Recurrent headaches and migraines are a very common condition that people live with for years without finding a way to effectively cure or manage them. The World Health Organisation state that 31% of all migraine sufferers have never seen a doctor regarding them and it is thought that they are underestimated, under-recognised and undertreated throughout the world. For those that do seek medical help, they are often given strong medications with many side effects that do little to control them.
What are headaches and migraines?
Although similar in nature, there is a great difference between headaches and migraines.
The most common type of headache are tension headaches. These are diffuse, unspecific headaches that radiate throughout whole of the head. They tend to have a band-like quality and patients often use the word “pressure” to describe them. Often they are worse on one side of head and are mild to moderate intensity.
Slightly rarer are cluster headaches. These are recurrent, severe in intensity and sufferers often describe them as sharp or “knife-like”. They are sometimes also accompanied by eye watering, nasal congestion and swelling around the eye. They are also much more common in males than females by a ratio of 6:1
Migraines are similar to headaches in that they cause severe pain in the head. But differ in that they also have associated symptoms including nausea and/or vomiting, sensitivity to light, sensitivity to noise and visual disturbances known as aura. Aura can present in many ways including blind spots, loss of vision in one eye, flashing lights and dark spots. In addition, sufferers can also experience numbness, weakness, impairment of speech and vertigo (severe dizziness). All of these symptoms are completely reversible and reside when the migraine attack ceases which can be anywhere between a few minutes and up to a few days.
What causes them?
Although no one still truly understands the exact reason for headaches and migraines occurring it is widely accepted that they can be caused by dysfunction in the neck, also known as the cervical spine. The upper two vertebrae in the neck, known as C1 and C2, refer pain up into the back of the head and over into the forehead. If these joints become irritated or stiff, they release noxious chemicals which aggravate the nerve roots situated close by which sends too many messages down the nerve leading to pain. Commonly (but not always!) neck pain is also present with headaches and migraines. This can sometimes causes pain and tightness in the shoulders and send pain down one or both arms.
There is normally something that can prompt the start of the migraine or headache, known as a trigger. These are different between people and no one knows why these triggers cause them. These include things like caffeine, cheese, chocolate, looking at the computer screen too long, watching too much television or sitting or standing with poor posture for extended periods. One of the best way to manage headaches and migraines is to work out what triggers it and avoid it as much as possible, although this often takes a fair bit of trial and error!
Interestingly, research has found that there is a strong correlation between traumatic birth deliveries and headaches and migraines later on in life, however they can start even as early as 18 months. It is thought that great stress is placed on the neck during a difficult birth, especially if it is a forceps delivery, which causes problems with C1 and C2 as described above, leading to headaches and migraines. Similarly, trauma to the neck either through a fall or incidents such as a car accident can also cause them. Headache-sufferers often do not recognise this correlation and that their migraines started after soon after such an incident.
Another cause of headaches, more so than migraines, is overuse of painkilling medications. This could be to treat the headache itself or to treat something else entirely that is painful. People with medication overuse headaches tend to wake up in the morning with a headache that gets better throughout the day. They may also feel very tired and almost hungover first thing in the morning.
This is normally due to taking too much opioid-base painkillers such as tramadol, codeine or cocodamol. It is advisable to not take these for headaches themselves as they actually fuel the headache! Anti-inflammatories such as ibuprofen or low level painkillers such as paracetamol don’t usually cause these sorts of headaches.
What to look out for and be aware of?
Rarely, there are other more serious causes of headaches which it is important to know about and be able to rule out.
If the headache comes on immediately, also known as thunderclap headache, it can sometimes be a sign of a stroke or a bleed in the brain. There will also be other symptoms such as weakness down one side and a loss of control of speech. Emergency medical attention should be sought if a stroke is suspected.
If the headache is constant, unremitting and unrelenting, then it should also be investigated by a doctor with blood tests and CT scan if possible. This is due to the remote possibility of a tumour being the cause of the headache or migraine. Other associated symptoms include weight loss and a general feeling of malaise.
Finally, headaches with symptoms of meningitis should also be investigated immediately. These symptoms include severe joint stiffness, muscle ache throughout the body, pale blotchy skin with spots or a rash, drowsiness and vomiting. These symptoms can be quite similar in nature to severe migraine and so it is important to differentiate between the two.
Can something be done about them?
Here in the clinic, all of our physiotherapists are trained in the Nelson Headache Approach. A treatment protocol devised by Rebecca Nelson, a world-leading headache and migraine specialist physiotherapist based in Belfast, Northern Ireland. This approach involves the patient lying face-down on the treatment bed with the physiotherapist performing passive mobilisations of C1 and C2. The intention is to reduce stiffness at these joints with the aim of reducing irritation of the nearby nerve roots that are causing the headache or migraine.
Her approach has been shown to be extremely effective in completely clearing thousands of people’s headaches and migraines which is why we chose her course for all of our physiotherapists to complete and offer the same treatment here at our clinic.
If you are unfortunate enough to suffer with headaches and migraines, call us on 01279414959 to book in with one of physiotherapists for an initial assessment and treatment.