Head Pain Switching Sides: The Migraine Mystery Often Ignored

It’s like the proverbial elephant in the room that no one is talking about. When diagnosing Cervicogenic Headache (CGH), the rulebook says pain must stick to one side – it is supposed to be always on the same side, never the other, a so-called ‘side-locked’ pain. But here is where things get puzzling. As a clinician well-versed in the complexities of the musculoskeletal system, I have observed that while such side-locked pain can indeed point to CGH, it is also true that head pain that swaps from one side to the other is a CGH. Yet, according to mainstream medical thinking, such a ‘switch’ behaviour of pain would mean CGH is out of the question.

Herein lies the riddle. The medical community has not fully delved into the alternating or ‘side-shifting’ nature of this pain, leaving us without answers. In the world of migraine, this side-swapping of head pain is a frequent occurrence, but explanations are few and far between, and the silence on the matter is rather striking.

This side-swapping pattern is not just about headache – it mirrors the alternating pains we see in areas like the neck, shoulder, arm, leg, and lower back linked with spinal dysfunction. While we’re still piecing together the science behind this, evidence from conditions like lower back pain suggests that shifting pressures within spinal discs could be at play. For those of us in manual therapy, we’re no strangers to clients whose back pain swaps sides; it seems alternating head pain might just be the (cervical) C2-3 disc’s version of this dance.

In practice, something notable happens: the side of a headache can swap sides after an examination of the C2-3 spinal segment. These clinical experiences clearly indicate a spinal connection to this elusive side-swapping of head pain, putting the diagnostic value of ‘side-locked’ pain into question.

The tendency for head pain to switch sides is not just a curious observation – it is a genuine musculoskeletal issue that needs a serious shift in thinking to understand fully. This is not just conjecture; studies and clinical observations suggest that as many as 83 percent of people with migraine see their pain switch sides at some point. This diagnostic oversight is preventing many migraine and other headache sufferers from getting the targeted examination and treatment they need for their migraine.

Before we part, there is another behaviour of one-sided head pain worth mentioning: it starts on one side (typically always the same starting side), and as the headache develops, it spreads to the other side without leaving the original side, becoming a headache on both sides simultaneously. This behaviour also represents the misbehaviour of the C2-3 disc.

If you experience one-sided head pain, which can swap sides or spread to include the other side, becoming a headache on both sides, then (an often subtle) disorder in your upper cervical spine is the cause of your migraine.

Until next time

If you are new to Watson Headache®, welcome to the Watson Headache® Approach, an evidence-informed practice when considering the role of the neck in Cervicogenic and Primary Headache.

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