The therapeutic management of common headaches
"Some pain you can distance yourself from, but a headache sits right where you live"
Headaches are a common occurrence, and can have a large impact on the day to day running of your life. If you’re a headache sufferer, you’ll be pleased to hear that you’re not alone. 50% of the population suffer from headaches at any one given time, making them a very prominent complaint seen in Primary care and they’re actually responsible for 30% of outpatient neurology clinics.
There are various types of headache and identifying which you suffer from can help with your treatment. Tension type headaches are more common than migraines, for example, affecting approximately 40% of the population at any one given time.
Healthcare practitioners sometimes find it difficult to diagnose headaches, prescribing patient pain killers rather than long term treatment. However, there is strong evidence to support the use of therapeutic management through physiotherapy, acupuncture and chiropractic manipulative therapy to reduce the pain and ease symptoms.
The International Headache Society categorise headaches into primary and secondary.
- Tension type headache
- Cluster headache
- Headache attributed to neck pain, trauma, cranial or cervical vascular disorders, cervicogenic headaches.
Identifying which type of headache you suffer from can greatly increase the success rate of your ongoing management and treatment.
So, which headache do you have?
Tension type headache:
This is the most common primary headache. It is described as a tight feeling, as if your head were in a vice. It is a mild to moderate steady ache, often in the forehead, or both sides of the neck and back of the head. It is commonly associated with soreness in the shoulder and neck, with muscle tightness and trigger points in the muscles that attach to the base of the head. Women are more affected than men, specifically between ages 30-39 years and does actually decrease with age. It can be episodic or chronic, and symptoms can last from days to weeks.
Migraines are generally a throbbing pain affecting one side of the head and are associated with nausea, vomiting, sensitivity to light and sound, and aura. This pulsating pain is moderate to severe and can last from 4-72 hours. This is a centrally mediated pain disorder stemming from your central nervous system however studies have shown changes in neck muscle tone and dysfunction in the joints of the cervical spine between episodes.
Cluster headaches are the rarest and most painful form of headache. It is a severe headache localised to one eye and the temporal region as the temporal artery bulges and pulsates. It is not uncommon to have associated tearing, nasal congestion and sweating with a cluster headache. Attacks generally last 45-90 minutes and usually occur at the same time of day, often from an afternoon nap or sleep at night.
This secondary type of headache originates from pain and dysfunction in the neck, specifically the upper cervical (C1, C2, C3) spinal joints. Symptoms affect only one side of the head and neck, and can last from an hour to weeks.
Pain is moderate to severe and exacerbated by movements of the neck and posture. It is associated with increased tightness of the surrounding neck and shoulder musculature, increased activity of superficial neck flexors and weakness of deep neck flexors.
Therapeutic management of your headache can ease your symptoms. Current evidence supports the following treatments-
- Cervical spine mobilisation and manipulation
- Strengthening exercises including deep neck flexors and postural scapular muscles
- Thoracic manipulation and thoracic mobility exercise
- Acupuncture, soft tissue release and trigger point therapy for overactive neck and shoulder muscles
- Relaxation training and lifestyle advice