A Physio's guide to Headaches
There are various types of headaches, each with its own cause and characteristics.
Sometimes more than one type of headache can occur at the same time, which can make an accurate diagnosis difficult.
It is essential that headaches are properly diagnosed. Especially if experiencing a new type of headache, which comes on quickly, may be associated with other symptoms, and is not settling within a reasonable period of time.
More gradual onset headaches, which are less severe and may fluctuate in intensity, could be less serious but still need to be assessed and treated early.
Beware of relying only on painkillers. Research has shown that over time painkillers can become less effective and might even start causing headaches, the so-called ‘re-bound headache’. If in doubt, get it checked out.
I’ll discuss some of the more common types of headaches:
Headaches associated with a viral illness, such as the flu.
These headaches usually settle as the infection resolves and can be treated symptomatically with medication from a pharmacist. If symptoms persist it is advised to see your GP. Tension in the neck and shoulders, with the development of trigger points may occur during the infection. Trigger points can be a secondary cause of headache which may be a reason for a headache persisting after the infection has cleared. In this case, treatment with a physiotherapist is recommended.
Vascular headaches, for example migraines and cluster headaches.
These are functional or primary headaches which occur due to wind-up or sensitisation within various centres in the brain and are thought to be partly related to altered blood flow. Migraines are more common than cluster headaches, are felt on either one or both sides of the head and may be associated with the ‘aura’. See your GP for advice and possibly medication to help abort migraine attacks and to exclude other causes for the headache. Then, I would recommend a physiotherapy consultation here at the clinic for a medical acupuncture-based approach to helping to prevent your migraines. Medical acupuncture has been shown to be very effective; it is a recognised and scientifically validated treatment approach for migraine treatment. When combined with lifestyle advice and graded gentle exercise it has been of great benefit to many of our clients. Cluster headaches are similar in cause to migraines, but usually felt only on one side of the head and with a more intense but briefer episode of pain. A consultation with your GP would be advised if you feel you may be suffering from cluster headaches.
These are referred pain type headaches with pain arising from joints, muscles, nerves and fasciae of the neck region. These types of headaches are usually felt on one side in the upper neck region, and are associated with neck stiffness or loss of movement and a feeling of tension within the neck muscles. Cervical headaches are treated with physiotherapy which includes manual or hands-on therapy techniques, specific exercises and medical acupuncture. Medical acupuncture, including dry needling, gently and carefully treats any associated trigger points which may have developed in the neck muscles, and helps to ease general muscle tension.
Tension or ‘muscular tension-type’ headaches.
These are similar to cervicogenic headaches but are felt on both sides of the neck, with tender and tense muscles often being the main cause. Stress is often a precipitating factor, as well as long periods sitting in front of a PC or performing repetitive tasks involving, for example, the neck and shoulders. Whiplash type injuries often give rise to a tension-type headache presentation. Tension headaches respond very well to physiotherapy involving medical acupuncture and dry needling for which there is also very good research evidence to support its effectiveness as a treatment technique. Supplementary medication is sometimes required. Certain types of supplementary medication, such as the TCA’s and SNRI’s, have a synergistic effect with the medical acupuncture and can improve the overall treatment effect. Manual therapy and therapeutic exercises are often also required.
Intracranial (within the skull) headaches.
As a result of brain tumours, haemorrhages (bleeds), subdural haematomas (bleed and blood collecting just outside the brain) and meningitis for example. The headaches which can occur with these types of pathologies are usually more severe and associated with other neurological symptoms such as loss of sensation, movement, visual disturbances, unable to concentrate, speech disturbances and others depending on what part of the brain is affected. Feeling unwell, having sleep disturbances and a loss of appetite can also be associated with these headaches. It is essential that these types of headaches are diagnosed early and medically treated after an initial consultation with your GP or in some cases a visit to A&E. Physiotherapy does not have any initial role with these headaches but may be required to treat any functional sequelae which may result.
For example, benign exertional headache and footballer's migraine. These types of headaches occur due to a rise in the pressure within the skull and brain, which may occur during times of acute physical exertion, and they usually settle afterwards. If experiencing these types of headache on a more frequent basis, a consultation with a GP is advised as further medical investigation may be required.
These may include psychogenic, drug use (for example medication overuse) and following spinal surgery. In these cases, an assessment with a GP should be sought in the first instance. In the case of a headache following spinal surgery, assuming there are no surgical complications, there is a role for physiotherapy to treat joint, muscle and nerve sensitivity and restriction that often follows surgery and may be the cause of residual headache symptoms.
In good health,