10. The Osteopathic Approach to Headaches and Migraines with a Muscular Cause
90% of headaches (migraines are one form of headache) originate from the neck and its musculoskeletal structure.
Surprisingly to me, I read recently that research had revealed that migraines were due to vasoconstriction (closing) of the blood vessels. I say "surprising to me", only because osteopaths like myself seem to have known this for years as osteopathic treatment tends to work very well in these cases.
If you believe some of the old stories relating to the founder of osteopathy (A.T.Still), we have it that one day he had a headache and then rested the back of his neck on a rope-swing and fell asleep.
On waking, his headache was gone and he surmised (correctly) that the mechanical compression on the soft-tissues relieved his pain. Another fine day for osteopathy ensued ... 140 years before this most recent research into migraines!
Now that I have convinced you that osteopathy is a fine and wondrous thing, I shall continue ...
When a patient presents to me with headaches, I first need to go through a thorough case history and differential diagnostic process to satisfy myself that the headache is not of a more serious nature. Presuming that no warning bells have been triggered with any suspicions of a pathological cause, treatment can usually start immediately.
Typically, most headaches originate in the upper neck, and one aspect can be due to the musculature, as the muscles can tighten for a variety of reasons with posture, stress, awkward or repetitive movements and joint strains being the most common. Although the pain can involve neurological referral pain patterns, tight muscles have three specific pain-causing effects:
The first is a relative hypoxia (lack of oxygen) to the muscle tissue which changes the pH level and affects the normal homeostatic metabolic process within the muscle. In plain English, normal function of muscle metabolism is compromised and pain develops within the muscle tissue itself as it "stagnates".
The second reason is that the muscle shortens and the spasm within the muscle also becomes painful too, as it continually contracts.
Thirdly, the tight muscle pulls on its attachment to the covering of the bone called periosteum. Although the periosteum does not come away, it has a lot of sensory pain fibres that fire (if you have ever bashed your shin, that's the periosteum complaining!)
Other research has suggested a fourth reason. It has been observed that the sub-occipital muscles have an attachment to the dura (covering) of the spinal cord. The neuromusculoskeletal science behind this is a sound principle and perhaps more headache and migraine suffers may be encouraged to seek effective manual treatment rather than just dose up on pain-killers.
Treatment is essentially to reduce the muscle tightness and therefore break the pain cycle by increasing blood flow and decreasing the continual contraction on the periosteum.
Many osteopathic techniques can achieve this, ranging from manipulation (to reset the stretch reflex) to very gentle counterstrain techniques that reset the pain receptors (as well as all of the techniques in between).
I usually expect most patients suffering from headaches to be benefitting from osteopathic treatment within three sessions. When the treatment plan has been successful (or relatively successful) in the past, patients in the future need only return as required for a single session if a migraine attack or headache returns. For some unfortunates it can be every month if their headaches are chronic, but for others it can only be needed a couple of times per year.
One final interesting fact: prolonged use of pain-killers for chronic headaches can cause ... chronic headaches.
* The image of the sub-occipital muscles contained within this article is taken from Gray's Anatomy and is looking at the back of the head and neck.
Marc Jones, BSc(Hons) Ost,
Registered Osteopath & Clinic Principal
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