Headaches have been said to be the most common complaint of pain. They affect almost two-thirds of the population and can be quite debilitating when severe. There are several types of headaches, which are classified by the International Headache Society, however, only TWO are treated by Physiotherapy – Cervicogenic Headache and Tension-type headache. Migraines may also be treated by Physiotherapy, however as these are more vascular in origin, the treatment focuses on associated muscle stiffness and spasm.
A cervicogenic headache is a headache that stems from the neck (Cervical Spine). This may be owing to stiff joints, muscles, nerve roots and fascia of the cervical spine, which then refer pain into the head. Commonly, the headache is referred to the head by active trigger points in the muscles particularly in the suboccipital muscles, anterior cervical muscles and upper trapezius muscles. The headaches may be triggered by repetitive movements, sustained postures and poor posture. They may be present for several days, weeks or months. There may be an associated trauma to the neck, such as whiplash or repetitive trauma and this type of headache may also be caused by stiffness and muscle spasm of the temporomandibular joint.
Signs and symptoms of a cervicogenic headache include a steady dull ache, often one-sided, but may also be on both sides. It can be a headache that “comes & goes” or may be constant, and often comes on gradually. The headaches may be aggravated by neck or head movements and can be associated with light-headedness, dizziness and, on occasion, tinnitus.
A tension-type headache is usually felt as a tight band around the head and forehead. This can be caused by tension or spasm in the surrounding muscles of the neck and shoulders; however, the exact cause is still unknown. Tension headaches occur mostly in young adults, who complain about a throbbing pain that comes on gradually. Physical activity does not usually aggravate this kind of headache and can even be present on waking or very soon after waking. Symptoms may include sensitivity to light and sound, but generally not nausea or vomiting.
As noted in the introduction to this article, a migraine is of vascular origin. Sufferers of these headaches may report a migraine with or without an aura. An aura indicates a neurological symptom that may present with a migraine, such as visual or sensory disturbances. These usually present on the side of the face that the migraine is affecting and may include a blind spot in the eye of the affected side, flashing spots in the eye, numbness, sweating, nausea, vomiting, sensitivity to light, tingling, double vision etc.
A migraine often has a precipitating factor that presents before the onset of the headache. Often the aura can be felt up to 2 weeks before the actual headache starts. Other factors can include temperature or altitude changes, blood pressure changes, changes in chronic medication, food (chocolate, cheese, caffeine etc), too much or too little sleep etc.
Other headaches which are common include (i) exercise-induced headaches, (ii) hormone-related headaches, (iii) medication-induced headaches and (iv) cluster headaches. These, however, cannot be treated with Physiotherapy, but therapy may assist in relieving associated muscle tightness and joint stiffness.
Physiotherapy treatment for headaches
This can be quite extensive and includes the following:
• Mobilisation of stiff joints
• Soft tissue techniques and release of trigger points
• Posture assessment and correction
• Exercises to strengthen the neck and shoulders.
• Stretching exercises for tight muscles
• Exercises for proprioception to help body awareness of the neck position.
• Ergonomic assessment and correction
• Stress management techniques
At Lamberti Physiotherapy, all physiotherapists are trained in treating and assessing headaches. Please contact us if you need any assistance.