Treating Stiff Neck Muscles and Migraine Headaches

• When diagnosing migraine headaches, one should first rule out serious causes and diseases such as ischemic stroke, hemorrhage, etc. Only then can a treatment plan be developed that depends on the frequency and severity of pain experienced by the patient.
• Red flag signs, such as the first or the worst headache of your life, sudden onset of headaches, progressive frequency or severity of headaches, or significant changes in headache characteristics, are signals that you should meet with a doctor immediately for diagnosis and treatment.
• Treatment planning for office syndrome to achieve the correct and most effective treatment can help reduce the duration of treatment as well as minimizing any risks or complications that could arise.

Untreated or unattended pain caused by neurological disorders, such as headaches, neck pain, back pain, etc., can lead to complications or even disabilities down the line.  Additionally, many patients may have an inaccurate understanding of these types of disorders, thinking that there are some types of pain that simply cannot be cured. For those experiencing neck and headache pain, the most important thing to do is to get an accurate diagnosis as to its cause, as there can sometimes be a variety of different factors at play. Once the cause of the symptoms is known, your doctor can provide you with the correct treatment. New technologies are now available that allow us to treat pain at the root cause in a more targeted manner. This includes the use of combined-modality treatments to control pain with greater efficiency, and to achieve faster results and a final cure.

Migraines are caused by the abnormal secretion or release of neurotransmitters in the brain. Once released, they travel to the outer layer of your brain, the meninges, resulting in the inflammation of blood vessels and the constriction of arteries supplying blood to the brain. In addition to headaches, a number of other symptoms may be experienced including blurred vision, flashing lights, dizziness, nausea, numbness, and weakness, collectively referred to as “aura” symptoms. The severe, throbbing headaches most people experience during migraines are likely the result of the aforementioned neurochemicals causing the dilation of arteries in the membrane enveloping the brain. Triggers causing migraines can include:

Intrinsic precipitating factors

• Genetics have been reported as a factor in as many as 50% of cases
• Women are three times more likely to get migraines than men
• Hormonal changes before/during/after menstruation throughout the reproductive years can trigger an increase in migraines
• A lack of sleep is a factor
• Stress can play a part

 Extrinsic precipitating factors

• Environmental conditions that can bring on a migraine include very hot/cold weather, changes in atmospheric pressure, bright sunlight, loud noises, and bad smells
• Certain foods, such as chocolate, cheese, MSG, tea, coffee, and wine can trigger a migraine
• Medications including birth control pills or hormone replacement therapy can trigger migraines or make them worse

• A headache on one side/both sides/alternating sides of the head
• Severe throbbing or pulsating pain
• Pain lasting for 4–72 hours
• nausea and vomiting
• Aura symptoms in addition to headache, the onset of which may be experienced either before or after the headache. These aura symptoms include blurred vision/flashing lights/dark spots, numbness (especially around the mouth and hands), weakness, and dizziness.
• Symptoms are often associated with clear, specific triggers.

When diagnosing migraine headaches, one should first rule out more serious causes and diseases associated with headaches, such as ischemic stroke, hemorrhage, etc. Once your doctor is certain that these more serious diseases can safely be ruled out, treatment planning depends on the frequency and severity of your pain. 
 

Treatment is divided into two main categories:     

• Acute (abortive) treatment: this can be administered as either oral or injectable pain relievers
• Preventative treatment: Patients experiencing frequent headaches, severe pain with each episode, long-lasting pain or pain accompanied by neurological symptoms such as blurred vision, dizziness, numbness, weakness, etc., can be treated using oral or injectable pain prevention medications

Additionally, factors triggering migraines should be avoided in order to prevent the onset of the headaches. Treatment of other possible causes, such as muscle stiffness and office syndrome, should also be carried out.

• First or the worst headache of your life
• Sudden onset of a headache
• Progressive frequency or severity of headaches or significant change in previous headache characteristics
• New onset of headaches in patients over 50 years of age
• New onset of headaches in patients with a history of cancer, patients taking immunosuppressants, and patients who are pregnant
• Headaches accompanied by temporary unconsciousness or seizures
• Headaches triggered by factors such as exertion, straining, or sexual intercourse
• Headaches occurring along with other neurological symptoms such as dizziness or weakness lasting longer than one hour
• Abnormalities found during a general physical examination or neurological exam

Untreated headaches may stem from thrombosis or blockage of the arteries, aortic aneurysms, blood clots in the brain, and other serious disorders. If the root cause is left undiagnosed or untreated, neurological complications can occur, including permanent weakness and loss of therapeutic efficacy, potentially leading to an overdose or addiction to painkillers. As for the prevention of recurrence, details differ for each type of headache but the key principles are to treat root causes, avoid triggers, and take pain relief medications.

Myofascial pain syndrome is caused by the repeated use of a particular muscle group or from remaining in the same position for long periods of time, causing the muscles to contract and freeze up, sometimes continuously. Additionally, neurotransmitters involved in triggering pain, the nitric oxide synthases, stimulate pain receptors surrounding the muscles, resulting in pain in those areas. Once a precipitating factor has occurred, and particularly if it persists for long periods of time, this in turn affects the central pain receptors and can cause chronic or long-lasting pain.  Factors causing muscle stiffness and pain include:

• Hypothyroidism or deficiencies of certain minerals such as magnesium, calcium, potassium, iron, vitamin B, vitamin C, or vitamin D
• Low muscular endurance
• Stress or sleep deprivation

• Patients often experience pain, stiffness, or tightness in frequently-used muscles, such as the neck, shoulder, temples, back, waist, or leg muscles. In some cases, muscle knots may be felt, caused by muscle fibers tensing or tightening; these are known as trigger points
• Dull or deep aching pain in a muscle that is related to the use of that particular muscle
• The duration of pain depends on the severity experienced by the individual patient. Other symptoms such as nausea, vomiting, weakness, and numbness are rarely found and, as such, if any of these are present a more serious disorder involving headaches should be suspected

The treatment typically involves reducing tightness and tension in the affected muscle group

• Tension treatment by using oral or injectable drugs, including muscle relaxants, paracetamol, nonsteroidal anti-inflammatory drugs, and opioid pain relievers
• Breaking up muscle tension in and around trigger points with dry needling or acupuncture
• Trigger point injections directly into the affected muscle to reduce inflammation
• Acupressure massage to release tension in tight muscles or trigger points
• Heat pack compression to help relieve tension and reduce pain
• Ultrasound using sound waves to increase blood circulation and warmth and to break up trigger points
• Shockwave therapy to release tension in tight muscles
• Magnetic stimulation therapy—one of the newest technologies available for treatment of myofascial pain

The Treatment Process

1. Assessment of the patient to provide diagnosis of the disorder and all causes
2. Additional testing in certain cases for differential diagnosis
3. Treatment planning with your doctor in order to achieve the correct, most effective, and most time-efficient treatment, as well as to reduce any risks or complications that could arise in certain patients from different types of treatment.