Studies have shown that of the patients presenting with headaches to private practice chartered physiotherapy, approximately one third are neck related cervicogenic headaches, one third are muscular tension type headaches and another third are migraine headaches.
Cervicogenic headache is a headache whereby the cause of the headache is a neck disorder, usually felt on one side. In other words the muscles, joints and nerves of the neck may not be functioning correctly resulting in referred pain to the head region. Common causes are sustained faulty postures, certain neck movements resulting in injury to the neck for example while lifting or carrying and sometimes stress.Typically clinical findings with this type of headache include musculoskeletal impairments such as muscular trigger points, restricted neck movements and reduced strength and endurance in the deep neck flexor muscles.
In terms of the management of cervicogenic headaches, the evidence shows that physiotherapy is very effective. Physiotherapy treatment may include medical acupuncture (including dry needling), manual joint mobilisation or manipulation, soft tissue release, therapeutic exercise and postural correction. Physiotherapy treatment can help to restore normal movement, correct posture and strengthen and release weak and restricted muscles respectively. The result is a restoration of normal neck function and with it a reduction in pain and sensitivity.
Physiotherapy management also involves treating the individual, not just the condition. This includes understanding the patient’s lifestyle in order to determine all contributing aspects of the headache such as daily posture in work or at home and stress.
Tension type headaches are primary headaches caused by an overactive and sensitised nervous system with associated increased muscle tension. They are classified by pressing pain on both sides of the head normally caused by stress or tension. Physiotherapy is one component of the treatment used for this type of headache to relieve any musculoskeletal contributing factors such as trigger points within tense overactive muscles. However, it is important that the underlying stress or tension is also addressed.
Migraine type headaches are also primary headaches caused by disturbance of the central nervous system. They are characterised by either both or sometimes one sided throbbing pain which is often associated with nausea and vomiting and also light and sound sensitivity. This is commonly an episodic severe headache which requires bed rest. Migraines can be triggered by a number of different factors including hormonal changes, food, disturbed sleep patterns and stress. These type of headaches are usually caused by a non-mechanical source. Again, physiotherapy can be used in the management of migraines to help to treat any musculoskeletal involvement, but is important to consult your GP or pharmacist for pharmacological treatment.
In conclusion, physiotherapy is a useful component in the management of headaches, particularly cervicogenic and tension headaches where there is a large musculoskeletal component. However, it is important to remember that there are other types and causes of headaches. If you experience any unfamiliar, severe or persistent headache, it is important to visit your GP.
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