Headaches are a common condition. Up to 46% of people suffer from some type of headache disorder. Headaches negatively impact quality of life and diminish paid and household work productivity. Migraine headaches are a disabling condition, second only to low back pain, and have a substantial economic cost worldwide. Fortunately, Physical Therapy treatment can help.
Types of Headaches
Many different types of headaches can affect your day-to-day life. Since each type has a different quality and cause, distinguishing between them can help determine the best treatment.
The causes and mechanisms of migraine headaches are complex and beyond the scope of this post. There is believed to be a genetic component. The pain of migraine headaches is thought to be related to nerve sensitivity, inflammation, and blood vessel dilation. Due to this blood vessel involvement, migraine headaches often have a ‘pulsating’ quality.
A migraine headache starts with a ‘pre-headache’ or ‘premonitory phase’ experienced 2-48 hours
before the migraine attack. Symptoms during this phase can include neck pain, fatigue, yawning, impaired concentration, mood changes, food cravings, increased urinary frequency, irritability, nausea, and difficulty sleeping. If your doctor has prescribed certain migraine medications, taking them during this phase can dampen the effects of the migraine.
The next phase of a migraine is the actual migraine attack, which usually lasts from 4-72 hours. Symptoms during this phase include pain, nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound), anxiety, hyperosmia (sensitivity to smell), depressed mood, neck pain and stiffness, and insomnia. The nature of migraine pain is typically throbbing.
Following the actual migraine attack, there is a ‘post-dromal’ phase. Symptoms during this phase include tiredness, head and neck soreness, decreased cognition, and mood change.
Migraine headaches are usually on one side of the head, have a pulsating quality as mentioned above, may or may not have an ‘aura’, and are usually aggravated by physical activity.
Tension headaches also have a complicated mechanism. They may be caused by muscle pain, inflammation, or tenderness, although the exact cause is debated. Some people with tension headaches also have more muscular tenderness and sensitivity even when they don’t have a headache.
Tension headaches typically last 30 minutes to 7 days, are usually on both sides of the head, and feel like pressing or tightening but not pulsating. They are generally not aggravated by physical activity and do not include nausea or vomiting.
Cervicogenenic headaches are believed to originate in the neck and are commonly seen after a whiplash injury. This type of headache is believed to arise from specific nerves in the upper part of the neck as they interact with nerves in the head and face, as well as parts of the spine itself. There can also be a contribution from the muscles in the jaw. Once again, the actual mechanism causing pain is complex.
Pain is usually on one side of the head and neck and can last from hours to weeks. The pain usually starts on one side of the upper neck and radiates into the head and possibly into the shoulder. This type of headache is diagnosed by a limitation in neck movement or pain that increases with neck movement or sustained neck and head postures.
Occipital neuralgia is pain that arises from the occipital nerve. The occipital nerve starts in the upper part of the neck and courses through several muscles before its branches end up in the area of the scalp. The nerve can be injured during whiplash or entrapped within various muscles.
Pain from occipital neuralgia can be either on one or both sides of the upper neck and head and is usually severe with a shooting, stabbing, or sharp quality. The attacks of pain can last from seconds to minutes. There may be sensitivity along the branches of the nerve and sensitivity of the scalp. The muscles in the area may have trigger points, or tender, tight nodules.
Post-traumatic headaches occur after a brain or neck injury, which may arise after a sports injury, a fall, or an accident. They develop within seven days of an injury and persist for over three months from the time of injury. These headaches may present as migraine headaches, cervicogenic headaches, or occipital neuralgia.
How can Physical Therapy help to manage headaches?
Physical therapy management of headaches focuses on addressing what’s happening in the body that may be contributing to your headaches. A thorough evaluation can determine which individual structures may be affected.
Neck and upper back tightness
There is evidence that mobilization and manipulation of the cervical (neck) and thoracic (upper back) spines can reduce the intensity and frequency of headaches. This is true for cervicogenic headaches, migraine headaches, tension headaches, and post-traumatic headaches. There are also specific exercises that address spinal tightness that have been shown to improve headaches.
Dry needling has also been shown to address tightness in the small muscles of the neck, as well as the upper back and shoulders. Advanced dry-needling techniques specifically target muscles and nerves contributing to headaches. These techniques can be highly effective in occipital neuralgia, migraine headaches, and cervicogenic headaches.
Weakness of the neck and upper back muscles
People who suffer from migraine headaches often have neck and scapular muscle weakness. Strengthening of the muscles of the neck, as well as postural muscles that can become weak with prolonged computer use, can help manage headaches. While exercising while you have an active headache may be painful, keeping up with strengthening exercises can help with prevention. Research has shown that moderate-intensity aerobic exercise can also help with headache management.
One of the most important things for a headache sufferer is to know and avoid their headache triggers. For example, certain foods like wine or chocolate can trigger migraine headaches. This link from the National Headache Foundation contains valuable information about food triggers, especially in the context of migraine headaches.
Proper sleep hygiene is also necessary to help reduce the frequency of headaches. The use of specific pillows can help reduce neck pain. Check out this buyer’s guide for more information on cervical pillows. Workstation modification can help if computer use is a trigger for headaches.
If stress appears to be a headache trigger, practicing deep breathing, mindfulness, and relaxation techniques can effectively reduce the frequency and intensity of headaches, especially migraine and tension headaches.
Medications can be effective in the treatment of headaches. Your physician can help determine which prescription medications are right for you.
Headaches are common and can be extremely disabling. Each person’s headache is different, and certain people may be experiencing several different types of headaches. Understanding your individual needs is vital to the successful treatment of headaches. A thorough evaluation will help determine a plan to manage your condition and get you on the path to recovery!