Screen Time Related Headaches
Over the years, Americans have spent less and less time staring at their TVs and more and more time staring at their phones. With the advent of the iPhone in 2007, screen time has progressively increased each year. In 2019, the average American spent 3 hours a day on their phone(1). While this increased time with our phones has improved productivity, allowing us to work and send emails remotely, as well as improved our interpersonal connections, allowing us face-to-face conversations with distant relatives at any time, there are also health risks associated with excessive time spent staring at a phone screen. One of the most significant health conditions associated with increased screen time is headaches.
When staring down at your phone, two headache inducing events occur simultaneously: neck strain and eye strain. Respectively, over time, these events trigger two different types of headaches with some overlapping symptoms.
Cervicalgia, or neck pain generated by strain or damage to the cervical spine (the portion of spine between the head and shoulders), has grown increasingly prevalent as the rate of smart phone use continues to soar(2). Imagine a large rock fused to a stick. As the stick tilts forward, the rock puts increasing pressure on the stick. This strain eventually leads the stick to splinter. Lean the stick far enough and the weight of the rock will cause the stick to bend, even break. Imagine that rock is a human skull and the stick is the cervical spine. As we stare down at our phones, our heads put pressure on our cervical spines. Initially, this pressure leads to neck strain, causing achy pain through the neck and shoulders. When the pain begins to radiate from the neck into the head, this condition is known as a cervicogenic headache. Cervicogenic headaches most often arise from strain or damage to the upper joints of the cervical spine. The pain is most often described as an achy pain that begins through the back of the neck and radiates to the back of the head. Frequently this pain can radiate forward to the top of the head, temples and forehead, making the diagnosis confusing to patients as well as many medical professionals. It is often misdiagnosed or mislabeled as tension headaches. Sometimes these headaches can even feel pulsatile and the patient is diagnosed with migraine headaches. Unfortunately, treating these headaches like migraine headaches will not work and can lead to years of frustration for patients.
If you think you are suffering from cervicogenic headaches, the first step is to significantly decrease time spent looking down at your phone. Try using a computer or a propped tablet as much as possible, with your neck in a neutral position, eyes facing forward. While this may prevent further strain or injury, it is unlikely to immediately cure the headaches if they have been going on for a while. In addition, if you find yourself taking over-the-counter pain medications more than once or twice a week, it is likely time to make an appointment to see your doctor.
The first step in medical treatment is typically physical therapy of the cervical spine. Range of motion and stretching exercises can certainly be beneficial, however, if the pain is severe and persistent, more invasive treatment is often needed. The only way to truly diagnose a cervicogenic headache is by performing a procedure called a cervical medial branch block. This is usually performed in an office or surgical center, with or without a mild sedative. Under x-ray guidance, the performing physician will inject a tiny bit of numbing medicine over the nerves supplying the upper joints in the back of the cervical spine. If it gives a lot of relief (over 80%) for a short period of time (12-24 hours) this confirms the diagnosis. Treatment is then most commonly a radio-frequency ablation, where tiny burns are placed around these nerves, causing them to degenerate. The nerves typically take a year to grow back, so a year of pain relief is often experienced. While these nerves can be burned again once they grow back, treatment after the procedure focuses mostly on posture correction, trigger avoidance, and cervical spine hygiene, to decrease neck strain and recurrence of pain.
Migraine headaches are one of the most common medical conditions experienced by adults. In fact, it is the third most frequent and sixth most disabling illness in the world, with 12% of the U.S. population suffering from them(3). A migraine is defined as a severe headache that lasts 4-72 hours, usually on one side of the head, often above the eye, associated with light and/or sound sensitivity as well as nausea and worsens with routine activity or exercise. While there are many known migraine triggers (lack of sleep, certain foods, not eating enough food, and stress), one of the most increasingly pervasive triggers is smart phone use. There are many competing theories as to why these devices are so problematic for migraine patients including blue light exposure, poor neck posture, scrolling text and flashing images. However, the most studied condition associated with prolonged screen time is eye strain. In fact, eye strain associated with screen time has its own name: Computer Vision Syndrome. This digital eye strain significantly increases migraine frequency(4).
Treating migraine headaches is complicated, especially if they occur more than four times per month. The first step is to identify and eliminate migraine triggers. As mentioned previously, this can include inadequate sleep, not eating enough food or drinking enough water, certain foods (wine, cheese, chocolate, processed meats, and citrus juice), as well as excessive screen time. This excessive screen time can be as little as 30 minutes of sustained use.
If migraines are persistent after triggers are eliminated and continue to occur more than four times a month, a prophylactic medication is often needed. Medications attempted first include certain blood pressure medications like beta-blockers, a class of anti-depressants known as TCAs, and certain anti-seizure medications like topiramate. If migraines are persistent after trying these for a few months, a new type of medication, just released to the public in 2018, known as CGRP receptor inhibitors can be tried. These medications prevent migraines from forming by blocking the receptors responsible for inciting the neurological cascade that triggers them. Currently, these include Aimovig, Ajovy, and Emgality. All three are once monthly injections the patient performs themselves.
If migraines occur 15 times or more per month, they are diagnosed as chronic migraines. Treatment is similar to episodic migraines, with prophylactic medications instituted as early as possible. However, if medications are unable to decrease the headache frequency to below 15 days per month, Botox for Migraines can be performed. This involves injecting a tiny amount of Botox in multiple locations throughout the forehead, temples, back of the head, neck and shoulders. It works by directly blocking most of the neurological pathways outside the brain where migraine headaches are felt. If headaches continue to persist frequently, one last option is IV ketamine infusions. This works by resetting the internal neurological pathways within the brain that lead to migraine development as well as toning down pain perception in general. These infusions are most often performing once to twice monthly under the supervision of a board-certified anesthesiologist.
While screen time has been on the rise this past decade, with smart phone use dramatically increasing each year, this use has skyrocketed during the Covid-19 pandemic. Unfortunately, so has the incidence of worsening and new onset cervicogenic and migraine headaches. Stress and lack of exercise due to stay-at-home orders certainly contribute, however, the neck and eye strain due to smart phone use should be limited. While in this digital age, limiting screen time is difficult, one tip that may help is the 20-20-20 rule: every 20 minutes look into the distance (20 feet) for 20 seconds(5). Most importantly, if headaches persist despite routine changes at home, contact your doctor and see if medication and/or a referral to a headache specialist is an option for you.
THERE IS HOPE!
For patients who experience chronic headaches, Dr. Daniel Feldman performs a number of interventional procedures, depending on the nature and chronicity of their headaches. Our organization makes receiving your call and booking your appointment our top priority.
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- Vincent AJ, Spierings EL, Messinger HB. A controlled study of visual symptoms and eye strain factors in chronic headache. Headache. 1989 Sep;29(8):523-7.
- Tribleya, S. McClaina, A. Karbasia and J. Kaldenberg. Tips for computer vision syndrome relief and prevention. Work, vol. 39, no. 1, pp. 85-87, 2011.