Comprehensive Guide to Headaches and Related Health Conditions

According to the WHO, headache disorders affect approximately 40% of the worldwide population, making headaches a leading cause of pain and disability across the globe. The International Headache Society identifies >100 different types of headaches. Understanding the different types of primary headaches and the other health conditions which may cause headaches secondarily is essential for proper management, beginning with recognizing the various symptoms, causes, and triggers to ensure appropriate diagnosis and treatment. 

As part of a comprehensive evaluation, physical therapists can identify muscle imbalances, postural tendencies, and movement patterns which may be contributing to headaches, determine which symptoms might require referral to a medical provider, and can be essential in the management of these symptoms to promote improved quality of life. 

Here at KNOSIS, detective work, pattern recognition, and a deep understanding of the body’s function help us get to the root cause of your headache pain. In this article, we share some of the most common headache types and discuss the various ways in which each can be managed. 

Types of Headaches

Migraine Headaches

Migraine headaches are severe, often debilitating headaches that can last from hours to days. They are typically characterized by intense, throbbing pain on one side of the head which may be accompanied by nausea, vomiting, and sensitivity to light and sound. Common migraine triggers include hormonal changes, certain foods and beverages, stress, and sensory stimuli. The exact cause of migraines is unknown, though they are thought to be related to inflammatory vascular changes in the head. While PT does not treat the migraine directly, it can be helpful in managing associated symptoms, including neck pain and stiffness, as well as addressing potential stimuli, including changes in breathing behavior.

Example keywords: migraine headache, migraine headache relief, migraine headache treatment

Tension-Type Headaches

Tension-type headaches are the most common type of headache. They are characterized by a dull, aching sensation all over the head and tenderness in the scalp, neck, and shoulder muscles. Common causes include stress, anxiety, poor posture, and muscle strain. Relief methods include over-the-counter pain relievers, stress management techniques, and physical therapy to improve posture and muscle tension. 

Example keywords: tension headache, tension headache relief, tension headache cure

Cluster Headaches

Cluster headaches are known for their severe, recurrent nature, often causing intense pain around one eye. These headaches can occur in groups or "clusters," lasting weeks to months, followed by remission periods. They can often occur along with parasympathetic nervous system symptoms, including those involving the affected eye. Common triggers include alcohol, certain medications, and heat. Treatment typically involves medication, avoidance of triggers, and pain management. 

Example keywords: cluster headaches, cluster headache treatment

Secondary Headaches

Secondary headaches are those that arise as a symptom of another health condition. These can include cervicogenic headaches, which originate from the joints and muscles of the neck, TMJ-related headaches, and headaches related to head or neck trauma. Physical therapists are often involved in differentiating and managing these headache types by restoring optimal joint mechanics, relieving soft tissue restrictions, and guiding postural training and strengthening. 

Other secondary headaches may be related to a variety of medical issues, including hypertension and vascular changes, certain medications, and other medical conditions. If your physical therapist suspects these causes, they will refer you back to your MD for further evaluation. 

Example keywords: cervicogenic headaches, TMD-related headaches, trauma headaches

Cervicogenic and TMJ-related headaches

Muscles in the neck and shoulder girdle, such as Sternocleidomastoid, Upper Trapezius, and the Suboccipital group, can refer pain to regions in the head. Additionally, muscle and joint restrictions throughout the neck and cranium can cause muscle imbalances and postural changes which contribute to headaches through increased mechanical stress. Physical therapy is often the first line of treatment to normalize soft tissue and joint function in order to relieve these headaches, though often injections (such as facet joint and trigger point injections) can be helpful for symptom relief. 

KNOSIS Physical Therapists have been highly influenced by master clinician and researcher Dr Gwen Jull who was the head of the University of Queensland Spinal Manips program when founder Tracey Vincel did her masters there in 2003. 

Research by Gwen Jull highlights the effectiveness of deep neck flexor training in treating cervicogenic headaches. Jull's studies demonstrate that improving the strength and endurance of deep neck flexors significantly reduces headache frequency and intensity. This targeted approach enhances cervical stability, leading to long-term relief in patients suffering from cervicogenic headaches.

TMJ-Related Headaches

Alterations in TMJ alignment and function, including dental changes, orthodontia, facial trauma, and habitual grinding/bruxism can contribute to headache pain through both bone/joint compression as well as muscle restriction. Jaw muscles including Temporalis and Medial/Lateral Pterygoid can cause pain around the cheekbones, eyes, and ears. Our TMJ specialists can address these impairments with a variety of intra- and extra-oral manual techniques, exercise, and respiratory training, in addition to working with your dentist to address any specific concerns. 

Nerve-Related Headaches

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition affecting the trigeminal nerve, which carries sensation from the face to the brain. It can cause severe, sharp, and electric-shock-like pain.

Occipital Neuralgia

Occipital neuralgia involves the occipital nerves and can cause piercing, throbbing, or persistent electric pain in the upper neck, back of the head, and behind the ears, typically on one side of the head.

Example keywords: trigeminal neuralgia, occipital neuralgia, nerve-related headaches

Stress and Anxiety-Related Headaches

Stress and anxiety can be related to headaches, whether as a trigger for migraines, or as a contributing factor to tension-type and cervicogenic headaches due to related muscle tension. Stress and anxiety can also be related to breathing dysfunction which can contribute to headaches due to drops in blood CO2 levels. Recognizing these headaches involves understanding the connection between emotional stress and physical symptoms and addressing the underlying stress or anxiety through techniques such as mindfulness, therapy, and relaxation exercises.

Example keywords: stress headache, stress headache relief, stress and anxiety, signs of stress and anxiety

Treatments and Remedies

As always, proper treatment and management of headaches requires accurate diagnosis and understanding the root cause and patterns behind your headaches. A medical doctor, particularly a neurologist specializing in headaches, can advise on prescription and over-the-counter medications to prevent headaches or manage pain. A skilled and experienced physical therapist is another important part of the team to help address musculoskeletal causes and symptoms, including muscle tension, neck and shoulder girdle issues, TMJ dysfunction, and faulty breathing behaviors. 

Self-Care

Home remedies for headaches include staying hydrated, applying cold or warm compresses, practicing relaxation techniques, and using gentle movements and stretches as recommended by your Physical Therapist. Regular exercise, adequate sleep, and proper nutrition also play a significant role in headache prevention. Stress relief techniques including relaxation exercises, yoga, and mindfulness practices can also be helpful in preventing stress-related triggers.

Example keywords: relieving stress, home remedies for stress and anxiety

Complementary Therapies

Complementary therapies such as hypnotherapy, acupuncture, and meditation practices can be effective for headache relief. Hypnotherapy helps in relaxation and stress management, potentially reducing the frequency and intensity of headaches when guided by a qualified practitioner. Acupuncture can also be helpful in relieving headache-producing trigger points, reducing stress and tension throughout the body, and promoting anxiety relief and relaxation.  

Example keywords: hypnotherapy, hypnosis near me, hypnosis and sleep, acupuncture and headache

Conclusion

Headaches, while common, can significantly impact one's quality of life. Understanding the different types, symptoms, and treatments is essential for effective management. Always seek professional medical advice for new or sudden headaches, as well as those which are persistent or severe to ensure proper diagnosis and treatment. Integrating lifestyle changes, stress management, and both traditional and alternative therapies can provide comprehensive relief and improve overall well-being.

References

[Migraine and other headache disorders (who.int)] 

The International Classification of Headache Disorders - ICHD-3

1. Jull, G., Barrett, C., Magee, R., & Ho, P. (2007). "Further clinical clarification of the muscle dysfunction in cervical headache." Cephalalgia, 27(9), 920-926.
   This study focuses on muscle dysfunction, particularly in the deep neck flexors, in patients with cervicogenic headaches.

2. Jull, G., Sterling, M., Falla, D., Treleaven, J., & O’Leary, S. (2008). "Whiplash, Headache, and Neck Pain: Research-Based Directions for Physical Therapies." Elsevier Health Sciences.
   This book covers various neck pain and headache conditions, including cervicogenic headaches, with a section dedicated to therapeutic approaches such as deep neck flexor training.

3. Jull, G. A., Trott, P. H., Potter, H., Zito, G., Niere, K., Shirley, D., & Richardson, C. (2002). "A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache." Spine, 27(17), 1835-1843.
   This study demonstrates the positive effects of specific exercises, including deep neck flexor training, in reducing cervicogenic headache symptoms.

4. Jull, G., Falla, D., Vicenzino, B., & Hodges, P. (2009). "The effect of therapeutic exercise on activation of the deep cervical flexor muscles in people with chronic neck pain." Manual Therapy, 14(6), 696-701.