Headaches and Hypermobility: Understanding the Connection
Do you experience frequent headaches, and also find yourself unusually flexible, perhaps even double-jointed? Have you been diagnosed with a hypermobility disorder? If so, you're not alone. Headaches and hypermobility are often connected, and people with hypermobility disorders frequently suffer from more disabling and frequent headaches and migraines. Understanding this link is the first step towards finding effective relief. This blog post will explain hypermobility, its connection to headaches, and offer tips and advice on managing these conditions.
This blog will cover the following topics on headaches and hypermobility:
- What is Hypermobility?
- The Headache-Hypermobility Link: How Are They Connected?
- I Have a Hypermobility Disorder and Headaches, So What Now?
- Physiotherapy: Retraining the Brain and Body
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What is Hypermobility?
Hypermobility means your joints have a greater range of movement than normal. This is due to changes in connective tissue, the "glue" that binds our bodies together. For people with a hypermobility disorder, this connective tissue is loose rather than tight. Instead of providing protection and holding our joints together, it stretches, allowing excessive mobility. This can lead to overstrain, hypermobility pain, and even frequent joint dislocations. Injuries related to hypermobility are also very common.
Common signs of joint hypermobility include:
- Being able to extend your elbows or knees beyond straight.
- Easily touching your thumbs to your forearms.
- Being able to bend your little finger back past 90 degrees.
- General flexibility throughout your body.
Hypermobility exists on a spectrum, from mild joint laxity to more significant conditions like Hypermobility Spectrum Disorder (HSD) or heritable disorders such as hypermobile Ehlers-Danlos Syndromes (hEDS) or Marfan syndrome. In these heritable disorders, the connective tissue problem also impacts other areas for example blood vessels, nerves, and even the brain. This is why individuals with these conditions may experience other symptoms, ranging from fragile skin, numbness and tingling, to breathing difficulties and generalized fatigue. (1,2)
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The Headache-Hypermobility Link: How Are They Connected?
Headaches are a frequent problem for people with Hypermobility Spectrum Disorders (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS). Studies show that 40-60% of people diagnosed with HSD or hEDS report headaches. (1)
It's important to understand that joint laxity isn't the sole explanation for headaches in hypermobility. As I mentioned above, changes in the connective tissue significantly affect the dura (the membrane surrounding the brain and spinal cord), blood vessels, and autonomic nervous system, all of which can predispose individuals to specific headache disorders.
To best explain the connection, let's explore the different types of headaches you might experience if you have HSD or hEDS.
Migraines:
Migraines are very common in people with hypermobility, with studies showing a prevalence of over 40% compared to 14% in the general population. Individuals with hypermobility often report increased frequency, severity, and earlier onset of migraines. Recognizing and diagnosing a hypermobility disorder is crucial because not all medications or treatments are helpful if you have a hypermobility disorder, and there's also a risk of medication overuse. The mechanisms and causes of migraine are still not fully understood.
Headaches related to Autonomic Dysfunction (Dysautonomia):
Many individuals with HSD/EDS also have dysautonomia (over 70%). Dysautonomia is when there is a problem with the autonomic nervous system which controls our heart rate and circulation (our fight and flight responses). Postural Orthostatic Tachycardia Syndrome (POTS) is a common co-occurring condition in dysautonomia. POTS is when the heart rate increases (by more than 30beats per minute) on standing up from lying down. Normally, the autonomic nervous system would respond by tightening blood vessels and increasing heart rate slightly to ensure enough blood flows to the brain. In someone with POTS, this process doesn't work correctly, and their heart rate increases excessively to compensate, leading to a variety of symptoms including headache.
- Orthostatic Headaches: These headaches occur or worsen when upright and improve when lying down. They are a common symptom of POTS and can be caused by reduced blood flow to the brain when standing.
Headaches due to Joint Laxity:
- Cervico-cranial Instability: The junction where the head meets the neck (atlanto-axial joint) relies on ligaments and connective tissue for stability. Excessive movement at this joint (atlanto-axial subluxation), can be serious potentially causing compression or distortion of neurological structures near the brainstem. Symptoms may include numbness, tingling or weakness. Treatment may involve the use of bracing or supports but may require surgery.
- Cervicogenic Headaches: These headaches originate from problems in the neck, such as wear and tear. In hypermobile patients, excessive joint movement and resulting stress over time can lead to wear and tear or irritation of surrounding soft tissues and nerves, particularly in the upper spine, which can refer into the head. These headaches are typically located in the occipital region (back of the head) and are mild to moderate in intensity.
- Temporomandibular Disorder (TMD) Headaches: TMD is common in hypermobility disorders due to changes in collagen affecting the jaw joint. Increased mobility can cause microtrauma and referred pain into the side of the head. Symptoms include clicking or subluxations of the jaw, pain around the side of the head and over the temporomandibular joint. Pain is often triggered by chewing, talking, or swallowing.
Chiari Malformation Headaches:
Chiari malformation is a structural abnormality where brain tissue extends into the spinal canal. This can obstruct cerebrospinal fluid (CSF) flow and put pressure on the brainstem. Headaches associated with Chiari malformation are often severe, located at the back of the head/neck, and can worsen with coughing, sneezing, or straining (Valsalva maneuvers). Approximately 12% of patients with Chiari malformation also have hEDS. Diagnosis involves an MRI scan of the brain and spine, and surgery may be considered for symptom relief.
Other Considerations:
- Vascular Issues: Important to screen for in HSD, hEDS, and Marfan syndrome. Cervical artery dissection (CAD), a tear in the inner lining of an artery, is one such concern.
- New Daily Persistent Headache (NDPH): A type of chronic daily headache that often begins abruptly.
- Medication Overuse Headache (MOH): If you experience many symptoms and pain, it's common for people with hEDS, for example, to rely on various pain-relieving medications. Unfortunately, these medications can cause headaches as a side effect or upon withdrawal.
Not sure why you are getting frequent headaches? Could it be linked to your hypermobility?
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I have Hypermobility Disorder and Headaches, So What Now?
If you experience frequent and disabling headaches along with other symptoms, and you suspect you might be hypermobile, you may have searched for information online. It's understandable to feel overwhelmed and scared by the vast amount of information available, or to feel disillusioned if you haven't received adequate help from traditional medical professionals. This is a common experience.
Understanding the assessment and management process is key. Physiotherapy for hypermobility can be an essential part of your healthcare team, helping you understand and manage your problems.
As mentioned, hypermobility exists on a spectrum. A thorough assessment by someone trained and experienced in caring for people with hypermobility is often the first step. For individuals further along the spectrum who experience other symptoms, your physiotherapist will be part of a collaborative team, with you at the center. This team may include a GP, Rheumatologist, Neurologist, Psychologist, Nutritionist, Gastroenterologist, and Pain Management Specialist, all working to advise and suggest treatment strategies based on how your condition impacts you.
Physiotherapy: Retraining the Brain and Body
Physiotherapy for hypermobility and headaches focuses on retraining the brain and body to better control and support your hypermobile joints.
Assessment
This involves a detailed history, including a hypermobility assessment, joint mobility tests, palpation of joints, muscles, and skin, and neurological testing to check nerve function.
Posture Retraining
A crucial part of physiotherapy for hypermobile individuals is retraining the brain to understand optimal joint positioning. This is often distorted over time, but the good news is that your brain can learn how to move best again. For headaches, this specifically involves learning how to best position your head and neck to minimize strain on joints and muscles, and how to relax jaw muscles to avoid over-clenching.
Movement and Muscle Retraining
Using feedback and repetition, this can include guided movements to learn optimal movement patterns. For headaches, this is vital for understanding how to move your head and jaw. Techniques like real-time ultrasound can help identify which muscles to engage and which to relax, creating new neural pathways from your brain to your muscles. With repetition, these can become your new normal.
Balance Training
Once posture and muscles are improving, the next step is to ensure they provide the brain with accurate information. Often, we overcompensate with vision or over-engage large muscles. With time and practice, you can learn to maintain an upright position with small, controlled movements without rigid holding, losing balance, or getting fatigued. This helps the joints around your head and neck stay in a more neutral position, reducing stress on surrounding soft tissues.
Strengthening
A closely monitored strength program focusing on good movement patterns has been shown to be helpful for some individuals with hypermobility, neck pain, or headaches.
Pain Relieving Modalities
Advice on hot/cold packs can help with generalized muscle tension across the shoulders. Acupuncture or dry needling can help some people with headaches. Massage, the use of a massage gun, or trigger point therapy can be helpful in reducing muscular tension. While muscles might feel like they need stretching, it's often more beneficial to relieve tension with massage or heat. In hypermobility, joints and ligaments typically stretch easily, but stretching muscles may not be effective.
Bracing/Supports
If neck instability contributes to headaches, a brace or neck support may be prescribed to provide stability and security.
Taping
With careful consideration for skin sensitivity, kinesiotape can be helpful in reducing muscle tension and providing a feeling of support. For headaches, this can include tape around the neck and trapezius muscle.
Treatment for the Circulation
There is some evidence (6) that supports the use of specific exercises to help with the autonomic system and the cardiovascular system with orthostatic headaches for example with POTs. Compression garments can also be helpful to maintain the venous return in particular for those with orthostatic headaches.
Hypermobility Assessment
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Author
This blog was written by Rachel Crosbee, one of our musculoskeletal physiotherapists, and our lead hypermobility physiotherapist. Rachel has broad interests in treating a wide variety of musculoskeletal problems from acute to chronic, spine, lower and upper limb conditions. She also has a particular interest and expertise in treating neck pain and headaches.
You can read more about Rachel here.
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References:
- Mehta D, Simmonds L, Hakim AJ, Matharu M. Headache disorders in patients with Ehlers-Danlos syndromes and hypermobility spectrum disorders. Front Neurol. 2024 Nov 8;15:1460352. doi: 10.3389/fneur.2024.1460352. PMID: 39582682; PMCID: PMC11581963.
- Joint Hypermobility and Headache: The Glue That Binds the Two Together – Part 2 Vincent T. Martin, MD; Derek Neilson, MD
- Fermo OP (2023) Evaluation and management of orthostatic headache in hypermobility disorders. Front. Neurol. 14:1321350. doi: 10.3389/fneur.2023.1321350
- Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Auton Neurosci. 2018 Dec;215:20-27. doi: 10.1016/j.autneu.2018.07.001. Epub 2018 Jul 4. PMID: 30001836; PMCID: PMC6289756.
- Bech K, Fogh FM, Lauridsen EF, Sonnesen L. Temporomandibular disorders, bite force and osseous changes of the temporomandibular joints in patients with hypermobile Ehlers-Danlos syndrome compared to a healthy control group. J Oral Rehabil. 2022 Sep;49(9):872-883. doi: 10.1111/joor.13348. Epub 2022 Jun 30. PMID: 35694904; PMCID: PMC9544469.
- NEILSON, D.; MARTIN, V. T. Joint Hypermobility and Headache: Understanding the Glue That Binds the Two Together - Part 1. Headache: The Journal of Head & Face Pain, [s. l.], v. 54, n. 8, p. 1393–1402, 2014. DOI 10.1111/head.12418. Disponível em:
- AILANI, J. A Practical Approach to Autonomic Dysfunction in Patients with Headache. Current neurology and neuroscience reports, [s. l.], v. 16, n. 5, p. 41, 2016. DOI 10.1007/s11910-016-0641-x.
- Bendik EM, Tinkle BT, Al-shuik E, Levin L, Martin A, Thaler R, Atzinger CL, Rueger J, Martin VT. Joint hypermobility syndrome: A common clinical disorder associated with migraine in women. Cephalalgia. 2011 Apr;31(5):603-13. doi: 10.1177/0333102410392606. Epub 2011 Jan 28. PMID: 21278238.
- Milhorat TH, Bolognese PA, Nishikawa M, McDonnell NB, Francomano CA. Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue. J Neurosurg Spine. 2007 Dec;7(6):601-9. doi: 10.3171/SPI-07/12/601. PMID: 18074684.
- Henderson FC Sr, Francomano CA, Koby M, Tuchman K, Adcock J, Patel S. Cervical medullary syndrome secondary to craniocervical instability and ventral brainstem compression in hereditary hypermobility connective tissue disorders: 5-year follow-up after craniocervical reduction, fusion, and stabilization. Neurosurg Rev. 2019 Dec;42(4):915-936. doi: 10.1007/s10143-018-01070-4. Epub 2019 Jan 9. PMID: 30627832; PMCID: PMC6821667.