Headaches are one of the most common reasons for people to see their primary care physician and account for twenty percent of outpatient visits to neurologists. Persons with chronic headaches report disabling symptoms that interfere with daily activities. Many have sought numerous 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 within two categories; primary headaches and secondary headaches. The primary headaches are the most common headache types and have no other underlying cause. They include migraine, tension-type, cluster, and other primary headaches. Secondary headaches are classified according to their causes. Examples of secondary headaches are headaches attributed to temporomandibular joint (TMJ) disorders related to the jaw and cervicogenic headaches attributed to mechanical disorders of the neck. Both are treated by various clinicians including osteopaths, dentists, chiropractors, massage therapists, and physical therapists.
Sources of headaches are often a combination of factors, including musculoskeletal, psychological, neurovascular, nutritional and chemical imbalances in the brain. Some headaches are associated with a disease process; some may be life threatening while others benign. Thus, a thorough medical evaluation is necessary with any onset of new or ongoing headaches. Most researchers and clinicians agree that there is a musculoskeletal component in migraine, tension-type, cervicogenic, and TMJ disorder related headaches.
Through an evaluation, a physical therapist may be able to determine the type of headache and define the musculoskeletal factors that contribute to the headache. Muscular tension, joint dysfunction of the neck and jaw, poor posture and stress are musculoskeletal factors that can be treated and addressed by a skilled physical therapist.
Muscles may contain tight bands and contraction knots called myofascial trigger points. Trigger points found in the muscles of the head, neck and shoulder typically refer pain to the head. Physical therapy of muscle tension and myofascial trigger points involves the release of trigger points, stretching the involved muscle and soft tissue, and restoring normal muscle function. Trigger point release can be accomplished by manual techniques (hands-on therapy) and trigger point dry-needling. Dry-needling is a technique in which a thin acupuncture needle is used to deactivate 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 a migraine or a tension-type headache. Treatment of spine dysfunction may include mobilization/manipulation of the spine or jaw, as well as 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 possible interventions.
Prolonged poor posture of the head, neck and shoulders leads to overloading of muscles resulting 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 the case when stress is a contributing factor, which it almost always is, treatment includes education with relaxation and breathing techniques.
If you are a headache sufferer, dont delay treatment. Talk to your healthcare provider about possible treatment options.