Chronic headaches can be one of the most debilitating conditions seen in clinic. Headaches lasting anything from a couple hours to a number of days can have a serious impact on peoples lives. Constantly having to worry about when the next flare will appear and the potential impact this may have on both their work and family life is a constant stress for many.
From cancelling family engagements to having to take time off work in order to recover from the latest flare is a pattern those who suffer from headaches will be all too familiar with.
For many others, having to work all week only to have a headache by Friday, spend much of Saturday in bed and then having to use Sunday as a recovery day is a reality they have to live with….only for the routine to start all over again on Monday.
The use of medication and advise around lifestyle changes can be successful for some, helping to reduce both intensity and regularity of their flares. For others there may be little improvement and the problem persists.
Often for those who have not had the improvements expected from these interventions may begin to feel – or it may have been suggested – that their pain is all in their head…well, maybe there’s something else which is having an effect…the fascial system.
We’ll look at the fascial system briefly here but for a more detailed breakdown then take a look at one of my earlier blogs where I talk in more depth about by clicking here.
Fascia is the main connective tissue in the body, connecting everything to everything else. Fascia is one continuous sheet of connective tissue which wraps around all of the soft tissues within the body. Starting with the superficial fascia which lies just blow to the deeper layers which encases and runs through our organs such as our heart, blood vessels, nerves and muscles which make our limbs work. The ligaments that hold our joints together and the tendons which connect the muscles to the bones are all made of fascia.
To describe fascia in it’s physical form would then it would be described as a flimsy, white membrane; this membrane is innervated by nerves which send signals back and forth to the brain and react to what is happening in the body.
If you have ever prepared a chicken breast for dinner and noticed the membrane which lies beneath the skin then this fascia (apologies to any vegetarians who may be reading!).
Above: The white web like structure of fascia.
In a nutshell, fascia wraps around all the muscles tendons and ligaments in the body. The fact that fascia encases all these tissues means if one area of fascia becomes tight or restricted (usually due to injury or posture related issues), then lines of tension can be formed resulting in pain and restriction in other, seemingly unrelated areas of the body…more on this later!
Before then, lets take a look at some of the causes of headaches…
Causes of Headaches
The causes of headaches can be complex; medical conditions, injury, lifestyle and certain prescribed medications can all be attributed but for many, the reasons can seem a little unclear.
One of the most common explanations given for the cause of chronic headaches is the link with stress levels and anxiety. Whilst there is certainly a link with stress and headache related disorders this is not always the case. Some of the increased stress the client is suffering from can be as a result of them constantly being in pain and the worry the impact of this will have on their work/ family life and social interactions. The heightened stress and anxiety levels the client is experiencing may be as a result of the constant pain and discomfort they are in as a result of their headaches rather than the other way around.
As earlier stated, stress and anxiety can certainly be an issue when it comes to chronic headaches and in these cases appropriate, professional support should be sought in order for the client to manage this. Problems can arise when the client feels their pain is entirely as a result of their stress levels. Simply informing someone their pain is due to their stress levels can potentially have a negative impact on their recovery; stressful situations – especially those relating to work or family pressures – cannot always be avoided and therefore may result in the client feeling powerless to improve their situation. Worse still, others can begin to convince themselves that their pain is simply all in their head.
Unfortunately, there is no one, simple answer as to the cause of headaches as there can be a number of reasons including medical, social and lifestyle issues. Despite this, there are ways in which pain can usually be reduced and managed in the long-term.
Before we talk a little more about this, lets look at the main types of headaches…
There are many different types of headaches but the most common where fascial tension can be having a significant impact include:
- Long COVID
Migraines, although essentially a headache, often also have other symptoms are in themselves a type of headache but they can come with other symptoms. These symptoms are usually pain related but this is not always the case. Pain is usually felt in the face and neck as a throbbing type of pain. Other common symptoms include nausea, light and sound sensitivity, auras and distorted vision. However, for some people, they may have other symptoms but no pain.
Often felt as a pressure type headaches with symptoms described as feeling like a tight band around the head or tension behind the nose or eyes. As pressure builds, this can also develop into a dull throbbing pain. Those involved in minor car crashes and suffer a whip lash injury can often go on to develop tension headaches.
Named cluster headaches as they tend to last for a period of weeks to months for a then go away for a period of time before re appearing. Many people can accurately predict when their headaches will appear. Cluster headaches usually cause severe pain and is usually located on one side. Common associated symptoms include tearing of the eye, runny nose and possible drooping eyelid all on the same side of the head.
New Daily Persistent Headaches (NDPH)
New Daily Persistent Headaches (NDPH) are literally headaches that are experienced every day. NDPH usually can persist for many months and for no apparent reason. Often found in children and teenagers symptoms include migraine and tension headache-like symptoms.
Long COVID Headaches
Covid headaches are a new form of headache that have emerged following the onset of the Covid-19 pandemic. Known to be one of the first signs of COVID – more so than the other early symptoms of covid including loss of small/ taste, cough and fever. Around 15% of people with Covid-19 reported a headache as their only symptom. Common symptoms of Covid headaches include a pulsing stabbing pain felt on both sides of the head, and do not respond to pain killers. Covid headaches generally last for a couple of days, but for some they remain as a common symptom of Long Covid.
Fascial Causes Of Headaches
As already discussed, there can be many causes for headaches including injury, poor posture, diet, hormones and dehydration. Despite this, for some, there can be no real explanation for the headaches they have suffered with for months and often years.
Where there is no clear medical diagnosis, there is good reason to look elsewhere for the cause…and one of them may be your fascia.
As we looked at earlier fascia is the main connective tissue in the body, forming a web like network that wraps around all the muscles nerves and bones of the body. If the fascia becomes restricted in an area of the body, then there can be an effect elsewhere.
Lets look at a few examples common examples to explain more…
One possible cause of fascial restrictions can be related to our posture. An example of this is when we sit at our desks for hour upon hour with our heads gradually gravitating towards the computer screen. Holding this position for many hours will cause the muscles and fascia at the back of the neck and shoulders to compensate in order to take the strain of the head as it veers forward, often causing restriction. Tension within the muscles and fascia of the neck and shoulders will often create tension upon the nerves and joints within the neck and the increased pressure within the muscles can create referred pain and headaches.
Above: An example of forward head posture. As the head veers forward towards the PC screen, the muscles and fascia at the back of the neck have to tension in order to counter balance the increased weight of the head as it inches forward. This can often create tension and restriction in the tissues of the neck and upper back – often the cause of headaches.
The fascial connections throughout the body can mean your headaches may be related to a restriction elsewhere in the body. These fascial restrictions can be located anywhere in the body and as we’ve already discussed, are usually related to postural issues or previous injury. There can potentially be a number of different areas of the body where restrictions can be present and these can only be determined via appropriate assessment but for demonstration of the point, lets look at one of the most common areas – the hips…give me a chance to explain!
One of the most common findings with hip imbalances is when the hips begin to tilt forward. This known as an anterior tilt of the pelvis (or the hips as they are known) and is usually as a result of the muscles at the front of the hips becoming short and tight and pulling the pelvis forward, which can have an effect on the lower back.
Above: Image on right shows an example of an anterior pelvic tilt. Note how the hips tilt forward at the front and there is a curve formed in the lower back. This can lead to compression and tension in the lower back which can then potentially create tension in the upper back and neck via fascial and connective tissue.
As can be seen, when the pelvis moves downwards and forward at the front, this can then cause the lower back tip upwards, creating a curve in the lower back. This can potentially create compression and restriction in the lower back. When the lower back becomes tight and restricted, this can then create a pull on the upper back and shoulders due to the fascia and connective tissue creating a link between the two. Remember that fascia is one continuous sheet of tissue and restriction in one area will often create a pull elsewhere.
To help to explain this, imagine if you where to pull one end of a table cloth, the pull at one end would see the table cloth at the other end of the table move towards you. This is what can potentially happen if there is restriction in the lower back. The lower back (or one end of the table cloth) will begin to pull on the upper back and shoulders (or the other end of the table cloth!), causing tension and restriction within the neck and shoulders. Tension within the neck and shoulders is a common cause of headaches and neck pain. Often massage or treatment to the neck and shoulders can help to release the tension and potentially reduce the headaches but the pain and headaches will usually return as the tension from the lower back has not been addressed. It can often seem very strange to think the headache your suffering from can be traced back to tightness at the front of your hips!
Above: As you can imagine in the image above, pulling on the table cloth will cause the cloth at the other end of table to move and cause the glass to topple over.This is because the table cloth is one continuous sheet, similar to fascia. If you imagine where the table cloth is being pulled is the lower back and where the glass is placed is the upper back and neck, then this may enable you to understand the analogy (…hopefully!)
Jaw Pain – TMJ.
Another common link with headaches which is very much overlooked is the connection between headaches and restrictions within the jaw – otherwise known as TMJ syndrome. Its not uncommon for those suffering from chronic headaches to also report restrictions within the jaw. The reason for this is the muscles and fascia of the jaw happen to have a direct connection with the muscles of the neck and shoulders, meaning any restrictions within the jaw can therefore have the potential to affect the muscles and fascia in the neck and shoulders.
The link can also be reversed where restrictions within the neck and shoulders can create tension within the jaw…but maybe we’ll leave that for another time?!
Above: Common links between the muscles of the shoulder and the jaw.
The connection between the jaw, neck and shoulder does not end there; restrictions further down – as far as the hip can create a lines of tension into the shoulder, neck and eventually into the jaw. Often, those with jaw pain will report hip tightness and pain – often a clue as to the link between the two.
Phew! So there we go, a whistle stop tour of all things fascia and it’s connections to headaches.
As we looked at today, restrictions within the fascia and connective tissue can have an impact on the causes of headaches and migraines. We also looked at how restrictions in other, seemingly unrelated parts of the body can be having an effect. Posture, pelvic imbalances and even restrictions within the jaw will often be areas to explore further in order to find a solution, particularly if the headaches have not responded to previous interventions. Often, repeatedly treating the area of pain can be futile if restrictions elsewhere are the true cause.
Unfortunately, there is no ‘silver bullet’ or magical quick fix when it comes to the treatment of any form of chronic pain and that includes the use of myofascial release and treating the fascial system. To help the client with chronic pain, treating the whole body, rather than just painful area can be the key to calming the nervous system and reducing symptoms.
So, if you have struggled with finding a cause for your pain and there seems to be no obvious answer then consider further the fascia and connective tissue as a possible link….maybe your pain is not all in your head after all.
Jeff Pringle is a Sports Therapist and myofascial release practitioner based in West Kirby on The Wirral.