Most of us have experienced a headache at some point in our life. For some people they are a more frequent occurrence and can have a significant impact on their daily lives. Over the counter medication is the most popular choice for immediate symptom relief, however for certain types of headaches, while medication may help to relieve the symptoms, the underlying cause of the headaches is not being treated, and symptoms are likely to return. What most people don’t realize is that Physiotherapists can treat the root cause of most headaches, not only relieving the immediate pain, but prevent it from reoccurring. Headaches can typically be grouped into three main types, tension, cervicogenic, and migraine. Each type is characterized by different causes of headache pain.
Tension Type Headache
Tension headaches are the most common. Pain from a tension headache is usually described as a dull pressure or tightening sensation. The pain is typically felt in the forehead, both temples and the back of the head. A tension headache can last anywhere from thirty minutes to seven days. A tension headache will not cause nausea but it may cause either increased sensitivity to light or sound. There are numerous causes or risk factors that can contribute to a headache. The most common triggers include muscle tension in the neck and shoulders, poor posture or sustained postures for an extended period of time, and eye strain. Stress, dehydration, hunger, and hormonal changes are additional factors that may contribute to tension headaches.
Another common type of headache is a cervicogenic headache. Approximately 1 out of 100 people experience this type of headache. A cervicogenic headache, as the name implies, is cervical in origin. The headache pain is perceived as occurring in the head but the actual cause is in the neck. The pain is usually a dull, one sided ache that starts in the back of the head and spreads to the forehead, temples and behind the eyes. The person may experience pain in the neck, and possibly difficulty turning the head. This type of headache can last days or even months and can be constant or reoccurring. The most significant causes or contributing factors are stiff joints in the neck, temporomandibular joint dysfunction (TMJ), poor posture, upper back pain or stiffness, muscle weakness or tightness in the neck shoulder and back area, whiplash or other neck injury, and poor sleep positions. Additionally, cervicogenic headaches can develop months after a concussion or head injury indicating dysfunction in the joints of the neck.
Migraine headaches, according to the international headache society, are a genetic neurological disease. Migraines can be categorized as being with or without an aura. An aura is described as visual or sensory symptoms or speech disturbance. Visual symptoms can be flickering lights, seeing spots or loss of vision. Sensory symptoms can include pins and needles, and numbness. The diagnostic criteria for a migraine states the aura must last longer than five minutes but less than one hour. A migraine headache can last from four to seventy-two hours. It is usually described as a one sided, pulsing type of pain. The pain is usually moderate to severe and aggravated with activity. A migraine may cause nausea, vomiting and sensitivity to light and sound. The sufferer may experience pre-headache symptoms such as food cravings, mood changes, and fatigue or muscle stiffness.
How Physio Can Help:
There are many other sub-categories of headaches, and although we have categorized them, it is possible for one type of headache to cause another type of headache. For example, a tension headache if left untreated can trigger a migraine for some people, making it more complex to diagnose what type of headache you have. Migraines are generally not treated by a physiotherapist, however if the you have pre-headache symptoms such as muscle tightness, pain or joint stiffness in the jaw, neck, upper back or shoulders these can often be the factor that trigger the migraine. The approach with physiotherapy in this case is to eliminate the muscle and joint issues to diminish the number of triggers.
Tension type headaches and cervicogenic headaches are the two main types that can be treated by physiotherapy. The most common contributing factors to these two types of headaches are poor posture, a combination of weak or tight muscles known as muscle imbalances, or joint stiffness which can be in the neck, jaw, back or shoulders. An issue in one or more of these areas is often the cause of re-occurring headaches because all of these areas are closely connected. If someone is experiencing headaches, but also has a shoulder problem, the two issues are not always considered in combination however, when it comes to treating headaches they should be linked as the muscles in the neck also help with movement or stability in the shoulder. In order to treat tension and cervicogenic headache a detailed assessment of the neck, shoulders, and upper and lower back would be required. The assessment should identify postural discrepancies, muscle dysfunctions such as weak, tight or overactive muscles, and joint mobility issues such as too much or too little movement.
Once specific areas of dysfunction have been identified, an individualized treatment approach can be developed. Treatment should include postural education and correction for specific postural positions. Postural awareness training on how to activate the correct group of muscles to achieve optimal posture is crucial in decreasing this contributing factor. Posture can also be corrected with specific taping techniques that can either help you turn on certain muscles or prevent you from falling into a poor posture. Taping can provide quick relief of discomfort but is only used temporarily until you are able to stretch and strengthen to achieve a good posture actively.
The next step in treatment is usually specific active and passive stretching of the shortened and tight neck and shoulder muscles. Stretching improves the muscle balance in the neck and will reduce the tension in the muscles surrounding the joint and thereby relieve pain. Stretches should be specific to isolate one muscles instead of general neck stretches which can further aggravate a headache.
Once the muscle tension has been reduced, strengthening of the weak neck, back and shoulder muscles should be started. Strengthening is important to help correct posture and eliminate strain of the muscles and joints when in certain positions. Weakness in certain muscles is often the cause of ongoing pain and inability to maintain good postural alignment. The focus with strengthening should start with the deep stabilizing muscles of the neck and back; these muscle require a combination of strength and endurance to support our upright postures throughout the day.
For tension and cervicogenic headaches, stretching and strengthening exercises alone are not enough to reduce the occurrence of a headache. Underlying the muscle tightness and weakness is usually cervical spine joint stiffness or lack of movement. This lack of movement in the neck joints needs to addressed in order to decrease the strain in the neck. Physiotherapists that are trained in manual therapy can help to loosen a stiff or locked joint through a technique called joint mobilization. Joint mobilization is a specific technique used to improve movement in a joint to restore range of motion and decrease the tension in the muscles around the area as well as reduce pain.
In addition to manual therapy and exercise there are other modalities a physiotherapist can use to help relieve pain. The application of a heating pad to the neck, shoulders and back can help to reduce muscle tension by increasing circulation in the area. The reduction in muscle tension provides relief of pain. Interferential current (IFC) can be used to provide immediate pain relief. IFC is the application of mild electrical stimulation to the muscle and nerve endings that cause pain. This blocks the pain receptors and decreases the pain, which in return helps to relax the muscles in the area.
Acupuncture is a common modality used to help relieve headaches and muscle tension. Acupuncture stimulates an increase in blood flow, which relieves muscle tension and thus relieves the pain in the surrounding area. It also helps in stimulating the production of our natural pain killers and anti-inflammatories. Often patients are too sore or tender to tolerate stretching or massage in the affected area; acupuncture is a great option to decrease the local soreness and allow treatment to continue.
To effectively treat headaches all of the contributing factors must be considered and addressed. Active participation from the patient is a necessity to be successful. Just as important is correcting or modifying aggravating activities or postures to decrease the severity and occurrence of pain. Additionally, continual prevention is an important step, if you are aware of stressors that contribute to your headaches you should try to modify or change these factors.
It is important to follow through with a prevention or maintenance program to reduce reoccurrence of future headaches. There are many options when it comes to preventative measures including massage therapy, relaxation and stress management techniques, postural awareness, workplace ergonomics, stretching and strengthening programs, regular aerobic exercise, and a headache diary.
A massage every couple of months can aid in reducing tension in the muscles, will help to maintain good posture and will also provide relaxation and stress relief. Regular massages can also help to point out problem areas before they become a pain causing structure. This will help with headache management as it may signify the need to restart certain exercises or visit your physiotherapist.
The ability to de-stress and relax is very important for headache sufferers as stress can affect blood flow and cause muscle tension. For some people stress may be one of the main contributing factors of their headaches. Yoga is an effective method to relax, stretch and de-stress the mind and body. Regular aerobic exercise is another effective method to help increase blood flow to the muscles which will help to reduce tension. When it comes to relaxation it is an individualized approach, and each person should strive to find what works for them.
If posture was identified as a main contributing factor for headache pain, steps should be taken to ensure your workplace station or home office is set up ergonomically for your body. An individualized ergonomic set-up will aid in maintaining good posture throughout the work day and decrease the stress and strain on your muscles and joints. Stretching frequently throughout the day will also reduce tension, as well as avoiding prolonged sustained positions will help to decrease stiffness and strain. Stretches should be held at a comfortable position, not into pain, for a minimum of 30 seconds and repeated throughout the day as necessary.
A headache diary can help to identify triggers or contributing factors. If you know what these factors are it is easier to avoid or modify them and will help reduce or eliminate your headaches.
A detailed physiotherapy assessment and complete physiotherapy treatment approach are necessary to address all of the contributing factors and therefore the root cause of a headache. Over the counter medications only treat the symptoms of the headache and not the pain. If headaches have become a normal part of life for you or someone you know, a physiotherapy assessment with a trained manual therapist should be considered to help solve the underlying issues.