Headaches – are they all in your head?

Headaches affect everyone at some point in their lives. Whether it is self inflicted after a night out, or from the flu, it is a part of life. But there are a high percentage of us who suffer regularly from headaches that could be avoided. There are many different types of headaches with different symptoms, many of which are still poorly understood. The International Headache Society (IHS) is a worldwide organisation which aims to help people affected by headaches. They have classified headaches into a hierarchy system to help identify what type of headache a patient is suffering from, so as to deliver the correct treatment plan.

The main headache types are migraine, cluster headaches, tension-type headaches (TTH), and cervicogenic headaches. Everyone has heard of migraines, they are typically one sided, and can be accompanied with nausea, vomiting, sensitivity to light and sound, and they experience an aura. A dark, silent room is a stereotypical cure! Cluster headaches generally are described as lancing, boring, drilling type pain that come on rapidly. Pain can be around the eye superficially and deep, as well as the temple and can radiate to the neck and shoulder. This type of headaches is also accompanied with facial flushing, runny nose/eye, and sweating on the same side of the face that the pain presents. TTH present with pain radiating from the upper back, neck, and eye, with the feeling of pressure. Patients complain of their head feeling like it is being squeezed. Possible causes can be stress, sleep-deprivation, uncomfortable positions, and bad posture.

Cervicogenic headaches are characterised by pain referred from the neck to the head and/or face. The top three vertebrae of the cervical spine have the same neural innervations, a part of the trigeminal nerve. This means that if there is a problem with these vertebrae they create pain along the trigeminal nerve, which is the nerve that innervates the skin of the face and certain muscles used when chewing. Through detailed questioning and a thorough physical examination, Physiotherapy can help diagnose the root cause of your headaches and decipher if the problems stem from a musculoskeletal cause. Once this is established, we can relieve tension in the muscles, improve joint mobility and posture, with a view to reducing the incidence and intensity of those headaches.

Recent studies have shown a high incidence of C1-C2 (the top two vertebrae) dysfunction involved with cervicogenic headaches, which can be managed by a mobilisation described by Brian Mulligan, a C1-C2 self-SNAG. An article written by Hall et al 2007 took a sample of 32 subjects with cervicogenic headache and decreased C1-C2 range of motion, and randomly assigned them into two groups; a C1-C2 self-SNAG or placebo group. It was found that after 4 week the headache index score that was used to assess severity of the patients pain reduced substantially compared to the placebo group.

What does this mean? Well, with a good diagnosis of your headache, and if appropriate, we can teach you how to relieve your headache yourself. If you would like more information or are suffering from headaches then call the clinic and one of our physiotherapists can help.

Study cited:

Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache

Toby Hall, MSc, Post Grad Dip Manip Ther1 • Ho Tak Chan, BSciPhysio, M Manip Ther, M Sports Physio2

Lene Christensen, BSciPhysio, M Manip Ther2 • Britta Odenthal, PT, M Manip Ther2

Cherie Wells, BAppSciPhysio, M Manip Ther3 • Kim Robinson, BSc, Post Grad Dip Manip Ther1 2007

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