Can Physical Therapy Treatment Help My Headaches?
Do you suffer from chronic headaches? Do they happen weekly or even greater than 15 days a month? You have probably tried your fair share of home remedies or pain killers to manage your symptoms, but they keep coming back. If so, physical therapy may be the solution you have been looking for.
You Are Not Alone
In 2016 The Global Burden of Disease study ranked headaches as the second leading cause worldwide for years lived with disability.
Type of Headaches
It is easy to find yourself going down a Google or WebMD rabbit hole when your symptoms are at their worst. Search engines can attribute your headache to anything from dehydration to a brain tumor. With such a wide variety of causes ranging from benign to sinister, it can be overwhelming to understand your particular condition.
There are many different types of headaches, however they can all be broken down into either primary or secondary. Primary headaches are not the result of any underlying condition. Secondary headaches are caused by an underlying condition.
Primary
Migraine
Tension Type Headaches
Cluster Headache (a form of trigeminal autonomic cephalgia)
Secondary
Cervicogenic- originating from the neck (most common)
Whiplash Associated Headache
Post concussion symptoms
Your physical therapist can help you determine what type of headache you are experiencing and form a treatment plan to start to decrease their intensity, frequency, and duration. However, it is important to remember that some underlying conditions require higher levels of care. When pain is severe it can be hard to decide if you fall into this category. As trained medical professionals we can help determine if you fall into one of the categories listed above that research has demonstrated responds well to physical therapy.
However, if you are experiencing any of the following symptoms in concert with your headache you should seek care immediate medical care:
Mental confusion
Speech difficulties
Seizures
Changes in vision
Personality changes
Paralysis or numbness
Fever, shortness of breath, or rash
Following head trauma or accident
Symptoms that are sudden, new and severe
Dizziness or sudden loss of balance**
**A wide range of vestibular as well as cervicogenic disturbances can lead to feelings of vertigo, dizziness or sudden loss of balance which can be treated or managed with Physical therapy however it may be important to rule out other condition, see below for vestibular disorders**
Why Physical Therapy?
In many cases physical therapy has been shown to be as effective or more effective than medication in the management of headaches.
Photo by Brass Tacks Photography
What will the treatment look like?
Each patient is unique and is treated as such, we will start by learning about your medical history and personal experiences with headaches. From there you can expect to go through an evaluation to assess individual restriction that may influence your symptoms which could include assessing posture, joint mobility, soft tissue restrictions, or oculomotor (eye movement) exam to name a few.
Following assessment there are several techniques effective with chronic headache we will likely combine to address your specific needs. Some of these techniques include:
Joint Mobilization: Is a hands on technique utilizing small passive movement to improve movement in a painful or dysfunctional joint.
Soft Tissue Mobilization/Massage: There are many different types of soft tissue mobilization including: cross friction, myofascial release, trigger point, instrument assisted, and manual lymphatic drainage to name a few. These techniques are utilized to address restrictions in “soft tissue” i.e. everything other than bone.
Dry Needling: This is the utilization of microfilament needles (i.e. acupuncture needles) to directly improve quality of connective tissue, release trigger points, and decrease pain. To learn more about dry needling visit our dry needling blog.
Exercise Prescription: Specific exercises will be provided by your physical therapist in order to complement the hands-on approach to your headache symptoms. These will vary depending on the patient but could look at improving mobility around specific joints, improving muscle flexibility, correcting muscular imbalances, or strengthening postural musculature.
Education/Lifestyle Modification: Including help identifying specific triggers and determining how to avoid or reduce exposure to ergonomic modifications to work and home environments.
Photo by Brass Tacks Photography
What does the research say?
“Manual trigger point treatment of head and neck muscles may reduce frequency, intensity, and duration of attacks in tension type headaches and migraines”- Falsiroli Maistrello L et al.
“Dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in tension type headaches and cervicogenic headaches.” - Pourahmadi M et al.
In Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular (TMJ) Disorders Garrigós-Pedrón M et al. reported “Significant improvement in Craniofacial Pain and Disability Inventory, the Headache Impact Test, and pain intensity.”
What should I do before my first appointment?
A great place to start is with a headache log or journal!
Tracking your symptoms and when they arise will help us to understand your specific condition. This includes keeping a log of frequency, intensity, and duration. However, descriptors such as where you feel the pain (i.e. behind my right eye, across my forehead, the back of my head) as well the quality of the pain (i.e. throbbing, pressure, stabbing) are equally important.
A log will also help you to better understand your personal triggers. Headaches are a multifaceted condition and while physical therapy can help manage the physical component many people also have external triggers. Things to track in association could include:
Weather
Eye strain
Allergies
Light sensitivity
Alcohol consumption
Menstrual Cycle
Hydration
Screen Time
Stress level
Dietary Changes
Sleep patterns
Medication changes
Caffeine intake
Hunger
Neck pain
Jaw pain
Mood
Related Conditions:
There are no shortage of conditions and symptoms a person with chronic headaches can experience some of the most common are neck and jaw pain, dizziness, and chronic pain.
Neck Pain
Neck pain can be a significant impediment to daily activity and movement which can interfere with your overall health, according to an article from Harvard Health in 2016 up to 80% of adults will be affected by this problem.
Neck pain or stiffness can manifest differently for everyone ranging from symptoms in one or both shoulders and arms, pain in your upper back, difficulty turning your head as well as facial and head pain. A common misconception is that it is inevitable to wake up with neck pain or unable to turn your head because you are aging. This is simply not true, it's important not to be complacent with pain simply because the general population experiences this. You should strive to be better than the norm, and we can help!
Temporomandibular Joint (TMJ) Disorders
In the US alone between 11-12 million people are affected by jaw pain. The Temporomandibular joint is the hinge joint right in front of your ear that is responsible for opening and closing your month. With its constant use for talking, eating, and drinking the health of this joint is of utmost importance in your daily living. Pain at the TMJ is often can often be classified as temporomandibular joint disorders, signs and symptoms of which include:
Pain in the chewing muscles or joint of the jaw
Stiffness, locking or lack of movement of the jaw
Pain that spreads to the face or neck.
Painful clicking, popping, or grating with opening or closing the mouth
Physical therapy management of TMD is instrumental in addressing muscle restrictions and joint limitations in order to restore motion and alleviate pain.
Cervicogenic Dizziness/Vestibular Disorders
Many different forms of dizziness can be treated with physical therapy ranging from intense “room spinning dizziness” often labeled as vertigo to unsteadiness and disorientation which can be associated with cervicogenic dizziness (dizziness triggered by neck pain or stiffness). Both as a part of their doctoral program and certifications in vestibular rehabilitation your physical therapist has been training to determine the underlying cause of your symptoms, help you understand your condition, and develop a plan for your treatment.
Chronic Pain
Chronic headache sufferers are more likely to develop widespread chronic pain, and vice versa. Sometimes when this happens we will refer to the patient having central sensitization. Central sensitization results in structural, functional, and chemical changes to the nervous system triggering a lower threshold for pain sensing neurons leading the individual to experience severe pain to stimulus that had previously been benign. Each individual experiencing chronic pain has their own uniques set of triggers, a physical therapist can play an integral role in the health care team in order to reduce symptoms and improve quality of living.
Author: Christine Biegert, PT, DPT, CSCS
References:
Falsiroli Maistrello L, Geri T, Gianola S, Zaninetti M, Testa M. Effectiveness of Trigger Point Manual Treatment on the Frequency, Intensity, and Duration of Attacks in Primary Headaches: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol. 2018;9:254. Published 2018 Apr 24. doi:10.3389/fneur.2018.00254
Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, et al. Dry Needling for the Treatment of Tension-Type, Cervicogenic, or Migraine Headaches: A Systematic Review and Meta-Analysis. Phys Ther. 2021;101(5):pzab068. doi:10.1093/ptj/pzab068
Garrigós-Pedrón M, La Touche R, Navarro-Desentre P, Gracia-Naya M, Segura-Ortí E. Effects of a Physical Therapy Protocol in Patients with Chronic Migraine and Temporomandibular Disorders: A Randomized, Single-Blinded, Clinical Trial. J Oral Facial Pain Headache. 2018;32(2):137-150. doi:10.11607/ofph.1912
Fernández-de-Las-Peñas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2016;36(12):1134-1142. doi:10.1177/0333102415596445
