Types of headaches
- Vascular: migraine and cluster headaches
- Tension: muscular contraction
- Cervicogenic: referred from neck structures
- Pressure: inflammatory: tumour, infection
- Cranial neuralgia: facial pain: trigeminal neuralgia, temporal mandibular joint/muscular pain (TMJ)
- Psychotic pain: delusional explanation of pain ie “feels like worms crawling”.
- Eye strain and sinus problems can also cause headaches along with dehydration.
What headache have I got?
Diagnosis is the difficult part and I guess the main reason for not responding to treatment or medication. Cervicogenic headache pain is usually one sided referred from muscles or joints of the neck but neck pain and shoulder tension is also a common symptom of migraine sufferers. It is however thought that tension -type and cervicogenic headache suffers have more myo-fascial involvement than migraine sufferers. Headaches due to eye-strain is also a common diagnosis but if the headache occurs in the morning it is unlikely to be due to eye-strain, more likely if the headache is during or after a days work.
What an Osteopath will do?
An osteopath will ask many questions, some of which you may think irrelevant but this is necessary for both your safety as a patient and for the osteopath to decide whether it is treatable osteopathically or if further examinations are required by your GP or a specialist. You are likely to be asked, when it started, location of pain, if there is a daily pattern, what kind of pain and how severe, duration of the headache, is it seconds, hours, days, is there a trigger or does a particular movement aggravate it, do you have visual changes or any fever, sore throat or a stiff neck.
Some tests and an examination will follow the questioning, active and passive movements of the neck and spine, possibly blood pressure and a neurological examination if felt necessary. Treatment will begin once the osteopath is happy that your headache has a musculo-skeletal component and no red flags. Red flags are more worrying symptoms that may accompany the headache that would require referral to a GP, specialist or although uncommon to A&E, such as severe pain/worst ever headache or a rash and neck stiffness.
This type of headache are chronic and one sided referred to the head from bony or soft tissue structures of the neck. Trigger points are hyper-irritable regions of contracted muscle which have a reduced pain threshold and refer pain in predictable patterns. Trigger points in the upper shoulders, between the shoulder blades and sub occipital muscles refer pain to the head up on finger pressure.
Trials have show that a combination of manual therapy, such as osteopathy alongside an exercise programme led to long-term control of these tension-type headaches. In 2004 it was shown by Bronfort that manual manipulation treatment was as effective, short term for chronic headaches, as prescribed drugs such as amitriptyline, but with much fewer side effects .
Osteopaths may use many techniques to help ease headaches, from manipulation of the neck and upper spine joints to gentle soft tissue massage ,dry needling /trigger point therapy and acupuncture. some stretching exercises may be given with advice on posture correction and possibly discuss an exercise regime.
Read more about headache here…Colgan Osteopath in Kettering Northamptonshire
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