You may have been diagnosed with migraines, tension headaches or cervicogenic headaches. You may have had scans, blood tests and countless consultations. Your cervical spine may already have been assessed by a physiotherapist, chiropractor or even by me. Treatments may have helped temporarily, made no difference, or even aggravated your symptoms, but nothing has addressed the problem in a way that has lasted. Eventually, you may simply have accepted that it’s a mystery and learned to live with the headaches.
Could something have been missed?
Healthcare professionals are human, conditions can change, and a detail may have been missed. A fresh assessment is not necessarily about proving a previous diagnosis wrong, but about looking at the problem from a different perspective and identifying what may not have been adequately investigated.
I have already written about the relationship between the cervical spine and headaches, because we know that structures in the neck can easily produce pain into the head. The thoracic spine, however, is much less commonly considered, while it has also been shown to cause headaches for some.
That does not mean that your headache is necessarily coming from your thoracic spine, but if you have been searching for an answer and everything else has proven fruitless, it is a possibility worth properly investigating.
Have they not checked your thoracic spine already?
Scans or local treatment of the thoracic spine are not enough to rule it in or out as a contributor to your headache. A scan can show structural changes, and treatment may change symptoms, but neither establishes whether the thoracic spine is responsible for or contributing to the headache. Investigating the mechanical factors known to contribute to headaches requires repeated movement testing while monitoring symptoms against baseline measures, including the location and intensity of the headache.
What is the value of a mechanical assessment?
The McKenzie approach starts with a detailed history, considering previous treatments, daily activities, known triggers, and whether particular times, positions or activities influence the headache. The mechanical examination then tests the relationship between spinal movement and the headache itself, rather than simply asking whether movement is painful.
If the headache changes predictably with mechanical testing, we have evidence that the spine is contributing. If the presentation instead suggests a structural, inflammatory, neurological or other condition, that information is valuable too. Either way, there is a reasonable chance of uncovering information that was not apparent previously.
Could this be the missing link?
If your headache has never quite made sense or left you feeling that you have no control over it, there may still be an avenue worth pursuing that does not depend solely on painkillers. This is not about assuming that your previous diagnosis was wrong or that your headache must be coming from your thoracic spine. It is about taking stock of what information about your headaches may not be known yet and recognising that the thoracic spine is one possibility that may not yet have been adequately considered.
If your thoracic spine has never been mechanically assessed, how can we know?
Every individual is different. Discuss your unique situation with your preferred physiotherapist to ensure you receive advice specific to you.