Personal Responsibility: A 'Manifesto' For Self-Care

The World Health Organization (WHO) Constitution states: ‘the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being’. Reducing vulnerability to ill-heath implies human rights to the basic pre-requisites of health including access to information, education, nutrition and clean water1. Where these elements are in place, vulnerability to ill health is determined to an important degree by the choices of the individual. It is, of course, perfectly possible to be living without disease but leading an unhealthy lifestyle which makes future disease more likely or even inevitable.

This paper focusses on the responsibilities and even duties that healthy people have to maintain their own health, through self-care. Self-care for health has many elements including appropriate nutrition, sufficient physical activity and the avoidance of risks such as tobacco consumption2. Through self-care an individual can remain healthy into their seventh, eighth and ninth decades, prevent or delay ‘lifestyle’ diseases, and maintain mental health. Conversely, without successful self-care the emerging epidemic of lifestyle diseases threatens to swamp healthcare systems around the world.

The reasonable responsibilities of the average healthy citizen to care for themselves and help prevent lifestyle diseases are therefore of great interest, but have received relatively little attention. There is a substantial literature on the duties of healthcare professionals, rather less on the duties of the patient, and very little on the duties of the healthy individual3.

Individuals have a right to information and education on how to maintain good health but ultimately they bear the responsibility to take action. The environment in which we live and the support we receive from healthcare professionals can help determine our lifestyle choices, but we alone can make them. Therefore we propose that a manifesto for self-care is needed. This fundamental expression of the responsibilities of individuals to take care of their own health could serve as a touchstone to guide the development of enabling tools and policies.

SELF-CARE AND THE LIFESTYLE DISEASES CHALLENGE

The need for people to undertake self-care to prevent or delay ‘lifestyle’ diseases (also called non-communicable diseases) is particularly pressing. The incidence of these diseases – particularly heart attack and stroke, cancer, chronic lung diseases and diabetes – has reached epidemic proportions in most countries around the world. Worldwide, 63% of all deaths annually, an estimated 36 million people, are as a result of lifestyle diseases4. The proportion is much higher in the most developed countries – 88% of deaths in the UK and 87% in the USA for example5. Lifestyle diseases are projected to increase by 15% globally between 2010 and 2020. These diseases are often particularly costly to the individual and healthcare systems because of their chronic nature.

Lifestyle diseases are strongly associated with, and causally linked to, four behaviours: physical inactivity, unhealthy diet, tobacco use and the harmful use of alcohol. Up to 80% of heart disease, stroke and type-2 diabetes, and over a third of cancers could be prevented by modifying these behaviours4,6. If people were to undertake more self-care, the benefits to themselves, their families, and to the health systems that serve them would be enormous. However for this to happen there are significant challenges to be overcome.

Firstly people have to recognise what is healthy and unhealthy and, having recognised that they are at risk through their lifestyle choices, possess sufficient knowledge to know what action to take. With some behaviours (e.g. smoking) the risks are relatively well known and the action to be taken clear, however difficult. For others the judgements involved can be more difficult and influenced by evolving societal norms.

A warning lesson is provided by the trend towards the ‘normalisation’ of being overweight. A substantial proportion of overweight men and women think they are ‘about the right weight’7,8. Manufacturers of clothes have increased the space in clothes without changing the label size – ‘size inflation’ in clothing9. A recent study showed that 79% of parents of overweight children did not recognise that their offspring were overweight10, and of those who did, 41% did not perceive this to be a health risk.

The implication of evolving societal attitudes is that being overweight or even obese could become ‘normalised’, rather than approached as a serious but preventable personal and public health problem. People can only accept responsibility for their health if they can agree about what is unhealthy.

The medical consequences of being overweight are clear: the risk of coronary heart disease, ischaemic stroke and type 2 diabetes grows steadily with increasing body mass, as do the risks of cancers of the breast, colon, prostate and other organs. Chronic overweight contributes to osteoarthritis, a major cause of disability. Globally, 44% of diabetes burden, 23% of ischaemic heart disease burden and 7-41% of certain cancer burdens are attributable to overweight and obesity6.

Even when a problem is recognised, knowing how to deal with it can be demanding. People may recognise that they lead an unhealthy lifestyle through inactivity or an unhealthy diet, but may still struggle to know what action to take. Mixed messages in the mass media and the plethora of biased information online may contribute to lack of clarity about what constitutes a healthy lifestyle.

There is no shortage of sound, practical, evidence-based advice on healthy lifestyles11,12,13, but this guidance is often assumed to be aimed primarly at those with responsibility for supporting individuals to change behaviours, rather than to the individuals themselves. To be effective at a population level, these initiatives have to change societal attitudes to what is accepted as normal and this necessarily involves everyone11.

We suggest that an important part of this change is attitudinal and involves people accepting responsibility for their own lifestyle rather than devolving responsibility for their future health to health care professionals or the government.

ACCEPTING RESPONSIBILITY FOR SELF-CARE: THE MORAL GROUNDING

The moral imperative to keep healthy through self-care is based in part on responsibility to others, primarily:

1. Other users of public healthcare services i.e. to current and future patients, and
2. Future generations, including one’s own children.

Current and future patients.
In a resource-constrained healthcare system, medical treatment offered to one patient represents an opportunity cost to other patients with potentially more pressing healthcare needs. We have a duty to others whenever our choices impact on them. People leading healthy lifestyles and practising self-care for self-limiting conditions will consume fewer healthcare resources, leaving more capacity to treat those requiring those resources most.

People readily accept responsibilities that recognise the needs of others in many spheres of society. Cars and properties have to be maintained so as to be at least minimally safe with regard to others as well as to the primary user. Smoking bans in public spaces are now ubiquitous and widely accepted public health measures. The excessive consumption of alcohol, tobacco smoking, an inactive lifestyle or an unhealthy diet may all appear to be purely personal choices but as the cause of lifestyle diseases which consume a large proportion of constrained healthcare resources, their impact on others should be similarly recognised.

Future generations.
Parents have a major influence on the lifestyle habits of their children, making parents suitable agents for change14. Children of parents who engage in physical exercise such as sports, who try to eat ‘5-a-day’ fruit and vegetables and who do not smoke are more likely to be aware of, and adopt, healthy habits when they are adults (and parents) themselves.

There is also a need to improve parental self-awareness of their children’s health determinants. As mentioned, it is well documented that parents are often unaware that their child is overweight10,15, or that their child’s weight poses a risk to their health16,17. Parents are, at least initially, primarily responsible for the lifestyle choices of their offspring and therefore for the consequences of those choices.

POTENTIAL OBJECTIONS TO THE IDEA OF PERSONAL RESPONSIBILITY FOR HEALTH

The ‘nanny state’ argument.
One possible objection to governments (local or national) encouraging more individual responsibility for health is that this implies some interference with personal choice. However, the healthy person who takes no steps to avoid lifestyle diseases will ultimately consume more healthcare resources than someone leading a healthy lifestyle. These resources are not just scarce but are also commonly held, being publicly funded. It does not seem unreasonable for society as a whole to expect individuals to behave responsibly when they have the opportunity to do so.

Popular opinion seems to support this approach – in 2004, The King’s Fund, an independent think tank, conducted a survey of more than 1,000 people and found that most favoured policies that combatted behaviour such as eating a poor diet and public smoking18. The ‘nanny state’ argument may have lost some force given the positive results of self-care enhancing policies such as public place smoking bans, mandated vehicle seatbelt and motorcycle helmet use.

The budget argument.
Some critics have suggested that promotion of self-care is driven by the vested interest of governments to curb their healthcare budgets by shifting responsibility to the individual. But even if healthcare resources were abundant, people would still benefit personally from self-care. Within a financially constrained system, responsible use of resources is intrinsically important and has ethical weight. The disadvantaged in society may need more support to achieve self-care, but whatever their socio-economic status, giving the healthy the means and responsibility to take care of themselves frees resources to constantly improve the care of those that become ill. The moral imperative to conserve shared resources remains, irrespective of the size of those resources. And the moral imperative towards the next generation is much more than an issue of funding.

Objections on societal grounds.
There is a practical objection that placing duties or responsibilities upon people should take into account the societal context and external environment in which the individual lives. It is more difficult for an inner-city tower block resident to take exercise than it is for a person living near green spaces. There is a positive association between the density of unhealthy food outlets in a neighbourhood and the prevalence of overweight and obesity in children19.

It is clear that there may be structural circumstances that inhibit positive self-care behaviours, but these difficulties do not dissolve the responsibility for self-care. The disadvantaged in society may have particular difficulties in adopting a healthy lifestyle and will require more support from the community, and from the healthcare system, than those with more physical or financial resource available to them. Giving people the means to make healthy choices is a legitimate obligation for govenments and their agents. However this does not change the priniciple that ultimately the individual is responsible for the choices that they do make.

Goverments may try to ‘enforce’ self-care responsibilities.
An important question arises as to whether fulfilling self-care responsibilities will come to be seen as an expectation (assuming that monitoring behaviours is even possible).

Denying provision of healthcare services to people who have neglected to lead a healthy lifestyle would be highly contentious, and in the context of societal inequalities that skew the ability to adopt such a lifestyle, morally indefensible. Nevertheless, there are clearly adverse consequences for the individual who adopts an unhealthy lifestyle, apart from ultimate ill-health. Those that smoke or drink heavily pay considerable taxes in the process. If one seeks health insurance, smoking, drinking alcohol to excess and evidence of being overweight will all have a marked effect on the level of premium paid.

Disincentives to an unhealthy lifestyle therefore already exist, and are a legitimate tool of government policy.

DEVELOPING PUBLIC POLICY APPROACHES

Establishing the principle of individual responsibilities in health leads to the question of what mechanisms and supports could be provided to help people with a potentially challenging objective.

Some general policy directions are clear. Policies which focus on supporting positive behaviours in healthy people are more appropriate and useful than those which penalise sick people. Policies which are universal in their application are also likely to be better accepted than those that appear to target individuals. For example, if the evidence continues to mount for the role of sugar in causing obesity and diabetes, then a general ‘sugar tax’ has clear advantages compared with penalising the obese.

The influence of public policies on the ability of people to self-care is extensive. Self-care may be substantially outside the reach of health and social systems, but many government policy decisions have a bearing on the practice. The UN 2011 resolution on Noncommunicable Diseases, Article 3620 illustrates this:

…(We) recognize that effective non-communicable disease prevention and control require leadership and multisectoral approaches for health at the government level, including, as appropriate, health in all policies and whole-of-government approaches across such sectors as health, education, energy, agriculture, sports, transport, communication, urban planning, environment, labour, employment, industry and trade, finance, and social and economic development…

Many programmes and policies which impact on self-care and lifestyle behaviours have already been implemented around the world. However, the results of these programmes have not been assessed and organised systematically. A consolidation of programme documentation and outcomes would provide a valuable reference database for policymakers and programme managers, and provide the basis for planning a comprehensive, articulated research strategy. In addition to providing evidence for policy-makers, a systematic review of such data could help to identify practical ways and means which could help individuals to undertake lifestyle changes.

THE SELF-CARE RESPONSIBILITIES OF HEALTHY PEOPLE

We suggest that healthy people should aim to preserve and promote their own health and wellbeing so far as it is reasonably open to them so to do. They should follow a healthy lifestyle through being aware of, and following, health promotion guidelines. This means that they should eat a healthy diet and avoid inactivity. They should not put their health at risk, for example, through smoking or consuming excess alcohol. They should seek to understand the risk factors for chronic diseases particularly relevant to them, and address them as far as possible.

The healthy person should not put at risk the health and safety of others when this can be avoided. Examples include not smoking in spaces shared with others, good hygiene practices in hand washing, in food preparation and when coughing or sneezing.

It is the responsibility of a healthy person to consume healthcare resources in a responsible way and therefore to self-care whenever possible for self-limiting illnesses.

People should also promote health and wellbeing in their families, not least their own children. Examples include encouraging their children to exercise, teaching them about healthy and unhealthy foods, and having them vaccinated.

There are clearly many qualifications and reservations in these proposed responsibilities. Questions obviously arise as to the meaning of ‘aim to’, ‘avoidable’ and so on. However, these are questions of scope and extent, which are open to debate, rather than matters of principle.

Figure 1: A Self Care Manifesto: Responsibilities and Expectations in Self-Care.

A MANIFESTO FOR SELF-CARE

Taken together, the responsibilities of the individual can be seen as  defining a ‘manifesto’ for self-care (Fig. 1). These responsibilities interact with, and are interdependent on those of healthcare professionals, and society as a whole, through government policy at a national and community level. This manifesto is proposed as an agenda and framework for discussion. There are gaps in our knowledge of what works in changing behaviour at the  level of the individual and thus a clear need for research to underpin future policy within this conceptual framework.

CONCLUSION

The Declaration of Alma-Ata, the International Conference on Primary Health Care in 197821 stated that ‘The people have the right and duty to participate individually and collectively in the planning and implementation of their health care’.

To a large extent the maintenance of good health is not a ‘gift’ of a government or a healthcare system, but a ‘purchase’ that each individual makes by expending some effort. There is an urgent need to accept the duty we owe to ourselves and each other to maintain our health through self-care. A world in which we believe that we have important duties in this regard, even where they are difficult to achieve, will differ materially from a world in which we continue to delegate the responsibility for our health to others.

We propose the ‘Self-Care Manifesto’ as a conceptual framework to consider a new alignment of responsibilities, whereby the healthy assume the principal responsibility for maintaining their own health, and other agencies and resources work to enable this to happen.

Correspondence to: David Webber, International Self-Care Foundation (www.isfglobal.org),
davidwebber@isfglobal.org

Acknowledgements: The authors are grateful to Professor H. Martyn Evans for comments.

Statement of Interests: The authors have no conflict of interest relating to the publication of this paper.

Funding: The International Self-Care Foundation is a charity registered in the UK.

References

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This article originally appeared on the Self Care Journal and was written by D E Webber*, Z Guo*, S Mann**

Stress: It’s Not in Your Head, it’s in Your Nervous System

Traumatic Memory and How to Heal it

Have you ever been told when you’re stressed to stop worrying and just relax? That it’s all in your head? It would be nice if it were that simple. But it’s not.

Physiology research shows that the stress response memory lives in your nervous system. Take for example exposure to a stressful event. One in which you felt helpless, hopeless, and lacked control. In this case your autonomic nervous system (ANS) is engaged. This is the part of the nervous system responsible for controlling unconscious bodily actions like breathing. To be more specific, it was the sympathetic branch (fight or flight) of the ANS that kicked in while you were strained. In addition, the hypothalamic-pituitary-adrenal axis of the midbrain began firing. In which a signal from your hypothalamus sends a hormonal message to your pituitary gland that stimulates to your adrenal glands.

To activate this fight or flight response, stress hormones like cortisol and adrenaline are released from your adrenal glands. They help our body suddenly mobilize to flee danger. According to Peter A. Levine, trauma expert in the field of psychotherapy, trauma occurs when this biological process is overwhelmed and a person is unable to release and process the stressful event. It is possible to avoid a traumatic response by discharging the energy generated. For example, shaking, crying, and screaming can allow the individual to physically process the stress.

Stress is not all in your head.

However, if the stress response is not processed, it remains in the tissues of the body. When a subsequent stressful event that does not pose a serious threat occurs, the traumatic memory is recalled. A large amount of stress hormones are released. Blood rushes to extremities, pupils dilate, muscle tone increases presenting as tension, breathing rate increases, the heartbeats faster, and sweating occurs. Hence, the nervous system responds as if this small incident is life threatening.

This biological response is clearly beyond the ability to rationally control. You can’t think your way out of it. Chronic stress leads to dissociation or immobility, a state of sympathetic charge and hormonal release, which is health damaging. The brainstem (the primitive part of the brain) governs emotional experience and biological response. When the brainstem is activated by the fight or flight response, it trumps the more developed front of the brain, the prefrontal cortex. It is therefore not possible to be in the primitive state of fight or flight and also to think rationally and critically (as the prefrontal cortex would have us do).

Levine elaborates:

The question is: how can humans become unstuck from immobility? Moving out of this frozen state can be a fiercely energetic experience. Without a rational brain animals don’t give it a second thought, they just do it. When humans begin to move out of the immobility response, however, we are often frightened by the intensity of our own energy and latent aggression, and we brace ourselves against the power of the sensations. This bracing prevents complete discharge of energy necessary to restore normal functioning.

Unprocessed stress is stored in the body as traumatic memory.

Unprocessed stress becomes traumatic memory that lies dormant in the body. A present day trigger can cause the stored memory to resurface. Understanding what is happening inside our body and brain, gives us compassion. Learning why our body responds the way it does, leads to awareness and empowerment. It moves us out of being isolated, fearful, victims. By caring for our bodies and understanding their self-protective responses, we can release shame.

When we comprehend the physiologic process that is trying to keep us safe, from an old memory or trauma, we can replace inner judgement with kindness. Self-love becomes possible. It may not be serving us in the present but in the past it did. In fact, this same response helped us survive.

The work is then to re-train the body. This can be done by invoking practices such as felt sense oriented meditation, deep breathing, vocal toning, spontaneous movement and dance, yoga, listening to soothing music, spending time in nature, running, or hiking. Or simply receiving a hug from a loved one, which releases oxytocin, a natural hormone produced by the pituitary gland that promotes bonding and connection.

Practices such as yoga and time in nature help to release stored trauma. 

These are tools to deactivate the sympathetic response and activate the opposing parasympathetic response, called the rest and digest mechanism. The goal is to feel safe. To regulate breathing, slow the heartbeat, and circulate blood back to the vital organs

These powerful practices change our physiology and affect our mood. The next time someone suggests it’s all in your head, you will have a different response. This knowledge empowers us to heal past wounds. Through acknowledging the power trauma plays in your life and understanding the mechanisms by which healing occurs, you can create a more embodied, joyful life.

This article originally appeared on upliftconnect.com and was written by Melody Walford.

The Busier You Are, The More You Need Quiet Time

In a recent interview with Vox’s Ezra Klein, journalist and author Ta-Nehisi Coates argued that serious thinkers and writers should get off Twitter.

It wasn’t a critique of the 140-character medium or even the quality of the social media discourse in the age of fake news.

It was a call to get beyond the noise.

For Coates, generating good ideas and quality work products requires something all too rare in modern life: quiet.

He’s in good company. Author JK Rowling, biographer Walter Isaacson, and psychiatrist Carl Jung have all had disciplined practices for managing the information flow and cultivating periods of deep silence. Ray Dalio, Bill George, California Governor Jerry Brown, and Ohio Congressman Tim Ryan have also described structured periods of silence as important factors in their success.

Recent studies are showing that taking time for silence restores the nervous system, helps sustain energy, and conditions our minds to be more adaptive and responsive to the complex environments in which so many of us now live, work, and lead. Duke Medical School’s Imke Kirste recently found that silence is associated with the development of new cells in the hippocampus, the key brain region associated with learning and memory. Physician Luciano Bernardi found that two-minutes of silence inserted between musical pieces proved more stabilizing to cardiovascular and respiratory systems than even the music categorized as “relaxing.” And a 2013 study in the Journal of Environmental Psychology, based on a survey of 43,000 workers, concluded that the disadvantages of noise and distraction associated with open office plans outweighed anticipated, but still unproven, benefits like increasing morale and productivity boosts from unplanned interactions.

But cultivating silence isn’t just about getting respite from the distractions of office chatter or tweets. Real sustained silence, the kind that facilitates clear and creative thinking, quiets inner chatter as well as outer.

This kind of silence is about resting the mental reflexes that habitually protect a reputation or promote a point of view. It’s about taking a temporary break from one of life’s most basic responsibilities: Having to think of what to say.

Cultivating silence, as Hal Gregersen writes in a recent HBR article, “increase[s] your chances of encountering novel ideas and information and discerning weak signals.” When we’re constantly fixated on the verbal agenda—what to say next, what to write next, what to tweet next—it’s tough to make room for truly different perspectives or radically new ideas. It’s hard to drop into deeper modes of listening and attention. And it’s in those deeper modes of attention that truly novel ideas are found.

Even incredibly busy people can cultivate periods of sustained quiet time. Here are four practical ideas:

1) Punctuate meetings with five minutes of quiet time. If you’re able to close the office door, retreat to a park bench, or find another quiet hideaway, it’s possible to hit reset by engaging in a silent practice of meditation or reflection.

2) Take a silent afternoon in nature. You need not be a rugged outdoors type to ditch the phone and go for a simple two-or-three-hour jaunt in nature. In our own experience and those of many of our clients, immersion in nature can be the clearest option for improving creative thinking capacities. Henry David Thoreau went to the woods for a reason.

3) Go on a media fast. Turn off your email for several hours or even a full day, or try “fasting” from news and entertainment. While there may still be plenty of noise around—family, conversation, city sounds—you can enjoy real benefits by resting the parts of your mind associated with unending work obligations and tracking social media or current events.

4) Take the plunge and try a meditation retreat: Even a short retreat is arguably the most straightforward way to turn toward deeper listening and awaken intuition. The journalist Andrew Sullivan recently described his experience at a silent retreat as “the ultimate detox.” As he put it: “My breathing slowed. My brain settled…It was if my brain were moving away from the abstract and the distant toward the tangible and the near.”

The world is getting louder. But silence is still accessible—it just takes commitment and creativity to cultivate it.

This article originally appeared on Harvard Business Review & was written by Justin Talbot-Zorn.

Cervicogenic Headache: Neck Headache

Neck Headache, or as it is known medically - Cervicogenic Headache, is a secondary headache disorder. In other words, your headache is caused by a neck joint problem.

The good news is that by fixing your neck problem, your neck headache can be alleviated. Researchers feel that neck headache accounts for between 4% to 22% of all headaches seen clinically. (Racicki et al 2013; Watson 2014)

What's Causes Your Neck Headache?

Your neck headache can originate from a variety of musculoskeletal and neurovascular structures in your upper neck; including the upper three neck joints, C2/3 disc, spinal cord coverings and neck muscles. A dysfunction in these areas can trigger pain signals that travel to your trigeminocervical nucleus (TCN) in your brainstem. This information is then transmitted into your brain and interpreted as a headache (Bogduk 2003).

Upper Neck Joints

The most likely sources of your neck headache is dysfunction of either your upper neck joints, neck muscles or nerves, which trigger pain signals that travel to your trigeminal nucleus in your brainstem, where you interpret the pain signals as a neck headache.

The most common cause of neck headache is dysfunction of your upper three neck joints. The most common neck joints involved are your:

• Atlanto-occipital joint (O-C1), 
• Atlanto-axial joint (C1/2), and 
• C2/3 cervical spine joints.

In simple terms, your neck joints can cause a neck headache or pain if they are either too stiffor move too much (eg wobbly and unsupported by weak muscles) or are locked in an abnormal joint position eg. locked facet joint or poor posture. 

Once your neck joint becomes stressed and painful, the pain signals are referred to the trigeminocervical nucleus in your brainstem... and you start to feel a neck headache or, in some cases, face pain!

Your physiotherapist is expert in the assessment and correction of neck joint dysfunctions that result in neck headache. Their professional diagnosis and treatment is essential for neck headache sufferers.

Neck Muscles

Your neck and shoulder blade muscles that originate from your neck will cause pain if they are overworking, knotted or in spasm. 

Some of your neck muscles overwork when protecting injured neck joints. Other neck muscles become weak with disuse, which places further demand on your overworking muscles resulting in muscle fatigue related symptoms. 

Your neck muscles work optimally when they have normal resting tension, length, strength, power and endurance.

Your physiotherapist is expert in the assessment and correction of muscle imbalances that result in neck headache.

Cervical and Occipital Nerves

Nerves in your upper neck may be directly pinched by extra bony growths eg arthritis, disc bulges or swelling. The results can result in nerve irritation or a reduction in neural motion known as neuromechanosensitivity or abnormal neurodynamics. 

Irritation of your upper neck structures refer pain messages along the nerves and cause your headache.

In simple terms, your neck is the "switch", nerves are the "power cords" and your headache is where the "light" comes on.

What are the Symptoms of Neck Headache?

Neck headaches can often be misdiagnosed or confused with other sources of headache, including migraine, since the head pain is typically felt in the same area as a migraine. 

It is really the interpretation from your headache physiotherapist of the whole combination of your symptoms plus the findings of your physical examination that will confirm a neck headache diagnosis

Commonly, neck headache sufferers will usually notice:

• Tenderness at the top of their neck and base of the skull. 
• Neck stiffness or a mild loss of movement, although this is sometimes is only subtle and needs to be confirmed during your physiotherapist's physical examination.

One of the main differences between neck headache and migraine is that physiotherapy treatment of your neck is able to alter or relieve your headache immediately.

Common Characteristics of a Neck Headache?

The following symptoms are characteristics of a neck headache. You may experience any one or several of these symptoms:

• Your headache may seem to radiate from the back to the front of your head.
• Your headache is provoked or eased by a neck movement, a sustained posture, stomach sleeping or with your head turned to one side.
• Your headache normally appears to be worse on one side of your head. The side is normally constant and does not swap sides.
• Your headache appears to temporarily ease up when you apply pressure or you massage your neck or the base of your skull.

If you experience any of the above symptoms, you are more likely than not to be suffering a neck headache. Please inform your physiotherapist and they will assist you.

What if Your Neck Isn’t Sore?

Even if your neck isn’t sore or painful, you can still experience neck headaches. It is important to remember that your neck joints may NOT be sore at REST, but they may be tender to touch or painful on movement. 

Neck joints that are sore at rest will normally be very tender to touch and painful at the extreme of movement. Obviously, this scenario is a more severe neck headache.

If your headache or a migraine has been present for years and your neck has not been examined, then a thorough neck examination is recommended and is appropriate to eitherconfirm and treat your neck headache or exclude a neck disorder as the cause of your headache.

How is a Neck Headache Diagnosed?

Accurate diagnosis is important to guide the correct treatment and management your neck headache. Headache and head pain can have many causes, not just neck headache or migraine. Correctly identifying the cause will lead to better treatment.

This article originally appeared p physioworks.com.au and was written by John Miller.

Photo by Jacob Morrison on Unsplash