Physical Therapy and Headaches

For millions of Americans, headaches and migraines are a recurring fact of life.  But they don’t have to be and Advance Physical Therapy is here to help.  Knowing what type of headache you suffer from and what is the cause of it will direct your therapy.   Hint: it’s not always in the head!  The main types of headaches that affect most Americans are cervicogenic, tension, and migraine.  Each of these have different symptoms, origins, and therapy options.

Cervicogenic headaches are actually generated by a dysfunction of the neck and since the nerves from the upper neck share the same transmission pathways with some of the nerves from the head, the brain will sometimes feel the pain in the head or facial area.  They are one of the more common types of headaches and are often misdiagnosed as “tension” or “migraine” headaches. These may occur due to improper posture, sleeping in a bad position, a car accident or other activity that leads to an imbalance in your cervical spinal joints and musculature.  This imbalance may be the cause of your headaches and could account for why medication only provides temporary relief or only mild relief of symptoms.  Sitting at a desk working for hours on a computer can lead to cervicogenic headaches from the muscles becoming overworked and eventually the upper cervical spinal joints becoming stiff.  There may be concurrent neck, shoulder area, or arm symptoms that go along with the headaches.  A classic presentation for this type of headache is the pain starting in the base of the skull at the upper neck and moving to the front of the forehead.  Resolution or modulation of the headache during a physical therapy session in which the cervical spine is evaluated and treated confirms a cervicogenic component to the headache.

Tension headaches are another common form of headaches and can have a negative impact on daily function, work productivity, and even mood.  One study (found here) reported that people who suffer from tension headaches miss 9 days of work per year on average because the pain becomes so debilitating.  The cause of these headaches may be difficult to diagnose, but with the right questions and evaluation techniques it becomes easier to treat and manage.  Probable causes are poor posture, emotional stress, overuse strain, squinting due to poor vision or use of bifocals, and jaw muscle dysfunction.  As with cervicogenic headaches, you can’t medicate your way out of this one.  A comprehensive physical therapy approach that evaluates and treats the affected areas coupled with patient education on how to improve posture, modify work stations if possible, and change habits will often provide resolution or long term relief of tension headaches.

Migraine headaches can be the worst of all.  Symptoms include changes in vision, extreme sensitivity to noise, light sensitivity, nausea, vomiting, and severe pain.  If you have never suffered from a true migraine, count yourself lucky.  Migraines are not just “really bad tension headaches” they are unto themselves their own class of pain.  Migraines are often produced by vascular dysfunction which can also cause muscle tension around the head/eyes compounding the debilitating effects.  These types of headaches should respond to medications such as triptans.  Patients who do not respond as well to medications may benefit from a physical therapy evaluation to determine if the headaches have a significant mechanical component such as muscle tension which could be treated by the physical therapist.  Many times we see patients for an unrelated issue and they state having migraine-like symptoms, but after discussing further and evaluating them it is evident that they are in fact moderate to severe cervicogenic or tension headaches, not a true chemically-mediated migraine.  For these patients we can usually help them find relief within a few visits.  Patient education and the right treatment is the key to decreasing headaches and achieving long-term resolution.  If you do have a full migraine brewing, finding a calm dark place, use ice or a cold pack for up to 30 minutes, and lightly massaging the head and neck which may reduce the severity of a migraine.

Determining the type of headache you suffer from is an important step to finding relief.  Those patients who are suspected of having a non-mechanical origin for the headache symptoms most likely would benefit from a consult with a medical doctor for further diagnostics.  Headaches with a sudden severe onset and/or with changes in vision, speech, cognition, hearing, gait, or balance may represent an emergency medical condition and the patient should call 911 immediately for medical assistance.  Chronic, episodic, or recent onset mild-moderate headaches can be evaluated by a doctor of physical therapy with most being treatable in the clinic and through the use of patient education and an individualized home program.  Treatments include the use of joint mobilizations, muscle and fascia release techniques, instrument assisted soft tissue mobilization, posture correction, ergonomic assessment, neuromuscular re-education, pain relieving modalities such as electric stimulation and therapeutic ultrasound, as well as stretching and strengthening exercises.  If you suffer from headaches, come see us and we will perform a thorough clinical evaluation and recommend the right kind of treatment for your specific type of headache.  Determining what is actually causing your headaches and providing long-term relief is the focal point of our sessions.  Most patients achieve resolution of symptoms within 1-2 months after starting a comprehensive course of physical therapy.  Call, e-mail, or post any questions you have and we will be happy to help!

Advance Physical Therapy & Sports Rehabilitation, Inc.

Advance Beyond Expectation[i]

Joshua C. Anderson, PTA, CKTP, CCI, Cert. ASTYM

Brad Bentley, DPT, OCS, CSCS, Cert. MDT, CMP, Cert. ASTYM

[i] Advance Physical Therapy August 2016