Headaches come in a number of different varieties, all with the common denominator of a pain in the head. From a physiotherapy point of view, it is important to ascertain what category a headache falls into, as this can determine the degree to which manual therapy can help. Some of the main headache types are:
Tension type – a mild ache in a tight band around the head, usually precipitated by stress
Migraine – a severe pulsating headache, often on one side, which may or may not be associated with aura (visual changes, speech disturbances, muscle weakness)
Cluster – severe one sided head pain which comes in groups of attacks, which may be associated with a runny eye or nose, sweating or a puffy eyelid
Cervicogenic – often on one side, associated with neck pain and eased by treatment to the neck
Hangover – You only have yourself to blame…
Although headache sufferers of all types tend to identify a co-existing neck ache or tightness, this is generally a minor contributor, or indeed a secondary effect to the headache. In cervicogenic headache, the neck is the major cause, and physiotherapy treatment can be extremely effective in eradicating the beast. Physiotherapy can be helpful for the other headache types also, but often a number of other factors need to be concurrently addressed. Note also that it is possible to get ‘hybrid’ versions of these headache types, ie combinations of two or more types.
So how can the neck cause a headache?
The nerves that supply the joints in the upper three vertebral bodies in our neck, also send nerve supply to our head. If there is a problem with one or more of these joints (eg moving too much or too little), then the nerve sends a pain message to alert us to said problem. Sometimes this results in a pain being perceived in the other areas that the nerve supplies, ie the head. The nerve messages get a little confused, you might say. If a joint on the left side of the neck is troublesome, you can get pain in the left side of your head, and vice versa.
So what leads to the upper neck problems?
Posture is the big one. If your shoulders roll forward when you sit and or stand, your head will be sitting forward of your body. This places a huge load on the muscles and joints that hold your head up. You may not feel this day to day, but with time tightness and stiffness build up to the point where your joints and muscles can no longer function effectively.
Injury or trauma can also be a trigger. In whiplash, for example, violent head movements can cause the tissues that support and protect the joints to become stretched and sensitive. The resultant nerve and joint function change can cause cervicogenic headaches.
What are other factors involved with headaches?
Genetic predisposition can play a role, particularly in Migraine (a headache type worthy of its own complete article!).
Stress is a biggie too, and not something we can always control. Eating well, exercising and regular sleep patterns help.
Food intolerances have been linked with headache. If identified, certain food types can be avoided, sometimes with great effect.
Hormones like oestrogen can be linked with headache in women. Suspect this if your headaches always seem to coincide with a particular phase of your cycle.
There are many other factors, like dehydration, substance withdrawal (think coffee!), even hunger!
So there you have it, a drop of information in the ocean of research on headaches. If you are a sufferer, take extra note of the pattern and triggers for your headaches, because it may help your health professional to manage you better.