Dealing with Headaches?

Headaches are one of the most common complaints patients seek medical care for. If you are someone who suffers from frequent headaches you know how frustrating it can be. Patients often try medication, dietary changes, and other medical interventions to try and relieve symptoms. Headaches can be caused by a variety of different factors, and what you may not know is that physical therapists can treat certain types of headaches without the use of pharmaceuticals.

Different Types of Headaches

Tension Headache

A tension headache is often describe as a mild to moderate pain in a patients head that often feels like a vice constricting around a patients head. Tenderness or pain can be felt along the base of the skull, along the forehead and across the shoulders or shoulder blades.

Cervicogenic Headache

A less common type of headache that is typically felt on one side of your head. Pain is intensified with neck movements because of an underlying mobility deficit. Patients may also have tenderness in their upper cervical spine and decreased range of motion. With this type of headache, trigger points are also commonly found muscles around the shoulder and neck of the painful side.

Migraine Headache

Migraines can be a debilitating headache, often associated with a throbbing pain, nausea, vomiting, and sensitivity to light and sound. Sometimes a patient reports seeing an aura, speckles or tingling in your arm or leg prior to the onset of a migraine.

How can a physical therapist help?

Physical therapists can help treat headaches when the problem stems from a muscle imbalance or mobility deficit. Often times, posture can play a large role in creating these muscle imbalances. Small things like proper workplace and computer set up paired with a good postural strengthening program can help correct poor posture, which can dramatically decrease the frequency of headaches. Occasionally, patients require hands on manual therapy to improve symptoms and restore normal mobility. Soft tissue treatments targeted at the small muscles that attach to the base of the skull, and around the neck and shoulders can often relieve symptoms, and help form a good starting point for postural strengthening exercises. These techniques work particularly well with tension headaches. Gentle cervical spine mobilizations can also play a large role in improving symptoms by increasing mobility, which research has shown to be particularly effective for cervicogenic headaches. When it comes to migraine headaches, there can be a variety of factors that cause them. So if you have tried other treatments without success, some of these manual therapy techniques may be an option to help relieve pain. Ultimately the best course of treatment a physical therapist can provide to help with headache related pain is a combination or patient education, postural training, and manual therapy.

What can you do at home?

1. Correct your computer or office set up so that your computer is at eye level and you are sitting upright in your chair, no slouching or rounded shoulders.
2. Complete a few reps of cervical retractions or shoulder blade squeezes to try and strengthen some of your key postural muscles.
3. Gentle self-massage at the base of your skull during a headache episode
4. If you are suffering from frequent headaches, keep a headache log to bring with you to a medical professional. In this log you can keep track of the following:
a. Day and time headache started
b. How long the headache lasted
c. Warning signs (like an aura or numbness and tingling)
d. Location and type of pain
e. Pain intensity
f. Treatment you tried to relieve symptoms
g. Any food you ate during the day
h. Any stressful events that occurred during the day

Not all types of headaches can be prevented or treated with strengthening and mobility exercises, but for certain types like tension headaches, cervicogenic headaches and even some migraine headaches, physical therapy treatments can provide an alternative route to traditional medications.

About the author:

Dr. Kevin Prue PT, DPT, CSCS is a graduate of Duke University’s Doctor of Physical Therapy Program. He is the president and director of Prue Physical Therapy & Sports Performance (www.pruept.com) located in Cary NC. He specializes sports and orthopedic physical therapy, sports performance training and injury prevention for youth and recreational athletes.