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Physiotherapy For Headaches

Hello friends today I will be talking about the role of Physiotherapy in Headache. Generally speaking, before I took the Mckenzie course I always thought the best way to treat any patient with headache was to refer them to a physician. However, my approach have changed a lot over the course of time, yet I still have lot to learn. So, would definitely welcome any feedbacks or querries.




What is headache?

"Headache is pain in any region of the head." - Mayoclinic.org


"Headache is the symptom of pain in the face, head, or neck." - Wikipedia


According to WHO

"It has been estimated that almost half of the adult population have had a headache at least once within the last year."


Hence, the best approach to sort weather a Headache can be cured through Physiotherapy is to first rule out its contraindication.


Rule out Serious Pathology:

First thing first, we need to rule out serious pathologies/contraindication related to headache. If a person complaints of following symptoms they are to be referred to a physician:

• Thunderclap Headache

• Severe/Initial Headache

• Headache with exertion

• Age above 50 (High chance of Stroke)

• Headache with visual change

• Headache with respiratory infection

• Nausea

• Headache with Speech or swallowing problem

• Related to systemic illness


Indication:

If a Headache is associated with following features it is highly favourable to respond to Physiotherapy.

• Intermittent in nature.

• Headache with consistent activity.

• Associated with neck pain, usually termed as Cervicogenic Headache.


Characteristic of Cervicogenic Headache.

1. Usually there will be loss of neck range of motion. Mostly, the loss will be minor.

2. Headache started with the onset of neck pain.

3. Repeated movement in one direction* causes increase in range or centralisation of pain (temporal headache will shift to occiput)


*Correct direction can be determined after thorough physical examination.


Treatment:

1. Most of the Headache which are Cervicogenic in origin responds to following movements of cervical spine;

• Repeated Retraction

• Retraction with Overpressure

• Sustained Retraction and

• Sustained Flexion with Overpressure.


2. Less frequently there are people whos Headache are triggered by end range cervical movement most commonly in one direction only. Whereas, rest of the range will be pain free. Treatment for this group requires consistent movement to end range every 2-3 waking hours. Usually, the movement will not worsen the condition.


So, if your Headache comes up while looking to the side everytime, treatment is pretty straightforward. Turning the neck to one side (usually that provokes Headache) to end range 10 repetion, every 2-3 hours. These type of Headache will take several weeks to dissipate but will seldome get worse.


3. In this group most of the individuals are employed who sustain certain position for long time. For example; computer workers looking on the screen for couple of hours. They have the tendency to blame stress, work load or sometimes other health conditions for the cause of Headache.



Typically for them, none of the movements or stretches will reduce Headache. Postural correction is the only technique which seems to help. Hence, proper postural eduation and avoidence of faulty posture is the key.


Use of lumbar roll and practicing Slouch Overcorrect (discussed in precious blog) will cure Headache.


4. Headache which falls on OTHER group such as; CONCUSSION INJURY are dealt seperately.


Conclusion:

It is preeminent to get dignosed by a qualified Physiotherapist for Headache before resorting to daily dosage of pain killers.

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