Chronic Headaches and Neck Pain: Possible Causes and Solutions

Headache and neck pain?

Hello, doctor.
Since I hit the back of my head on a stone step corner in sixth grade, I have been experiencing persistent headaches.
I have been to a large hospital for examinations, but they all said there was no problem.
After that, I often find myself easily short of breath during exercise, experiencing headaches, or suddenly feeling faint when I stand up quickly, needing some time to recover.
I also have sudden headaches, vision blackouts, cold sweats, and a sensation of blood rushing to my head, but squatting for a while helps alleviate it.
By the time I reached the second year of high school, the situation worsened; I felt headaches every day and often had difficulty breathing, especially when I was nervous, like during exams.
I considered whether it might be psychological stress, but I also experience headaches while reading novels or during other leisure activities.
It feels the same at all times; my head feels heavy, and I have pain on both sides of my neck's spine.
Sometimes, when I tilt my head to the sides, I hear cracking sounds in my bones, which provides slight relief from the pain, but it still persists.
If I lie flat, the headache remains and even intensifies.
My sleep is also poor, and now, whenever I sit down and then stand up, I feel headaches and my vision darkens.
Therefore, I went to the hospital for another examination, including MRI and CT scans of my head, but still, no issues were found.
What could be the problem? Is it related to my cervical spine or vertebrae?

Liang, 10~19 year old female. Ask Date: 2022/08/27

Dr. Cai Zongzhang reply Neurology

Hello, the symptoms mentioned may be related to cervical spine disorders or hypotension.
It is recommended to visit a neurology clinic for an examination to determine the underlying cause.

Reply Date: 2022/08/27

More Info

Chronic headaches and neck pain can be complex issues that often stem from a variety of underlying causes. Based on your description, it seems that your headaches and neck pain have persisted since a significant injury in sixth grade, which could indicate a connection between the trauma and your current symptoms. Although medical evaluations, including MRI and CT scans, have not revealed any structural problems, there are several potential explanations for your ongoing discomfort.

Possible Causes
1. Cervical Spine Issues: Given your history of neck pain and the sounds you hear when moving your head, it’s possible that there are issues related to your cervical spine. Conditions such as cervical spondylosis, herniated discs, or muscle strain can lead to chronic neck pain and headaches. The cervical spine is closely connected to the nervous system, and any dysfunction can lead to referred pain in the head.

2. Tension-Type Headaches: Chronic tension-type headaches are often associated with muscle tightness in the neck and shoulders. Stress, poor posture, and prolonged periods of sitting (especially if you are hunched over a desk or device) can exacerbate these headaches. The heaviness you feel in your head could be a symptom of muscle tension.

3. Migraine: Although you mentioned your headaches are not typical migraines, it’s worth considering that they could still be a form of migraine or a migraine variant. Migraines can be triggered by various factors, including stress, hormonal changes, and environmental stimuli. Symptoms like visual disturbances (seeing black spots) and sensitivity to light or sound can accompany migraines.

4. Post-Traumatic Headache: After a head injury, some individuals develop chronic headaches that can persist for months or even years. These headaches can be similar to tension-type headaches or migraines and may be exacerbated by stress or physical activity.

5. Psychological Factors: Anxiety and stress can significantly contribute to the perception of pain. The fact that you experience headaches during stressful situations, such as exams, suggests that psychological factors may play a role in your symptoms.
6. Orthostatic Hypotension: The symptoms you describe when standing up quickly—such as dizziness and blacking out—could indicate orthostatic hypotension, where blood pressure drops upon standing. This can lead to inadequate blood flow to the brain, causing dizziness and headaches.

Recommendations for Management
1. Physical Therapy: Engaging in physical therapy can help address any musculoskeletal issues related to your neck and spine. A physical therapist can provide exercises to strengthen neck muscles, improve posture, and alleviate tension.

2. Stress Management Techniques: Incorporating stress management strategies such as mindfulness, meditation, or yoga can help reduce the frequency and intensity of headaches. Learning relaxation techniques can also help manage anxiety that may be contributing to your symptoms.

3. Regular Exercise: Regular physical activity can improve overall health and reduce stress. It can also help alleviate tension in the neck and shoulders, which may contribute to headaches.

4. Ergonomic Adjustments: If you spend long hours sitting, ensure that your workspace is ergonomically designed to reduce strain on your neck and back. Adjust your chair, desk, and computer screen to promote good posture.

5. Medication: If headaches persist, consult with a healthcare provider about appropriate medications. Over-the-counter pain relievers may help, but a doctor can also prescribe medications specifically for chronic headaches or migraines.

6. Follow-Up with Specialists: If symptoms continue despite these interventions, consider consulting with a neurologist or a headache specialist. They can provide further evaluation and treatment options tailored to your specific condition.

In conclusion, chronic headaches and neck pain can arise from multiple factors, including past injuries, muscle tension, psychological stress, and potential cervical spine issues. A comprehensive approach that includes physical therapy, stress management, and ergonomic adjustments may help alleviate your symptoms. If your condition does not improve, further evaluation by a specialist may be necessary to explore other underlying causes.

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