1345 Queens Ct Suite B

St. Peters, MO 63376 US


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A Headache is defined as a pain in the head or upper neck right under the base of your skull. They are very common and have many causes.

There are three major categories of headaches:

1.primary headaches,
2.secondary headaches, and
3.cranial neuralgias, facial pain, and other headaches

The main primary headaches are migraine, tension, and cluster headaches. Tension headaches are the most common type of primary headache. 90% of adults have had or will have tension headaches. Tension headaches occur more commonly among women than men. Migraine headaches are the second most common type of primary headache. It is estimated 28-30 million people suffer from migraines in the U.S. Migraines affect children and adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected.

Cluster headaches are a rare type of primary headache affecting very few people but they are very severe. Cluster headaches affect men in their late 20s most commonly but can occur in women and children.  Primary headaches routinely have negative impacts on a persons ability to function normally. Primary headaches can be occasional headaches that resolve quickly or they can occur daily and be extremely debilitating. What are cranial neuralgias, facial pain, and other headaches?

Neuralgia means nerve pain. Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and become the source of the pain in the head. Facial pain and a variety of other causes for headache are included in this category.  Chiropractic care can be very effective for some forms of these headaches and often times acupuncture has proven beneficial.

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull and support the neck. When the muscles in the neck and those covering the skull spasm they cause pain. Common sites include the base of the skull where the trapezius and sub-occipital muscles of the neck attach, the temple muscles that move the jaw, and the forehead.

Tension headaches occur because of physical or emotional stress placed on the body. One of the most common physical causes for tension headaches are spinal mis-alignments in the neck. Physical stressors include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time concentrating. Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.

The symptoms of a tension headache are:

The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure. Often pain is described as pressure encircling the head. The pain usually is not disabling. The pain is not associated with nausea, vomiting, or sensitivity to light and sound. The pain usually occurs infrequently and without a pattern but can occur daily in some people.

The key to making the diagnosis of any headache is the history given by the patient. The chiropractor will ask questions to understand when the headache began, learn about the quality, quantity, and duration of the pain, and ask about any associated symptoms. The chiropractor should preform a physical examination.  When the examination is done usually you will only find some tender or sore muscles. Most of the neurologic portion of the exam will be normal. 

How are tension headaches treated?

In our office after the examination we will typically perform cervical spine x-rays to dtermine what correction needs to be made in your spine.  Often times we will give you stretching and some simple exercises to help restore your cervical spine to normal.
Massage and stress management can both be used to help with control of tension headaches.

It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It is always wise to ask your pharmacist if you have questions about OTC medications and their use. This is especially important with OTC pain medications, because patients use them so frequently.
It is important to read the listing of ingredients in OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third ingredient may have the potential for drug interaction or contraindication with medications a patient is currently taking. 

One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged period of time, headaches can recur as the effects of the medication wear off. Thus, the headache becomes a symptom of the withdrawal of medication (rebound headache).
It is best to have your chiropractor evaluate you when you have a headache rather than try to treat them with OTC pain medications.

What are the symptoms of cluster headaches?

Cluster headaches are headaches that come in groups lasting weeks or months, separated by pain-free periods of months or years.
During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.
Each episode of pain lasts from 30 to 90 minutes. Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.
The pain typically is excruciating and located around or behind one eye. Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery. The nose on the affected side may become congested and runny. Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in men than women.

The diagnosis of cluster headache is made by taking the patient's history like it is with most different forms of headaches. The description of the pain and it's clock-like recurrence is usually enough to make the diagnosis. If examined in the midst of an attack, the patient usually is in a painful crisis and may have the eye and nose watering as described previously. If the patient is seen when the pain is not present, the physical examination is normal and the diagnosis again depends upon the history. Cluster headaches may be very difficult to treat, and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled, and additional headaches need to be prevented.  In our office we will usually consult with your primary physician when we believe you are suffering from cluster headaches.

The most common form of secondary headaches we treat in our office are due to whiplash and neck injuries.  The headaches associated with whiplash and neck injuries often have symptoms like a tension headaches without the vice like sensation around the head.  Most patients have pain that starts in the shoulder blades and refers pain up to the back of the skull.  For more information on whiplash symptoms click here.
When you have suffered whiplash or some form of neck injury we will get your history and physical examination provide the initial direction for testing like x-rays, MRI or a CT scan. Once we have all of the test done treatment will begin with manipulation and physical terapy.  It is extremely important that patients with severe headaches from whiplash seek chiropractic care.

The last type of primary headache I would like to talk about is migraine headache. A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head. Some people who get migraines have warning symptoms before the actual headache begins. Most of the time these warning sypmtoms are visual disturbances or feeling like your in a mental fog. Migraine headaches tend to first appear between the ages of 10 and 45. Migraines occur more often in women than men. Migraines tend to run in families. Some women, but not all, may have fewer migraines when they are pregnant.  We have had patients with chronic migraines become almost completely free of migraines after a pregnancy. A migraine is caused by abnormal brain activity, which is triggered by stress, certain foods, environmental factors, mis-alignment of the cervical spine.

Migraine attacks may be triggered by:

Allergic reactions
Bright lights
Certain odors or perfumes
Changes in hormone levels
Changes in sleep patterns
Loud noises
Missed meals
Physical or emotional stress
Smoking or exposure to smoke
Certain foods and preservatives in foods may trigger migraines in some people. Foods containing monosodium glutamate (MSG) are the most commonly known.
Meats containing nitrates (bacon, hot dogs, salami, cured meats)


Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

A temporary blind spot
Blurred vision
Eye pain
Seeing stars or zigzag lines
Tunnel vision

Not every person with migraines has an aura. Those who do usually develop one about 10 - 15 minutes before the headache. However, it may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura.
Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

Feel throbbing, pounding, or pulsating
Are worse on one side of the head
Start as a dull ache and get worse within minutes to hours
Last 6 to 48 hours

Other common symptoms include:

Nausea and vomiting
Numbness, tingling, or weakness
Problems concentrating, trouble finding words
Sensitivity to light or sound

The best way to diagnose this type of headache is by examing the history of your symptoms and your families history. In our office we will examine you to make sure it is not some other type of headache and to see what type of imaging studies we will need to perform.

There is no specific test to prove that your headache is a migraine. However, your chiropractor may order a brain MRI or CT scan if you have never had one before.


There is no specific cure for migraine headaches. The goal is to prevent symptoms by avoiding or changing your triggers.  In our office we will have you keep a diary of your headaches and symptoms to get picture of how they are affecting you.
Many of our patients find chiropractic manipulation coupled with acupuncture and avoiding triggers greatly reduces the frequency and severity of their migraines.

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Review By Our Satisfied Patient

  • "Dr. Koelling is the first chiropractor that ever totally worked with me to heal my back and neck. I am so very grateful and his staff is just as caring and wondrous."
    Brenda R. - St. Peters, MO

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