Headaches are just one of those pains that all of us experience at some point or another in our lives, and often range from a minor nuisance to debilitating. While the variety, severity, and length of a headache can vary greatly, the one thing that most headaches have in common is that they are usually not the result of a serious underlying illness. Despite this fact, some headaches can be serious and do require urgent medical attention.

The majority of recurrent headaches fall into two categories: tension headaches (also called cervicogenic headaches) and migraine headaches. These two types of headaches can have a variety of causes, such as tightness in the neck muscles, low blood sugar, high blood pressure, TMJ, stress, and fatigue, but there is also a third, less common type of headache. This third type of headache is related to the migraine and is called a cluster headache. What follows is an in depth look at all three types of headaches.

Tension Headaches

75% of all headache sufferers are experiencing a tension headache, making it the most common type of headache. These headaches usually begin slowly and gradually build to a dull, achy feeling, often felt behind the eyes or around the head. Sometimes these headaches can be felt on one or both sides of the head and can last for minutes or for days. Tension headaches usually begin in the middle or toward the end of the day and often as a result of stress or bad posture. The stresses on the spine and muscles in the upper back and neck resultant of stress and bad posture result in the headache.

Tension headaches, also called stress headaches, can last a varying amount of time. Some headaches only last 30 minutes while other can last for days. Chronic sufferers may even experience the dull throb of a tension headache for months. Tension headaches rarely result in other symptoms (like nausea and vomiting), even when the pain is more severe.

A misalignment, or subluxation, in the upper back or neck, combined with active trigger points, is the most common cause of a tension headache. A small muscle called the rectus capitis posterior minor (RCPM) goes into spasm when the top cervical vertebrae lose their normal position or motion. Although the brain itself has no feeling, it is covered in a thin pain-sensitive tissue called the dura mater. The RCPM is connected to the dura mater through a small tendon which tugs at the dura mater when the RCPM muscle spasms. This tugging results in a headache. People who hold desk jobs often suffer from this type of headache.

Another cause of a tension headaches, more common in people with a whiplash injury, originates from trigger points in a muscle on the side of the neck called the sternocleidomastoid (SCM), or levator muscle. The muscle damage in the neck region causes the headache.

Migraine Headaches

Migraines are intense, throbbing headaches that can last from a few hours to a few days. Often migraines are associated with nausea and light and noise sensitivity. About 25 million people in the U.S. suffer from migraines each year and about 75% are women. Just prior to attack, many people experience an “aura” or flashing lights or everything takes on a dream-like quality.


Most sufferers experience their first migraine before they are 30, but find that their attacks occur less frequently and with less intensity as they age. The frequency of attacks varies per person. Some people have attacks on a regular basis while others have less than one a year. It is theorized that migraines may be genetic, as they often run in families.


Migraines begin with a constriction of blood vessels in the brain. The decrease in blood flow to the brain is the cause for the strange visual symptoms that many people experience, but even without the visual effects, many sufferers can tell that an attack is imminent. When the blood vessels in the brain dilate, there is a rapid increase in blood pressure in the brain. It is this rapid increase that causes the pounding headache where each heartbeat is another pulsing shock through  the carotid arteries up into the brain.

 While it is unknown exactly why the blood vessels constrict in the first place, there are a number of known migraine triggers. Sleep, stress, strong odors, flickering lights, certain foods (especially those high in the amino acid, tyramine), and changing weather patterns can all trigger a migraine. Through some simple lifestyle changes, you can reduce the likelihood of getting migraine headaches.

Cluster Headaches

Like migraines, cluster headaches are usually related to dilation of blood vessels causing an increase in blood pressure in the brain. Usually cluster headaches are felt behind the eyes on one side of the head. Out of the 1 million Americans affected by cluster headaches, a majority of them are men. These short but excruciating headaches tend to occur at night, but can occur one to four times a day over several days. Once the cluster headache has passed, it may be months or even years before a recurrence.

Chiropractic Care for Headaches

Chiropractic adjustments have been shown in numerous studies to be very effective in the treatment of tension headaches, especially those that originate in the neck.

In  2001, researchers at Duke University’s Evidence-Based Practice Center in Durham, NC,  released a report stating that, “spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than commonly prescribed medications.” The Journal of Manipulative and Physiological Therapeutics, in earlier studies, also found spinal manipulative therapy to be a very effective treatment for tension headaches. In contrast to patients given pain medicine, those who underwent chiropractic treatment continued to benefit even after treatment had ended.

While each individual’s case is different and requires thorough evaluation before a chiropractic care plan can be implemented, most cases of tension headaches and migraines can be treated effectively. Through manipulation of the upper two cervical vertebrae, coupled with adjustments to the junction between the cervical and thoracic spine, many patients can experience significant relief from tension headaches. As long as food and lifestyle triggers are avoided as well, chiropractic treatment is also effective against migraines.

Headache Trigger Points

Trigger point therapy for headaches usually engages four muscles: the Splenius muscles, the Suboccipitals, the Sternocleidomastoid (SCM) and the Trapezius. The two muscles, Splenius Capitis and the Splenius Cervicis, comprise the Splenius muscles.The Splenius muscles extend from the upper back to either the upper cervical vertebrae (splenius cervicis)or the base of the skull (splenius capitis).  headache pain that travels through the head to the back of the eye and the top of the head is often caused by trigger points in the Splenius muscles.

Trigger points in the Suboccipitals will cause pain that feels like it is inside the head, often feeling like the whole side of the head hurts. The pain feels similar to that of a migraine and extends from the back of the head to the eye or forehead. The suboccipitals are comprised of four small muscles that maintain the positioning and movement between the first cervical vertebra and the base of the skull.

The muscle that runs from the base of the skull, just behind the ear, down the side of the neck to attach to the top of the sternum (breastbone) is the Sternocleidomastoid (SCM). The SCM trigger points, while most people unaware of them, are unique because their effects are widespread, including dizziness, nausea, balance problems, and visual disturbances. SCM trigger points can also cause referred pain, which tends to present as a headache over the eye, deep eye pain, or even earaches.

A common trigger point located at the very top of the Trapezius muscle, a very large, flat muscle in the upper mid back, refers pain to the back of the head and temple, and is sometimes also responsible for headache pain. This trigger point is also capable of causing jaw or tooth pain by producing satellite trigger points in the temple or jaw muscles.

Avoid Headache Triggers

In order to avoid triggers, keeping a headache diary can help pin down whether factors such as change in weather, mood, and/or food hold any relationship with your headache patterns.

Stress may be a trigger, as well as emotional factors such as depression, anxiety, frustration, letdown, and even pleasant excitement.

Certain foods, especially hot dogs and other processed meats are high in sodium nitrite. Nitrites are vasodilators, meaning they cause blood vessels to widen, which can produce a dull, pounding headache, sometimes accompanied by a flushed face. Nitrites are also found in heart medicine and other products. Repeated exposure to nitrite compounds can lead to headaches.

Foods prepared with monosodium glutamate (MSG) cause headaches when consumed. MSG is used as a flavor enhancer in a variety of packaged goods,  soy sauce, and even meat tenderizer.

Other headache triggers include: odors, menstrual periods, and changes in weather.