Headache & Migraine: Physiotherapy Management
Is that pain in your head really a pain in the neck? Do you suffer from persistent headaches when sitting at your desk at work? Or does your headache come on when there is added stress in your life? Maybe when you get a migraine you’re in bed for the next 2 days?
These are all common descriptions physiotherapists hear when they treat someone who suffers from headaches or migraines. They are an incredibly common problem – up to 47% of the global population suffer with headache, and an estimated 10-15% suffer with 1-year prevalence of migraine according to the World Health Organization. They also create significant socio-economic burden due to the volume of time taken off work.
Some of the most common forms of headache include cervicogenic headache, tension-type headache, and of course, migraine. Cervicogenic headaches are ones that originate from the cervical spine (neck), whilst tension-type headaches are related to muscle tension in the forehead, face and neck. Migraines are a neuro-vascular cause of headache and relates to altered activity of the brainstem and nerve tissue. They usually have unique characteristics of sensitivity to light and sound, nausea or vomiting.
Your physiotherapist will be able to diagnose your specific type of headache according to key characteristics such as;
- quality and area of pain
- severity of pain
- chronicity (length of time you’ve suffered headaches) and length of each episode
- regularity of episodes
- the presence or absence of light/sound sensitivity.
Evidence strongly supports physiotherapy intervention for all three forms of headache. In the past there has been some controversy and debate when it comes to intervention for migraine, but recent research suggests the joints, muscles and nerve tissue in the neck may have a significant role to play when it comes to migraines – indicating physiotherapy management as an option.
Medical management of migraine includes non-steroidal anti-inflammatories, corticosteroids or the migraine-specific group of medication known as the triptans. Some patients report excellent results, however, quite a few report no improvement with medication, and some even report worsening symptoms!
Another intervention that has been experimented with in recent years is botox injections into the muscles of the forehead and neck in chronic migraine sufferers, paralyzing the muscles – however research shows only “small to modest” benefit and this must be repeated every 12 weeks.
In most cases, physiotherapy alone offers an effective solution for tension headaches.
- Correct diagnosis– On your first visit, we can establish a correct diagnosis to direct the most effective care to your headache. Establishing the correct diagnosis early is imperative as several injuries have similar symptoms yet have different treatment protocols. Early treatment will be focused on reducing pain and regaining normal neck range of motion.
- Improving neck joint mobility– Using manual therapy techniques to improve upper neck joint mobility and muscle flexibility will aid your symptoms
- Improving your posture– Your headaches and migraines can be improved by improving your posture. Poor posture can lead to strain on your back and neck muscles possibly leading to headaches and migraine.
- Pillow assessment– A cervical pillow assessment can help ensure that you have the proper pillow to obtain an optimal neck position during sleeping.
- Workstation /work desk set up– Sitting incorrectly at your desk, having the computer screen at an incorrect height could be some of the leading causes of headaches and migraines
- Strengthening program– The physiotherapist will then prescribe an exercise program to improve the strength and coordination of your deep neck stabilizers and upper back muscles, which are important for preventing re-injury.
If you are someone who suffers from headache or migraine then come and see a physiotherapist for a thorough and careful assessment followed by outlining an appropriate treatment regime to manage and resolve the condition.
Full recovery after an ankle sprain.
Fast forward to spring. The snow is melting, the birds are chirping and Sue is getting ready to once again get back to hiking and soccer. This time though, she observes some odd changes. Sue notices that her ankle still feels weak and she is worried about slipping when she goes out for her long hikes. She decides not to play soccer in the spring out the fear that running on the field with opponents may result in rolling her ankle again. She even feels unstable while standing on one foot and very stiff in her ankle when having to kneel or squat.
Sue is a classic example of someone who has recovered well from the acute symptoms of an ankle sprain but has not done the proper rehabilitation to recover fully from the injury. Ongoing symptoms of stiffness, weakness and poor balance are common. If someone has been limping or using crutches for a period of time after the initial injury, general weakness in that leg is also quite common. Due to the residual ankle weakness and reduced balance, there may be an increased risk of rolling the ankle again with return to sports and activities.
A physiotherapist can help get you on track for a full recovery. During an initial assessment, a physiotherapist will ask you questions about your specific injury and assess your mobility, strength and balance. Based on the findings of the assessment and your specific goals, your physiotherapist can come up with a personalized home exercise program for you. Manual therapy, which involves hands on techniques, is also used to treat stiffness and reduced range of motion. Following a physiotherapy treatment program most people are able to safely and confidently return to their regular sports and activities.
The fact of the matter is jaw pain can be down right miserable. Talking and eating are two of our most important functions in daily life and the jaw plays a large role in both. If wrapping your teeth around a big juicy Okanagan apple has lost its sweet satisfying crunch and been replaced by pain, then seek some help.
Many structures in and around the jaw can contribute to pain. The teeth and their attachment to the jaw and skull are obvious contributors that your dentist is well equipped in managing. Infection or dysfunction within the ears, sinuses, salivary glands or lymph nodes are problems best addressed by your family doctor. However, other structures such as the jaw joint (temporomandibular joint) and associated ligaments and tendons are common contributors to jaw pain that are often left untreated. Dysfunction in the neck can also refer pain and/or dysfunction to the jaw. Another, often overlooked contributor to jaw pain, is the effects of our mental health. It is well documented that stress, anxiety, exhaustion or depression will not only effect our head and neck postures but also how the nervous system reacts to messages sent from dysfunctional tissues, such as those in and around the jaw. A sensitized nervous system can increase one’s experience of pain.
Pain is complex but treatment doesn’t have to be. An assessment by your family doctor, dentist or physiotherapist with special interest in temporomandibular dysfunction will ensure you are referred to the correct health professional for managing your problem. If the problem relates to dysfunction of the jaw joint, the first step is to address any habits outside of normal jaw function, such as teeth grinding, pen chewing or jaw clenching. A restriction in joint mobility is common, affecting your mouths ability to fully open, in which case, the sleeve (capsule) of the joint is susceptible to strain and inflammation. Clicks and pops are very common but are rarely related to the cause of your pain.
Try this – gently place your finger tips about 3cm above your temples, then clench your teeth on and off. You will feel the temporalis muscle tightening under your fingers. Now gently place your fingers 5cm directly below your temples on the sides of your jaw and clench your teeth. You will feel the masseter muscles tightening. You have just located two of the most important muscles for eating. Both the temporalis and masseter muscles and their tendons are common contributors to jaw pain that respond well to hands-on soft tissue treatment techniques. In addition, many people can relate to how these muscles might be clenched a bit tighter in times of stress and anxiety, thereby contributing to the muscles overload.
The important message is that many structures, behaviours and feelings contribute to the experience of jaw pain and effective management is best achieved through identifying all factors involved.
Nick Black is a registered Physiotherapist with an interest in temporomandibular dysfunction at Sun City Physiotherapy Winfield. He can be contacted at the new Winfield location by phone: 250-766-2544 or email:[email protected]
Have you or someone you know just welcomed a new addition to the family? If so, this article may be for you! Since the promotion of “Back to Sleep” as well as babies having to spend time in the NICU or PICU due to numerous conditions, head shape issues have been increasing. Torticollis can also be caused by trauma during birth, awkward positioning in the uterus and other conditions.
When a baby is born, the bones that make up their skull are soft and gradually overtime they begin to fuse. If during this time there is more pressure put on one side than the other, the baby’s head may start to flatten more on one side. This is called “Plagiocephaly.”. Sometimes the flattening can be severe and facial features can begin to shift as well. The most notable being a shift of the ear and forehead and an asymmetry between the baby’s cheeks and jawline. If a baby spends most of the time on their back or had to spend time in the NICU/PICU, there may be equal flattening on both sides resulting in “Braciocephaly.”
Often the first time this is brought to the family’s attention is at their 3 month check-up or vaccinations. If this has happened to you, don’t fret and stay off the internet!! Most of the time this condition results from a tightness or imbalance of strength between the babies neck muscles called the sternocleidomastoid or SCM for short. If this muscle is the culprit then the condition can also be referred to as Congenital Torticollis. Torticollis can have many different causes, some worse than others, but 80% are due to muscular issues from the SCM.
The condition is most apparent around 2-3 months or older. At this time babies are getting stronger and exploring their environment more. If you notice your baby tends to look one direction more than the other, especially when they are on their back, this may be an indication of torticollis. Often the first indication is the flattening at the back of the head.
Torticollis can be easily treated without any manipulations or medications. With gentle stretches and strengthening exercises, the baby’s neck muscles can even out and this will help with their head shape as well. It is best to see your physiotherapist before 6 months of age. This is due to the skull bones becoming increasingly fused as well as the creeping, crawling and rolling when babies begin to explore their environment.
If your healthcare provider or someone you know has brought this condition to your attention, don’t worry. Come see your physiotherapist for an assessment and treatment plan that works for you and your little one.