Ask the Doctor: How to Manage Tension Headaches

The featured question this week:

I have headaches a few times a week. They start in the neck, and I usually wind up with a headache by the evening. Is there anything I can do?  Thanks!   - Jen

Thanks for the question. As a chiropractor, I see this type of headache a lot.  Tension headaches usually begin with some tension in the neck and shoulders and by evening, the tension turns into a headache that is oftentimes at the base of the skull.

Unfortunately, a lot of our daily activities are going to predispose many of us to getting these type of headaches. Spending lengthy amounts of time at a computer or desk, hunched over a cell phone, watching TV or playing video games sets us up for bad posture and increased tension on the muscles of the neck and shoulders. 

Joint dysfunction in the neck is the first culprit - most headaches and neck pain are caused by mechanical dysfunction of the joints. What this means is that we can't turn our head as much one way or the joints just don't have the range of motion they're supposed to. Over time, this leads to altered muscle function in the neck and shoulders - your muscles and supportive soft tissue have to compensate for the lack of motion in your neck. The person with rounded shoulders and a forward head position, for example, will have extremely tight muscles in upper shoulders and neck. This is because the muscles in the back essentially have to support the weight of the head and the muscles thicken in order to do this.  

It is important, however, to get this checked by a health professional to make sure there is no other underlying cause for any neck pain or headaches.

So, what can we do about tension headaches?

• Ice -  I know most people think of heat when they have headaches, but ice is usually my go-to recommendation. Not everybody does well with ice if they have a headache, so you have to listen to your own body on this.  The reason ice is my usual recommendation is because ice reduces inflammation and pain. Usually when our muscles feel really tight and we start to get a headache, there is some inflammation going on in the muscles. Icing for 10-15 minutes once or twice a day can really help.
• Stretching - There are a lot of simple neck stretches you can do throughout the day to help you stay loose. Tucking your chin to your chest and tilting your head side to side, and holding those positions for 15-20 seconds each direction will help. There are some other great stretches that I recommend as well, these are the simplest to do no matter where you are.
• Posture - Posture has a lot to do with where our muscles get tight. The typical posture I described above is very common and an easy one to fall into even after just 10 minutes sitting at a computer. When sitting at a computer, make sure your shoulders are relaxed and down and your head is up.  Ideally your eyes should be level with the middle of a computer monitor screen so you don't have to tilt your head up or down. You should also be sitting so that you're facing the monitor without twisting or turning your upper back.
• Get Up! - It's important to get up and move around at least every 30 minutes. Even if it's just to get some water, go to the bathroom, or pace around your office for 30 seconds, that little bit of movement goes a long way.
• Exercise - Exercise does a lot to rid our bodies of stress related hormones and keep muscle tightness at bay. It also helps get blood and oxygen flowing to our muscles to help keep them looser.
• Water - It's important to stay well hydrated. If we're not hydrated well, our muscles don't get the blood and oxygen supply they need and can tighten up. Lack of proper hydration can also be a cause of headaches by itself. Especially as the weather is getting warmer, it's even more important to drink plenty of water.
• Chiropractic care - As I mentioned, many headaches and neck pain are caused by an alteration of proper mechanical function of the joints.  Chiropractors restore proper alignment and motion to the joints in the spine (and extremities as well). A few visits can go a long way to reducing your neck pain and headaches. I've had many patients over the years that suffered from chronic migraines, neck pain, and tension headaches.  Within a few visits, the neck pain and headaches that were common are now very infrequent.
• Active Release Techniques (ART) - Chiropractic adjustments only address joint function, at least directly. After an adjustment, the muscles may ease and the spasm decreases. In my experience, however, if there is muscle dysfunction (which there often is, especially after any kind of injury or trauma, repetitive stress, and improper ergonomics), the adjustments may not hold for very long. This is why people feel like they need to keep seeing their chiropractor once a week just to keep pain away. ART works directly on the muscles to reduce muscle tension, spasm, pain, and increases range of motion and function. Using chiropractic adjustments and ART, I've gotten a lot of success in treating neck pain and headaches in fewer overall visits than when I was just doing adjustments as a standalone treatment.  

If you'd like your question featured in this column next week, please submit to the comments below or email Dr. Ayesha directly at QureshiDC@gmail.com.