Physiotherapy can help the majority of people who suffer from Primary Headaches (where there is no specific sinister pathology causing the headache). This article discusses the different types of headaches and how physiotherapy can help alleviate symptoms.
Most people are aware that if their headache is related to neck pain, then treating the neck is likely to help. These headaches are called cervicogenic, or neck-related headaches. As well as cervicogenic headaches, other debilitating headaches include migraines, Tension Headaches and Cluster Headaches. In the past it was thought that each type of headache responded to different treatments. However it has recently been recognised that there is an overlap of symptoms across the different headache types, pointing to the possibility of a common cause.
Recent research shows that sensitisation of the brainstem is a common factor in all headache types. The brainstem receives information from the head and face, as well as the top 3 joints of the neck (upper cervical spine). The upper cervical spine is a powerful source of sensitisation of the brainstem. This can result in information from the head and face, which may otherwise be unnoticed or cause mild discomfort, being interpreted as painful and resulting in a headache. We can consider the brainstem like an amplifier in a sound system: sensitisation from the neck ‘turns up the volume’ and can be responsible for triggers that seem to cause a headache (such as red wine, chocolate, exercise, stress and hormones). This sensitivity can be ‘turned down’ by treating the neck.
Physiotherapy treatment of upper neck problems can therefore be effective in managing primary headaches. This includes migraine with or without aura, menstrual migraine, silent migraine, tension type headaches, cluster headaches and neck related headaches. There are a huge variety of auras associated with migraine, sometimes even occurring without a headache. These can include visual aura: spots, flashing lights, wavy lines, and loss of visual field, numbness and even weakness. Provided these symptoms don’t have another cause, physiotherapy treatment of the neck can help manage them.
Even if you have not had success with physiotherapy for your neck in the past, assessment and treatment using this specific approach may bring you relief.
Assessment involves asking you questions about your headache symptoms, followed by a physical assessment of your upper cervical spine. Care is taken to identify any possible sinister cause of your headache.
It doesn’t matter if you don’t have a headache or migraine on the day of your assessment. It is still possible to identify and treat the problems causing your headache on a headache-free day.
Treatment aims to address postural changes and stiffness in the upper neck. This will reduce brainstem sensitivity by ‘turning down the amplifier’. In turn this will decrease your headache symptoms.
Physiotherapy will include slow sustained pressure/mobilisation of the joints (no cracking), home exercises and posture education. Treatment can also address any upper back/thoracic spine stiffness you might have, as well as muscle retraining and strengthening of the neck and upper back.
Initially five treatments over three weeks is suggested to ensure improvements are maintained and progress continues. After these initial sessions treatment becomes more spaced out, depending on your progress. The good news is that there is no need for long-term treatment. The aim is that once your headache symptoms have eased you will be able to manage any further problems yourself.
If you are a headache sufferer and would like to make an appointment to see Linda King (Launceston clinic), the author of this article, please contact Physiotas. If you are based on the North West Coast, Gareth Bell (Ulverstone clinic) is another of our Physiotherapists who specialises in headache management.
About the Author:
Linda King is a Watson Headache® Certified Practitioner. The Watson Headache® Approach is recognised as a scientifically researched method of examination and treatment. Linda’s interest in headache treatment began when she attended her first course with the Watson Headache® Institute in 2011. Linda has since attended two further courses with the Watson Headache® Institute, and has recently attended a course in management of the vestibular system to assist with management of dizziness, also a frequent symptom of headache.