Physiotherapy treatment of the neck (cervical spine) can help the vast majority of sufferers of "Primary Headaches" (where there is no specific sinister pathology causing the headache).
Most people will be aware that if their headache is clearly related to neck pain, treating the neck is likely to ease their headache. These headaches are called ‘cervicogenic” or neck related headaches. It may help to think of this head pain referred from the neck being similar to leg pain which can be referred from the back. But can physiotherapy provide relief from other debilitating type headaches (Migraine, Tension Headaches, Cluster Headaches)?
Traditionally the different headache types have been thought to have different presentations and causes which respond to different treatments. Recently it has been recognised that there is an overlap of symptoms across the different headache types, pointing to the possibility of a common cause.
Recent research has shown that sensitisation of the brainstem is a common factor in all headache types. The brainstem receives information from throughout the head and face as well as the top 3 joints of the neck (upper cervical spine). Irritation or dysfunction of structures in the upper cervical spine can sensitise the brainstem, acting like an amplifier in a stereo. This can result in fairly normal information from the head and face being interpreted as painful and resulting in a headache. This sensitisation can result in triggers seeming to cause a headache (red wine, chocolate, exercise, stress, hormones).
Treatment of dysfunction of the upper neck can “turn down the amplifier” and effectively treat all primary headaches, including migraine with or without aura, menstrual migraine, silent migraine, tension type headaches, cluster headaches and more as well as cervicogenic (neck related) headaches. There are a huge variety of auras associated with migraine, sometimes even occurring without headache. These can include visual aura (spots, flashing lights, wavy lines) loss of visual field, numbness and even weakness. Provided these symptoms don't have another cause physiotherapy treatment of the neck can also help to manage these symptoms.
Even if you have not had success with physiotherapy or other manual therapy for your neck in the past, assessment and treatment using this specific directed approach may bring you relief.
Assessment
Assessment initially involves talking with you to get a good understanding of the history and behaviour of your headache symptoms. Physical assessment focuses on the upper 3 neck joints assessing for stiffness, positional change and headache reproduction. If you have a headache, assessment will involve aiming to reduce symptoms through positioning or pressure on the joints of the upper neck. IT IS NOT NECESSARY TO BE EXPERIENCING HEADACHE OR MIGRAINE SYMPTOMS ON THE DAY OF ASSESSMENT AND TREATMENT! It is still possible to identify and treat the appropriate neck dysfunction on a headache free day.
Your posture, upper back movement and relevant strength may also be assessed.
Care is taken to identify any possibility of sinister cause of headache such as that which can follow concussion and refer appropriately.
Treatment
Treatment aims to address position changes and stiffness in the upper neck, thus reducing brainstem sensitivity, "turning down the amplifier" and reducing headache! Techniques include slow sustained pressure/mobilisation of the joints (no cracking), home exercises and posture education. Treatment can also address upper back /thoracic spine stiffness and specific muscle retraining and strengthening of the neck and upper back.
5 treatments over the initial 3 weeks are often suggested to ensure improvements are maintained and progress continues. This is reviewed and changed as appropriate over the course of treatment and can be worked around if you can’t manage that time commitment. After the initial few sessions, treatment becomes more spaced out depending on progress. There is no need for long term treatment: the aim is once symptoms have eased to continue self management.
Linda King is a Watson Headache® Certified Practitioner. She attended the 4 day Watson Headache® Institute, Level 3 Certification Headache Course titled “The Role of C1-C3 Cervical Afferents in Primary Headache”. The course was held on 27-30 March 2015, in Sydney, and presented by Dean H Watson, Australian Musculoskeletal Physiotherapist. The course comprised 40 hours and was based on the Watson Headache® Approach, a protocol for the skilled assessment and management of the upper cervical spine in headache and migraine conditions. The Watson Headache® Approach is recognised as a scientifically researched method of examination and treatment.
"My interest in headache treatment began when I attended my 1st course with the Watson Headache® Institute in 2011. I was looking for further skills in treating the upper neck and confidence in identifying headaches with sinister causes.
I learnt all that, but the most exciting thing was finding the incredible difference that treating the neck can bring to peoples whose lives are affected by severe headaches. I have also recently attended a course in management of the vestibular system to assist with management of dizziness, which is also a frequent symptom of headache".