Headache Causes And Solutions
Recently OSI Physical Therapy was featured on Twin Cities Live for treatment of headaches. (Link to the TCL feature) This was an exciting opportunity to make the public aware of the potential impact that physical therapy can have on certain common types of headaches. I want to take this opportunity to review what we, as Physical Therapist, can do to help people suffering from headaches.
There are many types of headaches including migraines (with or without aura), cluster, sinus, hormonal, exertional, vascular (cervical or intra-cranial artery dysfunction), post-traumatic/concussion, tension-type, and cervicogenic (neck-based). Primary headaches have their source within the head itself while secondary headaches are referred from a remote source like the neck. Headaches can also be related to temporomandibular joint (TMJ or Jaw) dysfunction, dental problems, neurological disease, medication, and psychiatric problems. Many times headaches may be considered “mixed” meaning that a person’s headache may be migraine and tension-type or cervicogenic and tension-type combined.
The most common symptom with cervicogenic or neck-based headaches is base of the head and /or top of the neck pain (sub occipital pain), which is typically one sided, “starts in the neck,” and radiates to the head and/or face. This type of headache is triggered or worsened with neck movements and certain postures or positions. People with these headaches will present with limited neck range of motion (sometimes this is a very subtle loss of motion while other times it can be significant) and palpable tenderness over upper neck muscles and joints. Other symptoms such as referred arm pain, dizziness, nausea, lightheadedness, inability to concentrate, retro-ocular (eye) pain, and visual disturbances can also be present.
Tension-type headaches typically are more diffuse, dull, less intense, and not as tightly linked to neck motion. Pain with these headaches is commonly felt in the forehead and is usually linked to stress. This type of headache may be commonly confused with cervicogenic headaches and is considered a type of cervicogenic headache by some people.
In a recent systematic review of current research (Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of Manual and Manipulative Therapy. 2013; 21(2): 113-124. Racicki S et al) management of cervicogenic headaches with physical therapy was analyzed. Physical therapy treatments reviewed were manual (hands on) therapy which included joint mobilizations and joint manipulations of the cervical spine (neck), therapeutic exercise which included cervical and scapulothoracic (shoulder blade and upper back) strengthening, and the combination of manual therapy and therapeutic exercise. The authors concluded that “utilizing a combination of joint mobilizations, manipulations, and cervico-scapular (neck and shoulder blade) strengthening exercises to treat a patient with cervicogenic headache may be the most effective intervention based on the results of this systemic review.”
Another article (The working mechanism of manual therapy in participants with chronic tension-type headache. JOSPT. 2013; 43(10): 693-699. Castien R et al) compared patients with chronic tension-type headache who received physical therapy to patients who received usual care. Physical therapist used a multimodal treatment plan which included manual therapy and therapeutic exercises. Manual therapy included joint mobilizations and/or manipulations to the cervical spine (neck) and upper thoracic spine (upper back) along with soft-tissue mobilizations if deemed necessary. Therapeutic exercises included postural correction exercises and neck flexor and scapular (shoulder blade) strengthening. Usual care from a general practitioner included educational information, reassurance, advice, benefits of lifestyle changes, and if necessary analgesic or non-steroidal anti-inflammatory drugs. The results showed significant improvements in headache frequency and neck flexor endurance strength in the patients who received multimodal physical therapy. Improved neck range of motion and reduced forward head posturing was also observed with patients who received physical therapy. A reduction of headache frequency of 50% or greater after 8 weeks of care was seen in 85% of the patients receiving multimodal physical therapy compared to 28% of the patients receiving usual care.
If you suffer from headaches and:
1) you have neck pain and/or
2) you feel that your headache radiates from your neck and/or
3) your headache is increased or decreased by neck motion or positions
…then physical therapy can help you. If you suffer from TMJ (jaw) dysfunction with or without headaches physical therapy can also help you.
At OSI Physical Therapy, we have highly skilled Physical Therapists that can deliver a multimodal treatment plan based on your individual needs. You will receive a thorough, comprehensive evaluation and will be treated with the most effective (evidence based/supported by research) treatment techniques, which will include manual (hands on) therapy and therapeutic exercises. Please call or stop in to make an appointment and start feeling better.