A headache can be very distressing, disabling and have an impact on many aspects of a person’s life. It can affect concentration, work, as well as engagement in social and physical activity.
People with a headache can also have other symptoms such as:
- Neck pain
- Sensitivity to light
- Difficulty concentrating
There are many types of headaches, such as migraine, tension headaches, medication-induced headaches, cluster headache and cervicogenic headaches. A headache may also be a combination of the above headache types known as a mixed headache.
Whilst there are many different causes for headaches, in most cases, the origin is not serious. People can suffer from recurrent headaches over many years. Concussion, a fall, a sporting injury, a motor vehicle accident or feeling tired and stressed can cause headaches.
In rare cases, a headache can be due to a serious medical reason. This will need immediate medical assessment and investigation.
Physiotherapists can assess headache presentations and determine when physiotherapy treatment can be helpful. Physiotherapy is usually helpful for cervicogenic headaches, tension headaches and mixed headaches.
Cervicogenic headaches come from structures of the upper neck (joints, nerves and muscles). This kind of headache is usually associated with pain on one side of the neck referring to the head. It is also related to stiffness with head/neck movements, such as turning and moving the head to look up and down. In this type of headache, there is usually tenderness of the upper neck to touch.
Factors that can lead to a cervicogenic headache:
- Neck injury or strain
- Neck muscle tension and stiffness
- Poor sleep
- Low mood
Tension headaches arise from the muscles and nerves of the neck and head. This kind of headache is more diffuse and is often described as a tight band around the head and base of neck. It is usually associated with tenderness of the scalp, neck and shoulder muscles.
Factors that can lead to tension headaches are:
- Chronic stress
- Poor (broken or reduced) sleep
- Low mood
The above factors can add to sensitivity and tension of the muscles of the head and neck.
Chronic headache is when the headache lasts for more than three months.
Factors that lead to chronic headaches are:
- Chronic stress
- Poor sleep
- Low mood
- Protective guarding of the neck
- Muscle weakness
Myths about headaches:
✖ My headaches mean there is serious pathology
✖ My headache means my neck is ‘out’
✖ My headache is because of poor posture
✖ If neck movements hurt, I should avoid moving my neck
✖ There is nothing Physiotherapy can do for headaches
✖ Medication is the only treatment for headaches
Facts about headaches:
✔ Headaches are more common in females and have a genetic basis (run in families)
✔ Most headaches are not caused by serious pathology
✔ There are different kinds of headaches, that need different treatments
✔ There is no one best posture for neck pain. Varying postures, learning to relax and getting regular movement and activity helps
✔ If neck movements hurt – neck movement, relaxing and getting regular activity can help
✔ Neck tension and stiffness, poor sleep, worry, low mood and stress all have an effect on headaches
✔ The best thing is to work out a plan of how you can help your headache. Some strategies in your plan may include:
- Learn how to relax and move your neck with confidence.
- Get strong and active
- Manage your sleep
- Look after your general health
Exercise can be beneficial for sufferers of migraines or headaches
Recent studies have highlighted the beneficial effects of exercise for headache and migraine sufferers.
Two recently published scientific papers concluded that aerobic exercise, in other words exercise that makes you huff and puff:
- Reduces the intensity of migraine pain
- Reduces the frequency of migraine.
- Reduces the number of migraine days
- Increases the ability to participate in work/study/family activities.
The type of exercise that was looked at included walking, jogging, cycling, and cross training for 30 to 45 minutes a few times a week.
Importantly, this aerobic exercise needs to be a regular part of life to have its beneficial effects.
In addition to aerobic exercise, tension-type headaches and cervicogenic headaches (those originating in the neck) have been shown to benefit from low load endurance and high load exercise that specifically targets the neck.
Exercise is therefore recommended as a part of treatment for migraine, tension-type headache and cervicogenic headache.
Physiotherapy treatment of headache:
There is now strong evidence that physiotherapy treatments can help the headaches mentioned previously.
At your first visit to Body Logic Physiotherapy we take the time to listen to your story. This helps us to understand all the factors linked to your headaches. We can then determine what type of headache you have.
We want to understand how your headaches are impacting your life. We explore aspects of your home and work life that may affect your headaches. Aspects such as your sleep, stress levels, activity levels and your lifestyle. We look at whether worries or mood is playing a role in your headache. We do this as there is strong evidence that these factors can contribute to headaches.
We ask you about your general health. We find out about medications you take for your headache or any other conditions you may have.
We ask other specific questions that help us determine if there maybe a serious causes for your headache.
Following this we will conduct a comprehensive examination. During the examination we look at the following:
- Movements of the neck
- Mobility of the different joints of the neck
- The sensitivity and tension of the muscles of the neck and your ability to relax the neck muscles
- We assess the control and the strength of your neck and shoulder muscles. We look at the shoulders, as some of the muscles that control the shoulder attach to the head and neck. Tension or weakness of these muscles can impact on how your neck feels and moves
- We may need to consider whether nerves are involved in your headache
The key is to establish what kind of headache you have and then identify the common triggers for them. If you have a cervicogenic or tension headache, physiotherapy can help you.
At Body Logic Physiotherapy we will identify the factors linked to your headache. Together we set a plan for you to manage them. The plan can involve several strategies and treatment such as:
- Education about what triggers your headache
- Physiotherpy techniques to help the joints, muscles or nerves.
- Relaxation techniques
- Exercises to mobilise and strengthen the neck and / or shoulders
- Advice about sleep, stress management and a physical activity program if indicated.
This can take between 3-8 sessions over a period of weeks. The amount of treatment you need will vary. It will depend on how long you have had your headaches, what the cause is and how severe and disabling they are.
We know that headaches can recur and so sometimes there is a need for extra sessions if this occurs after treatment has ended.
Sometimes it is helpful to involve other health care providers in managing your care.