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How can physiotherapy help with headaches and migraines?

Physiotherapy and Headaches

The most common human nervous system disorder is the headache, which is an umbrella term used to describe a number of different conditions that cause pain in the head, some of which include tension-type headaches, migraines, cluster and cervicogenic. Physiotherapist are most interested in the cervicogenic subgroup due to the fact that as the “cervico” part of its name suggests arises from the spine.

Cervicogenic headaches are estimated to account for around 15-20% of all chronic and recurring headaches and are the most common persistent feature that occurs following a trauma to the neck.

What is a Cervicogenic Headache?

The International Headache Society in 1988 defined a cervicogenic headache as “pain localised to neck and base of the skull radiating to the forehead, eyes, temples, or the ear, precipitated or aggravated by special neck movements or a sustained posture” (Pöllmann, Keidel and Pfaffenrath, 1997, p.801).

They can develop after trauma, such as whiplash or a specific neck strain or, can be of an gradual insidious onset. This is especially true later on in life, due to general degeneration and the repeated micro-trauma associated with poor habitual or static work postures, sustained neck positions and poor movement patterns which will have accumulated over time.

Suffers often describe the pain associated with a cervicogenic headache as being deep in origin, which maybe accompanied by dizziness, nauseous, phonophobia (fear of sound), photophobia (sensitivity to light) and blurred vision. Initially the pain will start in the neck, subsequently fanning out to other areas of the head. The location of which tends to be on one side of the head, or has a one sided dominance and unlike a migraine the pain in the head will not change sides between attacks.

The pain experienced can radiate from the joints, discs as well as the surrounding neck muscles. All these structures are innervated by the nerves that come from the upper neck so when they are aggravated they will refer pain upwards to the head.

Physical examination normally reveals a reduction in the neck range of motion especially with the forwards and backwards tilting movements, stiffness between the joints of the upper neck with these joints being painful on palpation. The supporting neck muscles are also found to be weak with tightness exhibit across the back of the shoulders. This can cause the whole area to lack proprioception (awareness of a joint position in space).

It must be noted that the symptoms associated with cervicogenic headaches are not solely unique to that particular headache subgroup but when these symptoms are present it provides a strong indication that the cervical spine should be assessed. Also, two different headache types can occur simultaneously thus physical treatment may only give partial relief. Musculoskeletal impairments have also been found in people with tension headaches and migraines so physiotherapy treatment may provide some gain.

So why can physiotherapy help with Headaches?

Physiotherapists can help to reduce the suffering by reducing the dysfunction between the joints by:-

• Mobilising joints to normalising the joint movement
• Soft tissue release to relax tight muscles and tension on the joints
• Strengthening the weak supporting musculature in the neck and shoulder girdle
• Stretching tight muscles
• Increase joint proprioception
• Acupuncture to release tight muscles
• Posture re-education

In order to restore the normal movement patterns and reduce the Pain.



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