Headaches are one of the most common reasons that people see their primary care physician and they account for 20% of outpatient visits to neurologists. People with chronic headaches report disabling symptoms that interfere with daily activities. Many have sought numerous different treatment approaches, have accepted that their headaches are a fact of life, and have become dependent on medications to relieve their symptoms.
The International Headache Society has classified hundreds of different types of headaches into two categories: primary headaches and secondary headaches. Primary headaches are the most common headache type and have a single cause. They include migraine, tension-type, cluster, and others. Secondary headaches are classified according to their causes. Examples of secondary headaches are headaches attributed to temporomandibular joint (TMJ) disorders and cervicogenic headaches, which are attributed to mechanical disorders of the neck. Both are treated by various clinicians including osteopaths, dentists, chiropractors, massage therapists, and physical therapists.
Upper Trapezius Referred Pain Pattern
Sources of headaches are often a combination of factors, including musculoskeletal, psychological, neurovascular, nutritional, and chemical imbalances in the brain. Some headaches relate to or are indicative of a disease process; some are life-threatening and others benign. Thus, a thorough medical evaluation is necessary with any onset of a new or ongoing headache. Most researchers agree that there is a musculoskeletal component in tension-type, cervicogenic, and TMJ disorder related headaches.
A thorough physical therapy examination attempts to determine the type of headache and to define the neuromusculoskeletal factors contributing to it. Muscle tension, joint dysfunction of the neck and jaw, poor posture and stress are factors that can be addressed and treated by a skilled physical therapist trained in manual therapy.
The muscles of the face, head, and neck may contain tight bands and contraction knots called myofascial trigger points. Trigger points found in these muscles typically refer pain to the head, causing headaches. Manual physical therapy addressing muscle tension involves the release of those trigger points, stretching the involved muscle and soft tissue, and restoring normal muscle function. Trigger point release can be accomplished by manual techniques and dry-needling. Dry-needling is a technique in which a thin acupuncture needle is used to deactivate the trigger points and proves to be highly effective.
Dysfunction in the spinal joints of the upper neck and of the TMJ can directly cause headaches or can trigger migraine or tension-type headaches. Treatment of spine dysfunction may include mobilization/manipulation of the spine or jaw and the performance of stabilization exercises of the neck and shoulder girdle. In the case of TMJ dysfunction, referral to a dentist may be indicated for splint therapy and other dental interventions.
Prolonged poor posture of the head, neck and shoulders leads to the overloading of muscles, which in turn results in the development of trigger points and altered mechanics of the spine and TMJ. Physical therapy treatment may include education for postural correction and prescription of a postural strengthening program. In cases where stress is a contributing factor — which it almost always is — treatment would include education with relaxation and breathing techniques.
If you are a headache sufferer and you are looking for a way to manage your headaches beyond using medication, talk to a manually trained physical therapist about possible conservative treatment options.