Headaches are one of the most common medical complaints with most people experience them at some point in their lives. Headaches can affect anyone regardless of age, race, and gender. Almost half of all adults worldwide will experience at least one headache in any given year. A headache can be a sign of stress or emotional tension, or it can result from a medical disorder, such as migraine or high blood pressure, anxiety, or depression. Headaches can lead to other problems and can make it hard to attend work or school regularly.
There are many types of headaches, headaches can be primary, when they are not caused by another condition, or secondary, when there is a further underlying cause. Primary headaches are caused directly by the over-activity of, or problems with, structures in the head or neck that are pain-sensitive. This includes the blood vessels, muscles, and nerves of the head and neck. They may also result from changes in chemical activity in the brain. Common primary headaches include;
- Cluster headaches
- Tension headaches (appropriate for physical therapy)
- Cervicogenic headaches (appropriate for physical therapy)
Secondary headaches are symptoms that happen when another condition stimulates the pain-sensitive nerves of the head. In other words, the headache symptoms can be attributed to another cause. A wide range of different factors can cause secondary headaches. These may include:
- alcohol-induced hangover
- brain tumor
- blood clots
- bleeding in or around the brain
- brain freeze or ice-cream headaches
- carbon monoxide poisoning
- teeth-grinding at night
- overuse of pain medication, known as rebound headaches
- panic attacks
Headaches can be a symptom of a more serious condition, therefore; it is important to seek medical advice if they become more severe or persistent. If a headache is more painful and disruptive than previous headaches, is severe and sudden, worsens, or fails to improve with medication or is accompanied by other symptoms such as confusion, fever, sensory changes, and stiffness in the neck, a doctor should be contacted immediately as they could be due to severe or life threatening condition.
Physical therapy intervention can be an extremely helpful tool for those individuals suffering from tension type and cervicogenic headaches. In some instances, individuals with migraine headaches may benefit from physical therapy intervention to decrease the irritation of nerves (branches of the trigeminal nerve) which may contribute to stimulation of migraine headaches.
A migraine headache may cause a pulsating, throbbing pain usually only on one side of the head. Migraine is the second most common form of primary headache and can have a substantial impact on the quality of life of an individual. A migraine can last from a few hours up to 2 and 3 days. The pain may be accompanied by:
- blurred vision
- sensory disturbances known as auras
In some cases, migraine headaches can be stimulated by irritation of the sensory nerve fibers of the Trigeminal nerve. Irritation of these sensory nerves can cause transformed migraines and can be stimulated by tension type or cervicogenic headaches. Alleviation of tension or cervicogenic headaches can decrease the frequency of true migraines.
Cluster headaches usually last between 15 minutes and 3 hours, and they occur suddenly once per day up to eight times per day for a period of weeks to months. In between clusters, there may be no headache symptoms, and this headache-free period can last months to years. The pain caused by cluster headaches is:
- often described as sharp or burning
- typically located in or around one eye
- The affected area may become red and swollen, the eyelid may droop, and the nasal passage on the affected side may become stuffy and runny.
Cluster headaches are not treated with physical therapy intervention.
The tension headache is the most common form of primary headache, and is often described as a constant sense of pressure or tightness in the skull, temple region, or forehead. Tension headaches can spread from the neck to the head and may range from mild to severe and are usually continuous, dull, aching, and non-throbbing in nature. Tension headaches normally begin slowly and gradually during the day and can occur on both sides of the head.
Tension-type headaches can be either episodic or chronic. Episodic attacks are usually a few hours in duration, but it can last for several days (occurring less than 15 days per month). Chronic headaches occur for 15 or more days a month for a period of at least 3 months.
Tension headaches are thought to be caused by sustained contraction of certain muscle groups in the head and neck. A sustained muscle contraction is thought to be involuntary hyperactivity of the muscle and can result in irritation at the muscle insertion points in the head, as well as pain in the muscle itself due to ischemia (restricted blood flow). The most common muscles contributing to tension type headaches include the levator scapula, upper trapezius, temporalis, and frontalis muscles.
The levator scapula and upper trapezius muscles often result in banana shaped headaches, headaches that begin at the base of your skull and radiate to the top of your head. The temporalis and frontalis muscles often result in temporal headaches or headband headaches.
Factors which may trigger a tension type headache include, but are not limited to:
- Environmental (excessive afferent input such as loud noise, bright lights)
- Psychosocial (before, during, after stress, anxiety, fear, anger, grief, depression)
- Jaw/temporomandibular joint (TMJ) occlusive problems and dysfunction causing abnormal activation of muscles of mastication (clenching/grinding)
- Impaired vision/eye strain
- Cervical spine impairments causing abnormal cervical spine muscle activation
- Poor posture & body mechanics placing cervical and TMJ muscles and joints in abnormal positions resulting in muscle activation
- Repetitive movements
Cervicogenic headaches are a newer classification of headaches that appear similar to that of a tension type headache, often making it difficult to distinguish between the two. Cervicogenic headaches are characterized by pain in the head or face that is referred from the neck due to irritation of the cervical nerve roots. Cervical nerve roots can be irritated anywhere along their route from the neck to the head. Structures that may result in nerve root irritation may include; bony structures (spine), soft tissue, or muscles in the neck.
Cervicogenic headaches can occur continually or several times per week and vary in duration pending aggravating factors. They are usually dull and aching in nature and commonly reported at the base of the skull, frontal region, or temporal region. Cervicogenic headaches can be unilateral or bilateral and be associated with dizziness, lightheadedness, nausea, visual disturbances. Headache may be relieved by lying down, supporting head, applying pressure to the sub-occipitals (muscles at the base of the skull), or using medication.
Cervicogenic headaches occur when there is irritation of the trigeminocervical nucleus, a region in the upper cervical spine where sensory nerve fibers (afferents from 7th, 9th, 10th cranial nerves) come down from the trigeminal nerve and interact with the sensory fibers (afferents from C1-3 spinal nerves) from the cervical nerve roots. This interaction can result in referred pain to the head and face. Any structure innervated by the above mentioned nerves can be a source of headache.
Factors and condition which may trigger a cervicogenic headache include, but are not limited to:
- Arthritic changes
- Degenerative Disc Disease
- Disc Herniation/Bulging Disc
- Neck injuries
- Poor posture & ergonomics
- Spinal stenosis
- Stomach sleeping
- Texting neck (looking down all the time)
- Whiplash injuries
Physical Therapy for Headaches
At Balance Solutions you will be evaluated by a skilled licensed physical therapist to determine factors contributing to your cervical condition, such as; upper cervical spine mechanics, passive intervertebral mobility (segmental movement of each vertebrae), range of motion, muscle strength, joint mobility, soft tissue mobility, postural alignment, body mechanics and your quality of movement with normal daily activities. Following a thorough evaluation, a personalized plan of care with goals will be constructed specifically to meet your individual needs.
Treatment for tension type & cervicogenic headaches may consist of the following interventions;
Balance Solutions therapists have been trained in many types of manual therapy techniques to effectively treat patients with cervicogenic & tension type headaches. Manual therapy is used in conjunction with therapeutic and neuromuscular re-education exercises to achieve the best possible outcomes. Manual therapy techniques can used to improve the mechanics of your cervical spine and alleviate symptoms of neck pain and headaches. Effective manual therapy intervention is used to speed up the heeling process and promote proper mechanics throughout the body. Click here to read more about manual therapy.
Proper mechanics in the cervical spine as well as shoulder girdle depend on muscle strength and tension relationships. When neck muscles are too weak or too tight more stress is placed on the ligaments and joint capsules. Tightening or shortening of the neck muscles can result in increased compression of the spine which may cause pain in the neck and wearing away of the joint surfaces. Poor shoulder mechanics may result in substitution by certain neck muscles resulting in neck pain. Therapeutic exercises can help to improve your neck and shoulder mechanics by stretching tight structures and strengthening weak muscles, restoring proper mechanics throughout your neck and shoulder regions. Click here to read more about therapeutic exercise.
Neuromuscular re-education exercises are designed to re-develop normal and controlled movement patterns. This type of exercise helps achieve a variety of goals, improving proprioception (how you sense the position of your neck, joint stabilization & biomechanics and energy efficient movement patterns. Neck injuries, repetitive stress injuries, neurological conditions, and poor posture can result in unhealthy and faulty biomechanics, making movement patters become inefficient and painful. Our therapists incorporate many neuromuscular re-education exercises to retrain and improve movement patterns, thus alleviating pain and preventing re-injury as well as improving posture and body mechanics.