Headaches and Physical Therapy

  • August 24, 2021
Headaches

Headaches!  

We all have them. Some are just annoying dull aching that we experience occasionally, but some can be intense and debilitating. Some people get headaches when they are tired or hungry. Certain foods can trigger a headache for some people, or we may get headaches after too many drinks! Some may get a headache once a year, but some have headaches daily, and the intensity can range from mild to debilitating and affect your quality of life.  

Different Types of Headaches

Any type of pain in any part of the head is called a headache, but there are many different types of headaches, and there are just as many causes. The International Headache Society has two categories of headaches. Primary headaches are Tension-type, Migraine, Cluster, Cranial neuralgias, facial pain. Secondary headaches come from an underlying condition, such as fever, an infectious disease, a sinus disorder, or in rare cases, a tumor or a more serious illness. 

Thankfully, most headaches are harmless and resolve on their own. Some resolve with rest stretches to the neck and shoulders, food elimination (if this is a trigger), or eating something if hungry. 

There are effective treatments for almost every type of headache. The challenge lies in determining the type of headache, its cause and then developing an appropriate treatment plan that will reduce both the headache frequency and intensity. Physical therapists can help determine the type of headache you have, and we are experts in managing pain from tension-type headaches, cervicogenic headaches, and TMJ.  

Headaches, like back pain, are one of the most common of all physical complaints and can be one of the most frustrating to manage. They affect 1/10th of the world population and 9 million people in the USA, having a huge effect on a person’s ability to function socially and emotionally. 

Tension-type Headaches 

Tension-type Headaches (also called Muscle Spasm headaches) occur randomly and are often the result of temporary stress, anger, anxiety, fatigue, or poor posture. Increased tightness in the back of the neck or problems in the neck or jaw, such as an injury or arthritis, can cause muscles in the neck to work incorrectly.

As we move or turn our head and neck to avoid pain or discomfort, we are pulling on the neck muscles differently. This can then lead to tension and tightness in the muscles at the back of the head. At the base of the skull, we have the occipital nerve and artery, which are sandwiched in the upper trapezius muscle and small suboccipital muscles. As these muscles tighten, it can increase pressure on the nerves and arteries to the face and head. Poor posture can cause these muscles to become tight and overworked, which can trigger a headache. 

Tension headache symptoms can be soreness in the temples on the side of the head, a tightening band-like sensation around the head,-“Vice-like grip,” “wearing a tight cap,” increased pressure, and tightness in the head and neck muscles. This headache begins in the forehead, temples, or the back of the neck. It is typically treated with over-the-counter medication, relaxation techniques, stretches, and strengthening of the neck and upper back to help support the head and offload the neck muscles.  

tension headache
 Migraine Headache 

A migraine headache typically starts as a dull ache and then develops into a constant throbbing and pulsating pain over the temples, the front or back of the head, and on one or both sides. It is usually accompanied by a combination of nausea, vomiting, and sensitivity to light and noise. 15% of people experience an aura before the headache. This is a set of neurological symptoms that occur before the headache. They may be jagged lines, dots, flashing lights, tunnel vision, or blind spots in one or both eyes. Some people have problems seeing, hearing and it may affect their taste, smell, touch, and ability to talk. These neurological events may last for up to 60 minutes, but they fade away as the headache begins. Migraines last from 3 hours to 72 hours. 

The cause of migraines is believed to be an altered chemical reaction in the brain. Women are more affected by migraines than men, and they affect people most between the ages of 25-55. Chemicals and hormones regulate many of our body functions, keeping everything in balance. When these levels are off-balance, such as during menstruation, pregnancy, or menopause, it can lead to a migraine attack. Three-quarters of all women with migraines report that their attacks are related to the menstrual cycle.  

Treatment includes over-the-counter medications and newer prescription medications that target the brain specifically. Due to migraines being triggered by so many different physical and environmental factors, which differ for each person, you may need to track what triggers your headaches in order to prevent them. Keeping a headache diary is an effective way to track these triggers. 

Cluster Headaches 

Cluster headaches affect more men than women. It gets its name because the attacks come in groups. The pain arrives with little to no warning and is typically on one side of the head. The pain is excruciating and can feel like someone has a searing hot poker in the head. Cluster headaches are known as “the suicide headache.” These headaches typically last 45 minutes to 3 hours. Migraines last from 4-72 hours.

Cluster headaches are also vascular but start at a different part of the brain than a migraine. These patients typically cannot get comfortable and cannot lie down. A bloodshot or tearing eye and a runny nose on the side of the headache may be noted. This type of headache has been described as the most severe of any headache type. Treatment for Cluster headaches includes prescription medication and oxygen.  

Sinus Headache 

Sinus headaches present when the sinuses become inflamed from an allergic reaction, an infection, or localized inflammation. If the headache is truly caused by a sinus blockage such as an infection, you will likely have a fever and will be treated with antibiotics for the infection. In addition, you will need over-the-counter antihistamines or decongestants.  

How can Physical Therapy help? 

Physical therapists are experts in evaluating the joints and muscles of the head and neck. They can conduct a thorough examination of the head, neck, shoulders, and posture, along with reviewing your health history. The type of questions and tests they perform during the examination can determine the most likely cause of your headaches. They will ask if you have ever had any neck, jaw, or shoulder problems.

Your physical therapist will complete neurological tests, looking at muscle strength and sensation and your reflexes. In addition, they will perform a full examination of your posture. Your therapist will look at your movement patterns while sitting and standing while doing various activities. Your physical therapist will measure the range of motion of your neck, shoulders, and other relevant parts of your body. These include the lumbar and thoracic spine and hips. Physical therapists use manual therapy to evaluate the joints and muscles’ mobility and then treat them. 

Once the full evaluation is completed, and it is determined if you have a tension-type, cervicogenic, or headache from muscular-skeletal and orthopedic dysfunction that can be treated with physical therapy. The therapist will set up a treatment plan and design a plan of care to meet your goals. Suppose the evaluation indicates that you may have a different type of headache, such as sinus or infection. In that case, your physical therapist likely will refer you to another health care professional for additional diagnostic tests and treatment. 

We can help!

Treatments for correcting headaches may include therapeutic exercises and simple changes in your posture and lifestyle. Some lifestyle changes include adjusting the computer or pillow and sleeping position. 

Manual Therapy, soft tissue mobilizations, joint mobilization to improve cervical, thoracic and lumbar mobility, along with strengthening exercises, to help stabilize your upper back and neck, and pelvis. By doing strengthening exercises, you’ll improve your posture and endurance. Improving your posture and endurance will make it easier to sit or stand for long periods without discomfort. Along with modifications to your home or office workstation, driving and sleeping posture, or even the way you stand to fix dinner. 

If you’re experiencing issues with headaches, come in for a complimentary, 30-minute physical therapy session. Schedule your appointment by calling 973.799.3314. 

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