Headache Types, Triggers and Neck Pain in Migraine

Toby describes headache as both a symptom of serious pathology and a disease in its own right, with links to anxiety, depression and traumatic facet joint injury at C2-3. The International Headache Society separates primary headaches, such as tension-type, migraine and medication overuse headache, from secondary headaches such as cervicogenic headache, and cranial neuropathies. Medication overuse means over-the-counter drugs on 15 days a month or triptans on 8 to 10, and physiotherapy works less well in these patients. A Norwegian study found that most people with chronic headache use complementary medicine but fewer get lasting relief. Neck pain is the most frequent reported trigger, present in 77% of people with migraine, and its presence worsens the presentation but makes physiotherapy about six times more likely to help. Work by Zhiqi Liang and Gwen Jull found that about 61% of people with migraine and neck pain had no significant cervical impairments, while about 39% did, so headache sits on a continuum and each patient needs assessment before physical treatment.