13 Commonly Missed Causes of Chronic Headaches and Migraines: A Root-Cause Guide for Patients Who Need More Answers
Why “Migraine” Might Not Be the Whole Story
If you’ve been living with chronic headaches or migraines for years and nothing seems to help—not medications, injections, or multiple specialists—you’re not alone. And you’re not wrong to feel frustrated.
At Movability, we believe one thing above all else: headaches and migraines are not diagnoses—they’re symptoms. And when symptoms persist despite treatment, it means something deeper hasn’t been identified.
This post was created to raise awareness about conditions that are often misdiagnosed, under-recognized, or missed entirely—especially in patients who feel like they’ve exhausted all options.
Some of these conditions respond well to conservative care once properly identified. Others require medical or surgical intervention. But all of them begin with one crucial step: recognition—and that’s where we come in.
Our Role at Movability
We don’t perform MRIs, CTs, or lab work in-house. But what we do is just as essential.
When patients come to us after years of frustration, our job is to ask:
“What hasn’t been considered yet?”
Through our physical assessments, deep history-taking, and pattern recognition, we often flag possibilities that haven’t been explored. If we suspect a condition like a CSF leak, venous compression, or cervical instability, we:
Help advocate for the appropriate testing through your physician or specialist
Communicate clearly with your medical team
Provide conservative, non-invasive care to support your body’s mechanics, nervous system, and tissue healing
And ensure no stone is left unturned in the search for answers
This is how we help people get on the right diagnostic path—and in many cases, finally begin to recover.
1. CSF Leak (Intracranial Hypotension)
What It Is
A cerebrospinal fluid (CSF) leak occurs when the protective fluid surrounding the brain and spinal cord escapes, often through a tear in the dura. This reduces intracranial pressure and causes the brain to sag downward.
Symptoms
Headaches worse when upright, relieved when lying flat
Neck stiffness, light sensitivity
Tinnitus, dizziness, or visual changes
Why It’s Missed
MRI often looks normal unless contrast-enhanced
CSF pressure on lumbar puncture can appear normal
Frequently mistaken for migraine
Movability’s Role
If your symptoms suggest a possible CSF leak, we guide you in advocating for advanced imaging and refer back to your physician to initiate diagnostic testing. We also offer gentle, supportive care to reduce mechanical strain while the diagnostic process unfolds.
2. Intracranial Venous Hypertension
What It Is
When venous drainage from the brain is restricted—due to jugular vein compression or sinus narrowing—intracranial pressure can rise, disrupting CSF absorption and triggering head pain.
Symptoms
Head pressure that worsens when lying down
Pulsatile tinnitus (a rhythmic whooshing sound)
Visual blurring, brain fog
Why It’s Missed
Often not visible on standard imaging
Symptoms mimic migraine or tension headaches
Requires MRV or upright studies to detect
Movability’s Role
We assess posture, fascial compression, and jugular flow dynamics. If patterns suggest venous congestion, we communicate with your doctor to recommend venous imaging and support postural decompression strategies where appropriate.
3. Nutcracker Syndrome
What It Is
The left renal vein becomes compressed between major arteries, leading to backpressure that travels through spinal veins and can elevate intracranial venous pressure.
Symptoms
Flank pain, pelvic pressure
Headaches that worsen with standing
Visible abdominal or lower back veins
Why It’s Missed
It’s an abdominal vascular condition, not typically considered in headache workups
Imaging is rarely ordered unless flank pain is prominent
Movability’s Role
We screen for pelvic and spinal congestion patterns, and refer to your primary care physician if Nutcracker Syndrome is suspected. We also support spinal decompression and mechanical balance to improve venous return.
4. May-Thurner Syndrome
What It Is
This condition involves compression of the left iliac vein, which impairs pelvic venous drainage. Backflow affects spinal and cranial venous systems, influencing CSF flow and pressure.
Symptoms
Head pressure, especially after sitting
Pelvic pain, left leg swelling
Headaches worsened by heat or exertion
Why It’s Missed
Rarely associated with head pain by default
Often overlooked in female patients with chronic headaches and pelvic symptoms
Movability’s Role
When symptom patterns align, we guide patients in seeking the appropriate vascular imaging and offer postural and fascial care to reduce strain on venous return pathways.
5. Eagle Syndrome
What It Is
An elongated styloid process (a small bone near the base of the skull) can compress either the jugular vein or carotid artery, or irritate nearby cranial nerves.
Symptoms
Unilateral head or neck pain
Pain with swallowing, chewing, or head turning
Tinnitus, dizziness, or facial pressure
Why It’s Missed
Requires 3D CT to diagnose
Symptoms often misattributed to TMJ, neuralgia, or stress
Movability’s Role
We assess the mechanical space surrounding the styloid and refer to imaging or ENT specialists when Eagle Syndrome is suspected. Our treatment may involve decompression of soft tissues around the neck to relieve contributing strain.
6. Thoracic Outlet Syndrome (TOS)
What It Is
In TOS, blood vessels or nerves are compressed between the clavicle and first rib. When the subclavian vein is involved, cerebral venous drainage may also be impacted.
Symptoms
Headaches that worsen when lying down or raising arms
Arm numbness, swelling, or tingling
Positional pressure in the head or face
Why It’s Missed
Symptoms overlap with anxiety or tension-type headaches
Vascular compression isn’t typically evaluated in neurology
Movability’s Role
We evaluate thoracic posture, rib mobility, and scalene tension. If vascular TOS is suspected, we support decompression and refer for imaging to investigate venous involvement.
7. Idiopathic Intracranial Hypertension (IIH)
What It Is
IIH involves increased CSF pressure without an obvious cause like a tumor or mass. It’s especially common in women of reproductive age.
Symptoms
Daily headaches with visual disturbances
Pulsatile tinnitus
Worsening with lying flat or during hormonal shifts
Why It’s Missed
Papilledema may be subtle or absent
Imaging may appear normal unless interpreted by a specialist
Movability’s Role
We screen for IIH symptoms and, if patterns suggest it, support your physician in requesting MRV or a lumbar puncture. We also help optimize fluid dynamics through posture and dietary support when appropriate.
8. Ehlers-Danlos Syndrome (EDS)
What It Is
EDS is a connective tissue disorder that leads to ligament laxity, tissue fragility, and vascular irregularities. It increases the risk for CSF leaks, craniocervical instability, and autonomic dysfunction.
Symptoms
Headaches triggered by posture, movement, or strain
Hypermobile joints
Frequent subluxations, fatigue, or GI issues
Why It’s Missed
It affects multiple systems, so symptoms are often seen as unrelated
Diagnosis of hypermobile EDS (hEDS) is clinical and often overlooked
Movability’s Role
We recognize systemic connective tissue patterns and provide stabilization therapy, joint support, and care coordination for medical assessment when needed.
9. Cervicogenic Headache & Occipital Neuralgia
What It Is
Dysfunction in the upper cervical spine or irritation of the occipital nerves can cause referred pain into the head and face.
Symptoms
One-sided headache starting at the base of the skull
Pain worsened by neck movement or sustained posture
Tenderness over the occipital ridge
Why It’s Missed
Often misclassified as tension or migraine
Cervical spine is rarely examined during headache assessments
Movability’s Role
We perform detailed cervical assessments and provide manual therapy, nerve release, and stabilization training. We also refer out for imaging if structural nerve entrapment is suspected.
10. Hormonal Rebound Loop
What It Is
Fluctuations in estrogen—particularly sharp drops—can lower the brain’s migraine threshold by affecting serotonin, mast cells, and vascular tone.
Symptoms
Headaches before menstruation
Postpartum migraines
Pain linked to hormonal birth control cycles
Why It’s Missed
Treated as “just hormonal migraine” without addressing the underlying imbalance
Hormone tracking is rarely part of headache care
Movability’s Role
Our naturopath works to support hormonal regulation through nutrition, stress reduction, and lifestyle. We also refer for lab testing or endocrinology input when necessary.
11. Craniocervical Instability (CCI)
What It Is
CCI occurs when the ligaments at the junction between the skull and spine are too lax, allowing excessive motion and instability.
Symptoms
Headaches worsened by neck movement
Brain fog, light sensitivity, nausea
“Bobblehead” sensation or neck fatigue
Why It’s Missed
Imaging is usually done lying down, not in functional positions
Symptoms overlap with anxiety or chronic fatigue
Movability’s Role
We assess for instability patterns and refer for upright imaging or dynamic studies when warranted. We provide stabilization-based rehab to support neuromuscular control.
12. Small Fiber Neuropathy & Dysautonomia (e.g. POTS)
What It Is
Damage to small autonomic nerve fibers affects blood flow, temperature regulation, and heart rate—leading to poor cerebral perfusion and orthostatic headaches.
Symptoms
Brain fog, fatigue, or “hangover” feeling when upright
Lightheadedness, racing heart
Headaches worsened by standing or heat
Why It’s Missed
Often misdiagnosed as anxiety
Standard nerve tests don’t detect small fiber damage
Movability’s Role
We screen for orthostatic intolerance and support nervous system regulation through hydration, compression strategies, and referral to autonomic specialists for testing if needed.
13. TMJ Instability & Malocclusion
What It Is
Dysfunction of the jaw joint or bite misalignment can irritate the trigeminal nerve, which plays a central role in migraine.
Symptoms
Temporal or facial pain
Jaw clicking or fatigue
Headaches after chewing or in the morning
Why It’s Missed
Jaw health is rarely assessed in headache care
Often mistaken for sinus or stress-related headaches
Movability’s Role
We assess bite alignment, fascial tension, and jaw movement. We provide TMJ-specific therapy and collaborate with orofacial specialists when needed.
The Right Diagnosis Changes Everything
Many people suffering from chronic headaches are told to “just manage it.” But what if the headache is a signal—not the root problem?
At Movability, we specialize in asking better questions. Not because we have every scan or test in-house, but because we know how to think differently, listen longer, and investigate more deeply.
Some of these conditions respond well to conservative care. Others require medical or surgical intervention. In every case, the right outcome starts with the right diagnosis—and a team willing to look beyond the surface.
Contact Movability today to book a comprehensive assessment and experience our results-driven approach.
