Does this sound like you?

Towards the end of the day a few times a week you develop a headache radiating from the back of your head to your forehead or just behind the eyes. You have intermittent neck pain that is especially bad when your stress levels and workload increase. Sometimes you pop and Advil or Tylenol and it kind of helps but usually by the next morning your headache is gone...until it comes back again. For many of my patients this non-stop loop of headaches is exhausting, frustrating and limits their ability to engage in and enjoy their lives. Chronic headaches are on the rise and are certainly a large part of my practice so, today on the blog I’m going to share with you some information on types of headaches and how you can find some relief.

Types of Headaches

Did you know there are well over 150 diagnostic conditions of headaches?!?! This may seem like an overwhelming number (and certainly it is!) but it just goes to show how there can be numerous reasons why you may be experiencing your headaches. From medications to nutritional deficiencies to musculoskeletal and/or neurological issues there is always a reason behind those pesky headaches so don’t ignore them! Make sure to seek the advice of a medical professional in order to get down to the bottom of your specific issue. The following 3 types are the most common I see in clinic:

1. Migraines

Third most prevalent disorder in the world and the third-highest cause of disability worldwide in both males and females under the age of 50 years according to the Global Burden of Disease Study 2010, 2015.
Recurrent headache disorder manifesting in attacks lasting 4–72 hours.
Typical characteristics of the headache are unilateral (one side of the head), pulsating and/or throbbing quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia (sensitivity to light) and phonophobia (sensitivity to noise).
Can present with or without a preceeding aura (changes in vision or sensory perception

2. Frequent Tension- Type Headaches

Tension-type headache is very common, with a life- time prevalence in the general population ranging in different studies between 30% and 78%.
Frequent episodes of headache, typically diffuse and bilateral(both sides of the head), pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days.
Patient will sometimes report head feels like it's in a vice
Can last for days or weeks
The pain does not worsen with routine physical activity and is not associated with nausea, although photophobia (sensitivity to light) or phonophobia (sensitivity to noise) may be present.

3. Cervicogenic Headaches

Unilateral headache radiating from the back of the head towards the front of the forehead and eye
Always experienced on the same side of the head
Limited upper cervical (neck) range of motion and mobility- most often difficulty rotating the head over one shoulder
Strength and endurance deficits of the deep neck flexor muscles
Often occurring after prolonged sustained postures or aggravated neck movements
No associated nausea, photophobia (sensitivity to light) or phonophobia (sensitivity to noise)

**Regardless of the type of headache, discussion with your family doctor about pharmacologic intervention is always recommended and may help you better participate in your physiotherapy treatment.

How Can Physio Help?

Physiotherapy treatment will differ depending on the type, chronicity, nature and presentation of your specific headaches. Certainly, physiotherapy has the best research and evidence in treating cervicogenic type headaches but there is evidence of benefit for both tension-type and migraines as well. Typically my treatment plans for patients with headaches will look to address the following:

The pressure biofeedback unit can be great at assisting with strengthening the anterior neck muscles when in clinic!

Range of motion limitations- cervical (neck), thoracic (upper back) and shoulder
Strength deficits- upper back, anterior neck musculature
Muscle tightness- chest, upper back and neck
Poor breathing patterns
Education- ergonomics, hydration, importance of regular physical activity, stress management techniques and role of other health care practitioners

Addressing these issues is best done through a combination of hands-on manual therapy, supervised and home exercises as well as education and discussion.

Home Interventions

Below are a few of my go-to exercises for patients suffering from headaches. Again, this is not meant to replace a session with a physiotherapist but may help you get started on your self-management plan!

1. Diaphragmatic breathing

The diaphragm is the primary muscle designed to control our breathing however many of us (myself included) often recruit our secondary or accesssory muscles of the neck and chest to control our breath. This not only creates a shallow breath but also overworks the musculature around the neck and can increase our perceptions of stress and anxiety. Taking 6-10 deep breaths every hour or two will help to ensure you diaphragm is doing its job, improve your air exchange, take stress off the neck musculature and increase your feelings of calm! Try it out!

2. Myofascial Release

One of my favourite tricks! I keep a lacrosse ball on hand all the time just incase I feel a headache coming on at the back of my head. You can either do this laying down or standing at the wall. Essentially, find the muscle, place the ball on it and maintain the pressure for 30 seconds-1 minute before moving to the next spot. Only apply as much pressure as you can tolerate without tensing up! More pressure is not better- remember this is supposed to relax the muscles not make things worse. Pick 4-6 spots per side everyday!

3. Thoracic Spine Mobilization

Especially for those who sit at a desk and computer all day long this one is important. Keeping your upper back moving is key to reducing stress on the joints and musculature of the neck. If you don't have access to a foam roller, roll up a large towel and it will do that trick to start.

You can also try some upper back rotation as shown by my bud, Jesse below. Aim for 1-3 sets of 15 per side.

4. Anterior Neck Strengthening

Do you ever find yourself staring at your phone or laptop hunched over with your chin poking far forward. If so, you could probably use some deep neck flexor strengthening. It may not seem like it but we do have muscles that line the front of our necks! The more you allow your head to sit forward of the body, the more these muscles weaken! We have leg day, chest/back day so why not have anterior neck day almost everyday! 3 sets of 10, holding 10 seconds.

5. Upper Back and Postural Strengthening

Wow, ok classic physio move- this is getting to be a lot of homework!

Lastly, you need to start thinking about strengthening through the upper back in order to decrease the load through the neck musculature and help maintain good posture throughout the day! There are many different exercises that can get this job done but below are two of my favourite moves that don't require any equipment or tools at home (except a wall!). With these exercises always think about HOW you are executing the exercise not how many. Doing 4-6 properly is more important than completing 10-12 reps improperly- form is key! If you are looking to make strength gains try to fit them in 3-5 times per week and aim for 2-3 sets of 6-12 each.

*For those of you who know of Eric Cressey- enjoy these retro treats!

**Last thing! Make sure to stay hydrated! In a recent study it was found that those experiencing headaches 3+ times per week had a reduction in frequency of headaches by ensuring they consumed 6 more cups of water than their average day! If drinking water improves your signs and symptoms you could simply be suffering from dehydration!

Remember this is not to take place of speaking with your trusted health care provider but I hope you find this information helpful and please feel free to reach out with any further questions!

Emma

Headaches 101