Headaches and Physiotherapy

Have you complained of headaches that pound behind one eye?  Have you felt pressure at the front or the back of your head for hours that goes away with a Tylenol?  If you have, most likely you have suffered from a simple tension headache and physiotherapists can address the issue without taking medications regularly. 

There are different reasons one individual could have headaches: sinus issues, blood pressure issues, exertion, migraines, muscle tension in the neck and shoulders, whiplash injuries, and concussions.

Differential diagnoses are important to determine the cause and find the best treatment route.  Physiotherapy cannot help if headaches are related to blood pressure, hormones, or other hematological issues.  Your medical practitioners will need to take time to diagnose while you focus on exercising to improve general circulation and well-being in tolerance. Your physiotherapists can guide you through that.  On the other hand, when physiotherapists notice a headache is not caused by reasons that are within the scope of physiotherapy practice, physiotherapists will refer you to your medical practitioner as well for further investigation. 

The easiest and fastest way to rule out tension headaches is to see a physiotherapist for an assessment and determine if the headache is related to the muscles and postural issues.  When we slouch at the desk or during driving, we develop a forward head posture and rounded thoracic spine.  Over time, the muscles become weakened, shortened, and possibly hardened and fixate our bone structure at a position that is far from optimal.  That is the modern disease that we see most often nowadays from prolonged sitting.  When our chin protrudes forward, the small muscles at the base of the skull attaching to the top portion of the neck can become so tight and cause severe pressure on the nerves leading into our face, behind the eye, and general head area.  That creates headaches.  It is possible to use over-the-counter pain medication to reduce headaches.  However, medications do not alter your posture, correct muscle tightness, and do not eliminate headaches in the long term.

Having good body biomechanics and ergonomics is important to combat poor posture leading to headaches or other spinal issues.  Having good flexibility and strength in the muscle groups along the spine will help us to maintain an upright position without getting fatigued early and subsequently slouching.  Physiotherapists can help you to gain proper flexibility and strength in the targeted area by conducting a detailed assessment and personalized treatment to address your issues and help you maintain good posture for a longer period.  Your physiotherapists could also discuss simple strategies that may work for your particular situation to maintain a good posture and prevent fatigue more easily. 

Whiplash and concussion related headaches can benefit from physiotherapy as well.  Whiplash and concussion injuries could cause our neck muscles to tighten and the swelling or bruising around the brain from being shaken could create pressure inside the skull to cause headaches.  In mild to moderate cases, hands-on gentle myofascial release treatment to reduce the tension around the brain and the neck could reduce the headaches.  Regular prescriptive exercises could also help to address the issues of weakness and tightness caused by the injury.  Dizziness associated with concussion can also be addressed by different balance or habituation exercises, which is not part of this article. 

Physiotherapy treatment to decrease headaches could include the following:

Myofascial release – manual passive release of muscle and myofascial tension will decrease myofascial tension causing pressure on vessels, nerves, and muscles. 

Myofascial is the membrane system that wraps around our body continuously from head to toe.  It is our inner organs to outer muscle-skin connections to our skeletal system.  The fibers of the wrapping system could get tightened or shortened by injuries, surgeries, a lack of regular movement and proper rest.  It is possible to lengthen the fibers by active range of motion exercises and gentle stretches.  However, sometimes it gets so tight over time, that it will require some passive treatment before you can feel at ease to perform exercises.  Physiotherapists can use various techniques, such as gentle pressure, gliding of the tissues, friction, and active release (pressure combined with active movement).  People usually feel relief right away due to the released pressure on the nerves and muscles.  It makes the contractions of the muscles easier as the muscles are not held down tight anymore.  Thus, it helps with better force exertion in maintaining a good posture and in sporting activities. 

Prescriptive exercises - assessment is needed to determine where and what structures are tight and weak. Then, physiotherapists will prescribe stretching and strengthening exercises accordingly.  This may be done through a few sessions to go through different areas of the body to correct posture from the neck down to the lower back and into the shoulders and hips. 

In order to support proper circulation, physiotherapists may also suggest regular cardiovascular exercises in a variety of forms.  Personalized recommendations depending on your work, activity level, and preference could give you a comprehensive understanding and strategy to maintain or improve musculoskeletal health and prevent future pain or injury from reoccurring.

Our body typically takes 4-6 weeks to change with a consistent exercise routine to correct the tightness and weakness.  However, you should feel better gradually with daily targeted exercises.

Acupuncture: working on the neural system and possibly also affecting the myofascial system and sinus system, acupuncture can reduce headaches in different levels of pain pathways.  It could calm our nervous systems, open up the sinus, and reduce tension along the myofascial system.  It, however, does not replace the benefits of exercise.  Acupuncture could in some cases improve our ability to exercise or to perform better in sports but it does not have long-lasting effects.  It could, though, in the long term, promote improved circulation and neurological transmission in severe conditions.  To change our body systems for the long term, exercises are still the best answer. 

 

 

References:

Ajimsha, M.S. (2011, October). Effectiveness of direct vs indirect technique myofascial release in the management of tension-type headache. Journal of Bodywork and Movement Therapies, Vol. 15, Issue 4: 431-435. https://doi.org/10.1016/j.jbmt.2011.01.021

Andersen, L. L, Mortensen, O. L., Zebis, M. K., Jensen, R. H. & Poulsen, O. M. (2011, November). Effect of brief daily exercise on headache among adults — secondary analysis of a randomized controlled trial. Scandinavian Journal of Work, Environment & Health, Vol. 37, No. 6, pp. 547-550. https://doi.org/10.5271/sjweh.3170

Ergonomics. Canadian Centre for Occupational Health and Safety. https://www.ccohs.ca/oshanswers/ergonomics

Headaches. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9639-headaches

Jena, S., Witt, C.M. & Willich, S.N. (2008, September). Acupuncture in Patients With Headache. International Headache Society. https://doi.org/10.1111/j.1468-2982.2008.01640.x

Sharma, T.L. (2018, January). Common Primary and Secondary Causes of Headache in the Elderly. The Journal of Head and Face Pain. Wiley Online Library. https://doi.org/10.1111/head.13252

Torelli P, Jensen R & Olesen J. (20024). Physiotherapy for tension-type headache: a controlled study. Sage Journals, 24:29–36, ISSN 0333-1024. https://doi.org/10.1111/j.1468-2982.2004.00633.x