Tension type headache, cervicogenic headache, migraine
The three types of headache we treat are tension type, cervicogenic and migraine. This is because they are all potentially influenced or caused by problems in the joints and muscles of the neck/jaw or head. Other headaches are not within an osteopath’s scope of practice and should be assessed by a medical doctor, some of which can have very serious consequences if mis-diagnosed. Hence, it is very important to get a good assessment from someone who knows what they’re doing. A good rule of thumb is – if it is a headache you have had before and you know it’s coming from your neck, then an osteopath can probably help with some treatment. Anything else can also be assessed by an osteopath, but if there are visual disturbances, nausea, or any other type of altered sensation it is better to seek a medical doctor or hospital because it might be more serious. If a patient presents with some of these types of symptoms, careful history and assessment will determine if treatment should be offered, or if referral to a medical doctor is necessary.
Tension type headache results from excessive contraction of the muscles of the head, jaw or neck. The tension in these muscles can cause pressure in the joints of the neck or jaw and aching occurs in the muscles and joints, so soft tissue massage, dry needling and joint mobilisation can be helpful. Some people may have normally deteriorating eyesight, which can also increase the tension in these muscles, so it may be worth also seeing the optometrist if this is possible. Upper back postural issues can also be a factor, which your osteopath can also help devise solutions for.
Cervicogenic headache is a different entity because it is caused by the referred pain mechanism. The nerves of the outside of the head mainly come from the trigeminal nerve, whose origins lay in close proximity with the nuclei of the nerves that sense neck pain. Overstimulation of these nerves from neck pain can cause the head to ache as well. The muscles of the head can also react, creating a version of tension headache driven by neck pain. The actual neck pain can have numerous causes, such as degenerative changes in the joints, or muscle / ligament strain / sprain. So soft tissue techniques and joint mobilisation type treatments can be helpful. Via the same causal mechanisms, this can then reduce the headache experience.
Migraine is a difficult problem to help because it has deeper neuro / vascular causes. Some migraines cannot be helped by osteopathic approaches because of this. Others might be triggered by neck problems, and in these cases we use the term cervicogenic migraine, which osteopaths may be able to help. Other triggers include hormonal fluctuations, certain foods stress, and even smells
The term migraine is frequently misused because people use it to describe a strong headache. The problem is characterised by strong pain and visual disturbances and nausea are common. Migraine itself is generally benign, but this headache can be confused with more serious causes, so even migraine sufferers who have had them many times before need to be careful to pay appropriate attention to new and different symptoms, especially if they appear neurological.