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Can Headaches Come from Lower Back Pain?

It’s a simple fact: pain hurts. Sometimes, the source of pain is very clear. If you accidentally touch a hot pan, it instantly causes a burning sensation. Ow! But you can deal with it because you know a) what caused it, and b) it will soon lessen. But pain isn’t always that straightforward or simple.

Pain messages

The body has millions of nerve endings that instantly detect bodily harm. In the hot pan example, the heat sensation triggers peripheral nerves to send electrical messages along nerve pathways to the spinal cord. The spinal cord is like a trunk line for all the peripheral nerve pathways that branch outward from it. There, specialized receptors register the severity of the incoming message, and relay it to the brain. The greater the damage, the more powerful the signals. In turn, the brain directs action and harnesses healing resources. As your hand registers the burn, outbound responses from the brain flash back down the spinal cord to the particular nerve branch that ends in your hand. You immediately pull your hand back, and as you run your fingers under cold water, an internal anti-inflammatory process begins in your stinging tissues, all thanks to directions from the brain.

However, there is another type of pain that also sends messages to the brain. It is called neuropathic pain (neuro means nerve and pathic means damaged or diseased) and it is more complicated. This occurs when nerves themselves are damaged. Even after the cause of damage is resolved, the nerves can continue to misfire, sending frequent or even chronic electrical messages to the brain. Put another way, the pain pathways are in a state of chronic activation, and the brain becomes abnormally sensitized to pain.

Lower back pain and headaches

In 2013, a team of German researchers published a paper on the connection between lower back pain and chronic migraines or chronic tension headaches. They found that for people with chronic headaches of any type, the odds of also having frequent low back pain were roughly 13 to 18 times greater than for people who reported no headaches. They note that there could be many explanations for this, such as abnormal pain processing due to chronic activation of neuropathic pain. It’s like asking which came first, the chicken or the egg? The back pain or the headache?

Arthritis in the spine

There is less mysterious explanation for many cases in which lower back pain co-exists with migraine or tension headaches, and it has to do with arthritis of the lower spine. This may sound puzzling. What would bone deterioration in the lower spine have to do with headaches?

Let’s return to the central nerve trunk, the spinal cord, that is housed within the spine itself. The spine is made up of a stack of backbones called vertebrae, each of which has a central opening that holds the spinal cord. The spine is sturdy yet flexible. It has “cushions” (discs) that absorb the shock of movement, and “hinges” (facet joints) that allow a certain amount of bending and twisting—all the while protecting the spinal cord within it. It’s a very clever system.

Like all material systems, though, parts can wear out, especially joints like the knee, hips, knuckles, etc. Joints are where the ends of bones meet and rub together during movement like crouching or grasping. The bony ends are protected by cartilage that allows them to rub smoothly. Over time, cartilage can become eroded, narrowing the gap between bony ends and exposing them to raw friction. Anyone who has experienced arthritis in the knee, hip or hand knows how quickly this discomfort can turn to pain.
In the spine, the small facet joints between each vertebra can also lose cartilage. Not only does this cause joint pain, but as the space between vertebrae becomes thinner, there is less room for the nerves that branch off the spinal cord—creating pinched nerves—and often compression on the discs and the spinal cord itself. Pain signals can radiate outward along the branching peripheral nerves, and even up the spinal cord toward the head. Thus, headache and neuropathic pain can be felt, but not readily traced to a few tiny joints in the lower back. If left undiagnosed and untreated, both lower back pain and the headaches themselves will become chronic pain, as in the German study.
Diagnosing facet joint arthritis as a possible source of headaches may not be easy. If two sources of pain are occurring at the same time, most people will attend to the one that hurts more first—and if it’s a migraine, they might seek headache help but overlook a lingering dull ache in the lower back. However, it’s important to pay attention to any discomfort in the body. You never know what might be connecting one thing to another—like lower back pain causing a headache.
If you or a loved one is diagnosed with facet joint arthritis, there is a new noninvasive MRI-guided treatment to stop facet joint nerve pain at its source. It is called Focused Ultrasound, a simple outpatient procedure using no needles, surgery or radiation. Learn more at the Sperling Medical Group.

iYoon MS, Manack A, Schramm S, Fritsche G et al. Chronic migraine and chronic tension-type headache are associated with concomitant low back pain: results of the German Headache Consortium study. Pain. 2013 Mar;154(3):484-92.

Facet Pain