What exactly is a headache, what symptoms are associated with it, and what causes it?
A very simplified definition of a headache is pain that occurs in the head or face. However, that is the only simple aspect of headaches. There are different types of headaches, and their symptoms vary widely in intensity, duration, location, and frequency. The brain itself has no pain-sensitive nerves, but the surrounding structures, such as the face, skull, jaw, and neck, certainly do.
Headaches are generally classified into two types:
Important fact: People with primary headaches often endure their pain unnecessarily for long periods, assuming it is something they just have to live with.
Below, we discuss the three most common types of headaches where physiotherapy can play a role in treatment:
The most well-known type of headache is likely migraine, which falls under primary headaches. In the Netherlands, around 280,000 people are diagnosed with migraine by their general practitioner. Migraine is more common in women than men, with the highest prevalence among 40 to 54-year-olds.
A defining characteristic of migraine is that the headache occurs on only one side of the head. It is also associated with severe sensitivity to light, sound, and smell. On a pain scale of 0-10, migraine is often rated 7 or 8. Many people also experience nausea and vomiting.
A migraine attack lasts between 4 and 72 hours and typically consists of four phases (though not all phases occur in every individual):
To diagnose migraine, specific criteria must be met to ensure clear communication between healthcare providers, such as general practitioners, neurologists, and physiotherapists. A migraine attack must occur at least five times to be classified as migraine. More details can be found on the ICHD-3 website: https://ichd-3.org/1-migraine/
What can you do yourself?
The most important aspect of managing migraine is identifying your triggers. These could include certain activities, sleep patterns, foods, drinks, or hormonal fluctuations.
How can a physiotherapist help?
A physiotherapist can help identify physical triggers, such as tension in the neck and shoulders. Training can sometimes reduce the frequency and even the intensity of migraine attacks. Additionally, studies show that better physical fitness leads to faster recovery after a migraine episode.
Another very common form of headache is tension-type headache (TTH). This is also a primary headache and is the most frequently occurring type. TTH is often linked to muscle tension or stress, but other factors such as sleep, physical activity, diet, jaw/neck issues, and posture also play a role.
A key characteristic of TTH is a slow onset of headache, often described as a tight band around the head or pain originating from the neck or back of the head. The pain occurs on both sides of the head but can be stronger on one side. The intensity, duration, location, and frequency of TTH can vary, which is why there are subcategories within the diagnosis.
TTH is diagnosed using ICHD-3 criteria. Physiotherapists often use palpation techniques to identify trigger points in the jaw, neck, and shoulder muscles. When pressing on these muscles, a localized pain may occur, which then spreads to the forehead or causes the characteristic “band-like” headache. More details can be found at: https://ichd-3.org/2-tension-type-headache/
What can you do yourself?
Although the exact cause of tension-type headache is unknown, it is likely related to muscle tension and an overactive central nervous system. Certain triggers can increase or decrease headache frequency:
As described above, tension headaches are mainly associated with muscle tension. This muscle tension can be reduced, often through treatments such as trigger point therapy or dry needling. However, for long-term results, more is needed. In this case, the therapist can assist with mobilization techniques in combination with exercise therapy.
For the diagnosis of cervicogenic headache, good communication between the general practitioner and the physiotherapist is always necessary. The physiotherapeutic examination for cervicogenic headache will primarily focus on assessing the neck. This includes evaluating the maximum range of neck rotation, strength tests for the neck muscles, and coordination of the neck muscles. Of course, the assessment takes into account the individual’s load-bearing capacity following a trauma. Source: ICHD-3
What can you do yourself?
Cervicogenic headache that arises after a trauma or whiplash is a sign that you haven’t fully recovered yet, so the most important thing is to set and communicate your boundaries — even if there are no visible symptoms.
How can the physiotherapist help you?
In treatment following a trauma, the main focus is on improving the mobility (also known as range of motion), coordination, and stability of the neck. This is achieved through a combination of mobilizations/manipulations, exercise therapy, and reducing muscle tension.
