Why do people experience headaches?

There are many potential causes for headaches, from minor afflictions such as stressful day at work, to life-threatening vascular problems. Physical therapists should only be concerned with treating those headaches that have their origins in conditions of the cervical spine and associated structures. These are referred to as cervicogenic headaches. Cervicogenic headaches arise as result of injury or strain to structures in the neck, eg. car accident, assault, head-high tackle at football, fall off playground equipment, fall onto buttocks, falling asleep on the couch, wry neck etc. Alternatively, cervicogenic headaches may arise atraumatically from postural problems in neighbouring body parts (eg. rounded shoulders, forward head posture, limited shoulder movement, leg length difference) or work or sport habits that impose strain onto neck structures (eg. plumber looking under kitchen sink, painting the ceiling etc). The issue with cervicogenic headaches is that they are a referred pain, ie. pain experienced away from the site of the actual site of injury or tissue damage. In the case of headaches, the brain misinterprets a problem in the neck as having its source in the head, so the brain ‘inflicts’ an unpleasant sensation message in that portion of the sensory cortex that relates to the head and face. This can be a confusing concept; think about an ice cream headache as an example of a referred headache (although not neck-related).

What causes headaches?

Apart from cervicogenic headaches, there are many reasons for a person to experience headache. All experienced physiotherapists could recall patients presenting with headaches that had symptoms that didn’t ‘fit the pattern’, that when diligently sent away for further investigation, were found to have alternative and often more sinister problems, eg. vascular problems, tumours, other systemic illness. There are other non-sinister causes for headaches that are unrelated to the neck. These need to be considered in the physiotherapist’s examination, eg. food intolerances (coffee, cheese, red wine, citrus, MSG etc), hormone (menstrual headaches), cluster headaches, migraines, light sensitivity, environmental pollutants, snoring and sleep apnoea, psychosocial issues etc.

How does Straight Back Physiotherapy examine for headaches?

The challenge for the physiotherapist is to employ a comprehensive and robust examination system that takes time and care to listen to the patient’s full account of their headache experience (onset, nature, intensity, progression, aggravating factors, associated symptoms, family history etc). In this way patterns of symptoms can be identified that might imply a certain pathology is present. It might sound unusual, but headaches seem to have a personality of their own, and a single person may experience several different headache types. This thorough examination enables the physiotherapist to ‘experience’ the headache and comprehend its features, qualities idiosyncrasies, which facilitates treatment choices and permits sound analysis of treatment effect. Many questions should be asked by the physiotherapist in a probing examination to screen for more sister forms of headache that should be directed to the doctor for further investigation. The physical examination should then be just as comprehensive and includes detailed analysis of the neck and related structures. The purpose of the physical examination is to identify posture, joint, muscle, disc, ligament, alignment and movement pattern faults that could cause headaches or put undue strain on the neck. It is essential to be able to indict neck structures as the source/cause of headache pain for headaches to be treated with physical therapy. It is not unusual for a patient to be referred by a general practitioner or medical specialist where the diagnosis for their headache is unclear. Cervicogenic headaches are usually the most benign source of headache and more often than not amenable to non-invasive treatment. Often the physiotherapist is used as the first port of call to exclude or confirm the neck as a source of headaches before more invasive, expensive and dangerous (possible side-effects) investigations and treatments are considered.

How does a Straight Back Physiotherapist treat headaches?

A range of techniques are available depending on the cause of your headache and your experience and preferences with past treatment. Manipulative physiotherapy has been shown to be a safe and effective method of treating cervicogenic headaches, and many people prefer the quick and fuss-free relief it can provide. To ensure longevity of treatment effect, manipulative physiotherapy should be accompanied by treatment of muscles, stability and posture, as well as addressing ergonomic and worksite issues. Be assured that we understand and respect the fact that some people don’t like manipulation in their neck. They may have had a bad experience in the past, or had heard that manipulation causes stroke (that needs to be qualified), or have had lengthy periods of chiropractic manipulation without lasting effect. Manipulation is only ever performed with your expressed, informed consent after a lengthy process of education and testing to ensure your safety. Whether your cervical joint problems are treated with manipulation or non-manipulative methods (of which there are many), there must be due attention paid to underlying contributors to headache such as poor posture, poor work habits, poor deep muscle (stabilising) function, muscle tightness and overactivity. These factors are more often than not the underlying perpetuators of the headache, and if they can be nullified, you have greater chance of reducing strain on neck structures and experience less frequent, intense or long-lasting headaches. Unfortunately, chronic headache sufferers are often headache sufferers for life, and headache treatment is a process rather than an event. Monitoring of your headache and risk factors becomes important. Sufferers of acute (recent onset) headaches are more likely to deal with their problem definitively, but if adverse postural, lifestyle and work-related risk factors remain, then recurrence is likely. It should not be under-stated that lifestyle and dietary factors need to be addressed in a comprehensive management system. Cervicogenic headaches are not mutually exclusive of other varieties, and headache sufferers may 2 or 3 different headache types. It is important for the physiotherapist to identify which headache varieties he/she can and can’t treat, so more appropriate advice/treatment can be sought. Simple issues such as caffeine intake, fluid intake, hours sleep, eye-wear, snoring patterns, contraceptive pill usage etc should be acknowledged. Physiotherapists at Straight Back Physiotherapy will never profess to be ‘headache specialists’ as these non-cervicogenic areas are out of our professional jurisdiction, but we will provide expert examination and treatment of your neck-related problems, and then identify features of your headache experience that aren’t neck-related that need to involve other professionals for advice in their area of specialty.