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Physical Therapy and Headaches

By: Dale Buchberger, PT, DC, CSCS, DACBSP

Headaches are so common it is estimated that up to 93% of the population will experience a headache in their lifetime. Visits to a primary care physician specifically for a complaint of headache can be a high as 10%. Chances are that you know someone who is a headache sufferer. Headaches can be caused by a large variety of conditions including tumors, vascular problems, sinus issues, and more. Some headaches are caused by stiffness with the muscles and joints of the neck and back. Physical therapy can treat headaches that are caused by musculoskeletal issues including muscle tension and tightness, disc injury, lack of neck motion, poor posture, and even tightness between the shoulder blades. Many patients who attend physical therapy with neck symptoms may also report frequent headaches, being unaware that the two may be connected.

Many headache sufferers have self-treated with a variety of home treatments, such as heat and ice. The most effective treatment for the chronic headache patient is to find the underlying structural cause or contributor to their illness and focus treatment on this area. For example, the physical therapist may identify a specific joint or muscle in the neck that is moving poorly, or a spasm or stiffness in one of the small muscles in the jaw or neck that when treated with a variety of manual therapy techniques can significantly reduce or resolve the patient’s pain.

The origin of any headache can be quite diversified. Identifying the type of headache and its underlying stimulus is the key to effective treatment. While over-the-counter anti-inflammatories may provide temporary relief they rarely resolve the cause of the headache. Here are the basic types of headaches. Keep in mind that there are several subtypes of headaches.

Muscle Tension headaches are typically associated with chronically tight muscles. Postural headaches are the result of poor postural habits. Mechanical headaches are caused by spinal problems such as degenerative changes and/or previous trauma. Migraine headaches are typically vascular or hormonal in origin but can be triggered by environmental smells or scents as well as muscle tension issues. Temporomandibular joint (TMJ) headaches are caused by issues with the jaw.

Most headaches are benign and self resolve, although severe headaches that recur frequently can affect your ability to perform your daily activities and can reduce your quality of life. There is effective treatment for almost every type of headache. The challenge lies in determining the type of headache, its cause, and in developing an appropriate treatment plan that will reduce both its frequency and intensity. Physical therapists can help determine the type of headache you have and are trained in managing pain from various headaches.

If it appears that you do have tension-type headaches, your physical therapist can design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache–such as sinus, migraine, or cluster headache–your physical therapist will co-treat your headaches with another health care professional so that you receive the most comprehensive treatment you can get. Your physical therapist will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes in your posture and lifestyle. Physical therapists can improve neck mobility by using a series of specialized manual therapy techniques such as Active Release Techniques and joint mobilization techniques. These techniques with restore joint motion and reduce muscular stiffness. Increasing the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance will make it easier for you to sit or stand for longer periods of time without discomfort. Improving your posture is directly related to reducing your headache frequency. Over time seated postures and chronic use of handheld devices take their toll on our posture and can be a major stimulus of headaches. Physical therapists will teach you methods to improve your posture. Whether it is simply pushing your chest out or pulling your shoulder blades backward and together, slight modifications to daily activities can make a big improvement in your posture.
Improved posture will ultimately reduce muscular strain. Last but not least modify your workstation or home office. Inexpensive changes such as using a headset instead of a handheld phone, adjusting your computer screen to the level of your eyes, and the use of a well fitting desk chair can reduce headaches.

Remember, if your headache hasn’t resolved in 2 weeks, it is time to get it assessed. Once it is assessed consider physical therapy as a drug free option to treatment. Remember, it’s your right as a patient to choose which physical therapist you want to see!

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