Headaches, for those of us who are unfortunate enough to have experienced them, can be debilitating experiences.

The skill in treating headaches starts with an accurate diagnosis. Broadly speaking, headaches fit into the following categories:

1. Migraines: Totally debilitating and accompanied by aura such as perceived flashing lights, blurred vision and light sensitivity. Migraines are essentially a vascular issue and with the correct medication can be very effectively managed. Certain stimuli such as caffeine or hormonal fluctuations may also contribute to the onset of a migraine episode.
2. Tension-type headaches: Caused by excessive muscle tension of the neck and shoulder muscles.
3. TMJ headaches: Headaches caused by excessive spasm or pain originating from the jaw-joint (tempero-mandibular joint).
4. Headaches related to pathology of the upper neck vertebra and the corresponding upper neck joints – for example after a whiplash accident, or with osteo-arthritic changes of the spine.
5. Dehydration headaches – all you hard-core athletes out there!
6. Concussion: Please ensure you are medically examined post concussion injuries.
7. More serious pathology which we are trained to flag and refer onward for further investigation. On that note, if you have a sudden onset of a first ever extremely severe headache, seek immediate medical attention.

Mostly however, chronic headache sufferers tend to have combinations of 1, 2, 3 and 4.

So where do we, your physiotherapists, come into the picture? Well, we can’t solve your migraines, but we can help you to effectively manage tension-type headaches, TMJ headaches and headaches related to the upper neck joints and spine.

We use a variety of techniques to decrease your pain, such as mobilisation of your upper neck joints and jaw joints, manipulation of these joints, soft tissue massage, dry needling, mobilisation of your nerve system, traction and electrotherapy modalities.

Most importantly, once your pain levels have stabilised, we will progress to preventing recurrences of your condition. This includes:

• Taping to correct postural issues (often bad habits that we are not even aware of!).
• Exercises: Stretching or strengthening depending on your problematic areas.
• Ergonomics: What is your desk and chair set-up like at work? Does your sports car’s bucket seat make you slouch when you drive?
• Lifestyle management: Hugely important, as stress is a significant factor which often contributes to headaches. As your therapists, we aim to find out what will help you relax – often exercise is actually a way to effectively reduce muscle spasm. As we exercise, our circulatory system pumps blood around our bodies. The nutrients and oxygen carried in our blood provides tight and stiff muscles (actually unhealthy muscles) with the ‘antidote’ they require in order to recover and soften. If we explore exercise as a pain reliever on a chemical level, exercise causes our brains to release endorphins which actually inhibit painful stimuli, therefore causing muscles to relax. A simple solution!
• Medication: We will often liaise with your GP’s in order to ensure that you have the correct medicinal options at hand should you feel the onset of a headache/migraine. At times, chronic medication may be recommended if you have developed a chronic pain cycle.

In summary, there are many, many elements involved which we must address in order to ensure the most effective management possible, and often a team approach ensures the best results.