Headaches are the most common neurological symptoms worldwide, as over 90% of people have noted at least one headache during their lifetime.¹⁰ It is very complex to try and distinguish between numerous types of headaches to find the best description for your specific headache, in order to provide the best treatment.
Two of the most common headaches treated in physiotherapy are tension-type and cervicogenic headaches. These have the most significant impact on social, physical and occupational functioning¹⁰ and can be managed with medication and physiotherapy.
A tension-type headache is a very common primary headache according to the Headache Classification Committee of the International Headache Society (IHS).⁸ Tension-type headaches cause intense pain in both sides of your head, neck and behind the eyes. Sometimes a patient complains of dull, throbbing pain in the head and neck region, as well as the sensation of having a tight band around the forehead or pressure of someone squeezing the head. Physical activity or movement does not usually aggravate this kind of headache.
Symptoms may include sensitivity to light and sound, but generally not nausea or vomiting.³ There are many influences which can aggravate tension-type headaches, such as anxiety, stress, poor posture, fatigue, insomnia, lack of physical activity and excessive workload.³ This can cause tension or spasm in the surrounding muscles of the head, neck and shoulders, but the exact cause is still unknown.
Cervicogenic headache is a secondary headache⁸ characterised by signs and symptoms of a steady dull ache, often one-sided, but rarely may be on both sides. It is often worsened by neck movement, sustained awkward head position, or external pressure over the upper neck or skull region.¹ Underlying causes can include traumatic incidents, such as whiplash injury, or degenerative joints causes. This type of headache may also be caused by stiffness and muscle spasm of the neck, back of the skull and jaw area.⁴ Generally, they may be felt by a patient for several days, weeks or months.¹ It can be a headache that “comes & goes” or may be constant and often arises gradually. The headaches may also be associated with light-headedness and dizziness on occasion, dependent on the severity. A definitive reason often cannot be found.
Conservative physiotherapy treatment techniques are effective methods for decreasing the intensity and frequency of a secondary headache, as well as the associated neck pain.⁹ Physiotherapy can be important in:
- Strengthening the muscles of the upper back;²
- Muscle stretching for flexibility and improved mobility;² ⁶ ⁷
- Mobilisation of stiff joints and manual neck/spinal traction;² ³
- Trigger point and soft tissue release techniques;⁶ ⁹
- Dry needling to assist trigger point release;¹⁰
- Posture assessment and correction;⁷
- Ergonomic/workstation assessment and correction;
- Stress management techniques;
- Head on neck proprioception;² ⁷
- Neural mobilisation techniques.⁶
The main aim of headache treatment is to decrease pain, provide rehabilitation for patients to regain any loss in function and to minimise re-occurrence.
This article was submitted by Jenilee Fortuin, who practises at Lamberti Physiotherapy Fourways. She can assist with optimal assessment and treatment for your headache. Contact her here using an online form for an appointment.
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- Racicki, S., Gerwin, S., DiClaudio, S., Reinmann, S., & Donaldson, M. (2013). Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of manual & manipulative therapy, 21(2), 113-124.
- López, C. L., Jiménez, J. M., de la Hoz Aizpurúa, J. L., Grande, J. P., & de Las Peñas, C. F. (2016). Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000 to 2013. Neurología (English Edition), 31(6), 357-369.
- Hamer, J. F., & Purath, T. A. (2016). Repeat RF ablation of C2 and third occipital nerves for recurrent occipital neuralgia and cervicogenic headaches. World Journal of Neuroscience, 6(4), 236-242.
- Amin, A., Maqsood, U., Niaz Awan, F., Arshad, H. S., & Arshad, A. H. (2017). Chronic tension-type headache as a risk factor of myofascial trigger points in upper trapezius muscle fibres in neck pain patients. Pakistan Journal of Neurological Sciences (PJNS), 12(3), 21-25.
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- Sertel, M., Bakar, Y., & Şimşek, T. T. (2017). The effect of body awareness therapy and aerobic exercises on pain and quality of life in patients with tension-type headache. African Journal of Traditional, Complementary and Alternative Medicines, 14(2), 288-310.
- Arnold, M. (2018). Headache classification committee of the international headache society (IHS) the international classification of headache disorders. Cephalalgia, 38(1), 1-211.
- Aslam, S., Ahmed, A., Zia, S., & Farooq, N. (2019). Comparison of trigger point therapy and conventional physical therapy in tension-type headaches. The Rehabilitation Journal, 3(1), 99-104.
- Pourahmadi, M., Mohseni-Bandpei, M. A., Keshtkar, A., Koes, B. W., Fernández-de-Las-Peñas, C., Dommerholt, J., & Bahramian, M. (2019). Effectiveness of dry needling for improving pain and disability in adults with tension-type, cervicogenic, or migraine headaches: protocol for a systematic review. Chiropractic & manual therapies, 27(1), 43.