Physical Therapy to Treat Headaches

Pain, TMD

In the US over 37 million people suffer from migraines or chronic headaches.  For many, headaches can be disabling, with chronic headache suffers being three times more likely to suffer depression as well. There is a treatment beyond medications that has been proven to help decrease the occurrence of headaches–physical therapy. Unfortunately most headache suffers have never been told about this possibility. Physical therapy including exercise, relaxation techniques and posture retraining have been shown to be as effective as many medications in decreasing the frequency of headaches.

In order to understand how physical therapy can help alleviate headache pain we must first look at the two main types of headaches.  Cervico-genic headaches, or tension headaches, are the most common type of headaches. Secondly and often more debilitating are migraine headaches.

Tension Headaches
Tension headaches are caused by referred pain from the muscles of the neck and the base of the head. Most people may know about referred pain during a heart attack, when pain is referred into the right arm. This is the same mechanism that can cause headaches when the muscles in the neck are tensioned.  Let’s take a look at what a large majority of Americans do for most of the day: sit at the computer. When we sit slumped over the computer, the muscles of the neck–mainly the upper trapezius, the sternocleidomastoid and the suboccipital muscles at the base of the skull–all become tensioned and over worked. This tension can cause pain and stiffness in the neck as well as refer pain to the head. Physical therapy can first relax the tension in the muscles with soft tissue mobilization or massage and joint mobilization which decreases acute pain. Exercises are then given to help strengthen the neck and postural muscles to allow these muscles to withstand the tensions of day to day life. Finally posture retraining and relaxation techniques can help decrease extraneous tension on these same muscles to help the patient continue to manage the symptoms after discharge from physical therapy.

Migraine Headaches
The rational for physical therapy treatment of migraine headaches is a little more complex. Migraines are a “centrally mediated” pain. This means the central nervous system is involved. We know that migraines are caused by a trigger that causes a change in the way the cranial nerve 5 or the trigeminal nerve interacts with the brain stem.  The trigeminal nerve is the same nerve that also regulates sensation to the face and is responsible for TMJ functions of biting and chewing. For this reason we know that treating TMD (temporomandibular joint dysfunction) can lessen the frequency of headaches. Furthermore, the fibers of the upper cervical spine that regulate the neck muscles meet with the trigeminal nerve in an area of the brain called the trigeminocervical nucleus. Because of this convergence of the nerves, the neck muscle dysfunction can now become a trigger of the trigeminal nerve and cause a migraine. Treating the neck as mentioned above can be very effective in alleviating the pain of a migraine and decreasing frequency of the occurrence for many sufferers.

If you suffer from migraines of chronic headaches, there may be help. Physical therapy is a very safe and cost effective treatment of headaches that might just be the answer for you.


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