Neck weakness and tension-type headaches

Tension headaches can be prevented, or at least made milder by strength training, according to a new Danish study just published in the journal of the International Headache Society, Cephalalgia.

Tension-type headache is the most common type of headaches and it is usually accompanied by increased muscle tenderness.

The researchers compared muscle strength in neck and shoulder muscles in 60 patients with tension-type headaches and 30 healthy controls, using rigorous strength measurement techniques. Patients were included if they had tension-type headaches on more than 8 days per month and had no more than 3 migraines a month. Compared to controls headache patients had significantly weaker muscle strength in neck extension, which helps keep the head straight. Headache patients also showed a tendency toward significantly lower muscle strength in shoulder muscles. Among the 60 headache patients, 25 had frequent headaches and 35 had chronic tension-type headaches (defined as occurring on 15 or more days each month).

The use of computers, laptops, tablets, and smart phones has increased in recent years and this may increase the time people are sitting with a forward leaning head posture, which contributes to neck muscle weakness.

Neck pain and tenderness is a common symptom in both tension-type and migraine headache sufferers.

This is not the first study to show that muscle strength and weakness were associated with tension-type headaches, but it is still not clear whether the muscle weakness is the cause or the effect of headaches. Neck and shoulder strengthening exercises have been shown to reduce neck pain in previous studies and in my experience strengthening neck muscles will often relieve not only tension-type headaches, but also migraines. So it is most likely that there is not a clear cause-and-effect relationship, but a vicious cycle of neck pain causing headaches and headaches causing worsening of neck pain and neck muscle weakness.

Physical therapy can help, but the mainstay of treatment is strengthening neck exercises. Here is a YouTube video showing how to do them. The exercise takes less than a minute, but needs to be repeated many times throughout the day (10 or more). Many people have difficulty remembering to do them, so using your cell phone alarm can help. Other treatment measures include being aware of your posture when sitting in front of a computer or when using your smart phone, wearing a head set if you spend long periods of time on the phone, doing yoga or other upper body exercises, in addition to the isometrics.

Sometimes pain medications or muscle relaxants are necessary, while for very severe pain, nerve blocks and trigger point injections can help. Persistent neck pain can respond to Botox injections. When treating chronic migraines with Botox, the standard protocol includes injections of neck and shoulder/upper back muscles. Here is a video of a typical Botox treatment procedure for chronic migraines.

  1. Dr. Mauskop says: 03/16/20173:52 pm

    Botox does not strengthen muscles, but relaxes them. So, if weakness is due to spasm, strength may improve and you ay be able to build them up with regular exercise. Neck weakness is possible, but is rare.

  2. Linda Reekie says: 03/16/20172:00 pm

    I have been considering Botox for my chronic migraine and tension headaches. However, I also have the neck and shoulder weakness that you describe My concern with Botox is that I will not be able to strengthen these muscles after my treatment. Is this true?

  3. Dr. Mauskop says: 11/04/20153:19 pm

    Botox is very effective for about 70% of patients with chronic migraines. Besides being more effective than drugs, which work for about 50% of patients, Botox is also much safer. The main drawback of Botox is the cost, but most insurers in the US pay for it.

  4. Dania says: 11/04/20155:32 am

    Great information shared! I’d like to know how effective can botox treatment be for treating migraine.
    I suffer from migraine and I understand how difficult it is to eat those pain killers each time it comes.
    I was offered this treatment at Med-Aesthetics (Brampton) and I just wanted to confirm the effectivity of this treatment.

  5. Dr. Mauskop says: 05/31/201511:20 am

    The other blog you referred to was by a cosmetic doctor so I decided not post it since I would urge all migraine and headache sufferers to see only doctors specializing in headache and pain management. These could be neurologists, anesthesiologists, or physiatrists, but not plastic surgeons or dermatologists. Managing headaches involves a lot more than just injecting Botox. First of all, the doctor has to be trained in diagnosing different headache types, aneurysms, brain tumors, strokes, and other conditions. They also need to know how to inject Botox into the neck, shoulders, jaw, and other muscles. They need to be experienced in combining Botox with medications and non-drug approaches.

  6. MonicaLorrane says: 05/31/20153:37 am

    This is a great blog! I am suffering from chronic migraine. The pain is severe. I was looking out for treatments and I read a similar blog which stated botox treatment for migraine. Since then I’ve been doing research on botox treatments. This blog has been informative and the youtube video for neck excercise is great. Thanks

  7. Dr. Mauskop says: 05/17/201512:05 am

    Yes, some people experience worsening of the neck muscle spasm and headaches. In order to avoid it, apply gentle pressure in the beginning and gradually increase the amount of pressure every few days.

  8. Adam says: 05/16/20159:06 pm

    Is your experience that migraineurs with weak necks often experience lots of pain when they start doing the isometric exercises? I feel no pain during the exercises, but they are causing lots of pain throughout the day. Is this a necessary evil that will improve as the muscles strengthen?

  9. Ellen says: 05/14/20155:30 pm

    Thank you for this informative blog post. I often say that my chronic migraine pain and neck/shoulder pain are a chicken and egg situation. It’s very difficult for me to determine which triggers which. I will start doing the isometric exercises and see if that helps.

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