Headache Part One: A Pain in the Neck
Headaches are one of my favorite issues to treat as a physical therapist because they are an everyday nuisance that are often completely fixable. The typical description I hear from patients is an ache at the base of head where it meets the neck that seems to get worse as the day goes on, especially while sitting at a desk.
As much as I’d like to tell everyone to just retire and the headaches will go away, that’s not sustainable for my patients. Their reports of aching and tightness at the base of the head often also includes a dull ache in the upper shoulders and shoulder blade region which improves briefly with massaging the area.
We all know that you can’t recruit someone to rub your neck and shoulders all day at work, so over the next few articles, I will offer tips for decreasing the pain and give techniques to manage it without medication or days off.
When dealing with headaches, it’s important to identify the cause or causes, so they can be treated effectively. Many times, there are a combination of issues which may include seasonal allergies, posture while sitting at your desk, driving or sleeping, stress, neurological problems and trauma. While not all of these causes are suited for physical therapy, there are many that can be improved and solved with physical therapy.
Headaches that are located behind the eyes, at the temples or radiate up the back of the head to the top are often caused by dysfunction in the neck and are called “cervicogenic headaches”. These types of headaches often respond very well to physical therapy. While the pain appears in these areas, it’s not actually caused by dysfunction there specifically.
Limited joint motion, tight muscles or instability at the joint can all cause these symptoms. A skilled physical therapist will utilize a variety of manual hands-on techniques focused on restoring normal joint motion, calming muscles that are overly tight or in a spasm, and re-educating the stabilizing muscles of the neck so that your body can maintain good posture.
Here are some basic ideas to get you started. In the next few blog posts, I will give advice on ergonomics at your desk, while driving and while sleeping as well as exercises to create a strong, stable posture, so stay tuned!
Correcting the forward head posture
The problem: head or neck pain at the computer, while driving or reading.
The reasoning: Posture is an important starting point because without restoring the neutral position of the spine, the joints and muscles will be perpetually strained and irritated which creates a pain cycle and forces your body to compensate with unhealthy patterns of movement.
When we sit at a desk or when driving, we all have the tendency to lean toward whatever we’re looking at, typically leading with the chin. This essentially shortens the muscles of at the base of the skull and overstretches the muscles on the front side of the neck. These muscles are deep; they bear the responsibility of stabilizing our spine. If you hold your head in the forward position long enough, those stabilizing muscles in the neck are unable to support the posture and you will begin to feel that ache at the base of your head.
The solution: Postural awareness…start by sitting tall in a chair with back support, look straight ahead keeping your chin level with the horizon. Squeeze your shoulder blades together gently to support the upper back, then pull your chin directly backwards into your spine (think double chin). The goal is to keep your chin level (not letting it drop toward the floor as you pull it backward) and reverse the curvature that was caused by the forward-head posture that was mentioned earlier. Hold for 10 seconds, while breathing and relaxing. Keep this posture in mind as you drive, work at your computer or read.
Pain while sitting at the computer
The problem: working at the computer for hours at a time and ending up with a headache
Take frequent mini-breaks – stand up and walk around for a few minutes at least once every hour, or sooner if you begin to notice a headache or neck pain
Good ergonomics – we will go in depth on this topic in the next blog post, but here are a few key points to keep in mind:
Sit in a chair with low back support that fills the natural curve of your spine. Using a rolled up sweatshirt or a few thin towels rolled together can accomplish this without needing to buy an expensive new chair.
The seat of your chair should be high enough that your hips are higher than your knees, but your feet are still fully on the ground. Try placing a few folded towels under your buttocks to achieve this position.
Your screen should be high enough so that you can see the most of the screen by looking straight ahead with your chin parallel with the floor, and without needing to tilt your head up or down.
Keep your chin tucked into your neck and avoid that forward-head posture we discussed before.
Balancing flexion and extension – in our society we spend a lot of time bent forward at a computer, driving a car or just staring at our phones. Your body needs to spend time out of that forward bent position (called flexion) with backward bent positions (called extension).
Here is a simple exercise you can do at work to loosen the muscles on the front of your body and give the ones on the back a break:
– Use a narrow doorway, place one forearm flat against each side of the doorframe with your elbows around shoulder height.
– Tighten your abdominal muscles and step into the doorway until you feel a stretch across your chest
– Hold this position for 30 seconds. You should feel the stretch in your chest and upper back. If you feel it in your low back, don’t step into the doorway so far.
– Repeat this stretch one to two times an hour as you go through your day
- Pain while sleeping
The problem: Restless sleep because of neck pain
Left-sided or right-sided – the key is support
Imagine lying on your favorite side…start with the pillow under your head only (not under your shoulders). Next, tuck one end under your chin, pulling the middle section into the crook of your neck and the end around to the back of your head. Picture a horseshoe shaped pillow wrapping around from your chin to your upper back. A great way to achieve the support of an expensive feather or memory foam pillow is to take a hand towel and roll it into a log, then slide that into the pillowcase at the base of the pillow. This creates support for the neck while also being adjustable to your comfort.
Next, support your top arm. Grab a standard pillow and tuck it all the way up under your armpit and so the length of your arm is comfortably resting on the pillow. Make sure all of it is supported by the pillow – upper arm, elbow, forearm and hand.
If you’re a back sleeper:
The goal is to support your head and neck while also keeping your neck in line with the rest of the spine. In the picture below, you see how too many pillows can raise the head so it’s no longer in line with the rest of the spine. Another important point about this picture is that the pillows are there to support your head and neck, and need not be under your shoulders. Pull the pillow under your head so that it fills the curve under your neck.
Finally, if you have any shoulder issues, you can put a pillow under your arm from your armpit to your belly button to support the weight of the arm. This support will allow the muscles in the neck to turn off at night and rest because they no longer have to hold the weight of the arm.