Headache disorders are among the most common disorders of the nervous system, causing substantial ill-health to individuals and a burden on society worldwide, including enormous financial costs through lost productivity, with most of which could be largely treatable and prevented. (1)
Headache is felt, at some time, by nearly everybody, and half of the world’s adults at any one time have a recent personal experience with one or more of the three very common headache disorders (2), namely Migraine, Tension-Type Headache and Medication-Overuse Headache.
Headache disorders can be classified into primary and secondary type headache categories.
A primary type headache is a headache which is not associated with any other known pathology or that cannot be attributed to some other causative disorder. Such as Migraine, Tension-type Headache or Cluster Headache.
A secondary type headache is a headache that can be attributed to an underlying pathological condition or causative disorder. Such as Medication-Overuse Headache, Cervicogenic Headache, Infection related headache, Brain Tumour, Meningitis, etc.
Migraine is a common disabling disorder and has been ranked as the third most prevalent disorder and seventh highest specific cause of disability worldwide. (3)
Migraine most often begins at puberty and most affects those aged between 35 and 45 years of age.
It is more common in women, usually by a factor of about 2:1, because of hormonal imbalances.
Migraine is often life-long and characterised by recurring attacks, where frequency of attacks can be anywhere between once a year and once a week.
Migraine can be further categorised into two major subtypes, namely Migraine without Aura and Migraine with Aura.
Migraine without Aura. (Common migraine)
recurrent headache disorder
of moderate or severe pain intensity
attacks last 4-72 hours
at least 2 of the following characteristics:
typically one sided head pain (in 60% of sufferers)4
pulsing or throbbing
impairs daily activities
intensified by exertion/physical activity
at least 1 characteristic of:
sensitivity to light
sensitivity to noise
Migraine with Aura (Classic migraine)
recurrent headache disorder
characterised by at least 1 fully reversible aura symptom, such as:
a visual disturbance (scintillations, scotoma, fortification spectra)
a sensory disturbance (tingling, numbness or weakness in an extremity)
disrupted speech or language
other central nervous system disturbance
no aura symptom last longer than 5-60 minutes
at least 1 aura symptom is unilateral
the aura is accompanied, or followed within 60 minutes, by migraine headache.
only about 20% of migraine sufferers experience an aura.
Migraine sufferers almost certainly have a genetic predisposition, however, environmental factors play a critical role in the frequency and intensity of this disorder.
It has been observed in various studies that a migraine sufferer’s brain is fundamentally different in some aspects of its anatomy, neurochemical and electrophysiological characteristics, to that of a non-sufferer.
The pathophysiology or cause of migraine is extremely complex, however for simplification of this article, it can be said that it seems to be attributed to underlying imbalances of excitation and inhibition processing of particular cranial nerves, spinal (cervical & thoracic) nerves and neurons of the brain (cortex & midbrain).
Although there may be an inherent predisposition to migraines, environmental factors are frequently attributed to the trigger of migraine. Such triggers may include, mental stress, fatigue, alcohol, hormonal changes, sleep disturbance, food intolerance or insufficiencies, smoking, neck pain and others.
Tension-Type Headache (TTH)
Is the most common primary headache disorder. Episodic, occurring on fewer than 15 days per month, has a global prevalence of 38%. Chronic, occurring on more than 15 days per month, affects 1-3% of the adult population. Often begins during the teenage years, affecting women more than man by a factor of 3:2
Characteristics of TTH
a feeling of pressure or tightening around the head, often described as having a strong band or a vice squeezing the head.
soreness in the shoulders or neck is common.
may have migraine-like symptoms, including sensitivity to light or sound (but not both), or visual disturbances (but symptoms tend to be less severe than in migraine).
do not cause nausea and are less disabling than migraines.
episodic attacks usually last a few hours, but can persist for several days.
chronic TTH can be unremitting and are much more disabling than episodic TTH.
The pathophysiology or cause of TTH is still poorly understood, however studies suggest an associated involvement with muscular trigger points in the neck and head, together with changes in the function (circuitry) of certain central nervous system nerve pathways, as the mechanisms of action for provoking TTH.
Cluster Headache (CH)
a relatively uncommon primary headache affecting fewer than 1 in 1000 adults, more prevalent in men than women by a factor of 6:1
occurs once every 24 hours for 6-12 weeks at a time and may occur episodically or be chronic in nature.
are of severe intensity, are felt on one side of the head in the regions of the eye, around the eye or the temporal area.
can last 15-180 minutes.
evokes other symptoms such as, a runny or blocked nose, tearing and redness of the eye, facial sweating, constriction of the pupil of the eye, swelling of the eyelid or a drooping eyelid.
Cluster headache is believed to be caused by a dysfunction of the autonomic (sympathetic) part of the central nervous system.
Cervicogenic headache is relatively uncommon, however it weighs a large burden on the daily lives in individuals suffering from this type of headache.
Cervicogenic headache is understood to arise from musculoskeletal structures of the neck, in particular the vertebral joints. They are relatively common after a whiplash injury from a motor vehicle accident or some other forms of head/neck trauma.
the upper segments of the neck (C2-3) facet joints account for 70% of the cases.
the head pain is typically one sided, dull and aching and non-throbbing in nature.
pain is normally localised to the neck and back of the skull, but may project to the forehead, around the eye, temple, ear, top of the head and occasionally to the shoulder or arm of the same side of the head and neck pain.
pain is usually aggravated by specific neck movements or in particular sustained head positions.
neck and back of the head muscles feel tense/tight and abnormally tender with palpation.
Medication-Overuse Headache (MOH)
the most common secondary headache disorder.
caused by chronic and excessive use of medication to treat headache, usually migraine or tension-type headache, which over time, episodes become more frequent and so does the medication intake, reaching the stage where headache persists all day.
it may affect up to 5% of some populations, women more than men.
it occurs by definition on 15 or more days every month.
it is oppressive, persistent and often at its worst on awakening in the morning.
How do we treat your headache?
We begin with a thorough assessment of your headache history, followed by the appropriate physical examination, to best determine the headache type you may be suffering from and whether you are likely to benefit from our treatment or should you be referred on to another specialist.
If we find your headache type has an underlying musculoskeletal implication and an associated neurological dysfunction contributing to your headache, as is the case with the most common types of headaches mentioned above, then we will take you on board for treatment.
Our approach is extensive and thorough by targeting specific musculoskeletal soft tissues with deep soft tissue therapies, mobilisation/manipulation techniques and exercises.
If you find yourself with a headache that is new or just not going away and perhaps becoming more frequent and severe and you are having to take more medication or medication is no longer giving you relief, then, don’t hesitate any longer to pick up the phone and call today. Let us help you to feel the difference, without those horrible and incapacitating headaches.