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Massage Today
April, 2008, Vol. 08, Issue 04

Misperceived Headache Pain

By Ben Benjamin, PhD

Q: True or false: Headache pain can be referred to the head from injuries to the C5, C6 and C7 ligaments.

A: False. Only the upper cervical ligaments refer pain to the head.

Supraspinous ligament injury. - Copyright – Stock Photo / Register Mark Fig. 1: Supraspinous ligament injury: The ligament at the back of the neck (A) is torn. Headache pain frequently is referred to the head from injuries to the C2 and C3 supraspinous and intertransverse ligaments. Among the many causes of headaches and neck injuries, these may be the ones most often misunderstood.

Headaches have plagued humans since the beginning of recorded history. As many as 50 million people in the U.S. regularly suffer from headaches. An additional 26 million people suffer from migraines. Some headaches are debilitating, while others simply are annoying. People whose primary complaint is a severe headache account for 18 million visits to the doctor each year.

Intertransverse ligament injury. - Copyright – Stock Photo / Register Mark Fig. 2: Intertransverse ligament injury: The ligament at the side of the neck (B) is torn. Headache pain may be felt at the back of the head, at the forehead, in one or both temple areas, localized in one or both eyes, or even behind the eyes. A headache may appear as a band-like pain around the head just above the ears or over the top of the head. The pain may be throbbing or stabbing, eyesight and hearing may be altered, and if head pain is severe, thinking processes may be affected. All of these head-pain patterns can be the result of referred pain from injured upper cervical ligaments.

Head pain caused by ligament injury may feel like a muscle tension headache. It takes a skilled assessment to differentiate a headache caused by stress and tension from one caused by ligament sprains. Some headaches are the result of both excess muscle tension and ligament sprains.

Neck injury pain patterns. - Copyright – Stock Photo / Register Mark Fig. 3: Neck injury pain patterns: If you feel pain in these areas (C1, C2 and C3), you may have injured the ligament that attaches the first, second or third cervical vertebra. Headaches usually are multifactorial, meaning many factors combine to bring about the headache. For example, a headache can be the result of a concussion, more than 200 diseases, allergies, chemical sensitivity, or exposure to fluorescent lights. Only when the causes of a headache are clearly identified can the pain be successfully treated.

Some headaches due to head or neck injuries may begin a few weeks after the injury is sustained, as in the case of whiplash. Often, the injury has been forgotten or is not associated with the headache because the neck no longer hurts. A whiplash injury frequently causes referred head pain due to damaged muscles, tendons and ligaments in the neck. (See Fig. 1 and Fig. 2)

Adhesive scar tissue usually is the primary factor in causing this type of referred pain headache (see Fig. 3 for the referred pain patterns). When the muscles, tendons or ligaments of the neck are injured, the torn fibers often heal in a matted scar. When normal movement pulls upon this adhesive scar tissue, it tears again and again, causing more referred pain and ridding the body of unwanted scar tissue. The unwanted tissue can be discarded through friction therapy combined with massage, together with appropriate exercises, and the pain cycle can be broken.

When you eliminate the poorly formed scar tissue and re-establish free movement in the neck, an injury-related headache usually disappears.
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