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Exercise and Manual Therapy: A More Conservative Approach to Headache Management

Headaches are one of the most common health issues affecting 50% of the general population during any given year. Headaches are classified in a variety of ways, one of which is based on their cause and can be divided into primary versus secondary headaches. Primary headaches are those that are not caused by any underlying disease or disorder and account for more than 90% of all headaches. They are recurrent but also considered to be benign, meaning the cause is not dangerous to your overall health. Secondary headaches result from other medical conditions such as infection or increased pressure in the skull, however these account for fewer than 10% of all headaches. Two of the most common types of primary headaches are cervicogenic and tension-type headaches. Both of these headache types are frequently treated with physiotherapy and chiropractic treatment.

Cervicogenic headaches are those that originate from disorders of the neck and refer pain into the back of the head (i.e. “occiput” region) on the same side. Pain is referred from sensory nerve roots in the upper cervical spine (i.e. from C1-C3). These headaches are often caused by sustained neck movements or positioning (e.g. painting the ceiling or poor desk posture) and can be accompanied by restricted neck range of motion and same-sided neck, shoulder and/or arm pain. Tension-type headaches (TTH) are the most common with a prevalence rate of 38% for episodic TTH. These can occur in response to stressful events and usually involve a steady aching pain described as the feeling of “pressure” or “tightening” around the head. TTH may last minutes to days and can affect both sides of the head. Although the exact cause is unclear, there is evidence suggesting that these headaches originate from myofascial mechanisms.

Given the widespread overuse of medications for headache management and the adverse events that can occur as a result, taking a more conservative approach to pain relief can be more beneficial. Exercise therapy is one method of treating your headache pain by correcting the neck and postural imbalances that may be triggering these events. Research has shown that therapeutic exercise in combination with manual therapy is significantly more effective than usual care (i.e. medication) for reducing headache frequency, intensity and duration. Exercise has also shown to improve neck range of motion, decrease neck pain and improve overall quality of life for those suffering with headaches. The types of exercises typically used for headache management are postural correction, flexibility training, as well as neck and scapular muscle strengthening. It’s important to be assessed by a physiotherapist or chiropractor to determine where the dysfunction in neck strength or mobility is occurring.

Manual therapy such as soft tissue massage is another beneficial treatment method for headache pain. Many people with headaches have what are called “trigger points” in the neck muscles and pericranial tissues which can be treated with soft tissue mobilization. Trigger points are painful sites that when compressed or stretched cause both local and referred pain to another location. This means that headache pain can be partly caused by referral from active trigger points in the head, neck and shoulder muscles. Typical trigger point locations for those with chronic tension-type headaches are in the sternocleidomastoid, trapezius and temporalis muscles. There are a variety of manual therapy techniques that are used to increase blood flow to these tissues which then reduces the trigger point activity and therefore lessens your headache symptoms. New research indicates that patients with recurrent headaches and associated neck pain demonstrate a reduction in daily medication use for those who participate in manual therapy combined with exercise. These treatments have shown to be twice as effective as medication for reducing headache frequency. Additional conservative treatment options include joint mobilization/manipulation as well as acupuncture treatment. Speak to your healthcare practitioner to determine which options would work best for your headache management.

Written by: Vanessa Younes, MScPT