Is Your Headache Really a Pain in the Neck?

Is it my imagination, or is this article likely to be read all over the world? Wherever you are, it is a good guess that commercials on your television will direct their attention to common local needs. Chances are good, then, that you will see commercials for chronic pain relief. Our local commercials frequently make offerings for head, neck and back aches from a variety of brands: Tylenol, Excedrin, Advil, Naprosen, etc. Of course there is regular, extra strength, prescription level 1,2,3, and eventually morphine and beyond. What joy it is to recover the freedom of mobility when the pain barrier is removed! What amazing things we can experience when we are on drugs! Not that some headache patients don't require medication (eg, migraine and cluster headaches) mind you, but the majority of chronic headache sufferers (eg, chronic tension-type, chronic daily headache, and cervicogenic headache sufferers) are better off with non-medicinal therapies.

There are legitimate drugs, but there may be a dark side. The Tylenol ad that I watched last night made it look so good: Old guys dancing and acting like young kids. Adults of both genders and all ages were all acting like, well, young kids and teenagers; and all with the help of pain relief medication. Their slogan that I saw a few minutes ago was "Get back to normal, whatever your normal is." What could be so wrong with that? For many people headache is chronic. It is a daily, hourly ordeal. If medication is required to get back to "normal", it requires a lot of medication. It isn't something that requires an occasional pill to remove the barrier. It doesn't go away unless you continually pop pills that load the body to toxic levels. If you are going to retain that kind freedom or "normal" it creates an unwanted dark side.

Have you got a calculator handy? Have you ever thought of how much you, or your insurance company spends, or someone spends for you to get relief from headaches? How much is it? Like cigarettes, or coffee, it gets absorbed into expenses for the daily necessities of life. Have you got something better to do with that money? I do and if I had to go out and add these extra costs, some things would have to go. Okay, I drink coffee; but usually one cup a day and I make it myself. I haven't started to make my own pain medication, although in my first organic chemistry lab at university, we made acetylsalicylic acid (aspirin). Looking at the medications in my cupboard, there is the range, but some of them have been there for 5 - 7 years and I now am afraid to use them.

Pain is usually a warning signal. Like the warning light on a car dashboard, it tells you that something is wrong, or a smoke alarm that is warning of impending danger. You only shut it off if you are aware and are dealing with the problem. Deactivating the warning signals means greater and greater damage and the repair bill just keeps on adding up.

Pain experienced in one area, could be a chain reaction to a problem in another one. Cracks in the walls, ceiling or windows of a house are often symptoms of problems in the foundation. Many of our aches and pains in the head, neck, shoulders, back, hips, knees, jaw, shoulders, etc. actually are related to problems with poor postural alignment of the spine. It causes muscles to tighten and use excessive energy and produce myofascial pain or "contraction knots." The knot locations are called trigger points.. According to Dr. Howard Makofsky, Professor of Physical Therapy and former co-director of the TMJ and Headache Centers at Southside Hospital in Bay Shore, New York, "It has been demonstrated with microdialysis needle technique that active trigger points contain significantly higher concentrations of protons, bradykinin, CGRP, substance P, serotonin, interleukin-1 beta, tumor necrosis factor-alpha, and norepinephrine than normal subjects and individuals with latent trigger points. The presence of these algogenic (pain producing) substances helps to explain why individuals with active trigger points have lower pressure pain thresholds and myofascial pain syndromes. The PostureJac/MyoPresser system, through specific compression therapy (massage therapy), helps to reduce contractile activity at the contraction knot and disperse pain-producing biochemicals from active trigger points in the upper trapezius, levator scapulae, paraspinals, and pectoralis minor muscles. These therapeutic effects help to explain the symptomatic relief experienced by using this unique approach to trigger point therapy.

Do you want to know more about chronic myofascial pain, headaches and trigger points? A simple search with key words will produce plenty of hits. We don't lack for evidence and expertise. The spine is the axis that everything moves around. If its function is impaired, other things have to change or stop functioning. Then they wear out more quickly because they weren't designed to operate that way.

Is your headache really a pain in the neck? Dr. Makofsky reports the following:

1. 70% of headache sufferers have neck pain.


2. 15-20% of headache sufferers have what is known as cervicogenic headaches (headache originating in the neck).


3. 50 million Americans suffer from chronic headaches.


4. Active trigger points (aka "contraction knots") have been found in the neck and shoulder muscles of people with chronic headaches to a greater degree than people who don't have headaches.


5. Forward head posture is more prevalent in headache sufferers than in people who don't suffer from headaches.


6. For an effective means of controlling neck-based headaches, Dr. Gwendolyn Jull, a professor of physiotherapy in Queensland, Australia, and a leading headache expert recommends the following:
   a. postural correction
   
   
   b. deep neck flexor strengthening as well as
   
   
   c. stretching and strengthening exercises to the shoulder, neck and back muscles
   
   
   
   
   
   


7. Drug-rebound headache is a worldwide epidemic. Leading headache specialists agree that headache sufferers need to learn non-medicinal headache strategies because chronic pain medicine use can lead to ulcers, kidney failure and liver damage.

Do you notice young children with alignment problems? Not many. Do you notice teenagers with posture problems. Yes! Lots, and it gets progressively worse in subsequent age groups. Why the rapid deterioration in adolescence? I suggest some big factors, but there are others: Computers, backpacks and self-esteem. Tylenol acknowledged poor posture as a source of headaches in a recent ad campaign, and then offered their product as the solution. The pharmaceutical industry is profiting nicely, but imagine the relief for the health care and insurance industry if the cause of recurring headaches and chronic pain in general were addressed. Fewer hip and knee replacements, fewer spinal surgeries, less medication, less rehab therapy, fewer canes and walkers and other corrective or assistive devices. That doesn't include the treatment of unwanted side effects: liver and kidney damage, hypertension, etc. Could there be some simple solutions?

With over 30 years experience in clinical orthopaedic physical therapy, Dr. Makofsky created the PostureJac as a mechanism to help the body recover its original alignment and function. A lot of it is lost when the body mistakes extended periods in unhealthy positions as "normal". A dentist or surgeon who continually bends over to treat patients, adapts. People spending extended time in front of a computer for work, or other purposes, adapt. Teenagers who carry a backpack, practice piano, self-consciously slouch to "fit in", adapt. And on it goes. "Get back to normal, whatever your normal is." Wait a minute. A faulty normal is causing the problem in the first place and pain medication is just masking it. Wouldn't it be nice if there was a non-toxic, non-addictive, and inexpensive remedy to correct alignment?

If people could correct their perception of what is "normal", then they could return to it. Bringing the body to proper position reduces stress on joints, muscles, ligaments and fascia. They don't complain and malfunction and send pain signals to the brain. Passive devices that hold your shoulders back don't do that. Like a splint or cast, they substitute for muscle activity and actually cause them to weaken. It is not much better to become dependent on a static device than on medication. The PostureJac is something that can correct muscle memory and internalize this mechanism.

Do you need some other reasons to correct your posture? Did you know that poor posture may also affect blood pressure? Pain from poor posture (eg, chronic headaches) stimulates the sympathetic nervous system, which is capable of raising blood pressure.

How about bone health? Studies show that it is enhanced when muscles attached to it are active. In typical forward head/rounded shoulders posture, vital support muscles in the mid and upper back are stretched. As you become more bent over, these muscles become less active and weaken. Leading experts on osteoporosis promote posture correction, muscle restoration and activation.

The PostureJac offers the following to headache sufferers:

• Correction of forward head posture/rounded shoulders posture


• Trigger point ("contraction knot") release


• Flexibility of tight neck, shoulder and back muscles


• Strengthening of the deep neck flexor and scapular stabilizing muscles

Is it necessary to use a device? Can't I just do some back exercises to get relief? Stand up straighter? Buy a different pillow? Use a static posture brace? I am not claiming that this is the only way to go, however it teaches the body a very significant mechanism to restore alignment. Dr. Makofsky calls it the Spinal "Corkscrew Principle." As your shoulders create a lateral downward force, they are like the handles of a corkscrew. Your spine is the cork. It goes up. Try if for yourself. Try it while you are lying on a flat surface like a bed. You will feel your spine stretch and elongate. Producing this mechanism creates a muscle memory and you have a new technique for aligning and lifting your spine. It is more stable and closer to where it should be. Depending on where you started, it may not be ideal, but with work it can get better. Improving spinal stability is where you want to be when you are stretching and strengthening the structures that are causing so many problems in the first place. This is a portable device that will reinforce it and get you there faster. Do you want to continue masking the pain or address the root causes?

The focus of this article has been on chronic headaches and their origin. The same holds true for backache, shoulder impingement, and temporomandibular disorders (TMD). A lot of those problems originate in the neck, where some muscles are tight, others are weak, and nerves are impinged. It looks like correcting the pain in the neck is important for many of our chronic pain issues.!

Consider this quote. "Observations of the striking influence of postural mechanics on function and symptomatology have led to our hypothesis that posture affects and moderates every physiologic function from breathing to hormonal production. Spinal pain, headache, mood, blood pressure, pulse, and lung capacity are among the functions most easily influenced by posture. The most significant influences of posture are upon respiration, oxygenation, and sympathetic function. Ultimately, it appears that homeostasis and autonomic regulation are intimately connected with posture. The corollary of these observations is that many symptoms, including pain, may be moderated or eliminated by improved posture." John Lennon, BM, MM, C. Norman Shealy, MD, Roger K. Cady, MD, William Matta, PhD., Richard Cox, PhD, and William F. Simpson, PhD, American Journal of Pain Management, Vol. 4, No. 1, January, 1994

Having said this about chronic headaches, it is important to realize that acute headache can be a danger sign of a serious condition. So please check with your physician before embarking on any self-treatment approach to headache management.