain, which causes the release of substance P.

What is the treatment for Migraines?

  • Acupuncture- NICE recommends 10 sessions over 5-8 weeks
  • Medications: Aspirin, metoclopramide, NSAIDs, triptan, topiramate, amitriptyline, riboflavin
  • Manual therapy
  • Rest in a dark room

Cervico-genic Headaches

Prevalence: 2.5% of the population

Risk groups: X4 in women than men, Middle age

Pain duration: Hours – days and worse at the end of the day

Pain Location: Unilateral – starts in the neck radiating towards the front by the eye

Pain Intensity: Mild to moderate

Pain Quality: Severe deep ache

What causes Cervico-genic headaches?

It is often a musculo-skeletal cause from reduced movement and inflammation of the C1/2 and C2/3 joints on one side of the neck (the top 3 joints in the neck) with referral due to the compression over the nerves, which causes the pain radiation towards the eye. Its often brought on my contration of the muscles under the base od the skill

What aggravates cervico-geneic headaches?

  • Neck movements
  • Bad posture
  • Stress
  • Tight muscles of the shoulder, neck and jaw

How do you treat cervico-genic headaches?

  • Manual therapy: Including Osteopathy, physio and chiropractic which would include a combination of manipulation, massage or soft tissue techniques
  • Medications: NSAIDs
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