Persistent headache and migraines can be incredibly disabling, however you’re not alone. Headache disorders rank as the third highest cause years lost due to disability.

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Those suffering from persistent headache and migraines have often seen an array of health professionals, GPs, physios, chiros, neurologists… the list goes on. However despite all the help out there, these conditions continue to contribute to ongoing disability.

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One of the factors limiting people’s ability to manage their persistent headache or migraine is a lack of understanding behind the true cause of the pain. Understanding this can help people take back control of the pain, further understand their triggers and develop great self-management strategies.

 

Sensitisation

Research shows that people who suffers these persistent conditions have had changes within a specific area of their brainstem. The brainstem is the part at the base of the brain, as it begins turning into the spinal cord.

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This area receives information from a number of different parts of your body:

• The upper parts of your neck – Joints C0/1, C1/2, C2/3 and surrounding muscles

• Your Jaw

• Your eyes, ears, nose and throat

• Your inner ear (vestibular system)

• Your Vagus nerve (supplies heart, lungs, gastrointestinal tract, stress response) 

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The brainstem receives signals from these area and then sends it up to your brain to be further processed.

The changes that happen with your brainstem are called “central sensitisation”. This is not something that is damaged or sinister. It can be thought of as a signal processing problem.

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The signals coming from the above areas are being misinterpreted and over amplified.

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To put it simply, pain – such as that from a headache or migraine can be thought of a warning sign. In theory it alerts you of actual or potential tissue damage.

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For example: You would expect that your smoke alarm might go off to warn you that your toaster, while cooking your toast had caught fire! However, it might be an over-reaction for it go off simply because your toast is burnt, or especially if you haven’t even put any bread in yet!

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For people with persistent headache conditions, with central sensitisation your alarm system is over protective and more easily triggered by things that should be mildly painful, or not painful at all!

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For example: Bright lights or strong smells causing pain or triggering headaches. These aren’t “dangerous”, so why does it hurt?

Or, you may have strained a muscle in your neck in the gym. Why has it turned into a crippling migraine lasting for days?

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Information coming from inputs to the brainstem – your neck or eyes, is being amplified, and looks more dangerous than it is. So your body reacts as it thinks it should by giving you a lot of pain!

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Referred pain

Understanding “referred pain” is also part of the picture to understanding your headache or migraine symptoms.

Referred pain is pain that is felt in one area of your body that is actually coming from another source.

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For example: when someone has a heart attack, one of the symptoms might be pain their left arm. The arm is not damaged, the problem is the heart. The signals are being misinterpreted.

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Feeding back to the inputs into the brainstem: From your neck, jaw, eyes, inner ear, vagus nerve; things start to make a bit more sense.

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A problem in any one of these areas can cause a headache or migraine. A joint or muscle problem in your neck might be felt as pain in your head. Temporomandibular joint dysfunction (TMD/Jaw) might also be felt as pain in a different part of your head.

Most commonly, in our clinic we would see that the main source that is driving sensitisation of your brainstem in a problem in the upper parts of your neck.

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It is also why many people with headaches and migraine suffer from a number of other symptoms:

• Tinnitus (ringing in ears)

• Dizziness

• Nausea or vomiting

• Spots in their vision

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There is often not a problem with these areas, but they all refer into the brainstem and again the signals are being misinterpreted.

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Why is my brainstem “sensitised”

There are few different reasons that can lead to central sensitisation or changes within your brainstem

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Genetics – unfortunately a number of people are predisposed to having these changes. Did you have family members that also suffer from headaches or migraines?

Trauma – A significant trauma to an area that refers into the brainstem might cause it to become sensitised. Such as whiplash to the neck

Long term pain – Pain that affecting one area such as the neck that has gone untreated or undertreated. Overtime it may sensitise the brainstem. You might have started with a bit of neck pain, that overtime has been getting worse, and now you are experiencing recurrent headaches.

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Regardless of how this started, the good news is that it is treatable. There are a number of strategies we can help with that will allow you to manage your headache and migraines, and regain control of your life. We discuss some if this in the next post. Click here!

 

To recap

Headaches and migraines:

• Are due to an area in your brainstem becoming sensitised. Misinterpreting and amplifying normal information

• The pain in your head is likely being referred from another source. This is needs to be treated to help desensitise your brainstem

• It may relate to your genetics, a past trauma or a persistent pain in another area. But it is treatable.  
   

For more information on how we treat this, read our next blog post.

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Owen is qualified in the Watson headache approach and has significant experience in treating persistent headache and migraine conditions, click here to book and appointment with Owen today.