Where do Headaches come from, what can you do about it ?
The “Headache Disorder” is becoming better understood as more studies start to unravel the complexities of this common disorder. Not just painful for the individual but also expensive to industry due to lost hours and poorer work performance.
The World Health Organisation (WHO) recognises Migraine, Cluster and Tension headaches as different entities with specific signs and symptoms. The “headache experience” is thought to be modulated in a central area in the brain and can be effected by any or all of these separate headache entities at the one time. This probably answers why headaches can be dulled by certain initiatives, like taking medication, but not completely cured. Cervicogenic headache (pain derived from the neck) is considered part of the tension headache experience. Physically, pain and dysfunction of the upper cervical spine has been shown to be closely associated with cervicogenic headaches. Physiotherapy treatment that eases the pain and dysfunction allows the neck to return to a "normal" pain free state and helps to alleviate the headache.
How do Cervicogenic headaches occur ?
Cervicogenic headaches can be due to a strain of the necks soft tissues with an acute trauma, or it may be more like a slow gradual onset due to issues such as sustained positioning Whatever the mechanism, it must be considered as a cascade of events which lead to the headache pain: There is a soft tissue strain (eg: muscle, ligament, joint capsule or disc) and a subsequent tissue reaction. The pain causes inhibited neck movement due to protective factors such as muscle spasm. As movement of the joint remains decreased, synovial fluid (the joints lubricant) is not produced (as this requires movement) and the joint becomes progressively stiffer with continued muscle spasm. Subsequently pain is elicited from the various compressed and damaged soft tissue's of the neck. Specific nerve structures of the neck can become directly irritated causing referral to the neck, shoulder, arm and headache pain. The aim of the physiotherapist is to restore normal movement, improve joint control (proprioception) and strength so that the neck can return to its normal resting state and the headache may be alleviated.
What do you feel with a cervicogenic headache ?
Commonly you might recognise the following characteristics :
Massage: Gentle massage of the neck and upper back muscles to help relieve muscle spasm.
Mobilisation: Movement of the neck joints aimed at improving joint mobility.
Stretching: To ease compressive stresses on the neck.
Acupuncture: To relieve muscle spasm and pain and improve tissue metabolism.
Strengthening: Gym based and home exercises to help alleviate pain and strengthen weakened muscles.
Posture retraining: to relieve stress and strain before it occurs. Tissue's maintained in a poor functional position are subject to continued stretch (termed “creep”) and eventual tissue damage.
Home Exercises: As part of a full treatment home exercises are required to be completed by the patient to help alleviate the headache pain and maintain the improvements made in the treatment session between visits. Some longer term exercises base on postural retraining in a practical context and strengthening may also be required.
In summary : Physiotherapy can provide good short term relief/recovery of headache pain and symptoms. In the longer term further considerations such as eliminating aggravating activities, improving workplace ergonomics and a more generalised program of postural control and overall core strengthening may be required in order to help prevent or at least alleviate future episodes. Drug therapies as advised by your GP or Pharmacist certainly aid with the pain but the physical characteristics of the individuals pain need to be considered in a full assessment of the headache disorder.
References ( a brief selection):
Watson, Dean H., and Peter D. Drummond. "Head Pain Referral During Examination of the Neck in Migraine and Tension‐Type Headache." Headache: The Journal of Head and Face Pain 52.8 (2012): 1226-1235.
Lost Productive Time and Cost Due to Common Pain
WF Stewart, JA Ricci, E Chee - JAMA, 2003
WHO Fact Sheet - http://www.who.int/mediacentre/factsheets/fs277/en/
Headaches treatment mississaugalink
10/9/2015 03:57:34 am
Jason is the Leichhardt Physiotherapy's practice principal and has been practicing as a physiotherapist for over 16 years