Headache classification

Headaches are classified into various groups, the most common being:

• Headaches originating from the cervical spine (cervicogenic)
• Headaches originating from the muscles in the neck (tension)
• Headaches originating from the vascular system/ blood vessels in the brain (migraine & cluster headaches)

Cervicogenic headaches

• Pain usually originates from the neck and the headaches are felt at the base of the neck, usually on one side
• Headaches can refer around the eye or to the temple area
• Felt as a dull aching, pain at the back of the neck
• Patients of ten wake up with headache that gets worse throughout the day
• Often associated with neck stiffness and headache could be aggravated by neck movement
• Pain could be aggravated by sustained postures e.g. sitting in front of the laptop

Tension headaches

• Most common type of headache
• Tight, pressure tight pain across the forehead and like a band on the sides and back of the head
• Tenderness of the scalp, neck and shoulder muscles
• Headaches may last for a few minutes up to a few hours
• Headaches usually not aggravated by exercise

Cluster headaches

• Severe headaches on the side of the head, usually over one eye
• Often described as a pain which “bores” into the head
• Headache is usually accompanied with autonomic symptoms such as: eye watering, nasal congestion and swelling around the eye
• Headaches typically last between 15-180 minutes
• Cluster headaches may have a genetic or hormonal component and may be linked to certain triggers e.g. environmental or smoking

Migraine

• Throbbing, pulsating type headache which can be aggravated by movement
• Usually present over one side of the head over the front/ side of the head
• Migraines can last anywhere from 4-72 hours
• Associated with Aura- nausea, dizziness, double vision, sensitivity to light, slurred speech

The cause is not clear. A theory is that the blood vessels in parts of the brain become narrower which cause the aura. The blood vessels were then thought to dilate soon afterwards, which caused the severe headache.  It is also thought that chemicals in the brain increase in activity and parts of the brain may then send out confusing signals which cause the symptoms. The cause of these changes in brain chemicals are not known. However, something may trigger a change in activity of some brain chemicals to set off a migraine attack. These triggers could be postural, environmental, and psychological or diet related.

Physiotherapy treatment is aimed finding the source of the headache, whether it is posture related, muscular or due to joint stiffness. Treatment usually includes mobilisations, dry needling or stretches to the associated stiff joints and tight muscles involved, as well as exercises and postural re-education to minimise further strain on the upper neck. Most patients will have a full recovery of their symptoms with the appropriate physiotherapy treatment.