Headaches

Having a headache of any kind can significantly affect every aspect of your daily life from your productivity at work, to your ability to relax and enjoy your free time. There are many types of headaches with a great variety of causes.
Finding out your type of headache will help you find the best possible treatment for it.
Some people have a combination of the headaches noted below and can therefore be more complicated to diagnose.
The following information and advice does not take all of your signs and symptoms into account, and it is important to remember that some headaches can be a sign of a serious pathology. You should always check with your Doctor or one of our Physiotherapists. Don’t suffer in silence…

Serious Headaches

There are some headaches that require urgent medical care. These include headaches of a sudden explosive onset for the first time. This can be an initial episode of migraine or rupture of an intracranial blood vessel. A low pressure headache, such as when following a lumbar puncture, needs to be assessed immediately by the person who has done the examination. Some medication may induce head aches, please check the side-effects accompanying the medication. Medications, including nitrates, are one example of medications that can induce headaches.

Due to the possibility of a more serious pathology such as meningitis, encephalitis, expanding clots and tumours these headaches need to be excluded when assessing any headache. If in doubt, seek medical aid.

Tension Headaches

Tension Headaches can be caused by stress, long work hours, depression, eye strain (frowning or squinting), and are more common in females than males. Jaw clenching or grinding your teeth at night may give you TMJ (Temperomandibular Joint) pain as well as headaches on one or both sides of the head. Neck and shoulder posture can put strain on the neck which in turn may pinch a nerve supplying the sensory part of the head or the tight muscles can directly pull on the head/scalp. Tension headaches can be constant or intermittent and often occur at the end of the week or month.

This type of headache can be improved or even eliminated through a variety of treatment techniques offered by your physiotherapist, such as massage, mobilisation, relaxation and acupuncture. They can also offer individually tailored advice to assist in the recovery of your headache and maintain the benefits achieved through attending physiotherapy.
Of note: Alcohol can ease / relieve these types but make migraines worse.

Cluster Headaches

Cluster Headaches are usually one-sided and often start in the eye and spread throughout the head and neck. Usually fuelled by stress, the sympathetic nervous system can often further contribute to this form of headache. They can last anywhere between 10min and 2hours, and one can have several of these headaches per day. The sufferer’s eye may redden or tear-up and the eyelid may droop on the affected side. These headaches are more commonly seen in males.

These headaches can sometimes be improved through relaxation techniques, local injection in the neck or by physiotherapy. Nasal oxygen can also be helpful during the attack.

Migraines (Classic)

Migraines are classically preceded by an aura, a vision of specs, flashes, zigzags or similar visual changes and occur more frequently in females. An episode is usually preceded by large change in mood being either positive or negative the day or night prior to the headache.

The ache is usually on one side on the front and/or the back of the head. A sufferer may feel sick and/or vomit, and is photosensitive and will therefore usually prefer a dark room. They may also lose part of their field of vision.

This form of headache is often treated with early medication, which is best taken when having an aura.

Migraines (common)

With common migraines there are no warning signs. The symptoms may be similar to a classic migraine, but may not include all of them making them more challenging to diagnose.

The pain often lasts until the sufferer goes to sleep, and they usually wake feeling washed out +/- dull ache and experience an increased sensitivity of their vision and hearing. Their triggers can vary greatly and involve consumption such as alcohol, nitrites (such as in preserved meats), MSG, tyramines (such as in tomatoes, chocolate, orange juice, red wine, aged cheeses, chicken skins) or even a low blood sugar level. Over or under sleeping may also contribute to the onset of a common migraine. Although often difficult, it is of great benefit to find the trigger and reduce or avoid it.

There are a many forms of medications available not only for relief of an acute onset, but also to prevent the migraine from reoccurring. The medication is much more effective when taken early prior to the onset of the severe symptoms.

When having migraines it is common for the neck muscles to tighten, and over time the neck joints can tighten. Although a physiotherapist cannot directly affect the vascular aspect of your migraine, they can reduce the associated muscle and joint tightness and promote relaxation and pain relief.

Sinusitis

A sinus headache can occur when a sinus or nasal passage is inflamed. With this form of headache, sufferers often complain of pain and pressure around the eyes, across the cheeks, the forehead and possibly an ache in the upper teeth. Associated symptoms generally include facial swelling, stuffy nose with discharge, and possibly even fever and chills. Leaning forward or lying down often worsens the headache, and the headache is often worse in the morning than in the afternoon.

Treatment aims to reduce inflammation and associated swelling, as well as to enhance drainage from the sinuses and nasal passages. Your doctor or naturopath can work with you to give you medication like anti histamines or work on desensitising you to your allergy.

Trigeminal Neuralgia

Trigeminal neuralgia involves painful spasms in the distribution of the trigeminal nerve. This nerve originates in the brain and supplies information for sensation of the face and motor function to the muscles responsible for chewing your food. It is more commonly seen in the older population, is often related to TMJ pathology or uneven bite, but may also be due to a tooth infection or scarring post shingles. This results in pain in the cheek, jaw, side of the face, and occasionally the forehead.

If scarring or muscle tightness is present, the sufferer may respond to ultrasound, relaxation, or techniques to loosen muscles.

Rebound Headaches

Headaches can also follow a variety of activities such as smoking (nicotine) or drinking coffee (Caffeine), or after ceasing certain migraine preventers. Headaches can also occur on the weekend when finally relaxing following a stressful week due to the dilating of the blood vessels (vasodilation). This is the same concept behind waking with a headache following too much sleep.

Exertional Headaches (blood vessels dilate)

Too much exertion, especially when not used to it can cause a headache to form. Examples include sport, sex, weight lifting or more seriously with coughing, sneezing and bending over. These are usually due to obstruction of blood vessels and often require urgent medical aid, particularly if initiated by minor activity.

Cervical headaches and neuralgia

Cervical headaches can occur due to tightness or postural abnormalities and are mostly associated with the upper two vertebrae of the spine, though may also originate from lower segments. The location of pain within the neck is often a good indicator of the location from where the headache has arisen. The sufferer may or may not have segmentally restricted movement in the upper neck, and is usually tender to touch over the upper neck.

T4 syndrome

T4 syndrome, a headache that arises in the mid to upper back and often involves the entire head, or paraesthesia (tingling, pins and needles, or numbness) in the whole hand in a non-dermatomal distribution. The headache is usually described as a fuzzy or fluffy feeling like cotton wool in the ears or a band around the head similar to a tension headache.

Physiotherapy treatment is often very successful with the use of techniques such as mobilisations, manipulations, correction of movement dysfunction or work posture, and retraining of muscles required for correct posture. Anti-inflammatory medication, if appropriate, is often helpful in conjunction with other treatment.

Other headaches

There are a great number of other headaches which I have not covered including:

• Ice cream headaches (over stimulation of the Glossopharyngeal/trigeminal which are nerves within the skull). In people who are susceptible to migraines it refers to the area where the migraines are felt.
• Goggle headaches
• Head band and hats too tight (all over stimulation).
• Mountain sickness
• Fasting headaches caused by low blood sugar levels
• Low oxygen headaches caused by sleeping with closed windows and doors or crowded meetings with low ventilation.