Headaches are one of the most common health conditions in Australia. It is likely that all of us will experience headaches at some stage, with many of us too familiar with the throbbing, discomfort and distracting pain they can cause.
There are a magnitude of causes of headache including those related to tissues both inside and outside the cranium, psychosocial and trauma. Persistent headaches should always be investigated with scanning particularly in the younger population and those with a history of trauma.
The elaborate nerve innervation around the head and neck makes identifying the primary cause of headaches a clinical challenge. This is often compounded by associated symptoms of the ear, eyes, nose and throat. Often the diagnostic time-line will involve ruling out serious pathologies and sometimes necessitate referral to specialist medical and allied health professionals. Headaches that are most amenable to manual therapy will be explored with insights from Jason Wells, Musculoskeletal and Sports Physio.
Neck related headaches - caused by pain and dysfunction usually from the upper neck (cervical) spine and called cervicogenic headaches. Often the patient experiences upper cervical pain which spreads to the back of the head. It is aggravated with positions or activities that increase the force and load to this area, for example reading with the head bent over for extended periods of time or painting a ceiling. Movement is usually preserved but the local cervical pain and headache can be reproduced with local pressure palpation to the affected level of the spine.
Like a lot of pains caused by muscular-skeletal tissues, the best management approach is a multi-modality treatment routine. That is, addressing the underlying cause of the aggravation (faulty movement, positional habits or behaviours) as well as reducing symptoms with techniques such as:
Mobilisation
Manipulation
Massage
Dry needling
Stretches
Muscle strengthening
and taping.
Manipulation is a treatment option in this cohort of patients but only for patients with a very low medical risk of complications. A discussion on the merits of spinal manipulation by physiotherapists is provided here.
Stretches to the neck are an important part of middle to end-stages of the condition and form part of a preventative management program. General neck stretches are not as effective as those localised to the upper cervical spine. This is a specialised area of therapy and it is very important to be gentle to avoid aggravating the patient and their pain.
Ergonomic strategies in which a patient’s work-station is set up to reduce cervical loading particularly in head-forward positions.
Head and neck support are critical for the patient in the early stages of the condition and this combined often with heat therapy and gentle mobilisation either from the therapist or actively from the patient are excellent pain-easing strategies. Video guides to this subcategory of headaches are provided here .
In our next blog on this topic we will discuss tension headaches.
