Frequently Asked Questions
Headaches present as pain, aching or throbbing in different regions of the head or behind the eyes. Headaches can present on both sides of the head or just one side, and can sometimes be associated with pain in the neck, the jaw or the teeth. A headache can be related to different postures and have associated symptoms of blurred vision, dizziness, disorientation, difficulty speaking, swallowing or feeling faint. They can also be associated with migraine symptoms subsequent to a visual aura.
A headache can be a stand-alone condition without a specific medical cause known as a “primary headache’, eg tension headache, cluster headache and exertional headache.
“Secondary headaches” have a medical cause due to involvement of neck muscles, joints or nerves, the jaw (TMJ), infections, tumours, hormonal changes or circulatory changes. One of the most common causes of secondary headaches is referred to as “rebound headache” and is a result of medication usage.
Lifestyle stressors can contribute to or make headaches worse. These include anxiety, anger and depression. Foods containing tyramine which is included in some smoked or fermented meats and aged cheeses can also contribute to or worsen headaches.
The most common headache treated by physiotherapists is the cervicogenic (neck-related) headache.
This term describes a neck-related headache, one of the many causes of recurrent headaches that can persist over many years. Cervicogenic headaches are secondary to a disorder in one of the top three or four joints in the neck which are usually felt on one side of the head and on the same side during recurrent episodes. Unlike migraine, neck-related headaches do not swap sides. Cervicogenic headaches are often of mild-to-moderate intensity and are almost always accompanied by neck pain that usually begins in the neck and spreads upwards to become a headache.
Excessive strain caused by poor working postures (prolonged sitting, working in awkward neck postures) can irritate the upper joints of the neck and cause a headache. The joints can also be injured by trauma such as a sporting or recreational injury or vehicle accident. In older age groups, osteoarthritis of the upper neck joints is a common cause of cervicogenic headache.
Neck pain and cervicogenic headaches are typically aggravated by neck movements. The neck is tender and movements are often slightly restricted or stiff. In about one third of cervicogenic headache cases some light-headedness, unsteadiness or visual disturbance is also reported.
It may be confusing to know whether you have a cervicogenic headache as the symptoms of different types of headaches are often quite similar. Neck pain and tenderness are common symptoms of migraine, tension headaches and cervicogenic headache. Correct diagnosis by your physiotherapist is therefore important as each headache type requires a different treatment method.
Your physio will first undertake a full assessment to determine if your headache symptoms fit the pattern of a cervicogenic headache and whether there are problems with the joints and muscles, particularly in the upper part of the neck. Once the diagnosis is confirmed your physio will decide on the best treatment methods for your presentation which may include:
- education, advice and assurance to help you understand the nature of your headache
- gentle hands-on treatment to ease the headache, neck pain and associated symptoms
- dry needling to assist in symptom reduction
- prescription of specific exercises to ease pain and enhance flexibility
address posture and train weak stabilising muscles
- advice on self-management techniques to use at home and work to relieve neck strain
- devise a self-management program