Chiropractor in Clarksville TN Talks About Headaches
Headaches disrupt concentration, cancel plans, and for some people force an afternoon in a dark room. Most are not dangerous. A small number are, and those features are worth reading before anything else here.
Read this part first: the features that need urgent assessment
Seek emergency medical care for:
- A headache of sudden, severe onset, reaching maximum intensity within about five minutes
- Headache with fever, or with a stiff neck, or with a rash. Any one of these is enough, and they often do not appear together
- Headache with new neurological symptoms: weakness, numbness, difficulty speaking, confusion, loss of coordination, or visual loss
- Headache after a head injury, particularly with drowsiness or repeated vomiting
- A painful red eye with blurred vision or halos seen around lights
- In anyone over fifty, a new headache with scalp tenderness, pain in the jaw when chewing, or any change in vision. Visual loss from this cause can be permanent, and it is treatable if caught early.
- Severe neck pain, or a new and unexplained headache, or both, especially alongside visual disturbance, unsteadiness or slurred speech. Either symptom alone can be the first sign. That combination can indicate a tear in an artery in the neck, and it needs immediate medical investigation rather than manual treatment. It does not always announce itself at once: in reported cases the neurological signs followed the first headache or neck pain by a median of several hours to several days, so a day or two of "just" severe neck pain and headache does not rule it out.
Arrange prompt medical review for:
- A headache that is new in a person over fifty
- A headache that has changed its usual pattern, or is progressively worsening
- A headache consistently worse on coughing, straining or exertion
- A headache that changes markedly with posture, clearly worse either standing up or lying down
- Headache with vomiting that has no other explanation
- Headache in someone who is pregnant or has recently given birth, is immunosuppressed, or has a history of cancer
- Headache on most days of the month in someone taking pain relief for it regularly, which can be caused by the pain relief itself
This list is not exhaustive, the timings on it are approximate, and it is not a test to pass before seeking help. If something about your headache worries you, that is reason enough.
What actually triggers headaches
In surveys of people with migraine, the most commonly reported triggers include stress, hormonal changes, missed meals, weather, disrupted sleep, certain smells, bright light, alcohol, and neck pain. Trigger patterns vary a great deal between individuals, which is why headache diaries are commonly used to identify them rather than working from a general list.
Two things often included in lists like this deserve a correction. Ordinary high blood pressure is not a common cause of headache, and treating a headache as evidence of blood pressure trouble is more likely to mislead than to help. And a headache that is genuinely new and severe alongside very high blood pressure belongs in the list at the top of this page, not in a discussion of triggers.
Posture, sustained positions and neck tension
Holding the head and neck in one position for long periods loads the neck extensor muscles continuously, and a head carried forward of the trunk increases that load for as long as the position is held. Tenderness in the muscles around the skull is a recognised feature of tension-type headache, and reduced neck extensor strength has been reported alongside it. That evidence is weak and cannot say which came first, so sustained posture is worth describing as an association rather than as an established cause.
Practical measures that follow from it are low risk and worth trying: change position every half hour or so, move the neck gently through its range when you have been still, and notice whether you are clenching your jaw, which many people do without realising.
Headache and exercise, and why the usual advice here is wrong
Older versions of this page advised that if you get headaches after a workout you should reduce your workload and pick a different exercise. That advice is withdrawn, because it points the wrong way.
A headache brought on consistently by exertion, coughing or straining is on the list above for prompt medical review. Exertional headache is usually benign, but it is also one of the recognised presentations of a secondary cause, and the appropriate response is to have it assessed rather than to quietly train around it. Scaling back the activity removes the trigger and therefore removes the signal, which is precisely the wrong outcome if something is being missed.
If exertional headache has been assessed and no cause was found, then adjusting warm-up, hydration and intensity is a reasonable conversation to have. The order matters.
What a chiropractic examination can answer
An examination addresses one specific question: is the neck contributing to this headache pattern. It looks at movement and tenderness in the upper cervical joints, at posture and sustained loading, and at whether the headache can be provoked or eased through the neck. Headache referred from the neck is called cervicogenic headache, and our page on headache tips describes it and how it is distinguished from migraine.
That question has a real answer and a limited scope. Where the picture does not fit a neck-related headache, or where anything in the lists above is present, referral is the right answer rather than a course of treatment.
Safety, alternatives, and what else treats this
A realistic assessment of the risk. Manual treatment of the neck is not risk-free. The effects reported most often are short-lived neck soreness, headache or tiredness after treatment. Serious events, including injury to the arteries in the neck, are reported rarely. Whether manipulation causes those injuries, or coincides with an arterial problem already underway that brought the person in with neck pain in the first place, is genuinely unsettled. The largest population study of the question found an association between chiropractic visits and this kind of stroke in people under 45, and found a comparable association with visits to primary care doctors, which is the main reason reverse causation is taken seriously. The same authors state plainly that they have not ruled out neck manipulation as a potential cause of some of these events. Rarely reported is not the same as rare. There is no systematic reporting system for adverse events after manual therapy in this country, so published counts describe what has been written up rather than what has happened, and the true rate is not known. Where an examination suggests an arterial cause, manual treatment of the neck is not appropriate and the answer is immediate referral.
The alternatives, and what they are good for. Which fits depends on the headache:
- Medical assessment and prescribed treatment. For migraine and cluster headache this is the route to the treatments with the strongest evidence, including drugs taken at the onset of an attack and drugs taken daily to reduce how often attacks happen. Neither is something a chiropractor provides.
- Treating an identified secondary cause. If a headache turns out to be driven by medication overuse, by a jaw problem, by uncorrected vision, or by anything on the urgent list above, treating that cause is the answer and manual therapy is beside the point.
- Physical therapy and exercise programmes. These overlap with what a chiropractic examination assesses and add supervised progression, which suits a persistent neck-related pattern.
- Doing less, deliberately. For infrequent tension-type headache, sleep, hydration and a break from the provoking position resolve a great many episodes without anyone treating anything.
If you want the neck question answered specifically, contact Source Chiropractic to arrange an examination. If your headaches are frequent, severe, or changing, start with a medical assessment.
Related: headache tips and what an examination looks for, and the different types of headaches.
Follow the evidence
Research, with context.
Published sources behind the discussion. Read the findings alongside the limits; a study is not a diagnosis or a promise of a result.
A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache
200 people with cervicogenic headache, assigned to manipulation, specific exercise, both, or a control group.
What it foundManipulative therapy and exercise each reduced headache frequency and intensity, with benefits reported at 12 months.
What it cannot tell usParticipants were not blinded, and the combined approach was not significantly superior. These findings concern cervicogenic headache, not migraine in general.
Publication details & citation
Jull et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002. DOI: 10.1097/00007632-200209010-00004.
Read the publication recordChiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial
104 people with migraine, assigned spinal manipulation, sham treatment or usual pharmacological management.
What it foundMigraine days decreased in all groups, with no significant between-group difference in the primary outcome. The authors considered the observed manipulation effect probably a placebo response.
What it cannot tell usThe trial was small. Secondary outcomes do not overturn the primary result, and a treatment trial of this size cannot establish the frequency of rare serious harms.
Publication details & citation
Chaibi et al. Chiropractic spinal manipulative therapy for migraine: a three-armed, single-blinded, placebo, randomized controlled trial. European Journal of Neurology. 2017. DOI: 10.1111/ene.13166.
Read the publication record
Read our editorial policy for how sources and clinical review are identified.