Pathophysiology: Understanding the Classification and Underlying Mechanisms of Headaches
The pathophysiology of headaches, particularly migraine, is complex and involves interactions between the trigeminal system, neurotransmitters, brain structures, and phenomena like cortical spreading depression. Understanding these mechanisms is crucial for developing effective treatments and prevention strategies.
*This article is only meant to be educational and informative. It is not meant to provide medical advice. We strongly encourage you to seek the help of a medical professional if you are suffering from chronic headaches. We also support the use of mental health counseling or therapy of your pain is interfering with your quality of life.
Classification of Headaches
Headaches are a very common condition characterized by pain in the head or face, according to the Cleveland Clinic. While most are not dangerous, they can significantly impact daily life. Headaches fall into two main categories: primary and secondary.
Primary Headaches
Primary headaches are caused by dysfunction or overactivity of pain-sensitive structures within the head, and are not a symptom of an underlying medical condition, disease, or trauma. Examples include:
Migraine: Characterized by severe, throbbing pain, often on one side, along with possible nausea, vomiting, and sensitivity to light and sound. Migraine is now considered a sensory perceptual disorder, with many sensory systems altered during an attack. Abnormalities in brain function, particularly a hyperexcitable state of the brain, are thought to underlie migraine. Migraines often get worse with movement, lights, smells, and sounds. They last 4+ hrs and can even last 2-3 days.
Tension-type headache (TTH): Often described as a tight band around the head, generally less intense than migraines. Thought to be linked to stress, poor posture, and muscle tension. Central sensitization of the trigeminal nerve also seems to play a role, particularly in chronic TTH.
Cluster headache: Intense, excruciating pain typically localized around one eye, occurring in cyclical patterns or clusters. Often associated with unilateral autonomic symptoms like eye watering or nasal congestion. Overactivation of the trigeminal nerve and the hypothalamus are implicated.
Lifestyle Choices are a Leading Cause of Primary Headaches
If you or your clients get frequent headaches, now is a great time to start making note of various lifestyle factors that could be contributing to these unfortunate experiences.
According to the Cleveland Clinic, some primary headaches can be triggered by lifestyle factors or situations, including:
Alcohol, particularly red wine.
Certain foods, such as processed meats that contain nitrates (food-triggered headaches).
Consuming nicotine (nicotine headache).
Changes in sleep or lack of sleep.
Poor posture.
Physical activity, such as exercise (exertion headaches).
Skipped meals (hunger headache).
Coughing, sneezing, blowing your nose, straining (such as when having a bowel movement), or laughing or crying vigorously (cough headaches).
Primary headaches typically aren’t dangerous, but they can be very painful and disrupt your day-to-day life. Nobody wants to miss out on the enjoyment of life because they’re suffering from headaches. Read more about how to support your clients who are living with chronic illnesses here.
Secondary Headaches
Secondary headaches are caused by an underlying medical condition and are considered a symptom or sign of that condition. Examples include:
Dehydration headache: Caused by insufficient fluid intake, leading to brain tissue shrinkage and pressure on surrounding nerves.
Sinus headache: Resulting from inflammation or infection of the sinuses, causing pressure and pain around the cheeks, forehead, and eyes.
Medication overuse headache: A pre-existing headache disorder worsens due to the overuse of headache medications, notes the National Institutes of Health (NIH).
Trigeminal neuralgia: A chronic pain condition affecting the trigeminal nerve, characterized by intense, stabbing facial pain.
Are you looking for different techniques to help your clients get relief from headaches, jaw pain, or sinus pressure? This is for you. We will discuss the pathophysiology of headaches, jaw pain, and sinus pressure. Learn a variety of techniques for headache and stress relief, including acupressure points, trigger point therapy, neuromuscular re-education, positional release, PNF stretching, and more!
Pathophysiology of Headaches
The Trigeminal System
The trigeminal nerve (cranial nerve V) plays a central role in transmitting sensory information, including pain, from the face and head to the brain. Its three branches – ophthalmic, maxillary, and mandibular – innervate various facial and cranial structures. The trigeminovascular system, encompassing the trigeminal nerve's innervation of blood vessels and meninges, is considered a key area in headache pain generation.
The trigeminal nerve and the trigeminovascular system are intricately involved in the complex pathophysiology of migraine, playing a crucial role in the development and transmission of migraine pain signals.. Release of CGRP (calcitonin gene-related peptide) and other vasoactive neuropeptides from trigeminal nerve endings in response to stimulation, along with neurogenic inflammation, play crucial roles in migraine pain and its associated symptoms.
Neurotransmitters and Headache Pathophysiology
Several neurotransmitters are involved in headache pathophysiology, particularly in migraine:
Serotonin (5-HT): Involved in pain modulation, its levels may fluctuate in individuals with migraine. Triptans, a class of migraine medications, act on serotonin receptors.
Calcitonin Gene-Related Peptide (CGRP): Released from trigeminal nerve endings during migraine attacks, CGRP can cause vasodilation and trigger pain. CGRP receptor antagonists (gepants) and CGRP antibodies are newer medications for migraine prevention and treatment.
Glutamate: A major excitatory neurotransmitter, glutamate is implicated in trigeminal activation, central sensitization, and cortical spreading depression, according to the National Institutes of Health (NIH).
Other neurotransmitters and neuromodulators: Substance P, dynorphins, PACAP, and trace amines (tyramine, octopamine, synephrine) also play roles in headache pathways.
Central Sensitization as a Key Cause of Headaches
Central sensitization, where the central nervous system becomes overly sensitive to pain signals, is a key mechanism in the development of chronic headaches like chronic migraine and chronic tension-type headaches. Peripheral sensitization of trigeminal neurons, followed by central sensitization of neurons in the trigeminal nucleus caudalis and thalamus, contributes to the chronification of migraine.
Role of Cortical Spreading Depression (CSD) in the Development of Headaches
Cortical spreading depression (CSD) is a wave of neuronal and glial depolarization that travels across the brain’s cortex. This phenomenon is believed to play a key role in triggering headaches, particularly migraine with aura. CSD can lead to changes in blood flow and release of inflammatory substances, which activate pain pathways and contribute to the onset of headache symptoms. Understanding the connection between CSD and headache helps in developing targeted treatments for migraine relief.
Headaches Can Be Very Serious
Headaches can be connected to temporomandibular joint (TMJ) dysfunction, which can be a source of significant discomfort, affecting someone’s ability to speak, chew, and even sleep. Headaches can be connected to sinus pressure or other seemingly minor issues. However, some headache symptoms require immediate medical care.
Interested in learning more about TMJ? Check out this article— Unlocking the TMJ Dysfunction: A Guide to Relief and Recovery.
What headache symptoms require immediate medical care?
According to the Cleveland Clinic, If you or your child has any of these headache symptoms, get medical care right away:
A sudden, new and severe headache.
Headache with a fever, shortness of breath, stiff neck or rash.
Headaches that occur after a head injury or accident.
Getting a new type of headache after age 55.
Also seek medical care right away if your headache is associated with neurological symptoms, such as:
Weakness.
Dizziness.
Sudden loss of balance or falling.
Numbness or tingling.
Paralysis.
Speech difficulties.
Mental confusion.
Seizures.
Personality changes/inappropriate behavior.
Vision changes (blurry vision, double vision or blind spots).
Helping Our Clients Find Relief from Headaches
Massage therapy is an effective non-invasive approach to alleviating headaches by targeting muscle tension and improving circulation. There are a variety of techniques that can reduce the intensity and frequency of tension headaches and migraines. Additionally, by promoting relaxation and decreasing stress, massage therapy helps to release endorphins, the body’s natural pain relievers, which can further ease headache symptoms. Regular sessions may provide immediate relief while addressing underlying muscular imbalances that contribute to recurring headaches.
In addition to using your hands (or feet if you have the training), we also encourage you to learn and use specialized tools or products for helping your clients find relief from headaches. We encourage you to read these articles and learn more about using Heated Bamboo and CBD in your massage therapy practice. Further, we recommend integrating mindfulness or meditition into your massage therapy sessions to further facilitate relaxation and stress relief. Be sure to seek education and gain proper training before using tools and products in your massage therapy practice.
Many individuals who suffer from headaches have experienced trauma. We strongly believe all massage therapists and wellness professionals should be trauma-informed practitioners. Have a look at the class below and consider joining us.
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Empower yourself to transform lives by harnessing the power of empathy and understanding trauma. This course equips you to facilitate healing in a more informed and compassionate way.