Headache is a collective term for all the pain we feel from the back of our head to our forehead. These complaints can be accompanied by neck pain, shoulder pain, dizziness , nausea and even light or audio shyness.
Some people experience headaches and neck pain when standing up, while others experience them after a long day of working in front of a computer. Within manual therapy there is a specialized branch that deals with the investigation and treatment of headaches, dizziness and tinnitus complaints.
Significant progress has been made in recent years in identifying different types of headaches as well as treating them. Three common types of headaches that can be treated by the manual therapist are migraine, tension headache and cervicogenic headache.
Headache is a very frequent complaint, with an average annual prevalence of around 50% worldwide, making it the most common neurological disorder.
Because this complaint most often occurs in the most productive phase of life, the impact of headaches on quality of life is significant.
Vinding et al. (2007) Siberstein (2004) Stovner et al. (2007)
Headaches are, despite their common occurrence, a rather vague complaint. However, as mentioned before, we can distinguish between several different types. The following section briefly discusses four common headache types.
Migraine is a neurovascular disease. This means that the cause of the migraine lies in the brain.
Tension headaches are a common type of headache in Western society. It is characterized by the onset of headaches just after a busy period, for example after a busy working day or at the end of the week after a busy week.
This type of headache is due to increased muscle tone of the neck and shoulder muscles.
The literal translation is “headache through the neck”. This type of headache is accompanied by neck complaints in which the neck is the cause of the headache complaints. Research shows that >60% of headache sufferers also have complaints in the neck region. This type of headache is common after trauma (fall or accident) in the history.
Medication overuse headache
This type of headache is a substance-induced headache. we can get these when
Multiple headache forms
You can have up to three types of headaches
During the interview, all characteristics are discussed with the patient and usually the patient also recognizes the different forms of headache
For example, migraine often occurs with a kind of tension headache
Patients with headaches seek refuge in a variety of treatments, which usually consist of medication, physiotherapy, stress management or acupuncture.
However, there is no strong evidence that these treatments are effective on their own. We know that for headache complaints, whatever form, the treatment is different for each patient. It is therefore recommended that headaches are treated multimodally. Recent research shows that manual therapy on top of conventional treatment is a good addition with proven effectiveness.
Manual therapeutic approach to headache complaints.
Within manual therapy there is a branch that is concerned with the research and treatment of headaches, dizziness and tinnitus complaints. Over the last few years there has been a significant evolution in the identification and treatment of different types of headaches.
In manual therapy, it is rationalized that neck pain is often present in headache patients (> 60%) and associated with pericranial tenderness in adults with migraine or tension headache. We also know that an incorrect position of the head in relation to the body and a reduced strength of the deep neck muscles play a major role in the maintenance of headache complaints.
Manual therapy can lead to a decrease in frequency and influence of headache complaints on activities and participation both in the short term and after 26 weeks (Castien et al. 2011). In addition, exercise therapy targeting the deep neck muscles has been shown to be beneficial.
The headache treatment at the manual therapist consists of finding out the headache type, looking for disorders in the neck/shoulder region that may be related to the headache symptoms. Provide information on possible triggers for the development of headaches and then map out an individual therapy trajectory. This is done by means of an extensive interview and physical examination.
The conclusion is that headache treatments should be multimodal. Manual therapy has proven effectiveness but will always be optimal in combination with other therapy. The manual therapist can refer the patient to the appropriate health professional if necessary.
René Castien, DAWN van der windt: Effectiveness of manual therapy in chronic muscle tension headache. 2011. General Practitioner Act 4(5): 244-7.
Stovner Li, Hagen K: The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia 2007; 27(3): 193-210. review.
Silberstein SD. Migraine. Lancet. 2004; 363(9406): 381-91. Review
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disroders, 3th edition (Beta version). cephalalgia. 2013; 33(9): 629-808. dog:10.1177/0333102413485658.