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The Truth About Headaches and Treatments
We all know how painfully brutal “dad jokes” can be. This is a similar sensation to headaches; and if you're like my family, my wife gets a lot of these kinds of headaches, and mostly driven by myself.
Unfortunately, this is not the only way in which headaches manifest themselves. According to the World Health Organization (WHO) the prevalence of headaches worldwide is about 50% (1 incidence a year) and of the 18-65 year old adults, 75% of them have reported a headache in the past year, and 30% of those persons reported having a migraine.
The WHO reports 4 types of headaches, there is also 1 headache in particular that is not mentioned that we see in the clinic and has a more profound prevalence. The 4 types that are described by the WHO are;
-Migraine
-Tension Type headache
-Cluster headache
-Medication induced headache
The one type of HA that is not mentioned, and is more relevant to the manual physical therapist is a Cervicogenic headache. Below I will breakdown the differences between the 5 types, and more specifically the treatment for cervicogenic headaches.
Migraine: this type of headache presents in a manner of vision disturbances, aura, sensitivity to light, as well as feeling of nausea and can create dizziness. This has to do with potential vascular changes that can occur in the brain as well as hormonal changes that can occur.
Tension Type: is usually thought of as mechanical in nature dealing with the muscular tension and tightness that people experience. This type can be felt as banding that is noted around the forehead or even at the base of the skull.
Cluster Headaches: can present with multiple, brief, sharp headaches that can focus around the eyes.
Medication Induced: is pretty self explanatory as a headache can result in overmedication and have similar effects to tension or cluster headaches.
The last topic in regards to headache presentation is Cervicogenic Headache pathology. In the outpatient orthopedic world this is a relatively new physical therapy diagnosis and is by far the most common that I see as a clinician. Cervicogenic headaches are typically generated from the cervical spine and present as head pain. Now, it is my belief that tension headaches can fit into this category because the muscle can be directly affected by several factors from the cervical spine. Clinically, I can report that in the presence of a stiff neck, or one that moves too much naturally, that the joints of the neck can actually interrupt the flow of the nerves that come out of the spine. When this occurs the nerve acts as a water hose, can get compressed, and not feed the brain and muscles of the head like the hose feeds the garden. Thus, what can happen when compression occurs, is that the muscle can spasm and create headaches.
Let’s now discuss the treatment for cervicogenic headache and how we, as therapists can, and should address your concerns as patients. First, the therapy diagnosis is important as it does guide where the treatment goes. Depending on the source of the headache the treatment can be entirely different. As therapists, we will assess the joint mobility of the spine/neck and can and should determine if there are any areas of concern, whether too much motion, or too much stiffness. If either of these movements happen then nerves can get irritated, and this is transposed to head pain.
In certain areas there can be a “Rams Horn” distribution which is where the pain starts around the ear and goes to the temple/jaw area. It can also start at the base of your skull and go up to your forehead or behind your eye (resembling the shape of a ram’s horn) Another area that can create increased head pain is at the base of the skull that would be represented as the same as putting your palm at the back of your head as the pain distribution. We have also heard of presentations of sinus pressure that turns out to be coming from the mid cervical spine!
If these are areas of concern, then as a therapist, we have to address the epicenter, or
source of the pain, which is the treatment of the neck; joints, nerves and muscles included. Mobility is really the key to initiate the healing process, and finding the right therapist for you is the crucial step in initiating the correct treatment. After this point there have to be some mobility exercises for home as well as some exercises to address the muscles that are now functioning properly.
Lastly, it is important to discuss the ever important issue of posture, and postural strengthening. I would be a rich man if I was paid just a nickel every time a patient/family member or even coworker asked me if posture was important and it is truly a hot topic debate in the physical therapy field. My opinion, because you asked, is that posture plays a crucial part in the position of your spine, the compressive (bad) forces in the neck, and the prevalence of headaches. It starts from a very young age where we see “tech neck” and “text neck” which gets people in these poor postures with our head on our necks, that it creates a myriad of issues; one of those including headaches. My last metaphor for the blog is this; imagine your head is a bowling ball and your arm is your neck. When you are bowling, how long do you think you could hold the ball straight out in front of you without dropping the ball?? My guess is not very long at all. Well this is the same as keeping your head way out in front and away from your body and trying to hold it up all day. Something will break down. This, this is why we are here for you at Curnyn Physical Therapy.
With this being said, if you decide that your headaches are a continuing issue, and you would like some tips, pointers, help or treatment, please don't hesitate to give us a call here at Curnyn Physical Therapy our number is (817) 923-9000. If you aren’t sure if PT is the right option to help you we can offer a FREE 15 minute screen to let you know if we think we can help you with your headaches. So give us a call!
“Headaches were like birds. Starlings. They could be perfectly calm, then a single acorn could drop and send the entire flock to the sky.”
― Erika Swyler, The Mermaid Girl: A Story