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A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes. How are headaches classified? According to the International Headache Society, there are three major categories of headaches: 1. Primary headaches such as tension headache, migraine headache, and cluster headache 2. Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis. 3. Cranial neuralgias, facial pain, and other headaches. Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and become the source of the pain in the head. Facial pain and a variety of other causes for headache are included in this category. What Causes Headaches? There are myriads of reasons that cause headache. Physical and emotional stresses are the major players. Excessive muscle tension on trapezius will create multiple trigger points that will lead to headache as well. Bad neck posture and arthritis especially in the upper cervical area can give rise to cervicogenic headache and sometimes dizziness. If you have TMJ dysfunction, you are 70% likely to have headache also. The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus, an area located at the base of the brain is responsible for the body's biologic clock and may be the part of the brain that is the source for the headaches. When brain scans are performed on patients who are in the midst of a cluster headache, there is abnormal activity in the hypothalamus. The causes of migraine headaches are not clearly understood. In the 1940s, it was proposed that a migraine begins with a spasm, or partial closing, of the arteries leading to the main part of the brain (called the cerebrum). The first spasm decreases blood supply to part of the brain, which causes the aura (lights, haze, zig-zag lines, or other symptoms) that some people experience. These same arteries then become too relaxed, which increases blood flow and causes pain. About 30 years later, the chemicals dopamine and serotonin were found to play a role in migraine headaches. (These chemicals are called neurotransmitters.) Dopamine and serotonin are normally found in the brain, but they can cause blood vessels to act in uncharacteristic ways if they are present in abnormal amounts or if the blood vessels are unusually sensitive to them. Various triggers are thought to initiate migraine headaches in people who are prone to developing them. Different people may have different triggers. Smoking has been identified as a trigger for many people. Certain foods, especially chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG), may trigger migraine headaches. (MSG is a flavor enhancer used in many foods, including Chinese dishes.) Missing a meal or changing sleep patterns may bring on a headache. Stress and tension are also risk factors. People often have migraines during times of increased emotional or physical stress. Contraceptives (birth control pills) are a common trigger. Women may have migraines at the end of the pill cycle as the estrogen component of the pill is stopped. This is called an estrogen-withdrawal headache. How are headaches diagnosed? Based on the history, physical examination and lab tests such as blood tests, computerized tomography (CT Scan), magnetic resonance imaging (MRI) scans of the head, or lumbar puncture, physicians will make a differential diagnosis and give you the recommended treatment. What are the treatment options? Different medications are prescribed based on the types of headaches. Some people are sensitive to the prescribed medications or are afraid of the side effects. There are other non-pharmalogical treatment options such as physical therapy, acupuncture and biofeedback available for people with headache. No side effects have been reported with these conservative treatment regimens. Physical therapy Based on the physical evaluation, physical therapist will work on posture correction, neck stretching and strengthening exercises, manual therapy such as spinal manipulation, massage, soft tissue mobilization and electrophysical agents e.g. TENS, ultrasound, hot and cold packs, or infrared.