In this blog, we’re going to dive into the topic of headaches. We’ll take a closer look at the types of headaches and their impact. This will involve examination of migraines, tension-type headaches and cervicogenic (related to neck tightness/pain) headaches. From here we'll look at treatment options, including physiotherapy.
TYPES OF HEADACHES
Before looking at the impact of headaches and migraines, it is worth understanding some of the different types of headache. The International Headache Society (IHS) describe a remarkably extensive list of the types of headache, so in the interest of brevity, the main categories and types will be looked at.
The IHS divides headaches into two main categories; Primary and Secondary.
1. Primary Headaches
Primary headaches generally are those not attributed directly to an underlying condition, whilst secondary headaches are caused by another disorder. The main primary headache types include; migraines, tension-type headache and cluster headaches.
Migraines are a particularly disabling subset of primary headaches which can present with or without aura. Aura involves neurological symptoms, commonly occurring for around one hour before the onset of a migraine. These symptoms can include, but are not limited to, visual disturbances such as flashing lights, blind spots, fortification spectrum (zig-zag lines appearing at points of focus) as well as dizziness, pins and needles, numbness and photophobia (sensitivity to light).
In some instances, migraines with or without aura may be associated with a premonitory period. These are a collection of symptoms, which are differentiated from auras in that they typically present hours to days before the onset of migraine. Symptoms can include fatigue, nausea, sensitivity to sound or light as well as neck tightness/pain.
Chronic migraines can also develop when headaches are experienced over 15 days per month, with at least half being migraines. Migraines can also be triggered, exist prior to, or be otherwise associated with, other types of headaches, most commonly medication overuse and cervicogenic headaches.
Tension-type headaches are a prevalent sub-set of primary headaches. These headaches are common and are divided by the IHS into episodic and chronic tension-type headaches.
Episodic tension-type headaches generally involve a ‘tightening’ or ‘pressure’ sensation of mild to moderate intensity lasting a few minutes to days. Chronic tension-type headaches present similarly, although are particularly detrimental to quality of life and disability due to their capacity to last hours to days and even constantly. The symptoms can present similarly to mild migraines (including light and sound sensitivity) making diagnosis at times challenging.
2. Secondary headaches
Secondary Headaches generally are caused by an underlying condition or disorder. These headaches can be secondary to causes such as; neck tightness, head trauma, vascular disorders, medication overuse and infections amongst many others.
Cervicogenic headaches are headaches referring from the neck. They are typically categorised by the reproduction of headache symptoms with manual pressure on areas of the neck, as well headache symptoms generally beginning from the back of the head and moving to the front. It’s most commonly caused by degenerative changes in the joints of the upper neck or muscular dysfunction of the neck and surrounding muscles. Due to the neck being the source of the headache, cervicogenic headaches are often associated with neck tightness and joint stiffness producing reduced range of motion.
PHYSIOLOGY OF HEADACHES
The underlying processes of headaches, particularly migraines, are not fully understood, however general theories revolve around the concept of a dysfunction in the processes carried out by the brainstem. The brainstem acts as a modulator of sensations the body receives, such as light, sound, smell, touch and pain. It is theorised in headaches, specifically migraines, the brainstem begins to modulate these normally harmless sensations, as sensations of pain (known as ‘allodynia’), explaining the commonly associated light and sound sensitivity.
The cause of these changes is yet to be determined, although recent studies suggest various potential contributors in a complex association between genetic and environmental factors. For example, associations have been found between migraines and changes in function of calcium channels secondary to genetic changes, acting as a potential contributing factor, as well as environmental factors, such as the association found between chronic headache onset and childhood trauma.
Impact of Headaches
Despite the uncertainty regarding the physiology of headaches, their impact is unquestionable, both at an individual and global level.
As one of the most common types of everyday pain, headaches have a significant prevalence, with studies suggesting tension-type headaches alone affecting one in ten people on a weekly basis and migraines being the second largest cause of disability worldwide. Overall, an estimated 3 billion people experienced a headache disorder in the year 2016, of which 1.89 billion experienced tension type headaches and 1.04 billion suffering migraines with an economic cost of $35.7 billion per annum in Australia alone.
At an individual level, migraine sufferers commonly experience decreased quality of life, particularly due to their association with depression. Furthermore, sleep quality is often affected, with studies finding migraines and tension-type headaches to be associated with increased sleep disturbances. Vice versa, a lack of sleep can also trigger headache symptoms promoting a vicious cycle which can present as a risk factor in the progress from episodic to chronic symptoms.
Headache management can often be quite challenging, particularly due to the limitations of the understanding of the processes behind them. For this reason, the principles of managing headaches, particularly migraines, are based around a multi-modal approach of medication, complementary therapies, lifestyle modification, and, particularly in the case of cervicogenic headaches, physiotherapy and exercise which can be guided with the assistance of a doctor, specialist and/or physiotherapist.