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Headaches are another difficult subject in medicine. This is another area full of controversy, old wives tales and misinformation. Some sources claim that 93% of men and 99% of women will have headache pain in their lives making it a very common problem (Saper). Headaches are also a common reason that many people see their physician. As a matter of fact headaches are the #1 reason patients see a neurologist.
The treatment of headaches is as controversial as the diagnosis of headaches. There are literally hundreds of treatments available but often times what works for one person may not work for another and people are often caught in a cycle of treatment after treatment with no long term benefit or relief.
Are there different kinds of headaches?
For our purposes we are going to try to simplify some of the discussion. The patients we see at RehabAuthority for headaches generally fall into 3 different categories.
Tension type headaches
Tension type headaches are by far the most common headache presentation. A recent study reported that many people will miss work 8.9 days per year due to tension type headaches (Schwartz). The most common symptom of tension type headaches is pain in the head. Unfortunately there are a lot of things that can cause pain in your head so tension type headaches are often not diagnosed correctly.
Tension type headaches typically have their origin in muscle problems in the neck. This can be caused by overuse, poor posture and work habits. Many people have been given advice to improve their posture but it is not that simple. Muscles adapt over time and can develop some significant problems that lead to chronic headache pain. They do not simply “return to normal” just because you sit up straight. As a matter of fact many people have developed a condition called “dysfunction” which means that their muscles and ligaments have adapted to poor posture and now it hurts worse when they try to sit up straight or improve their posture!
Many people with tension type headaches get some temporary relief of symptoms if they receive some treatment directly to the muscles of the neck. The key word is TEMPORARY. These patients are often stuck in an endless loop of massages, manipulations and hot packs to reduce their symptoms but within days their symptoms return. To eliminate tension type headaches requires a thorough examination of the muscles of the neck and a comprehensive treatment plan. There is no “one size fits all” approach.
Cervicogenic headaches are less common than Tension type headaches. They are also sometime referred to as “mechanical” headaches. These are headaches that are generated by a mechanical problem in the neck (cervical spine). These types of headaches are often associated with trauma such as a whiplash injury. Certain joints in the neck (facets) as well as numerous nerves and even discs can cause headache pain.
There can be overlap in the symptoms and causes of headache pain. Some of the typical signs that help determine if a headache is Cervicogenic in origin is neck pain or stiffness combined with head pain. Cervicogenic headaches also don’t typically respond to headache medications because the ultimate source of the problem is mechanical in origin.
In very simple terms a migraine headache is a chemical and vascular problem. There is very exciting research into the area of migraine headaches but we are still a long way from “curing” this terrible problem. Migraine sufferers often describe intense pain, nausea, vomiting and visual auras. Migraines are absolutely devastating to people and often don’t respond to typical headache treatments. That is not to say Physical Therapy doesn’t have something to offer migraine sufferers.
Migraine headaches are common but are often under evaluated. Many people have been told they have migraine headaches and that is that, but in reality they have a mechanical problem in their neck, and their headaches are actually more tension type or Cervicogenic in origin. It has also been our experience with hundreds of patients that they do indeed have migraine headaches BUT the trigger that sets off their migraines is actually a mechanical problem in their neck! When we eliminate the neck problem their migraines happen much less frequently and the intensity is not nearly as severe. Instead of having 1 migraine per week many of these patients now have 1 or 2 per year!
What can RehabAuthority Physical Therapy do for my headaches?
One of the most important things is to have a proper evaluation of your history, symptoms, activities and work as well as a thorough physical examination of your spine, especially the neck. As mentioned above, many people have significant problems in their neck and this can trigger their headaches. The Physical Therapists at RehabAuthority have advanced training in Mechanical Diagnosis and Treatment also known as MDT. MDT is one of the most thorough assessment methods of the spine in the world today. Using this assessment system your Physical Therapist will be able to determine the type of headache you are having and give you a specific exercise prescription based on your specific needs. These exercises can help decrease your existing headaches and hopefully eliminate them for good.
Our Physical Therapists also have advanced training in “hands on” techniques. These techniques are called manual therapy and there are dozens of scientific studies that demonstrate these techniques can significantly help patients with tension type and Cervicogenic headaches.
Our offices work for YOU!
Our clinics are not like a typical Physical Therapy clinic. They are clean and attractive and offer a wonderful environment for your recovery. We offer extended business hours and we will work around your schedule. We will also schedule you within 24 hours of your phone call. We know that headache problems can severely impact your life and we want the opportunity to SOLVE your headache problem not just treat it.
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