The Most Common Types of Headaches and How to Navigate Them-Lewis Craig

Headaches are a common complaint for many people presenting to physiotherapy each and everyday. Whether it is your main problem, or occurring alongside other aches, pains, tightness or stiffness; headaches can be frustrating and debilitating. Headaches can reduce your ability to concentrate, work and do the things you love to do.

In this post I explore some of the most common types of headaches, how they present and what can be done to alleviate, treat, and/or manage them. With over 300 different types and causes of headaches, physiotherapist’s can play an important role in determining the type of headache and if it is caused by dysfunction in the cervical or thoracic spine (neck and trunk, respectively). It is also important to determine if these dysfunctions may be contributing to, or enhancing other causes of headaches. Tackling these dysfunctions can greatly impact headache nature, frequency and severity.

Let’s explore the most common types of headaches.

The Most Common Types of Headaches

1. Cervicogenic Headache

Cervicogenic headaches are not a single pathological entity but rather a pain syndrome resulting from dysfunction in the cervical spine (neck), referring pain up into the face and head.  Commonly the headache is a result of changes within one or more of the upper 3 cervical joints, muscles, ligaments and the adjacent nerves. This information is referred from the upper cervical nerves to the sensory fields of the face and head (1, 2).

How Cervicogenic Headaches present

Theses headaches often present unilaterally (on a single side), with nagging, non-throbbing quality behind the eye and neck pain at the base of the skull (sub-occipital region).

Cervicogenic headaches are triggered or aggravated by neck movements, prolonged awkward neck postures and or sustained pressure to the base of the skull. These headaches can also be associated with shoulder or arm discomfort, dizziness, nausea, light-headedness, inability to concentrate and visual disturbances (1, 2).

How Cervicogenic Headaches are treated

Cervicogenic headaches are treated through physiotherapy with a variety of manual therapy techniques to address the joint and soft tissue dysfunctions in the neck. Additionally exercises may be uses to correct deficits in cervical muscle motor control or any postural dysfunctions.

2. Migraines

Migraines are the second most common form of headache. These commonly affect females greater than males, often beginning before the age of 30, but rarely after the age of 50. The International Headache Society’s classification of migraine is a very detailed clinical entity.

How Migraine Headaches present

The most common criteria used to determine a migraine headache is a unilateral (0ne-sided), often throbbing headache, lasting 4 to 72 hours in duration. Migraine headaches also commonly occur alongside additional symptoms of nausea, vomiting and light or sound sensitivity (photophobia and phonophobia) (3). Other symtoms are also possible with migraines such as vertigo, dizziness, confusion, dysarthria (difficulty speaking), tingling of extremities, and incoordination. Routine physical activity and fast head movements often increase the intensity of the headache.

Migraines are classified as being with or without aura. Aura refers to sensations or symptoms that a person feels immediately prior to the onset of a migraine headache. This usually occurs consistently with every headache 20-30 minutes prior and may include; dizziness, tinnitus (ringing in ears), visual symptoms (seeing flashing lights, zigzag lines, blind spots, loss of half field of vision or hallucinations), numbness, weakness or pins and needles.

How Migraine Headaches are treated

Management of migraines often takes a multidisciplinary approach. This incorporates medication to control the intensity, severity or frequency of the migraine (4). Physiotherapy can be beneficial in addressing cervical (neck) dysfunctions that may be enhancing the migraine.  A key systematic review in 2011 identified that massage therapy, physiotherapy, relaxation and manipulative therapy might be efficient in management of migraine.  Some studies have demonstrated that physiotherapy is most effective for the treatment of migraine when combined with cognitive behavioural therapy, relaxation training, and exercise (5).  A multidisciplinary approach additionally help to identify potential causes or triggers of migraines.

3. Tension Headaches

Tension-type headache (TTH) is the most prevalent headache in the general population. The typical presentation of a TTH attack is that of a mild to moderate intensity, bilateral (both sides) and non-throbbing headache. They do typically are not accompanied by nausea or vomiting and are not aggravated by physical activity or head movements (6). An episodic tension headache typically will be a tight or pressing quality and last 30 minutes to 7 days.

How Tension Headaches present

There is commonly tenderness of head and neck myofascial tissues and accompanied trigger points. Muscle tenderness in the head, neck, or shoulders is associated with both the intensity and the frequency of tension-type headaches attacks and is typically exacerbated during the headache experience (6). Typically there are no other specific assessment findings.

How Tension Headaches are treated

Management of tension headaches often involves use of simple analgesics and physiotherapy to reduce areas of tightness (tension). A 2014 systematic review has found that there is inconclusive evidence for various manual therapy treatments due to variations in study design and outcomes measures. However there are promising results for benefit of manual therapy techniques over no treatment (7).  Physiotherapy can also make a significant and lasting decrease in headache frequency and drug consumption (8). Trigger point releases such as demonstrated HERE (upper traps and rhomboid muscles) can prove very useful and effective.

4. Cluster Headaches

The cause and pathogenesis of cluster headache is complex and remains incompletely understood. Attacks occur in series several times a year, with attacks varying from one to eight times per day and are relatively short lived. Cluster headache is characterized by attacks of severe unilateral (single sided) pain anywhere in face or head but usually behind the eye, cheek bone, or temporal region.

How Cluster Headaches present

In contrast to migraines, patients with cluster headaches are often restless and prefer to pace about or sit and rock back and forth. These headaches also have autonomic (nervous system) symptoms on the involved side, such as; drooping of the eyelid, excessive tearing, eye redness or swelling, stuffy or runny nasal passage, sweating and pale skin (pallor) (9).

How Cluster Headaches are treated

Cluster Headache management primarily involves medical management with medications or oxygen therapy to reduce attack severity and medication to use prophylactically during a series of attacks.  To maximize the effects of managing cluster headaches, strategies including relaxation, biofeedback, smoking cessation, and alcohol intake reduction should be considered.

5. Other Headaches

With hundreds of other different types of headaches including those associated with vascular disorders, head trauma, cold stimulus, alcohol, drug abuse and temporal arteritis, it can be difficult to navigate through a debilitating headache.

If you do experience a headache, physiotherapy can be excellent in identifying the type of headache and assist in finding the right treatment path to alleviate it.

If you have any questions or comments please feel free to leave them in the comments below.

References

1. Racicki, S., Gerwin, S., DiClaudio, S., Reinmann, S., & Donaldson, M. (2013). Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of Manual & Manipulative Therapy, 21(2), 113-124.
2. Chaibi, A., & Russell, M. B. (2012). Manual therapies for cervicogenic headache: a systematic review. The journal of headache and pain, 13(5), 351-359.
3. Kindelan‐Calvo, P., Gil‐Martínez, A., Paris‐Alemany, A., Pardo‐Montero, J., Muñoz‐García, D., Angulo‐Díaz‐Parreño, S., & La Touche, R. (2014). Effectiveness of therapeutic patient education for adults with migraine. A systematic review and Meta‐Analysis of randomized controlled trials. Pain Medicine, 15(9), 1619-1636. doi:10.1111/pme.12505
4. Harmon, T. P. (2015). Diagnosis and management of migraines and migraine variants. Primary Care, 42(2), 233-241. doi:10.1016/j.pop.2015.01.003
5. Chaibi, A., Tuchin, P.J. & Russell, M.J. (2011) Manual therapies for migraine: a systematic review. J Headache Pain. 12(2): 127–133
6. May, A., Swanson, J.W., & Dashe J.F. (2013) Tension headache: Epidemiology, clinical features, and diagnosis. Up To Date 2013.
7. Lozano, L. C., Mesa, J. J., de la Hoz, A. J., Pareja, G. J., & Fernández, D. L. P. C. (2014). Efficacy of manual therapy in the treatment of tension-type headache. A systematic review from 2000-2013. Neurologia (Barcelona, Spain).
8. Torelli, R. Jenson, & J. Olsen (2004) Physiotherapy for tension-Type Headache: A Controlled Study. Cephalalgia 24, 29-36
9. May, A., Swanson, J.W., & Dashe J.F. (2013) Cluster headache: Epidemiology, clinical features, and diagnosis. Up To Date 2013.
10. May, A. (2005). Cluster headache: pathogenesis, diagnosis, and management. The Lancet, 366(9488), 843-855.

PAIN-FREE. PERFORM. PROLONG

Lewis Craig (APAM)

Physiotherapist POGO Physio

POGO Physiotherapist