THE STORY BEHIND HEADACHES

When exposed to a headache trigger, the trigeminal nerve which supplies sensation to the face, scalp, mouth, neck, ears, eyes, throat and meninges, communicates with an area of the brain called the thalamus that is a relay center for pain sensations all over the body. The term “headache” is an umbrella term referring to several subtypes of headaches which can cause pain and discomfort in the head and neck and can lead to additional symptoms like light and sound sensitivity, fatigue, nausea and vomiting.

Headache subtypes are broken up into primary and secondary headache types:

Primary Headaches

• Migraine headaches (with or without aura)
• Tension-type headache
• Exercise headache
• Trigeminal autonomic cephalgia
• (cluster headache and paroxysmal hemicrania)

Secondary Headaches (can be attributed to another condition, not a comprehensive list)

• Medication overuse headache
• Cervicogenic headache
• Hypertension headache
• Sinus/allergy headache
• Exertional headache
• Hormonal headache
• Stroke and intracranial hemorrhage
• Trigeminal neuralgia
• Dehydration

• The headache is severe, violent, or unbearable, the “worst headache of my life”
• It is accompanied by changes in vision, slurred speech, problems moving your arms or legs, loss of balance, confusion, dizziness, or memory loss
• You are also experiencing a stiff neck and fever, nausea or vomiting
• Your headache occurs after a head injury
• Your headache gets worse over 24 hours
• You suddenly started getting headaches when you never had them before

If you decide to work with a physical therapist to help with headache related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

HOW CAN HEADACHES IMPROVE WITH PHYSICAL THERAPY

As mentioned above, headache management often requires a team approach. You might work with a neurologist or other headache specialist who may order blood work or imaging and discuss with you how medication management may fit into your treatment plan. You can also work with your physical therapist to identify modifiable triggers that can help reduce headache frequency and severity. Through a subjective interview about lifestyle habits and symptom pattern and a physical examination of body structures and activities that may contribute to your headaches, your PT can develop a plan of care to address your symptoms. Some of the headache triggers your PT may help you identify are as follows:

• Postural impairments: how are you sitting, standing, sleeping or otherwise positioning your back, arms, head, neck and jaw for prolonged periods or repeated activities throughout the day and night? Any activity or posture that causes tightness, tension or shortness of the muscles, nerves and joints around the head, neck and jaw may be contributing to headaches
• Dietary triggers: food and drink can be serious headache triggers in some people. Your PT may provide you a list of possible headache triggers and suggest you keep a food and symptoms diary to help look for correlations
• Stress levels:stress can contribute to a host of illnesses including headaches. Your PT can help you identify your level of stress and recommend lifestyle modifications, exercises and activities to help modulate your nervous system
• Sleep: poor or inadequate sleep can increase headaches in some. Your PT can help educate you on proper sleep hygiene strategies as well as address any symptoms of pain or discomfort that might be negatively impacting your sleep
• Muscle and soft tissue strength, length and mobility: impairments in the muscles and soft tissue around the head, neck, jaw and upper back may contribute to certain types of headaches such as tension-type headaches or cervicogenic headaches
• Joint mobility and stability: impairments in joint mobility and stability in the neck, upper back, jaw and even shoulders can trigger headaches if sustained postures or repeated activities are a headache trigger for you
• Breathing: if you are going to physical therapy you are already breathing, however, suboptimal patterns of both inhalation and exhalation can contribute to headaches in some people