Headaches are one of the most common complaints from patients who are seen in medical practice. There are numerous types of headaches described in literature, with three of the most common being tension-type headaches, migraines, and cervicogenic headaches. Figuring out the cause of a person’s headache complaint is the first step towards properly treating it, which involves detailed analysis of its triggers, how it presents itself (where the pain is located and the pain sensation), the frequency of occurrence, and the duration of the symptoms.
Tension-type headache pain is typically located on both sides of the head, and can travel from the back of the skull around the head to behind the eyes. It is described as episodic (occurring < 15 days per month) or chronic (>15 days per month), and typically lasts for 4-6 hours (but can last for days or months). Emotional stress, poor postural patterns, sleep deprivation, and eye-strain are all factors associated with tension-type headaches. Successful treatment of tension headaches can occur if treatment is aimed at identifying, and relieving, the cause of the increased tension.
Migraines typically onset around puberty, and are chronic neurological headaches of moderate-to-severe intensity. They are frequently unilateral (on one side of the head), and can last up to a few days and include symptoms such as light and/or sound sensitivity, nausea and vomiting. Many patients with migraines sense an aura prior to the headache onset, which is something signaling that a headache is on the horizon. There are various criteria which need to be met for headaches to be considered ‘migraine’, established by the International Headache Society. Medications are useful in helping manage these headaches, from pain-relieving medication, during a headache episode, to preventative medication.
Cervicogenic headaches (aka neck headaches) are the most common type of headaches treated successfully in physical therapy (along with tension-type headaches). They are defined as referred pain perceived in any part of head caused by a painful structure in the musculoskeletal system innervated by cervical nerves. Pain associated with cervicogenic headaches have been attributed to impairments of joint, muscle, and neural structures of the upper three cervical joint regions. Cervicogenic headaches typically are unilateral and do not change sides, and are located from the base of the skull and travel around the side of the head to behind the eye. It can occur at any age, and often are associated with postural habits or sustained head positions (such as an office-worker sitting at the computer all day, or a mother holding her baby on one arm habitually for breast-feeding and looking to one-direction repetitively). Treatment for neck headaches aims at identifying the habits which are triggering the headaches and improving them, working on joint mobility within the cervical/thoracic spine, improving muscle control around the neck/thorax for postural retraining, and detailed education about the condition and how to have long-term improvements.
Identifying the type of headache a patient is presenting with, and appropriately treating the condition, is a difficult task. A physical therapist is trained to ask various questions about the symptoms to get an idea of how it presents. The therapist also knows how to objectively determine if the headaches are mechanical in nature, helping determine if the patient is appropriate, or not, for physical therapy. If you are experiencing headaches, contact your physical therapist today to have an evaluation and begin gaining control of your symptoms.