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Living with Headaches: The Guide to Proper Management

By Joshua Bruner, Physical Therapist

Have you ever experienced an intense headache that never seems to go away? Do you ever feel helpless trying to treat your headaches? Headaches can be very disabling and interfere with your daily life. It has been reported that 47% of people in the United States have regular headaches. They can be very challenging to treat and diagnose, which makes it difficult for individuals to find relief. Therefore, the first step towards proper treatment involves correctly diagnosing the true cause of the headache.

The ability to rule out red flags that may point to a serious issue is the first step when diagnosing headaches. If you experience any of the following symptoms, you should see your physician immediately.

• Intense and exploding pain with stiffness in the neck
• New onset of headaches in individuals greater than 50 years old or younger than 10 years old
• Persistent morning headaches with nausea
• New onset of headaches with a history of cancer
• Progressive headaches, worsening over weeks
• Headaches associated with fever, rash, and altered consciousness

Once any serious conditions have been ruled out, the true origin of your headaches can be determined. There are multiple types of headaches, but the most common types are migraines, tension-type, cluster, and cervicogenic (headaches coming from the neck).

Diagnosing the correct type of headache will help you find the most appropriate treatment options. There are a variety of signs and symptoms that help classify the type of headache. Below is a list of the common signs and symptoms for each type.

Migraines:
• Headache is throbbing or pulsating
• Pain behind one eye
• Moderate to severe pain
• Episodes lasting between 4-72 hours with full resolution afterwards
• Often accompanied by vomiting, nausea, and sensitivity to lights, sounds, and smells

Tension-type headaches:
• Pain described as pressure or aching (non-pulsating)
• Feeling of a tight band around the head
• May be associated with medication overuse
• Episodes last for minutes or weeks
• Rarely have nausea or vomiting
• May be induced by stress

Cluster headaches:
• More common in males and/or smokers
• Severe/disabling pain
• Episodes last between 15 minutes to 3 hours
• Often feel restless, agitated, and sweat significantly
• Episodes can occur multiple times per day for a few months followed by gaps of no headaches for months

Cervicogenic headaches (coming from the neck):
• One sided headaches without shifting sides
• Headaches triggered by movement of the neck or awkward/sustained positions
• Moderate, but not severe pain
• Pain or headache starts in the back of the head and moves towards the forehead
• Pain with pressure to the muscles of the upper neck
• More common in females

All of these types of headaches can be treated with a conservative approach, but it’s important to be referred to the correct healthcare provider.

Physical therapists and primary care physicians are healthcare providers who often treat cervicogenic and tension-type headaches. Treatment options include a combination of medications, soft tissue mobilizations, dry needling, joint mobilizations/manipulations, relaxation techniques, cognitive-behavioral therapy, stretches, and exercises to help alleviate one’s pain.

Regular aerobic exercise has been shown to reduce the frequency and intensity of headaches and migraines. Physical therapy can be very effective in treating cervicogenic and tension-type headaches by addressing neck impairments and teaching individuals relaxation/stress alleviating techniques, respectively.

An individual diagnosed with migraines or cluster headaches would benefit from receiving a consultation from a neurologist. These types of headaches usually require medications to help manage the pain. A neurologist can help to determine the appropriate type of medication, dosage, and frequency needed to provide symptom relief. A physical therapist can also assist with treating migraines and cluster headaches by showing the individual relaxation techniques, stress relieving methods, and integrating aerobic exercise into one’s daily life.

Unfortunately, these types of headaches do not always occur individually. Multiple types of headaches can occur at once, which makes it more difficult to treat and diagnose. Therefore, it is recommended that you seek care from a physical therapist even if you present with migraines or cluster headaches. Migraines and cervicogenic headaches can occur together, so conservative treatment from a therapist can help alleviate the intensity and frequency of the headaches by addressing the neck impairments.

If you still have concerns regarding your type of headache or are not sure about how to properly manage them, contact your primary physician or physical therapist for proper guidance. For further questions or additional information, contact The Orthopedic Institute and Physical Therapy Rehab Department at 608.342.4748 or the Platteville Clinic at 608.348.4330.

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