Understanding Headaches: Cervicogenic, Tension, and Migraine.
How Physiotherapy Can Help?
Cervicogenic Headache (CEH)
Cervicogenic headache (CEH) is a type of headache originating from the cervical spine (neck) and is often triggered by neck movements or sustained postures. It is classified as a secondary headache, meaning it arises from an underlying issue rather than being a primary headache disorder like migraines.
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Symptoms
Cervicogenic headache typically presents as a one-sided headache that originates from the neck and radiates toward the head. The pain often worsens with neck movement or prolonged poor posture. Patients may also experience neck stiffness, reduced range of motion, shoulder discomfort, dizziness, or even nausea in some cases.
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Diagnosis
Diagnosis is primarily clinical, based on history and physical examination. Restricted neck movement, tenderness over the cervical joints, and weakness in the deep neck flexor muscles are common findings. Imaging such as MRI or CT scans may be used to rule out other causes. A diagnostic nerve block targeting the cervical nerves is considered the gold standard for confirmation.
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Treatment
Treatment for cervicogenic headaches involves a multidisciplinary approach, with physiotherapy being a cornerstone. Physiotherapy includes manual therapy, strengthening exercises, and posture correction to reduce pain and restore function. Modalities such as heat or cold therapy may also be used for pain relief. Medications, including pain relievers, muscle relaxants, and nerve blockers, are often prescribed to manage symptoms. In some cases, injections like nerve blocks can provide significant, longer-lasting relief. Surgery is reserved for severe cases involving cervical degeneration or radiculopathy. Combining these treatments provides effective management of cervicogenic headaches.
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Migraine
Migraine is a neurological disorder characterized by recurrent, severe headaches often accompanied by nausea, vomiting, and heightened sensitivity to light and sound. The pain is typically unilateral (on one side of the head) and pulsating, with episodes lasting from 4 to 72 hours. Migraine is believed to be caused by abnormal brain activity that affects nerve signals, blood vessels, and brain chemicals.
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Symptoms
The symptoms of migraine include a pulsating headache, often unilateral, that ranges from moderate to severe in intensity. Other common symptoms include nausea, vomiting, photophobia (sensitivity to light), phonophobia (sensitivity to sound), and, in some cases, visual disturbances (aura). The headache is usually aggravated by physical activity, such as walking or climbing stairs.
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Diagnosis
The diagnosis of migraine is based on a detailed medical history and the patient's symptom pattern. To diagnose migraine, a person must have at least five episodes of headache lasting from 4 to 72 hours and meeting the following criteria: unilateral location, pulsating quality, and severity aggravated by physical activity. At least one of the following must also be present during the headache: nausea, vomiting, photophobia, or phonophobia. The symptoms should not be better explained by another condition.
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Treatment
Treatment of migraines includes both acute and preventive approaches. Acute treatments often involve medications such as triptans (e.g., sumatriptan) and NSAIDs to relieve pain and nausea. For frequent migraines, preventive medications such as beta-blockers, anticonvulsants, or antidepressants may be prescribed. Physiotherapy techniques, such as manual therapy and relaxation exercises, can help alleviate muscle tension that may trigger migraines. Lifestyle changes, including managing stress, maintaining a regular sleep schedule, and avoiding known triggers, also play a significant role in treatment.
Tension-Type Headache (TTH)
Tension-type headache (TTH) is the most common form of headache, typically caused by stress, anxiety, or muscle tension in the neck and head. It is characterized by bilateral, dull, and constant pain, described as a pressing or tightening sensation. TTH can last from 30 minutes to 24 hours and is not aggravated by physical activity, unlike migraines.
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Symptoms
Symptoms of TTH include bilateral pain with a pressing or tightening quality. The pain is generally mild to moderate in intensity and is not aggravated by routine physical activities. Some individuals may experience mild nausea, but it does not typically involve the more severe symptoms seen in migraines, such as vomiting or sensitivity to light and sound. In chronic cases, the headache may occur frequently, up to 15 or more days a month.
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Diagnosis
Diagnosis is based on the patient's history and the characteristics of the headache. For episodic TTH, there must be at least 10 headache episodes per year lasting between 30 minutes and 7 days, with bilateral pain and a non-pulsating quality. The headache should not be aggravated by physical activity, and there should be no significant nausea or vomiting. Chronic TTH is diagnosed when headaches occur on 15 or more days per month for more than 3 months.
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Treatment
Treatment for TTH includes medications such as NSAIDs for acute pain relief. For chronic TTH, medications like muscle relaxants or low-dose antidepressants (e.g., amitriptyline) may be prescribed. Physiotherapy is an essential part of treatment, focusing on reducing muscle tension in the neck and shoulders through manual therapy, postural correction, and relaxation exercises. Stress management, maintaining good posture, staying hydrated, and regular physical activity also contribute to preventing TTH.
References
J.A. Cady et al., Cervicogenic Headache: Current Perspectives, Neurology, 2021, https://journals.lww.com/neur/fulltext/2021/69001/cervicogenic_headache__current_perspectives.24.aspx.
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Darmawan, J, Antono, S, Budhiarta, AA, & Noer, MS. 'WHO-ILAR COPCORD: A global perspective of musculoskeletal pain from the community', Rheumatology (Oxford), vol. 58, no. 1, 2019, pp. 1–3. Available from: https://pubmed.ncbi.nlm.nih.gov/30785242/.
