Headache Treatment in Dallas

What kinds of headaches are there?

Doctors split headaches into two groups. Primary headaches, such as migraine, tension-type and cluster headaches, are conditions in their own right. Secondary headaches are caused by something else, such as a neck problem, an injury, an infection or a medication.

The type matters because treatments and evidence differ. A chiropractor's role is mainly with headaches that involve the neck and surrounding muscles.

What causes headaches that start in the neck?

A cervicogenic headache is pain felt in the head that actually comes from the joints, discs or muscles of the upper neck. The nerves of the upper neck share pathways with nerves of the head, so irritation in one can be felt in the other.

Common contributors include:

• Long hours with the head pushed forward at a screen (see posture and tech neck)
• Stiff joints in the upper neck
• Tight muscles at the base of the skull and across the shoulders
• A past neck injury, such as whiplash from a car accident
• Poor sleep position or an unsupportive pillow

Stress, dehydration, skipped meals and poor sleep can add to almost any type of headache.

How do we evaluate headaches at our clinic?

We start with a detailed history: when the headaches began, where they start, how long they last, what triggers them and what helps. We ask specific questions to screen for warning signs that point to a physician or emergency room instead.

The physical exam checks neck motion, posture, tender points in the neck and shoulder muscles, and a basic neurological screen. If your headaches follow an injury or your exam suggests a structural problem, X-rays may be taken when needed. We review what we find and recommend a plan, or a referral when your headaches look like something outside our scope.

Which treatments may help?

When the neck or muscles play a role, a combination of approaches usually works better than one alone. Results vary.

• Chiropractic adjustments: manipulation or gentle mobilization of stiff joints in the neck and upper back.
• Physical rehab: deep neck flexor and upper back strengthening, which research supports for cervicogenic headache.
• Medical massage: soft tissue and trigger point work for tight neck and shoulder muscles.
• Dry needling: thin needles placed into tight bands of muscle that may refer pain to the head.

What does the research show?

The evidence depends on headache type. A Cochrane review of physical treatments found that both spinal manipulation and low-intensity neck exercise reduced cervicogenic headache compared with no treatment. A later review summarized by the National Center for Complementary and Integrative Health found manipulation may reduce how often and how intensely cervicogenic headaches occur.

For migraine, one review found manipulation may reduce migraine days and pain, but the reviewers called the results preliminary. For tension-type headache the picture is mixed, and adding manipulation to massage did not help episodic tension-type headache in the Cochrane review. NCCIH's overall summary is that evidence for manipulation across headache types is too inconsistent for firm conclusions.

What can I do at home to prevent headaches?

1. Keep a headache diary with timing, triggers, sleep, food and stress.
2. Set your screen at eye level and take a short break every 30 to 45 minutes.
3. Practice chin tucks and shoulder blade squeezes from your plan.
4. Drink water through the day and keep regular meal and sleep times.
5. Use a pillow that keeps your neck level when you sleep.

For desk setup ideas, see our desk posture and spine tips. If your headaches come with ongoing neck pain, that page explains how we approach both together.