Patients with migraines and chronic headache have a cervical neck instability problem

This article will concentrate on the role of the cervical ligaments and treatments that include Prolotherapy for stabilizing the neck and possibly providing a cure for chronic headaches.

Headache researchers are understanding that patients with migraines and chronic headache have a neck pain/instability problem.

Let’s look at five recent research studies.

Researchers representing Lund University in Sweden and the University of Copenhagen in Denmark published a December 2017 study in The Journal of headache and pain showing that the prevalence of migraine with co-existing tension-type headache and neck pain is high in the general population.

They also acknowledge the problem that there is very little literature on the characteristics of these combined conditions.

The aim of their study was to investigate:

  • the prevalence of migraine with co-existing tension-type headache and neck pain
  • the level of physical activity, psychological well-being, perceived stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain compared to healthy controls,
  • the perceived ability of persons with migraine and co-existing tension-type headache and neck pain to perform physical activity, and
  • which among the three conditions (migraine, tension-type headache or neck pain) is rated as the most burdensome condition.

Here are the results which gives evidence to the neck pain connection to headaches:

  • Out of 148 persons with migraine
    • 100 (67%) suffered from co-existing tension-type headache and neck pain.
    • Only 11% suffered from migraine only. (Only 1 in 9 migraines did not have a neck component).
  • Persons with migraine and co-existing tension-type headache and neck pain had lower level of physical activity and psychological well-being, higher level of perceived stress and poorer self-rated health compared to healthy controls.
  • They reported reduced ability to perform physical activity owing to migraine (high degree), tension-type headache (moderate degree) and neck pain (low degree). The most burdensome condition was migraine, followed by tension-type headache and neck pain.

The researchers were able to conclude that migraine with co-existing tension-type headache and neck pain was highly prevalent and that persons with migraine and co-existing tension-type headache and neck pain may require more individually tailored interventions to increase the level of physical activity, and to improve psychological well-being, perceived stress and self-rated health.1

Now let’s examine the second study from a diverse team of Canadian researchers from medical universities and hospitals throughout Canada. Here doctors writing in the European Spine Journal explored treatments for managing  patients who suffered from chronic tension-type headaches with constant neck pain and muscle spasm. The muscle spasms should have been a clue that the headaches were being caused by cervical neck instability. Muscles spasm in unstable joints because they are being overworked trying to help or replace the function of damaged ligaments and tendons in stabilizing the joint. 

This is shown by the Canadian doctor’s suggestion that treatments should include exercise (to help stabilize), relaxation training with stress coping therapy (to reduce spasm) and perhaps manual therapy (chiropractic) to help get the neck back in its natural position. 2

  • Quick summary: Doctors found that headache had a neck instability component and the treatments offered were symptom management techniques, not curative techniques.

The connection and problems of headache and neck pain in the work place has also found recommendations from University of Turin doctors for relaxation techniques to help manage muscle spasms and tension. The doctors noted a muscle relaxation program could significantly reduce the high rate of work disability.3

Again, the researchers point to system suppression, at least in these papers attempts are made to get away from pharmaceutical management of chronic headache and do seek to find the problems of headache routed in neck pain  and instability and muscle spasm.

In the fourth study from doctors at University of São Paulo in Brazil, researchers concluded: “We cannot assume that physical therapy promotes additional improvement in migraine treatment; however, it can increase the cervical pressure pain threshold, anticipate clinically relevant changes, and enhance patient satisfaction.”4

  • Quick summary:  Why increase pain threshold? Why not get rid of headache pain?

Lastly, the fifth paper doctors examined the 4th phase of a migraine cycle – The migraine postdrome – that is the physical aftermath after the migraine episode has dissipated. In this study of 120 patients, 81% reported at least one non-headache symptom in the postdrome.

Postdrome symptoms, in order of frequency, included feeling tired/weary and having difficulty concentrating and stiff neck. Many patients also reported a mild residual head discomfort.5

One notable characteristic of the patients was noted by the doctors:

There is a striking underestimation of the frequency of neck stiffness and sensitivity to light and noise.

neck pain headaches

Prolotherapy and the neck element in headaches

Do weakened ligaments in the neck cause an unnatural head posture which can cause headaches? Can strengthening these neck ligaments resolve the problem of chronic headaches and migraines by resolving the problem of cervical instability?

In a study published in the medical journal Practical Pain Management, the authors showed the mechanism by which Prolotherapy effectively treated tension and migraine headaches in fifteen patients by stimulating cervical ligament repair.(6)

The study followed patients, on average, 22 months after their last Prolotherapy treatment and all 100% still had benefit.

Clinically significant improvements were reported including:

  • decreased headache intensity level,
  • frequency,
  • duration,
  • number of associated symptoms and light sensitivity in patients with tension and migraine headache pain.

While the research is much more in depth, it is not a new claim. As far back as 1962, doctors reported good to excellent results in 90 percent of  patients with neck and/or head pain treated with Prolotherapy.7

Typical areas treated during Prolotherapy sessions for chronic headaches and neck pain are the base of the skull, cervical vertebral ligaments, posterior-lateral clavicle, where the trapezius muscle attaches, as well as the attachments of the levator scapulae muscles. Because there is an anesthetic in the solution, generally the neck or headache pain is immediately relieved. This again, confirms the diagnosis both for the patient and the physician.

1 Krøll LS, Hammarlund CS, Westergaard ML, Nielsen T, Sloth LB, Jensen RH, Gard G. Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The journal of headache and pain. 2017 Dec 1;18(1):46.

2 Varatharajan S, Ferguson B, Chrobak K, Shergill Y, Côté P, Wong JJ, Yu H, Shearer HM, Southerst D, Sutton D, Randhawa K. Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Spine Journal. 2016 Jul 1;25(7):1971-99.

3 Rota E, Evangelista A, Ceccarelli M, Ferrero L, Milani C, Ugolini A, Mongini F. Efficacy of a workplace relaxation exercise program on muscle tenderness in a working community with headache and neck pain: a longitudinal, controlled study. Eur J Phys Rehabil Med. 2016 Jan 8.PubMed PMID: 26745361. 

4. Bevilaqua-Grossi D, Gonçalves MC, Carvalho GF, Florencio LL, Dach F, Speciali JG, Bigal ME, Chaves TC. Additional Effects of a Physical Therapy Protocol on Headache Frequency, Pressure Pain Threshold, and Improvement Perception in Patients With Migraine and Associated Neck Pain: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2015 Dec 21.

5. Giffin NJ, Lipton RB, Silberstein SD, Olesen J, Goadsby PJ. The migraine postdrome: An electronic diary study. Neurology. 2016;87(3):309-313 [Google Scholar]

6 Hauser RA, McCullough H. Dextrose Prolotherapy for recurring headache and migraine pain. Practical Pain Management. 2009:58-65.

7 Hackett GS, et al.Prolotherapy for headache. Pain in the head and neck, and neuritis. Headache. 1962 Apr;2:20-8.


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