When is PT the fix for headaches?

I never really get headaches. I feel as though I often take this for granted until I get a really bad one, and then like most things, the contrast immediately reminds me of the rarity of the occurrence. As I interact with patients each week, I am frequently reminded of just how much pain and suffering many of us will put up with prior to seeking help: this is especially true of headaches.

It is so empowering for patients to have solutions to their pain and other symptoms. This is really the foundation of my PT practice and physical therapy as a whole: patient education. When it comes to headaches, I've observed that many patients continue to feel powerless. They may have some mildly successful medications or renowned coping skills, but I encounter several patients each week that simply must live with the pain, without adequate tools in their toolbox. 

I'm Dr. Allan Buccola, physical therapist and owner of Impetus Physical Therapy in Greensboro, NC. This post will dissect headaches a little bit, and hopefully will give some readers a great starting point for finding help and solutions. Not all headaches are created equal. As a disclaimer, this post is not implied to serve as, medical advice. It is meant to be educational only. If you are having a medical issue that is concerning, please seek the care of a qualified healthcare professional for proper diagnosis and evaluation. Onward! 

Different primary Headache Types

When it comes to headaches, there are more varieties than one could possibly review in detail in this article. My goal here is to identify a few common characteristics of headaches that respond well to physical therapy treatment. Many headaches are not related to serious medical problems, but a few can be. Most simple headaches will respond well to prescription drug therapy or lifestyle changes, but there are a few instances where PT many be the best solution. 

Even though headaches are fairly common, they can also be related to many serious and rare disorders such as stroke, brain bleeds, or a variety of infections. These headaches tend to be debilitating, and progressively worse over time and often create cause for concern. If you are experiencing a headache with increasingly frequency and/or intensity, you should seek medical attention quickly to rule out any serious conditions.  

Headaches neurological in origin

There are also several common headaches of neurological origin. Cluster headaches tend to occur around the eye on only one side, with eye watering and mild swelling, and are known to occur at the same time each day or night. Trigeminal Neuralgia is another pain disorder associated with short bursts of stabbing or shooting pain on one side of the face triggered by mild stimuli to the face or chewing. Because of this, it is often mistaken for dental complications. I had a friend who had this condition who had a tooth removed to no avail prior to an accurate diagnosis.

Migrane headaches are a complex and severe neurological phenomenon of the brain, and although different with each person, share some common characteristics. Migranes are often throbbing in nature, and can include poor tolerance to light and loud noises.  They may also be preceded by a visual phenomenon known as an aura. Migranes commonly include instances of vomiting or nausea, and can last from 4 hours to 3 days. Many persons who experience migrane headaches are typically able to identify some type of trigger that brings about the phenomenon, such as chocolate or cheese.  

Prolonged extreme postures associated with cycling can quickly result in neck pain with related headache. 

Prolonged extreme postures associated with cycling can quickly result in neck pain with related headache. 

Cervicogenic Headaches respond well to Physical Therapy

As the name suggests, cervicogenic headaches are headaches that originate (genic) from neck (cervical) related dysfunction. There are as many different cervicogenic headache types as there are muscles above the chest (and more.) Some of them have some fairly consistent patterns of pain that will only be realized after a thorough patient interview.  

Cervicogenic headaches can easily be confused with other primary headaches, but one key difference is that they are not likely to respond as well to medication therapies. Since they are often misdiagnosed, many patients continue to live in pain too after treatment and as the headaches continue to get worse, disability may become a part of the picture. 

Pain medications may provide some minor relief, but unless the underlying dysfunction of the musculoskeletal system is corrected with physical therapy, the symptoms are likely to remain, and often progress. If you have already seen a physician regarding headaches and are not getting adequate relief, consider consulting an orthopedic or manual therapy specialist PT. These clinicians can evaluate your case determine whether you could benefit from PT in finding additional relief. 

Even purely neurological headaches such as migranes, which are often managed fairly well with medications, can present with neck stiffness that creates secondary headache pain that can be alleviated with physical therapy. I can speak to my own personal experience reflecting on the last time I was sick this winter. The 24 hours of fever and body aches resolved quickly, but I was left with some persistent neck tightness that resulted in at least a week of headaches.  

The neck is a modern marvel of mechanical engineering. 

The neck is a modern marvel of mechanical engineering. 

Cervicogenic headaches are often tricky to diagnose, but have some common characteristics that may lead you to suspect them. Often, if headache is provoked by repetitive head or neck movement, or prolonged positioning, they should be considered a cause. These headaches often correspond with or may be precluded by neck pain, but not always. 

Many different muscles in the head and neck area can be involved, resulting in some variation of symptoms, but often pain can radiate across the scalp and into the eye. Occasionally, pain may be more localized, or even refer down. I had one patient just recently with a locked-up upper trapezius who swore that she had a rotator cuff tear for two weeks. I was able to reduce her pain by more than 50% in less than 20 minutes of hands-on treatment. No pills, no scalpel, and no injections. No shoulder xray or MRI was needed. 

Many patients will also prevent with mobility restrictions of the neck. This can be a good self-screening tool I recommend for some clients. Check your range of motion in the neck. Can you turn your head 90 degrees in each direction to gaze directly over the shoulder? Can you bring your chin down to your sternum? Are you able to sidebend at the neck about 45 degrees on each side, as you try to bring your ear to the shoulder? What happens when you try to look up, directly over head? 

If any of these movements is limited, especially in an asymmetrical way, if all of them are limited significantly, or if any one of them in particular aggravates your headache, it is likely that physical therapy can help you find resolution. As a word of caution, be mindful that excessive neck mobility may be even more problematic than a mobility deficit, so if you consider yourself to be a fairly flexible person, take caution in screening your neck movements. 

Final Message

If you are one of many who lives each day with chronic headaches, make sure your case has been thoroughly evaluated. Cervicogenic headaches can fly under the radar sometimes, but once identified can be resolved fairly quickly with physical therapy. If you suspect your would benefit from an in-depth evaluation, contact me to set up a consult. Why live another day in pain if you don't have to?

Until next time: don't stop moving! 

-Allan 

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