Headaches can range from mild & infrequent to severe and disabling. The severely disabling type of headache can throw our personal life into complete disarray.
What Causes Headaches?
The International Headache Society has categorised headaches into primary and secondary headaches.
Primary Headaches are relatively mild and usually recurrent. They are the commonest variety and include migraines, sinus headache, tension headaches and cluster headaches.
Secondary headaches occur due to underlying systemic causes like hypertension, meningitis, whiplash injury, tumours, vascular disorders, brain bleeds etc. In other words they have a secondary cause.
Another increasingly recognised cause of secondary headaches include problems in the cervical spine like dysfunction in the joints of the neck. Tight muscles at the base of the skull can also refer up to the back & frontal region of the forehead above the eyes. These are called as the Cervicogenic headaches.
Headaches due to TMJ joint dysfunction (jaw problems) are also a common occurrence that are frequently missed.
A glimpse into the headache types:
The neck in medical parlance is referred to as the cervical spine. Cervicogenic headaches are headaches caused by referral from the neck joints. Research has shown that pain from the joints in the upper part of the neck and neck muscles can refer pain into the head.
In my experience, many people attend the clinic because they are unsure whether there headache is coming from the neck or not. Generally speaking, if the neck is the source of the headache, then the pain should ideally be reproduced by pressing on the joint or muscle in the upper part of the neck
There may also be a restriction in neck range of motion which can simultaneously produce head pain. The after effects of a whiplash-type injury can frequently give rise to this pain pattern.
How do I know if it’s a Tension headache?
Tension headaches are the most common variety of headache. A tension headache gives rise to a mild aching sensation. It is generally felt both sides of the head. Oftentimes, people describe a sensation of a tight band around the head. The pain normally lasts anywhere from minutes to several hours &, in some cases, it is relieved in certain positions.
It is well established that women are more prone to headaches than men. They usually happen between the ages of 20-40. Patients complain of continuous pain in the forehead, temples, back of the head or neck and it may be episodic or chronic. As with all neurological conditions, a link between depression and anxiety is commonly present.
Tension headaches are linked to several factors, for example, links have been shown with bad posture, increased stress, irregular meals, & dehydration. Over the counter medications such as paracetamol or ibuprofen can help relieve the headaches short-term. Medium to long-term it is vital to incorporate lifestyle changes like practicing relaxation techniques, regularising mealtimes and consuming plenty of water.
3. What are Migraines?
Migraines are less common than tension headaches and usually cause severe, throbbing pain at the front or side of the head in around 70% of sufferers. It is common to report symptoms like nausea, vomiting, and increased sensitivity to light or sound. The frequency of migraines vary from two to four times per month to a couple of times per year. As migraines can be very debilitating and long lasting, some people end up bedridden or struggling to go to work.
Changes within the cardiovascular and nervous systems have been linked to migraines. For example a link between migraines & inflammation & swelling of the arteries in and outside of the brain have been proposed.
Each episode may last for between four hours to several days. Many of the migraine patients also experience an aura a few minutes before the onset of the actual headache. The aura can include visual disturbances or auditory hallucinations.
A recent review compared the published literature on the effectiveness of spinal manipulation, acupuncture and medication in the treatment of tension type headache and migraine headaches.
Manual therapy involving Physiotherapy and Chiropractic manipulation was found to be more effective than pharmacological treatments for patients with tension type headache and migraine headache
Manual therapy is often used by patients as an alternative to medication due to the risk of drug abuse or medication overuse in headache cases.
4. Can headaches be caused by jaw problems?
According to a recent study of TMJ (temporomandibular joint) disorders, the jaw may may be a common source of recurring tension headaches. TMJ headaches are commonly undiagnosed because its symptoms may resemble sinus headache, tension headaches or migraines.
TMJ headaches affect women more than men and are most common between the ages of 20 to 50.
TMJ pain shows up like migraine headache accompanied by neck pain, which occur at the back of the head often associated with stress. The pain often radiates down into one or both shoulders.
Headaches due to TMJ disorders can be relieved by TMJ mobilisation and upper cervical joint mobilisation. Massage to the neck and facial muscles, especially the masseter muscle, can help to alleviate headaches due to facial muscle tightness in TMJ disorders. Our physiotherapists and Chiropractors are highly trained in TMJ dysfunction related headaches.
Headaches after Whiplash injury
Whiplash injury of the neck is a sudden acceleration-deceleration injury of the cervical spine following a road traffic accident. The sudden contraction of the neck muscles to protect the head and neck results in pain in the neck and shoulder region often accompanied by headaches that can last for weeks or months.
Deep neck flexor strengthening exercises, stretching and joint mobilisation techniques help to successfully alleviate these headaches. Including scapular bracing and postural correction exercises ensure that the pain does not recur again.
How do we treat headaches at Naas Physio Clinic?
At Naas Physiotherapy Clinic our physiotherapy and chiropractor treatments provide excellent results for Cervicogenic, Tension, Migraine, Post whiplash, Fibromyalgia and TMJ dysfunction.
Our efforts are directed towards a thorough assessment and accurate diagnosis as proper diagnosis is vital for the success of the treatment. This includes eliminating red flag. Red flags are serious systemic causes of head pain such as tumours, aneurysms, hypertension etc.
We believe in using the right mix of available treatment techniques to come up with a treatment plan that is unique for each patient and will provide optimal results. Our highly qualified and dedicated team is well trained in the art and skill of mobilisation and manipulation – key tools to ease the head symptoms significantly.
Our approach to the headache problem
Tension and Migraine headaches may be triggered by poor neck postures, neck muscle tightness and restricted neck range of motion. Many patients are actually unaware that the discomfort in their necks could be related to their recurrent head symptoms.
Such patients can benefit hugely from cervical joint manipulation, trigger point release, and exercise rehabilitation of the neck muscles followed by postural correction. Acupuncture can also provide pain relief in these cases.
Patients with Cervicogenic (neck driven) headache respond excellently to facet joint mobilisation, stretching and strengthening of neck and upper back muscles. Trigger point release, acupuncture, soft tissue massage, and deep neck flexor strengthening also provide long lasting relief in these cases. We also advise you on work place ergonomics which plays an important role in preventing the recurrence of pain.
Falsiroli L and Rafanelli M (2019). Manual Therapy and Quality of Life in People with Headache: Systematic Review and Meta-analysis of Randomised Controlled Trials. Curren Pain and Headache Reports, 23(10). https://pubmed.ncbi.nlm.nih.gov/31401702/
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