What are Headaches?
A headache is characterized as any pain that occurs on the head. There are several types of headaches, each with its own cause.
Following are the main categories of common headaches and their separate causes:
- Tension and cervicogenic headaches
- Migraine and cluster headaches
- Secondary headaches resulting from another underlying illness, such as sinus infection, infectious disease, tumor or other serious illnesses.
Most headaches are acute and temporary, though if symptoms last for longer than a day, can disrupt a patient's ability to function in daily life due to its proximal nature on the body.
There are effective treatments for most headaches, but the key to finding the appropriate intervention lies in the evaluation and classification of type of headache that the patient is experiencing. Headache treatments are different for the different types of headaches and a physical therapist can help distinguish them and create effective headache relief plans both in the clinic and at home that would help reduce the frequency and intensity of headache pain.
What are Tension Headaches?
Tension headaches have a muscle spasm origination and are the most common types of headaches seen in adults. These muscle spasms may result from neck injuries or jaw issues, stress and fatigue, or from poor posture. Physical therapy is the most effective in treating tension headaches by way of correcting poor postural habits, improving strength and range of motion of joints of the jaw, neck and shoulders.
Oftentimes, an inherent neck or jaw issue such as from injury or degenerative causes can lead to tension in the muscles in the back of the neck that extend to the base of the skull. This increased tension propagates a feeling of compression and tightness on the facial nerves and muscles of the cranium. Poor posture can be a leading cause to this increased tension as well because posterior neck muscles become overworked and strained, later triggering a headache.
A tension headache generally starts as a muscle spasm that starts either at the back of the neck or at the base of the skull. The pain may radiate to the sides of the head and up to the top of the eyes. The patient may even feel increased tension by the jaw bone that radiates to the sides of the neck and behind the ears. Patients oftentimes feel tightness, ache, and sometimes burning from stretching or moving a tight muscle. Tension headaches may worsen with poor computer desk posture and may ease with rest and sleep. Tension headache relief can be achieved with property physical therapy techniques.
How a Physical Therapist Can Help with Tension Headaches
A physical therapist conducts a thorough evaluation to determine the cause of the headache. If a tension headache is suspected, their goal is then to hone in on the anatomical and biomechanical causes of the tension headache. The physical therapist would ask about daily habits and activities and perform tests to analyze the likely culprits that are the cause of the headache.
Following are subjective and objective data that would help a physical therapist hone in on the causes and remedies to achieved headache relief:
- History of previous injuries to the neck, head, or jaw – such as from sports, trauma or a car accident.
- The locations, intensity, frequency and nature of the pain experienced.
- Muscle strength tests of the neck, shoulder, and arm.
- Sensation tests of the neck, shoulder and arm.
- Postural examination during sitting, standing and while performing daily activities required for sports, work and/or living.
- Range of motion measurements of the the neck, shoulder, arm, thoracic spine.
- Palpation and assessment of joint mobility and muscle soft tissue flexibility in the muscles around the head and neck.
If the origination of headache pain is truly stemming from the jaw or cervical spine, a physical therapist can then form a plan of care that would encompass improving strength, mobility and posture. If the physical therapist's' evaluation determines another causative factor, such as migraine or a secondary headache from a systemic illness, he/she will refer the patient out to another healthcare professional for more diagnostic tests and treatment.
Following is an example of a physical therapist's treatment plan for solving tension headaches:
- Manual mobilization of muscles and joints to improve segmental mobility in the cervical and thoracic spine. Stretching tight muscles in the back of the skull and neck. Manually treating trigger points, or "hot" areas of pain and tension.
- Improve strength and endurance of anterior stability muscles of the neck and upper back muscles that would in turn improve posture, allowing the patient to hold a healthier posture for longer periods of time while they perform daily activities.
- Posture re-education by verbal instructions, and self-correction tools like using mirrors. Guided modification of computer workdesk parameters to ensure a comfortable and healthy sitting environment for work. This may involve use of a headset instead of a handheld phone; adjusting the tilt angle of the computer screen; changing the desk chair's parameters so the arms are resting in a comfortable and appropriate position; adjusting the location and position of the computer mouse and keyboard.
Physical Therapy and Migraine Headaches
Migraine headaches are a more complicated condition that can be a severe and disabling. Patients generally experience an intense period of pain whereby they are unable to function or do anything in the presence of light or sound. Migraine headaches typically begin with the presence of an ‘aura' – a visual disturbance or an usual olfactory experience that is unrelated to the external environment. The patient may also feel nauseous before the migraine occurs. Cures for migraines are elusive and typically remedies other than medication usually involves the patient shutting himself into a quiet and dark room for a long period of time to wait it out.
Migraines are a disorder of the central nervous system, the brain and the spinal cord. It involves the nerves and blood vessels and may be linked to epilepsy. Migraines can be triggered by stress, at random, or by mechanical injury/strain to the neck muscles and joints. When the trigger is more centralized, medications are useful in abating the symptoms; and when the trigger is more peripheral and mechanical in nature a physical therapist may be helpful in reducing the noxious stimuli. A physical therapist is able to educate the patient on relaxation techniques and on modalities to help reduce the intensity of the headaches, but most sufferers of classic cases of migraine headaches would find physical therapy benefits limited and would need more extensive healthcare intervention.
If you suffer from headaches, contact one of our Clinics in Portland for headache relief today!