Southeast WI Archive
  • Southeast Wisconsin
  • August 2014
Written by  Tracy Bretl, D.O.


Headaches are one of the top 10 reasons for visiting a physician. The causes of headaches are many and varied, and include muscle tension, migraine, trauma, hypertension, premenstrual syndrome, tumors and meningitis. The vast majority of headaches are due to muscle tension or migraine, or a combination of the two. Although standard textbooks of medicine agree on a musculoskeletal cause for headaches, this factor is rarely considered in their diagnosis and treatment.

The brain itself is almost insensitive to pain. There are many pain-sensitive structures outside the cranium, including the scalp, arteries, muscles, mucous membranes of the sinuses, external and middle ear, and the teeth. The musculoskeletal cause of tension headaches is straightforward. The contracting muscles or associated nerves release a number of chemicals that lower the pain threshold. The crucial area is the base of the head and the upper neck area. Nerves in this area mediate the referral of excessive connective tension in the neck as pain in the head.

Intracranially, only the membranes covering the brain and the blood vessels are sensitive to pain. The pain of migraines can be due to stretching of the membranes covering the brain and tension on the venous sinuses (channels in the dura where blood drains from the head). Prolonged tension can cause a reflex spasm in/constriction of the blood vessels, which can decrease blood flow. The body’s response to this is excessive stretching of the arteries in the head which causes the pain of the migraine. Various chemicals in the brain are thought to cause this contraction and dilatation. In both migraine and tension headaches, excessive tension in the connective tissues structures is a primary cause of pain.

Tension headaches are usually on both sides of the head and can be preceded by emotional stress and can worsen as the day progresses. The pain can be a constant tight pressure encircling the head like a hat band and is often unchanged with rest. Migraines are often preceded by an aura and are usually on one side of the head. Migraine headaches can be started by flashing lights, foods with a high level of tyramine (such as cheese), certain medications, and alcohol, especially red wine. Sleeping or lying down in a dark room can offer some relief. Migraines tend to be familial.

The osteopathic physician is able to palpate the bones, muscle and connective tissue to determine the areas of tension. There are 22 bones in the head and they have a small amount of motion. By knowing how the bones are supposed to move and how they are currently moving, the osteopathic physician is able to determine if restriction in the tissues is present, where the restriction is located, and is then able to gauge improvement in the tissues/tissue motion.

Evaluation of the neck includes looking at restriction in motion along with restriction/tenderness in the muscles and connective tissue. The sacrum must be evaluated as well. The membranes that cover the brain and spinal cord are attached to the bones in the head, neck and sacrum. Thus, restrictions in the head and neck can affect the motion of the sacrum between the hip bones and vice versa.

Osteopathic manipulation can be added to conventional treatments of headache. While structure may not be the only cause, correction of structural restrictions can significantly aid in the reduction and recurrence of pain.

Tracy Bretl, D.O., graduated from Des Moines University’s College of Osteopathic Medicine and Surgery in 1989. She then spent three years in the United States Navy. Dr. Bretl is board certified in neuromusculoskeletal medicine and osteopathic manipulative medicine (NMM/OMM). She has been in private practice specializing in NMM/OMM since 1992. For more information, visit or call 414-351-1844.

References: An Osteopathic Approach to Diagnosis and Treatment. Eileen L. DioGiovanna, et al. LWW. 1991.

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