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Migraines and Concussions

Why Concussions Hit Migraine Patients Harder

Migraines and Concussions

 

The vast majority of people who suffer concussive injuries will recover without any chronic symptoms. However, about 15% of people who suffer concussions will go on to have post-concussion syndrome, where they will experience headaches, dizziness, and cognitive problems beyond 30 days after an injury. These symptoms can be debilitating, and some people can experience the effects of these head injuries for years later.

A lot of research has been done to identify people who are at higher risk of developing post-concussion syndrome. The most significant risk factor for this is having multiple concussions, but that’s a rather obvious one. The more concussions you’re exposed to, the greater the opportunity to have chronic symptoms. However, research has pointed to one specific risk factor that seems to contribute heavily to post-concussion syndrome in the athletic population. That risk factor? A history of migraine headaches.

Migraines and Concussion: a terrible duet

Post-traumatic headache is one of the hallmark symptoms of post-concussion syndrome. These headaches look a lot like migraines because of the wide range of neurological symptoms that concussions can cause.

It’s no secret that concussions can cause terrible headaches in people, but many people don’t know that having a history of migraine headache is a risk factor for worse outcomes in post-concussion syndrome. ¹ ² ³

This is important for a couple of reasons:

  1. If you know someone with migraines is at a higher risk for post-concussion symptoms we can be better prepared to see appropriate specialists in the event of a concussion.
  2. We have a better understanding for why sports like girls’ soccer are more susceptible to concussive injuries and can be more prone to chronic post-concussion syndrome.
  3. Because understanding the common physiology in migraines and concussion can help us identify effective treatments for one of its most debilitating symptoms.

Migraines, Post-Concussion Syndrome, and the Neck

Treatment for headache symptoms in migraine and post-concussion syndrome are pretty similar. Amitriptyline, propanolol, and topirimate. These medications target receptors in the brain that can become overactive and underactive during a migraine attack.

Most research is focused on finding effective drugs to treat headaches, but this treatment philosophy ignores the fact that the headaches from a migraine or concussion can often stem from dysfunction of the cervical spine.

When the neck is compromised the muscles and nerves that surround the upper neck can become areas of concern for the headache patient. The muscles at the top of the neck transmit information to the brain about where the head is in space.  Studies have shown that these muscles can be tied to chronic headache symptoms. ¹ Some studies have even shown that cutting these muscles can lead to headache relief.¹

You can read more about these troublesome little muscles on a previous article I wrote here:

Is This Small Neck Muscle Driving You Mad?

 

The muscles in the deep part of the neck have been implicated in headache disorderrs

The muscles in the deep part of the neck have been implicated in headache disorderrs

 

Additionally, the nerves in the top of the neck are important transmitters of pain. The C1, C2, and C3 nerve roots in the neck are linked to the trigeminal cervical nucleus which is an important relay center for pain in the head. Branches off the C1 nerve like the suboccipital nerve have been targets for nerve blocks in migraine patients with good success.¹

 

The nerves in the upper neck play a major role in headache physiology

The nerves in the upper neck play a major role in headache physiology

 

These mechanisms are important because research has shown that whiplash and concussions can have a significant impact on these anatomical structures. ¹ ² ³

Concussions Worsen Cervical Spine Problems

So here’s the main issue. Many (but not all) migraine issues can be tied to the neck. More than 80% of the migraine patients that come into our office get a tremendous improvement in the frequency of their migraine attacks just by fixing biomechanical issues in the neck, and there is some research that supports it. ¹

When someone has a biomechanical issue in their neck, then a major blow to the head like a concussion can make these neck problems worse. Several studies are starting to show that there are some interesting similarities with what happens in a whiplash and what happens in a concussion. The fact is that the amount of force that it takes to cause a concussion FAR exceeds the amount of force it takes to create a mild whiplash injury.

Whiplash and Concussion

The force required to sustain a concussion far exceeds the forces necessary to cause a whiplash

Obviously not every force over 5 g’s causes a whiplash and not every force over 100 g’s causes a concussion. Otherwise we’d all be walking around with with severe neck injuries every time we got off a roller coaster. There are factors involved like neck strength, timing of muscle bracing, and previous injuries that affect our susceptibility to these forces.

My point is that if you have sustained a concussion, then the probability of you also suffering an injury to the neck is really really high.

If you were a migraine patient before the concussion and the migraine was stemming from your neck, then the odds of that neck injury becoming worse and making the healing process after a concussion is much higher for you than most others.

If you had a small biomechanical issue in your neck that was contributing to your migraine headache symptoms, then the force of a concussion is going to injure the ligaments and muscles that were already compromised! This is addition to the way that concussions knock out your vestibular and ocular systems which are also known contributors to headache physiology.

Addressing the Neck

So what does this mean for you?

  1. If you are an athlete and have a migraine headache problem, you should get your neck checked and rule out any biomechanical problems in the upper cervical spine. Fixing these issues will likely address your migraines, and may provide some protection from head contact.This is even more true for female athletes than male athletes. Women suffer from migraine headache issues at a much higher rate than men, and this can be a contributing factor to the increased rates of concussion we see in girls’ soccer.
  2. If you play contact sports, getting your neck stronger may provide protection from concussive injury. Again, this applies even more so to female athletes because women will tend to have smaller neck muscles than men. Weight training and specific neck exercises is a safe and easy way to possibly mitigate this risk.
  3. If you have a history of neck injury from whiplash and concussion, make sure you’re seeing someone with expertise in addressing the cervical spine. People with traumatic neck injuries may not respond well with vigorous treatment methods and may regress with too much force applied to injured tissue.

 

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TMJ Ruining

TMJ Pain is Ruining My Life

TMJ Ruining

Outline:

  • When treating TMJ pain seems hopeless
  • Surgery may not be your best solution
  • TMJ pain may not be a jaw problem

I’ve seen a lot of patients with TMJ in my Wellington office in the past couple of months.

Patients with TMJ often see a large drop in the quality of their life:

  • “I feel like a baby because I can’t eat solid foods anymore”
  • “There are times where I just have to stop talking because all I can think about is the pain”
  • “That popping sound creeps me out and drives me nuts”

A lot of people will experience jaw pain for a day or two if they bite into a hard/chewy piece of food, but imagine if your life was plagued with jaw pain every single day. We underestimate the importance of our jaw, but it’s the piece of anatomy that allows you to enjoy some of the finest pleasures in life. Everything from kissing, to chewing, to a casual conversation with friends becomes a burden when your jaw fails to function.

Desperate Times and Desperate Measures

Severe cases of TMD can make people reach their breaking point quickly. Many of the patients that come to see me are usually looking at surgery as their next and final option because they don’t know what to do.

Even worse is when a patient spends tens of thousands of dollars for surgery but the pain doesn’t go away. Procedures that help to remove or replace a degenerated disc in the joint is sometimes performed to eliminate this pain sensitive piece of anatomy. The problem is that a degenerated disc can show up on imaging, but it isn’t necessarily the cause of the pain.

Unfortunately this happens more often than you might think, and it’s something that can make a patient with TMD hopeless if even surgery couldn’t get the job done.

This isn’t to say that surgery is not the answer, or that surgery can’t help, but we have to remember that TMD is a problem that science has yet to reveal all of the answers, and dental surgery is still working on figuring out what works and when it’s appropriate. Source

TMJ Pain May Not Be A Jaw Problem

There are many different causes for TMJ pain. They can range from abnormal jaw movement, tight jaw muscles, and degenerated discs. These can all be problem areas for a TMJ patient, but  they all have something in common.

In fact, their commonality goes back to some of the same neurological mechanisms that contribute to neck pain and headaches. That’s why people with TMJ don’t just have jaw pain, they often have neck pain and headaches at the same time. It’s because almost all pain signals from the head and neck go through a small piece of spinal cord called the trigemino-cervical nucleus.

…..Trigemino what????

Sometimes Pain is a Computer Problem

So if you don’t have a medical background, some of that terminology might jump over your head.

Instead of thinking anatomy, let’s talk about it like a computer.

garbage in garbage out

Your brain and spinal cord are like a computer chip. The part of your computer chip that feels head and neck pain is the trigemino-cevical nucleus.

Just like all computer chips, the quality of information that comes out is dependent on the quality of information that comes in. If you put junk information in, you get junk information out.

The computer chip of your body relies heavily on information from the muscles and joints. These signals are like computer programs. Whenever these joints move poorly from bad positioning, then it’s like a bad program that gives faulty information about what’s happening inside the body. This can occur from malpositioning of the jaw, faulty jaw movement, neck positioning errors, and faulty neck movement.

It’s like a computer virus going into your system and scrambling important signals into the brain.

This tells the body to produce a junk signals including:

  • Tight and tense jaw muscles
  • Inappropriate inflammation
  • Central pain sensitivity

Can This Program Get Shut Off?

Fortunately your body’s program for pain can be re-written by changing the way these joints move.

A specialist like a neuromuscular dentist can use non-invasive methods to change the way your jaw moves and alter your bite with an orthotic.

Chiropractors that can correct the craniocervical region can create a dramatic impact on the pain programming in the brain.

That’s why both of these doctors frequently see similar patients, and will actually co-manage them between each other. Neck pain patients may get better relief from a dentist changing their bite, while some TMJ patients will get better relief from correcting their neck.

While we can’t say for certain which takes priority, but many patients can benefit from an interdisciplinary approach to care. Take the time to get a Complimentary Consultation to find out what method fits with you. You may even find that getting the entire jaw/neck complex fixed may be the key to solving your TMD.