Headaches can affect up to two thirds of the population and the cause of headaches is multifactorial.
- Headaches associated with viral illness (respiratory infections, etc.,)
- Vascular headaches (migraine or cluster headache)
- Cervical headache (referred from the joints, muscles and/or fascia)
- Tension headaches (muscular tension)
- Intracranial headaches (tumours, haemorrhage, subdural haematoma and meningitis)
- An exercise-related headache, also a benign exertional headache
- Other causes such as drugs, psychogenic factors through to post spinal procedure and post traumatic incidents can cause headache.
Specifically, for a musculoskeletal derived headache, symptoms can range from muscle pain and tightness presenting in the neck and shoulders, to a limited range of movement in the neck. Generally speaking, these headaches can occur around the base of the neck, back of the skull and to the side of the skull. A mechanism of injury can also trigger the musculoskeletal derived headache, as well as a sustained or awkward posture, with symptoms also influenced by various activities encouraging these postures, such as painting a ceiling, reversing a car, etc.
The types of headaches that a Physiotherapist may see include: Tension Headache, Migraine, Facet Joint Irritation, Acute Wry Neck and Cervical Nerve Root Compression.
The tension headache can have an onset anywhere from 20 to 60 years of age. The onset is usually slow, with the duration potentially lasting days. A tension headache will generally come in the form of a dull ache and can arise in the back of head / behind the eye and temple regions. It may also present in the back, neck and shoulder regions. The likely triggers for such a headache are generated by trauma and / or posture, with pain also present in the back, neck and shoulder regions.
Migraines are normally irregular in frequency and distressing for the client. Age onset can occur in children as much as adults, but generally around the 10 to 40-year age bracket. The headache will normally present as a throbbing pain in the frontal and temporal lobes and is very fast in onset. Lasting hours, the migraine, which is vascular in origin, can be accompanied by blurred vision and nausea. However painful migraines are, they are generally not related to any particular activity, but rather hormones, food, stress or medications.
Facet Joint Irritation
Facet Joint Irritation can present as upper neck pain (Upper Facet Joint Irritation), or with referred pain to the shoulder and scapular regions (Lower Cervical Facet Joint Irritation). In the case of Upper Facet Joint Irritation, the referral of pain can move to the base of the skull and the forehead on the same side as the neck pain.
Acute Wry Neck
Acute Wry Neck can have a clinical presentation of facet joint irritation combined with several other symptoms. These symptoms can vary from a presentation of sharp pain or muscular spasm, through to reduced neck movement, more commonly towards the affected side. An episode may occur, where one turns their head quickly; has slept awkwardly or has had a sustained, awkward posture. With Acute Wry Neck, you can commonly have a headache.
Cervical Nerve Root Compression
Several symptoms accompany cervical nerve root compression, including a moderate to severe arm pain, to more serious symptoms such as the presence of pins and needles, paraesthesia, weakness or reduced reflexes. The client may also present with neck pain and headache.
Before you receive any treatment, your Physiotherapist will take you through a comprehensive assessment, including questions relating to your symptoms and then a series of movements and tests before accurately diagnosing your condition.
Management for the musculoskeletal derived headaches as listed above, may include a combination of massage, dry needling and manual therapy; the mobilising of joints; gentle stretches and assisted movement. Further management may also include exercise prescription; traction of the spine and the application of heat. Recommendations for medications in consultation with your GP and pharmacist can also be advised. Should you experience any unfamiliar, sudden, severe or persistent headaches, it’s important to consult your GP or specialist.
About The Author
Sophie Halsall-McLennan is the owner of Fresh Start Physio in the Geelong, Victoria. She has a Bachelor of Physiotherapy from Charles Sturt Physiotherapy, and has over 11 years of clinical experience as a Physiotherapist and is registered with AHPRA. She is also a lecturer at Deakin University.