Headaches are very common in the general population and often will spontaneously resolve. However, many times, headaches become chronic or recurring causing missed workdays, missed school days, and difficulty concentrating. Two thirds of the population will have headaches at some time.
Headaches can have a number of causes. A small number will be vascular in nature, and the rest are given a number of different diagnoses and may be related to depression, fatigue, tension, dehydration, nutrition, or cervical problems. Common causes of headache pain are dysfunction of the cervical spine, trigeminal neuralgia, temporalmandibular joint dysfunction (TMJ), and craniovertebral dysfunction (that area where the head sits on top of the spine). Pain or injury of the structures in the neck can cause muscle tension and induce headache. Also increased muscle tension in the neck can aggravate existing problems in the neck such as arthritis, degenerative joint disease, or degenerative disc disease. Headache, again, can result with this increased muscle tension. I have also treated individuals who suffer from severe headaches and who have been diagnosed with nerve pain. These diagnoses would include neuralgias and radiculopathies.
Recently, I had the opportunity to help a patient with trigeminal neuralgia. He told me he was advised to undergo extensive testing and possibly aggressive treatment but wanted to try physical therapy first. His family doctor was in agreement and within a few weeks of physical therapy, he noticed a significant decrease in the frequency and intensity of his symptoms. He continued to progress and his pain has been reduced from intense pain (10/10, 10 being severe) on a daily basis to very infrequent and relatively mild pain (0/10 most of the time but two bouts of 3/10 pain in the past six weeks). His words were “this therapy has been a God send.” I include his story because he told me he wished he could let others with similar problems know how his condition has been improved with treatment.
Biomechanical dysfunction of the joints in the neck, the jaw (TMJ), or the base of the skull can also lead to headache. Limitation of motion or injury to these joints can cause pain in the joint, increased muscle tension in the area, or irritation of a nearby nerve; all of which can result in headache. Injury or irritation of the surrounding soft tissue can result in dysfunction in these joints or can, in and of themselves, lead to headache. Also, postural dysfunction is a common cause of headache. This is a common cause in persons with poor posture and especially in young people during their growing years when posture is more of an issue. Forward head posture, rounded shoulders, and a rounded back cause increased cervical extension, placing additional stress at the base of the skull and on the muscles around the TMJ. Additionally, trigger points in the upper back and neck region can lead to headache.
As you can see, a headache can have multiple causes. A thorough evaluation by your health care practitioner should be done to determine the specific cause and rule out very serious causes such as tumor or aneurysm. When the cause is determined to be musculoskeletal in nature, physical therapy is a very effective and conservative approach in resolving your symptoms. Your physical therapist can thoroughly evaluate your condition and discuss with you the best approach to resolve your symptoms. Improving joint mechanics, resolving increased soft tissue tightness, improving posture and postural strength, and decreasing nerve compression and irritation will help to decrease headaches of musculoskeletal origin with good long-term results. Your physical therapist may use spinal manipulation, joint mobilization, soft tissue mobilization, therapeutic exercise, and other treatments to help improve posture, joint mechanics, and muscle tightness. Your physical therapist will also work with you on postural dysfunction and assess your daily activities to discover any contributing factors (such as computer use or poor lighting).