Physiotherapy Treatment for Headaches

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Headache? Don't run straight to the medicine cabinet!

A headache is one of those things we could all do without. We often hear of friends, family, or colleagues who just 'always' have a headache - that nagging, throbbing, unpredictable and unrelenting ache. There are a number of medical causes of headache-like symptoms and they are not to be disregarded. A physiotherapist's role in differentiating between these causes is essential in providing the best possible care and the appropriate advice and management options.

Differential diagnoses:

• Migraines - with/without aura
• Cluster headaches
• Chronic paroxysmal hemicrania
• Tension-type headache
• Temporo-mandibular (TMJ - jaw) disorders
• Cervicogenic headaches

Physiotherapy plays a major role in the management of cervicogenic headaches and TMJ disorders. Cervicogenic headaches are headaches which originate from areas of the neck and are one of the most common types of headaches. the neck is comprised of vertebrae connected via two types of joints: facets on either side of the spine and the disc centrally. The neck's main role is to position the head appropriately for all activities of daily living - sitting, walking, writing, bending, lifting etc. - the list goes on! Importantly, the neck requires efficient postural muscles to sustain these postures with minimal load on the joints. The neck will withstand certain compression and sustained stretch forces to a point, however, repetitive poor postural movements will eventually cause tissue failure.

The key in all of this, to simplify the wonderful complexities of the neck, is the nerves supplying these components of the neck also supply the skin overlying the head, forehead, jawline, back of the ears and eyes. Therefore, when there is tissue damage or dysfunction in the neck, the symptoms present in these areas. This is a form of referred pain - a cervicogenic headache. It can be caused by a traumatic incident such as whiplash or an awkward landing playing sport or more commonly, sustained poor postures or dysfunction in the shoulders and neck. Sustained postures such as working on a computer station for long periods or a laptop watching a movie can also cause these headaches; we usually find our clients come in after a busy period of work (or a movie marathon!).

Symptoms:

• Gradual onset of neck pain
• Gradual onset of headache
• Constant, dull ache at the back of the head
• Usually one-sided, but can be both, towards the forehead and face
• Reduced neck range of movement
• Trigger points upper shoulder and neck musculature

Less common symptoms:

• Light-headedness
• Dizziness
• Nausea
• Tinnitus
• Decreased concentration

What do we do?

It is important to find the true contributing factors to your condition. We want long-term improvement and we want you to self-manage and be at your best as efficiently as possible. Our assessment will highlight these contributing factors and we can address them with management options such as:

• Joint mobilization
• Manual therapy for soft tissue release of neck and shoulder musculature
• Dry needling
• Stretching and range of movement techniques
• Postural awareness and retraining
• Scapula control (shoulder blade)
• Postural taping
• Education
• Activity management
• Anti-inflammatory advice
• Hot/cold advice
• Ergonomic assessment
• Pillow prescription
• Clinical pilates
• Home exercise prescription

The management of cervicogenic headaches can sometimes be resolved within days, but most commonly over a 3-4 week period. The self-management program is essential in maintaining a healthy neck and posture. If you are suffering from headaches or similar symptoms to thise described, have a concern about your posture and ergonomic set up or simply need some advice around your sport and activity management - book in below for an assessment!