Headaches come in different forms. The most familiar form of headache is migraine this form is episodic and often on one side of the head. Physical therapy is helpful for certain forms of headaches. The forms of headaches where physical therapy can make a difference are Muscular tension headaches and Cervicogenic headaches (headaches from the neck). There are many similarities in the symptoms in the different types of headaches. Therefore, extensive examination is necessary to come to a proper conclusion for the final treatment plan.
Primary or secondary headache
First, a distinction is often made between primary and secondary headache forms. In which primary headache the headache is not a symptom but the condition itself. Migraines or cluster headaches are examples of primary headache forms.
In secondary headaches, the headache is often a symptom of another complaint. Tension headaches and cervicogenic headaches are both examples of secondary headaches. Medication-dependent headaches may also be present. This is a form of headache symptoms that occurs as a result of excessive use of medication in the form of paracetamol or triptans. Fluctuations in the intake of caffeine often in the form of coffee can possibly also be a source of headaches.
To see what type of headache a person has, a distinction can be made based on its location. Different types of headaches produce a different radiating area of pain. Also, the way the symptoms develop and the duration of the symptoms give an indication of what type of headache it could possibly be. Therefore, the client's story is very important in headache complaints
Tension headache: In this type of headache, it feels as if there is a tight band around the head. This pain lasts up to 14 days and subsides somewhat when relaxing.
Cervicogenic headache: This form arises from tension in the neck. Pain gets worse when the neck is moved, decreases when the neck moves less. Pain starts at the back of the head and pulls forward, usually on one side of the head. The pain does not change sides. Often this pain occurs during a period of stress or after working long hours at a computer.
Physical therapy examination for headaches
When you visit the physical therapist with a headache, at first you will be asked many questions about the complaints and symptoms that are causing the headache. The purpose of this is to rule out any causes other than tension or neck pain. Some standard questions are also asked to rule out any serious causes of the headache.
Then, based on the story, an examination is started, often is an examination of the neck and muscles around the neck and shoulders. This is done by moving the neck in certain directions and testing the muscles. Should the complaints be evoked or become less, this is a reason to treat the relevant structure.
Physical tests for headache complaints
There are a number of tests described to understand possible factors contributing to headache symptoms:
Flexion rotation test:
The flexion rotation test is a test of the high cervical spine. The patient lies supine the examination brings the head into a maximally flexed position. After this, the head is rotated to both sides. Normally this is more than 30 degrees. If this is not the case then this may be a cause for cervicogenic headache symptoms.
Craniocervical flexion test(CCFT):
This is a test that assesses the strength of the deep flexors in the neck. This is a test of both coordination and endurance of this muscle group in the neck. The patient lies supine with a towel or pillow under the skull rim. For an ideal test position, the ear canal should be in line with the collarbone of the person being examined. In this position, both coordination and endurance can be tested of the deep flexors of the neck.
Symptoms of muscle tension headaches:
- Moderate nagging pain
- Usually on both sides of the head
- A band feeling to the front of the head
Symptoms of cervicogenic headache
- Headache is located on one side
- Possible complaints to the shoulder
- Often in combination with other forms of headaches
Headaches in relation to neck pain
The treatment of headaches
Treatment of headache symptoms will be tailored to what form it is. The approach is often different and requires a different perspective.
Tension headaches: with tension headaches, there is a focus to relax, the therapy often consists of relaxation massage and moderate-intensity exercise this includes walking and gentle exercise, often these headaches then go away.
Cervicogenic headache: Because this headache form originates in the neck, this treatment consists of mobilizing the neck, massage of the neck and light training of the small neck muscles. Postural advice is also part of this therapy.
For the other types of headaches, collaboration with the hospital or family physician may be possible.