Headaches and their treatment by manual therapy.

Headache has been called the most common complaint of civilized man affecting two thirds of the population.

There are eight types of headaches, the first four of which are seen commonly and the last four less commonly.

  1. Headaches associated with viral illnesses for example the common cold or flu.
  2. Vascular headaches such as migraines or cluster headaches which affect men 20 to 40 years causing excruciating pain behind the eyes and temples.
  3. Cervical headaches where pain is referred to the head from muscles, joints and fascia of the neck.
  4. Tension headaches due to muscle contraction.
  5. Serious headaches caused by brain tumours, brain infections such as meningitis or internal bleeding or haemorrhage.
  6. Exercise related headaches such as footballer’s migraine.
  7. Caffeine or other drug withdrawal, or drug induced headaches.
  8. Trauma and injury to the head eg. falls, and blows.

Cervical and tension headaches are very common and are able to be treated by manual therapists such as Osteopaths. They are usually described as a constant steady dull ache more often on one side of the head. The patient may describe a pulling or gripping feeling or may describe a tight band like pressure around the head. They usually start in the sub occipital area where the head and neck meet and commonly travel to the front, temples or behind the eyes.  They are usually associated with neck pain or stiffness and may be aggravated by neck and head movements or by holding the neck in sustained positions such as when using computers.

Cervical headaches often come on gradually over weeks. There may have been a previous injury such as whiplash due to a motor vehicle accident.

They are often associated with poor posture that usually consists of rounded shoulders, with the head jutting forward and an extended neck. This posture is a common occurrence in our modern lifestyles with hours of sitting and computer use. It causes tightness in the shoulders and upper back, and cervical muscles at the upper back of the neck and weakness in the frontal neck muscles. Stress also contributes to this type of headache and aggravates muscle tension and postural abnormalities.

Cervical headaches are mostly caused by irritation to the nerve roots of the upper neck due to damage or restrictions to the joints and ligaments of the upper or lower neck or compression of the nerves as they pass through the deep muscles.

Tension headaches with pain in the front and temporal part of the head may also be commonly caused by trigger points. Trigger points are small hyper irritable spots in tight bands of muscle that cause referred pain to specific areas and are found in all people with chronic musculo skeletal pain.  These are often found in the upper shoulder muscles, and muscles in the front and back of the neck and often cause headaches.

Treatment by Osteopaths involves examination of the joints, muscles and neural structures of the neck region and postural assessment and screening of other areas for imbalances that may be contributing to tension in the neck including the thoracic spine shoulders, lower back and pelvis. Treatment aims to improve the structure of the area to improve joint function nerve and blood flow and reduce muscle and facial tension. After treatment postural advice can be given to help maintain better alignment of the head, neck and upper back Specific self treatment exercises are also given to help reduce tension in the shoulders, and upper back.

Matt Blackburn


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