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Why do I have a severe headache and neck pain at the base of my skull? Is this a tension headache? Is this a migraine? Do I have a brain tumor?  These are all questions that undoubtedly roll through your mind when a headache kicks-in the back of your head and neck.  Below we talk about the common types of headaches and how they are different. We explain what that pain behind your head and neck could mean. And we review forms of treatment for severe head and neck pain. 

Types of headaches

Headaches can be a pain in the neck, both literally and figuratively.  The cause of this pain can be due to a variety of reasons, ultimately resulting in a diagnosis of “headache.” There are many types of headaches which are differentiated by the cause of symptoms. We will review tension headaches, cervicogenic headaches and migraines. But what is causing the headache? Is it a disruption in your nervous system? Is it muscle tension in your neck from finishing up a deadline at work? While symptoms of different types of headaches can overlap, it can become challenging or confusing to diagnose. What is important is if you are currently receiving treatment for your headache and neck pain, you need to ask yourself, “is this treatment helping?” “Do I feel better?” Sometimes we take advice from a medical professional as FACT when in truth, we/they are practicing medicine. If a treatment is not actually helping to reduce your symptoms and it’s underlying causes then why not consider another option? Why not consider that your migraine may in fact be a recurring tension headache?  Or maybe your neck and head pain is really a migraine in disguise.  Below we dive further into the three most commonly seen reasons for headaches and neck pain: tension headaches, cervicogenic headaches and migraines.

Tension headaches

Tension headaches are the most common type of headache which are also referred to as “ordinary headaches, muscle- tension headaches and stress headaches.”  Since there are many terms, for this “ordinary headache” the International Headache Society (it’s a real thing) suggests the term “tension-type headache” for clarity purposes.  Individuals who are experiencing a tension-type headache tend to report generally diffuse, mild-moderate pain accompanied by a “tight band” or “vise” around their head.  Compared to other headaches we will discuss, tension-type headaches are NOT accompanied by nausea, do not have a pulsating quality to the symptoms, and symptoms do not get worse with activity.  Diagnosis of tension-type headache occurs via subjective reports of symptoms and review of medical history to rule-out other possible causes.  The exact cause of tension-type headaches is unknown. Some believe changes in how the nerves of the head, neck, and shoulders sense pain are the root cause, while others suggest changes in how the brain interprets these pain signals, is the root cause.  What we tend to see clinically, is someone presenting with an imbalance in muscle length and strength of muscles of the head and neck. This imbalance creates increased tension or an abnormal pull in the muscles where they attach to the spine and skull,  leading to a headache.  Stress, inadequate sleep, and poor hydration are also factors to consider when addressing tension-type headaches.  If tension-type headaches are infrequent, they can be managed with OTC (over-the-counter) medications including aspirin, ibuprofen (Advil, Motrin) and acetaminophen (Tylenol).  Ice compress, heating pad, acupuncture, massage. 

Cervicogenic headaches

While symptoms may be similar, a cervicogenic headache is slightly different from a tension-type headache in that the underlying cause is related to a condition in the neck/ cervical spine.  This means any joint, muscle, ligament, nerve, related to your cervical spine, could be the cause for the headache and neck pain.  Patients often describe a feeling of dull pain in the back of the neck, which can radiate up into the back of the head, and even further on to the temple, forehead or behind the eye.  Pain is typically one-sided, but can occur on both.  Addressing a cervicogenic headache with OTC medications may be helpful temporarily but symptoms will most likely return, since the underlying cause was never addressed. Are you someone who deals with severe neck pain and headache at the base of your skull? Do you experience recurring headaches behind your eye? You may be dealing with a cervicogenic headache and in this case an evaluation by a Doctor of Physical Therapy would be indicated to further identify the root cause of your symptoms. 


Migraines are a little more complicated than the previous two because we still don’t really understand the mechanism for what is happening to create the symptoms of a migraine. Broadly speaking, migraines are characterized by a recurrent, throbbing headache, which typically affects one side of the head and is usually accompanied by nausea and disturbed vision.  About ⅓ of migraine sufferers experience auras (visual disturbances including zigzagging lines, flashing lights), and have a pulsating quality to them. Symptoms seem to be sensitive to light and sound. While other headaches can occur in the face, head and neck, migraines tend to occur primarily in the head, and generally speaking, symptoms tend to be more severe than a tension-type headache.  Many common triggers for migraines include stress, with onset typically occurring after the stressful event. Migraines have many overlapping qualities with a tension-type headache, and can also appear as a sinus infection with a runny nose and nasal congestion. Confusing much?  Again, this is when you need to ask yourself if the treatment you are receiving for your headache and neck pain is helping.  If it isn’t, then let’s consider another type of headache as the possible cause of your symptoms. 

Treatment for headaches and neck pain

So what can you do to help yourself? Ultimately one of the best ways to hone in on which type of headache you may be suffering from, keep a journal. Write down hours slept, water consumed, diet, and when/where/what your symptoms were when they begin, how long they last.  As mentioned above, tension-type headaches may be managed well with OTC medications. Those same medications may treat the symptoms of migraines and cervicogenic headaches but if symptoms persist, it may require further treatment or assessment by a physical therapist. Other conservative forms of managing symptoms include, cold compress, heat pack, foam roller to thoracic spine, massage, and other forms of stress-management. 

Try out something new if what you have been doing isn’t working any longer.  Contact us and we can help.

Lindsay Mercier, PT, DPT, OCS

With 2020 moving full steam ahead, and COVID-related changes to our lives evolving, let’s talk about the immune system, and how you can keep yourself healthy this year.

For starters, our immune system is composed of a group of organs, cells and proteins, which aim to defend our bodies against infections (caused by pathogens/germs/antigens).  It keeps track of every germ it has defeated so it can recognize it quicker if it were to enter your body again.  We have an innate immune system (one we are born with) and an adaptive immune system. The adaptive portion develops antibodies in response to detection of new germs.  Antibodies (aka immunoglobulin) are protective proteins produced by the immune system in response to an antigen (aka pathogen, germ).  Wait, what?  Let’s go over that again. Our bodies and immune systems have to be exposed to a pathogen/germ in order to create antibodies which then will attack and destroy said germ. (This is how vaccines work). 

So is it possible to “boost” your immunity?  Technically…no.  Your immune system is just that, a system. It’s a system which requires balance and harmony and the fact is we don’t have research to support any specific diet or supplement or lifestyle as having a direct and positive effect on your immune system.  What about supplements which say they “boost” immunity?  Those guys fall into either a vitamin or probiotic supplement. Only those who are suffering from a nutrient deficiency will see their immune systems benefit from supplementing with vitamins. Probiotics are gaining more popularity, as has discussion and research of our microbiome (totally different blog post).  They help support healthy bacteria living in your gut which can affect our immunity in both positive and negative ways.  

In general, the difference between those who rarely get sick and those who get sick often, are habits.  While there may not be a proven method to “boost” your immune system, scientists and healthcare providers agree, practicing healthy lifestyle habits, gives your immune system the upper hand. Listed below are some habits we have heard a lot about this year, but it never hurts to be repeated:

Wash your hands: we pick up, carry and transmit germs from surfaces we touch and we are most vulnerable to contracting those germs when they come into contact with our faces (nose, eyes, mouths).

Exercise regularly: keeping body in top shape, creates an ideal environment for your immune system to react, in the event it senses a germ. 

Get sleep: put down your smart phone, tablet, kindle, and go to bed.  

Meditate: manage stress and heart rate 

Get vaccinated: getting vaccinated against the flu and other diseases stimulates the immune system to protect against illness.  Vaccines teach our body to recognize certain pathogens so they can better mount a defense when they are encountered. 

So instead of spending money on supplements, put your money towards something else that will help you create daily healthy habits!

Lindsay Mercier, PT, DPT, OCS

3 Tips to Meet Your Goals for 2020

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3 Tips to Meet Your Goals for 2020 

2020 is here and has been here for one month, and time continues to move forward.  Did you make any big or small goals for this new year? Have you been able to stay motivated and on-track with your goals?  It’s easy to get distracted, slack off, and even easier to give-up. However, with our help, you can set yourself up to meet your goals for 2020.  

For starters, WRITE IT DOWN.  Research has found that setting goals is linked with self-confidence, motivation, and autonomy, and has even showed when people wrote down their goals, they were 33 percent more successful in achieving those goals compared to those who only formulated goals in their head!  

It’s okay to focus on a year-end goal. It’s ok to focus on a 6-month goal. Pick something that maybe makes you a little uncomfortable. Your goal can be big and lofty, and it can be somewhat vague and broad.  However, the steps used to reach your goals are going to force you to 1. Break big goals down into small and achievable goals, 2. Focus on effort-oriented goals vs. outcome-oriented goals and 3. Create some accountability. Now let’s break these ideas down a little further…

3 tips to meet your goals for 2020:

Small and achievable goals for the win:

To set yourself up for success, aim to create small, achievable goals (you may still have a more broad, or lofty goal) which you will focus on one day at a time, and one week at a time.  You don’t climb Everest overnight, and you certainly don’t run a marathon 3 weeks after a cesarean section. So, let’s consider what it takes to achieve this big goal, and aim to break it down into smaller, monthly goals. Then let’s take those smaller monthly goals, and break those down further into weekly goals. Finally, you guessed it, daily goals. It sounds like a lot of work, but if you want to reach your big and lofty goal, it takes DAILY choices. (Think, this month “I’m going to exercise 20/29 days in February”, or this week “I’m going to walk 5 out of 7 days this week” or “I’m going to get 10,000 steps today.”)

Effort-oriented goals versus outcome-oriented goals:

Shift from an outcome-oriented goal, to an effort-oriented goal.  Taking the focus from an outcome-oriented goal (think, “run a marathon”), to an effort-oriented goal (think, “run 20/29 days in February), allows you to focus on the process versus the outcome.  What if you sprained your ankle one week before the marathon? You no longer can run in the marathon, and if that was your goals focus, then we are left in a situation we prepared for and cannot physically achieve because it would be unwise for our health. Instead of then feeling let down that you didn’t meet your goal` of running a marathon, you can focus on the fact that you ran 20/29 days this month! Focusing on the process also allows us to create steady habits.  By aiming for consistent behaviors we can enjoy the success of meeting a goal every single day. 


Keep track, write it down, share it with someone. Heck, blow up social media about your new goal. When we are accountable to someone or some group, we tend to make decisions which support our goals.


Goal-  “Exercise more in 2020”

Monthly goal: What does “exercise more” look like Over the course of 30 days, lets say you want to aim to exercise at least 20/29 day in Feb (yep, it’s a leap year!). This goal is small and achievable, it’s effort-oriented, and now you just need to be accountable to someone. 

Weekly goal: I’m going to walk 5 days this week for 20 minutes. This goal is also small and achievable, as well as effort-oriented. Now tell someone about your activity! 

Daily goal: I’m going to walk 10,000 steps today.  Now take a pretty picture on your walk and send it to your bf bragging about your #goals2020

Go get after it!  Let us know what you think about 3 tips to meet your goals for 2020. How did it work for you?  Have questions? Reach out.  

Lindsay Mercier, PT, DPT, OCS

“Let’s not view the changes we make to meet our goals as sacrifices, rather as a choice we make every day to better ourselves”- Tactic owners, Meredith Root and Alex Parker 

Knee replacement

“My knee is bone-on-bone.”

“I have the knee of a 70 year old.” (what does that even MEAN by the way? I know plenty of 70+ year olds in better shape than 20+ yr olds).

Some of you have been told these phrases, which is then usually followed with the suggestion of undergoing a total knee replacement. Let’s repeat that…a TOTAL knee REPLACEMENT! That is a massive surgery. Most people don’t quite grasp the severity of the surgery because they hear friends, families, coworkers all speak about personal experiences, or re-telling stories, most often years after their operation. Your surgeon will cut into your bones with a saw, and then they will hammer a titanium rod into your femur.  Think about how that feels? Because even though the surgical technique is well established as successful (body accepts prosthetic and patient reports reduced pain and improved function), the recovery from the surgery is LONG, and can be painful. While this may sound obvious, people are consistently surprised as to the length of time and effort on their end, needed to get their knee to a place that makes them happy they had the operation. 

While this operation is an effective form of treatment, alternative methods have proven to reduce pain and improve function, and should be considered as the first line of defense. There are approximately 600,000 total knee replacements performed in the U.S. annually.  And that number is expected to rise to more than 4 million by 2030. 

What we have found is many people can delay undergoing a total knee replacement by months-years if not indefinitely by actively participating in a combination of manual hands-on treatments aimed at improved tissue mobility and consistent strengthening and mobility work both inside AND outside of the physical therapy clinic. Take this example…

Example: patient presents to physical therapy with recent onset of right knee pain. Patient is 67 year old female and up until onset of knee pain, was walking 2.5 miles daily without any difficulty.  She then took a long drive over the weekend to visit her cousin, woke up the next morning to go for a walk and had right knee pain. 

Considering this case, the patient then consults her physician who takes x-rays because that’s standard protocol, and they notice “narrowed spacing” between bones or they say your knee is “bone-on-bone.”  They send you to an orthopedic specialist, who then examines your x-rays, maybe takes a few more, and says you are a prime candidate for a total knee replacement. You are young enough on the spectrum of age, active enough, and motivated. And obviously your X-rays show “bone-on-bone” so you MUST have the operation.

Pause…when someone says “bone-on-bone” they are implying that you no longer have the protective covering of your cartilage which covers the ends of bones that move against one another in a joint.  This wear and tear is considered normal as we age, and we know that imaging DOES NOT directly reflect what the patient standing in front of us may be experiencing.  

X-rays do NOT illuminate soft tissue. You cannot appreciate the integrity of soft tissue, which includes cartilage which lines the ends of bones, AND your meniscus.  (MRI is the image which would provide more information about these structures, but again, it’s absolutely normal to see signs of wear and tear on our joints soft tissue structures).  

So when your provider suggests you should consider a total knee replacement, I urge you to inquire about consulting a physical therapist, or do so on your own.  As a movement specialist we can help identify faulty movement patterns, imbalances in muscle strength and posture deficits. Let’s aim to put off massive surgery for another year, yeah?

Lindsay Mercier, PT, DPT, OCS