Have you ever suffered from headaches?
Have you ever suffered from headaches? Chances are yes! Indeed, headaches (or headaches) are among the most widespread and debilitating health problems…
HEADACHE = MIGRAINE?
There are many different types of headaches included in a broad, internationally recognized classification. (2) Rest assured, despite the sometimes significant pain, the vast majority of headaches are not serious. Here are some examples.
Migraine is characterized by moderate to severe throbbing pain that affects one side of the head (or both), often accompanied by nausea and/or vomiting as well as sensitivity to light or sound. An untreated migraine attack lasts between 4 hours and 3 days and makes daily activities difficult or even impossible. Other symptoms, called auras, can also appear in the hour preceding the migraine, such as visual disturbances (black spots, flashes). (3)
So keep in mind that migraine is a diagnosis that meets specific criteria. It is still frequently misused as a generic term for any headache that is often not as disabling…
2. Tension headache
Tension headache is very common. Unlike migraine, it feels like a squeeze or pressure around the head, with mild to moderate pain and not aggravated by physical activity. It may be accompanied by tenderness in the muscles of the head, face or shoulders. (4)
3. Headache or facial pain caused by damage to cranial, facial or cervical structures.
Many headaches seem to come from the cervical region, the temporomandibular joint (TMJ = jaw), a condition of the sinuses or the ears etc. For example, in the case of a cervicogenic headache (which comes from the neck), cervical mobility is reduced and causes headaches. (2)
4. Neuralgia: trigeminal and occipital
Sometimes it is the nerves in the skull or spine that are causing the symptoms. The pains occur in this case as small, brief and intense electric shocks.
Trigeminal neuralgia usually extends to one side of the face, in the cheek or jaw. Arnold’s neuralgia affects the base of the skull and can radiate from the back of the head to the top. It is often accompanied by hypersensitivity of the scalp, felt for example when brushing hair. (2)
THE DIFFERENT TREATMENTS
For any recent or unusual headache, it is recommended to see your doctor to establish a diagnosis and receive appropriate drug treatment (crisis and/or prevention). Be careful, however, with painkillers because they can aggravate symptoms when taken too frequently… and thus give rise to another type of headache. (3) If in doubt, do not hesitate to seek advice from your doctor or pharmacist.
2. Manual therapies
In the management of benign (but nevertheless debilitating) headaches, conventional medical treatment, which is not always sufficient, is increasingly combined with different non-drug approaches. Among these are psychological therapies (6), acupuncture (7) and in particular manual therapy (which includes physiotherapy, osteopathy, etc.). (8)
Recent studies support the role of osteopathy in the management of headaches. Concretely, the osteopath can act on the muscle contractures present in many patients complaining of headaches, and on the mobility of the neck and jaw. More generally, he/she will take care to treat the other areas of tension in the body relevant to each patient, to take into account their biopsychosocial context and to approach exercises or certain advice together.
Osteopathy would have a positive effect on the intensity and frequency of symptoms as well as on the quality of life of the patients concerned. The proposed mechanisms are the stimulation of the parasympathetic nervous system (which corresponds to the mode of relaxation) and the reduction of pro-inflammatory substances. (6,9,10,11) However, more high-quality studies are needed to strengthen the current evidence and there is still no consensus on the most relevant complementary approach.
Good news, headache management can start at home! During a migraine attack, here are some “tricks” to try: resting in the dark (when possible…), relaxation techniques, applying cold to the forehead or a few drops of peppermint essential oil to the temples. (12)
On the prevention side, it is advisable to have a healthy lifestyle: drink more water (13), practice regular physical activity (14 15), avoid skipping meals (16) and have a regular sleep pattern. It may also be interesting to look into certain factors that may act as a trigger for these headaches (migraines and tension headaches in particular), namely the consumption of caffeine, alcohol, but also fatigue or stress. . (17)
WHEN TO CONSULT A DOCTOR ?
The majority of headaches are not serious. It is still advisable to see your doctor:
– for any recent or unusual headache,
– if your symptoms get rapidly worse,
– if the headache is associated with a fever (in the absence of an obvious cause such as the flu)
– if you are over 50,
– during pregnancy and up to 6 weeks postpartum
– for post-traumatic headache (less than 7 days after the trauma) (5, 7)
If you have a new headache that reaches maximum intensity (pain goes from 0-10) within minutes, call an ambulance.
Apart from these last points of attention, the majority of headaches are benign. The combination of medical treatment and a non-drug approach seems promising, our physios and osteos are here to help you 😊
We care, U perform.
1. GBD 2016 Headache Collaborators (2018). Global, regional, and national burden of migraine and tension-type headache, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurology, 17(11), 954-976.
2. International Classification of Headache Disorders, 3rd Edition (ICHD-3) (2018).
3. National Institute for Health and Care Excellence (NICE) (2021). Headaches in over 12s: diagnosis and management. Clinical guideline. https://www.nice.org.uk/guidance/cg150/chapter/Recommendations
4. Roos, C. (2021). Cephalées de tension. Revue du Rhumatisme Monographies, 88(4), 324-328.
5. Do, T. P., Remmers, A., Schytz, H. W., Schankin, C., Nelson, S. E., Obermann, M., et al. (2019). Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. Neurology, 92(3), 134-144.
6. Moore, C.S., Sibbritt, D.W. & Adams, J. A. (2017). Critical review of manual therapy use for headache disorders: prevalence, profiles, motivations, communication and self-reported effectiveness. BMC Neurology 17(1), 1-11.
7. British Associtation for the Study of Headache (BASH) (2019). National headache management system for adults.
8. De Pauw, R., Dewitte, V., de Hertogh, W., Cnockaert, E., Chys, M., & Cagnie, B. (2021). Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskeletal Science and Practice, 52, 102325.
9. Cerritelli, F., Lacorte, E., Ruffini, N., & Vanacore, N. (2017). Osteopathy for primary headache patients: a systematic review. Journal of pain research, 10, 601.
10. Adragna, V., Bertino, A. S., Carano, M., Soru, A., Taranto, G., & Desideri, R. (2015). O052. Migraine without aura and osteopathic medicine, a non-pharmacological approach to pain and quality of life: open pilot study. Journal of headache and pain, 16(1), 1-3.
11. Racicki, S., Gerwin, S., DiClaudio, S., Reinmann, S., & Donaldson, M. (2013). Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. Journal of Manual & Manipulative Therapy, 21(2), 113–124.
12. Centre Belge d’Information Pharmaco-thérapeutique CBIP (2012). Fiche de transparence – Antimigraineux.
13. Khorsha, F., Mirzababaei, A., Togha, M., & Mirzaei, K. (2020). Association of drinking water and migraine headache severity. Journal of Clinical Neuroscience, 77, 81-84.
14. Lemmens J, De Pauw J, Van Soom T, et al. (2019). The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. Journal of Headache and Pain, 20(1),1-9.
15. Madsen BK, Sogaard K, Andersen LL, et al. (2018). Efficacy of strength training on tension-type headache: A randomised controlled study. Cephalalgia, 38(6):1071-80.
16. Gelfand, A. A., & Irwin, S. L. (2020). Lifestyle Advice for Pediatric Migraine: Blaming the Patient, or Evidence Based? Seminars in Neurology, 40(3), 277-285.
17. Pellegrino, A. B. W., Davis-Martin, R. E., Houle, T. T., Turner, D. P., & Smitherman, T. A. (2017). Perceived triggers of primary headache disorders: A meta-analysis. Cephalalgia, 38(6), 1188–1198.