I’ve been a practicing chiropractor in Miami Beach for nearly the past 20 years. However after graduating, I started my career in a practice in West Palm Beach where we encountered a patient with a very interesting headache. She initially called the office complaining of a headache. I asked her about her symptoms and told her to go directly to the emergency room. Why? Because her headache symptoms weren’t from a simple headache, they were something else entirely.
She showed up at our office anyway and having a good idea what was going on from our telephone conversation, I immediately called 911 and took her back to examine her. Although she was complaining of a headache, there was more going on. Most of the public isn’t aware, but chiropractic physicians are trained to be primary care physicians. So, I examined this lady. Things immediately obvious were that the left side of her mouth wasn’t moving as she spoke. I asked her to smile and only the right side of her mouth smiled. I asked her to raise her eyebrows and only the right eye brow elevated. The left side of her nose was runny, the left eye was tearing and her speech was somewhat slurred. Yes, she was having a headache, but the headache was merely a symptom – she was having a stroke. The paramedics arrived and took her to the local emergency room to save her life.
This brings to light the many different headaches that are our there. Some are simple headaches where the headache is the primary diagnosis. There are several types of ‘primary headache’, then there are situations where the headache is secondary to another condition, just like the situation I described above.
Here’s a list of various headaches. Sometimes the symptoms can be similar between the different type. However in all cases, it’s very important to get to a physician and have your headache evaluated. As a chiropractic physician, there are many types of headaches that we can help and there are some that need medical referral. The only way to tell is with a good consultation, history and physical exam.
Tension or Stress Headaches
Also known as stress headaches or chronic daily headaches. These are the most common types of headaches in society. Typically due to chronic tightness or contraction of the muscles of the upper back, neck and head causing a mild to moderate aching that tend to come and go throughout the day. During high or prolonged stress activity, symptoms worsen.
Cervicogenic Headaches (Generated from the Cervical Spine/Neck)
Cervicogenic headaches are headaches that are caused by the neck. (in medical terminology, the neck is known as the cervical spine). These headaches are typically one sided but can be bilateral (both left and right sided at the same time). Pain can be triggered by movement of the neck or shoulders or can be provoked by a certain position. Whiplash, which can occur from car accidents or sports injuries can be a cause of cervicogenic headaches. Fatigue, problems sleeping, disc problems, poor posture, poor work position (such as sitting at your desk working on a computer) as well as excessive stress to your neck or upper back can all contribute to this type of headache. Old injuries can also be a factor.
The pain of Cervicogenic headaches is typically a constant or steady pain, not throbbing. The pain can extend from the upper back, between the shoulder blades and trapezius area, up to the neck and base or back of the head. Sometimes Cervicogenic headaches can cause pain in the temples, forehead and by the eye brows. For a majority of people the pain is simply in the head. Sneezing, overexertion and stress can trigger this type of headache. Some people feel migraine like symptoms but they don’t occur with the same regularity or by the same causes.
Sinus headache symptoms typically effect the forehead, the bridge of your nose or the cheek bones. People with seasonal allergies that cause sinus congestion as well as those with head colds, flus or sensitivities to dairy that cause swelling of the nasal or sinus mucosa can suffer from sinus headaches. Pain can intensity with sudden jarring or movement of the head or neck.
Migraine headaches have been my personal nemesis since I was about 11 years old and they are literally responsible for my choosing to become a chiropractic physician. I can tell you many many stories about how my parents use to take me to various type of doctors and was on various types of medications throughout my teenage years. But it wasn’t until I found a chiropractor did I start to find relief.
Although according to research, the specific causes of migraine headaches remain unknown, migraine headaches seem to cause some type of abnormal brain activity. This causes some vascular changes (changes in the blood vessels) in the brain. Genetics plays a role in this and it is more common in women than men. Migraine pain can range from mild dull aching throbbing pain, typically unilateral (one side of the head or the other) and can be moderate or severely painful (trust me, I’ve had them all!!!). Sometimes the symptoms are described as starting in the mid/upper neck or base of the head and traveling around the head and to behind either the left or right eye. They headaches can last from a few hours to several days. They are often associated other symptoms such as increased sensitivity to bright light, loud noises, odors (for me it’s cheap flowery perfumes). Upset stomach, nausea or vomiting is also associated with the migraine headache syndrome.
In some migraine sufferers, blurred vision or a “prodromal” syndrome can precede the onset of the migraine pain. You’ll be trekking through your day when all of a sudden, you notice something is “off” with your vision. Then, over the course of 15-30 minutes or so, your vision becomes disturbed. For me, it looked like that glare you get when you look into the sun on a bright day. It starts small, then grows to affect your vision. Then, all of a sudden the visual disturbance goes away and hello headache!!
Luckily, cluster headaches are the least common. Why? Because they are the most severe type of headache. The pain of a cluster headache has been described as a “burning or piercing”, throbbing or constant pain. Often seen in “Type-A” personalities and often attributed to stress. During cluster headache attacks, the sufferer will pace back-n-forth. The headaches occur in clusters with several of these headaches occurring throughout their name (clusters of headaches). They occur several times per day for a couple weeks to a few months in a row.
The clusters of headaches can disappear and go into remission and then, seemingly without cause, simply return to haunt you all over again. There have been stories of the cluster headache pain being so intense, people have shot themselves in the head to relieve the pain.
Yes, I said stroke headaches. Typically a sudden onset of headache, neck or face pain that’s “different” that you’ve ever had before. This could be the first sign of a cerebro-vascular accident or dissecting stroke. If you’re experiencing a headache that is unlike any you’ve ever had before, if you are having “the worst headache” you’ve ever experienced or have any numbness, tingling or any of the other symptoms I’ve outlined in the story above about the lady having the stroke, call 911 and go to the emergency room. Don’t make the mistake she made and go to the doctor’s office. The time wasted could have been the difference between life and death. She was very lucky.
With any ache or pain or other symptoms, there’s always a differential diagnosis. This means there are many conditions that could have similar symptoms. It’s important to get to the right diagnosis so the right treatment can be started.
If you have any questions about any of the symptoms you’re feeling, contact your physician. If you are in Miami or the Miami Beach area, I’m always here to help.
Dr. Todd M. Narson
Diplomate of the American Chirorpactic Board of Sports Physicians
Miami Beach, FL
Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.
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