Every year, 17% of women and 14% of men present themselves to a doctor or family practitioner looking for relief from headaches. Practitioners seeking to offer maximum, long-term relief to their patients can include headache treatment intervention strategies by referring a patient to a physical therapist. A skilled physical therapist can provide an assessment of the patient’s condition and develop a plan of care. An assessment will typically consist of posture evaluation, range of motion evaluation of the spine, jaw and shoulders and a neurologic exam.
The next component will consist of the physical therapist performing a manual examination. This will consist of palpating muscles during passive movement to identify abnormal patterns of movement or “snags & nags”. This manual examination by the physical therapist can also identify hypermobility indicating over-stretched muscles, weakness, and/or damaged connective tissues. Palpation can also serve to assess trigger points, muscle spasms and hypertonicity. Some other tests that the physical therapist may perform include orthopedic tests. These specialized tests are used to assess referred pain and to isolate problematic joints, nerve roots and dysfunctional muscle patterns.
Once the physical therapist has ruled out diseases such as vascular disorders, infection, metabolic disorders or substance abuse, the remaining cases often present with a biomechanical component. Various studies have demonstrated that biomechanical lesions of the cervical spine and/or shoulder can result in referred pain subjectively experienced in the anterior or posterior cranial muscles. In addition, doctors have connected myofascial conditions of the head, neck and shoulders such as triggerpoints, hypertonicity, and spasms with stress headaches, cluster headaches and migraines. Under chronic stress and/or poor posture, muscles can become adaptively shortened or lengthened and predispose patients for recurring headaches. Studies have repeatedly demonstrated that physical therapy effectively manages certain types of headaches. The positive results and outcome provided by a physical therapist usually last long after therapy and/or when medication has been discontinued.
The indications for referral to a physical therapist:
Headache pain not responsive to medical management.
Trigger points in the cervical, cranial, or shoulder muscles.
Spasm or hypertonicity in muscles of the head, neck or shoulders.
Reduced active range of motion in the cervical spine, shoulders or jaw (TMJ).
Complaints of myofascial pain associated with headaches. (In some cases, the myofascial discomfort is secondary to a migraine. Even in these case, a physical therapist can help because the myofascial dysfunction can cyclically worsen the migraine).
Poor posture (especially rounded shoulders, anterior head carriage, and slouch).
Pain described as a tight band around the head.
A history of neck trauma such as whiplash.
Headaches brought on by movement.
Headaches worsened by movement.
Radicular arm pain.
If you are experiencing chronic headaches or muscle tension consult your primary health care provider. Seek out a physical therapist who specializes in the use of manual therapy techniques for evaluation and therapeutic intervention. Consider daily walking and enrolling in progressive swimming 1-2 times per week. Most physical therapists will be able to resolve your headaches utilizing, targeted progressive exercises (strengthening & stretching), mobilization, manipulation and/or cervical traction. The use of postural re-education, frequency specific microcurrent or electrical stimulation can also be extremely beneficial. The use of breathing exercises for pain/stress management may also be included. A home exercise plan and independent pain management program will also be included. The use of ergonomic teaching will also be incorporated for work place strategies. Finally there may be therapeutic equipment recommendations such as cervical pillows, resistance exercise bands and home traction devices.
Gary J. Maguire, PT