It’s headache and migraine week here in Australia and we would like to raise awareness on the topic!

Headaches are one of the most common conditions amongst Australians. In fact, half to three quarters of adults aged 18–65 years in the world have had headaches in the last year and, among those individuals, 30% or more have reported migraines.

Given that headaches is a common issue, we thought we would educate you on them and how physio can help.

There are many different types of headaches. The International Headache Society has classified over 200 types of headaches, and the list is growing! Some include:

  • Tension type headaches
  • Cluster headaches
  • Migraines

Headaches can be classified and divided into primary and secondary:
Primary: Migraine, cluster headache, tension type headache
Secondary: Caused by a structural or infectious problem in the head or neck.
Such as:

  • Cervicogenic headaches
  • Vertigo
  • Alcohol induced headaches
  • Cranial neuralgias (i.e – pain of the nerves supplying the head and neck)
  • Infection or dehydration
  • Fascial, Dental or jaw (TMJ) pain
  • Medication over-use headache
  • Infections (such as sinusitis, encephalitis or meningitis)
  • Trauma (e.g – post concussion or whiplash)
  • Substance abuse or withdrawal
  • Other physiological causes (e.g – hormonal imbalances, thyroid issues)

Not a single headache type can be confirmed by biomechanical, radiological or laboratory tests. Accurate diagnosis is essential in determining the right treatment, and as mentioned above, there can be many different causes for headaches, so it is really important to undertake proper screening and history taking to determine the most likely cause and therefore management.

In the physio world, the upper neck can play a significant role in a wide variety of headaches, including both tension headaches and migraine. And…if we can determine that the neck does play a role…physiotherapy can provide effective relief!

From our experience, many people come into our practice complaining of neck pain and after proper screening realise their headache that they thought was caused by something else, is actually related to their neck, also known as cervicogenic headache.

Here are some signs/symptoms that may indicate a headache is coming from the neck:

  • Headache’s present around the same time as your neck pain
  • Headache’s worsen with neck movements
  • Reduced range of motion of neck or prolonged postures (range of motion is reduced in the cervical spine with a forward head posture)
  • Able to reproduce headache when putting pressure on the joints or muscles surrounding your neck
  • Headache may be felt on one side of your head
  • Effective relief from physiotherapy

In our experience, headaches caused by neck issues respond extremely well to manual therapy, almost providing immediate relief. Even if physio initially aggravates your headache, at the very least, it allows us to determine that the headache is coming from the neck.

Cervicogenic or neck headaches can originate from a number of structures in your neck, including your upper neck joints, neck muscles and your nerves.

However, it is important to determine the dysfunction of the neck and possible cause of the headache first…

If the dysfunction is stiffness or the joints aren’t gliding properly, then massage, joint mobilisations, strengthening, exercises and manipulation of the segments of the neck can be done. Sometimes dry needling can be of benefit too.

If the dysfunction is the opposite, and the joints are too mobile and the muscles surrounding these joints aren’t strong enough, then instability can occur at these joints. In this case, massage and joint mobilisation, may not necessarily fix the issue. Instead, strengthening and control exercises for the neck are given to help alleviate any pain or headaches experienced.

Here at Jannali Physiotherapy and Sports Injury Clinic, we often find an association between headaches and jaw dysfunction – also known as temporomandibular joint dysfunction. We routinely assess jaw function in anyone who reports headaches. After an extensive examination, we often find that those who have headaches related to their jaw pain, are often stressed and subconsciously tensing or grinding/clenching their jaw during their sleep or stressful situations. If this is the case, we must also determine why the jaw may be contributing and treat accordingly. Luckily, the jaw responds well to manual therapy (joint mobilisation and massage) and exercise.

Headaches may also be a common symptom of vertigo. At Jannali Physio, we often treat many people with a type of vertigo called benign paroxysmal positional vertigo (BPPV). We are able to carry out testing manoeuvres to help us diagnose and treat BPPV.

The C1, C2 and C3 segments of the upper neck play a vital role in causing primary headaches and often refer pain to the head (via sensory nerves)

How Physiotherapists can treat headaches?

  • Determine the source of your headache (e.g - neck, jaw, vestibular/vertigo?)
  • Manual therapy including joint mobilisation, massage and manipulation
  • Strength, stretching and control exercises
  • Dry needling
  • Education regarding postural advice and ergonomic set-up
  • Education regarding potential triggers of your headache (stress, diet, hormonal etc)

Top tips to avoid headaches

  • Learn your headache triggers (i.e – alcohol, diet, hormonal fluctuations)
  • Be aware of certain postures that may aggravate your headache and work towards avoiding these
  • Maintain neck mobility/movement (motion is lotion for your joints)
  • Reduce/avoid alcohol consumption
  • No smoking
  • Avoid trigger foods
  • Regular sleep
  • Avoid dehydration
  • Regular exercise + neck strengthening
  • Implement stress management strategies (e.g – meditation, yoga, stretching)