Headaches come in different forms. The most well-known 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 headache where physical therapy can make a difference are Muscle tension headache and Cervicogenic headache (headache from the neck). There are many similarities in the symptoms with the different types of headaches. Therefore, extensive examination is necessary to reach a correct conclusion for the final treatment plan.
Primary or secondary headaches
First, a distinction is often made between primary and secondary headache forms. In which primary headache is the headache not a symptom but the condition itself. Migraine 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 complaint that occurs as a result of overuse 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 find out which form of headache a person has, a distinction can be made based on the location. Different forms of headache give a different radiating area of pain. Also the way the complaints arise and the duration of the complaints give an indication for which type of headache it could possibly be. Therefore, the client's story is very important in headache complaints
Tension headache: With this type of headache, it feels like there is a tight band around the head. This pain lasts for up to 14 days and goes away somewhat when relaxing.
Cervicogenic headache: This form is caused by tension in the neck. Pain gets worse when the neck is moved, decreases when the neck is moved less. Pain starts at the back of the head and travels 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.
Physiotherapy examination for headaches
When you visit the physical therapist with a headache, you will initially be asked many questions about the complaints and symptoms that are occurring with the headache. The purpose of this is to rule out any causes other than tension or neck pain. Also, some standard questions will be 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 by moving the neck in certain directions and testing the muscles. If the complaints can be evoked or become less, this is a reason to treat the relevant structure.
Physical testing for headache symptoms
There are a number of described tests to gain insight into 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 is a possible cause for cervicogenic headache complaints.
Craniocervical flexion test(CCFT):
This is a test that identifies 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 in the supine position 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 of the deep flexors of the neck can be tested.
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
- Headaches are located on one side
- Possible complaints to the shoulder
- Often in combination with other forms of headache
Headaches in relation to neck pain
The treatment of headaches
The treatment of the headache symptoms will be adapted to what form it is. The approach is often different and requires a different perspective.
Tension headaches: With tension headaches, the focus is on relaxing, the therapy often consists of relaxation massage and moderate intensity exercise this for example by walking and quiet exercise, often these headaches then go away.
Cervicogenic headache: Because this headache form originates in the neck, this treatment consists of mobilization of the neck, massage of the neck and light training of the small neck muscles. Giving posture advice is also part of this therapy.
For the other types of headaches, it may be possible to seek collaboration with the hospital or family physician.