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When is a headache, not a headache?

Most of us have suffered from a headache at some point in our lives. Most will resolve. But for many, regular bouts of a headache are a recurring and potentially disabling part of life. At the very least a headache disrupts your activity and your enjoyment of life. Even more frustrating is that all headaches are not the same, and in fact, there are multiple causes and diagnoses of a headache, all requiring a different approach to management. It is possible that one headache sufferer may have more than one source of a headache, making diagnosis and management all the more challenging.

One thing that is certain – headaches are common.

Migraine and tension-type headaches are the most prevalent headache disorders and, both with disabling potential, they have the greatest impact on public health; according to the Australian Bureau of Statistics there are up to three million migraine sufferers (10% – 15% of the population as at June 2001). 23% of households contain at least one migraine sufferer. There are up to seven million tension-type headache sufferers (36% for men and 42% for women). These most common headache types require medical management.

One type of headache – “Cervicogenic headache” – can be managed by a trained physiotherapist. The prevalence of a cervicogenic headache ranges from 1- 2.5% in the general population and up to 17.5% amongst severe headache sufferers .This common type of headache is characterised by its pattern:

  • Pain starts with pain in the neck or base of the skull;
  • Pain may have followed a trauma to the neck or following sustained or repeated (poor) postures;
  • Pain can be excruciating and is usually felt in any or all of the following; behind the eyes, the temples the top of the head and the base of the skull;
  • It can be on both sides of the head at once;
  • The pain can resolve on one side but remain on the other, but never swaps side during a headache episode; and
  • There may be other features including shoulder pain or upper limb symptoms.

Cervicogenic headache sufferers have often been given diagnoses such as a migraine or sinus infection, or a tension-type headache owing to some overlap in the symptoms; however, the possibility of a cervicogenic headache has been overlooked.

The reason why this type of a headache occurs owes to the complex way in which the brain processes nerve impulses from the upper part of the neck and the head. Simply put, owing to the amount of brain space given to processing input from the front of the face and the senses therein, and the amount and type of sensory information going to the brain from the upper part of the neck – the brain concludes that the pain is from the head not from the neck.

A trained physiotherapist will be able to assess your neck and confirm if it is a source of a headache. The goal of management is to not only confirm the neck as a source of pain but also reduce the pain, using manual (hands-on) techniques such as:

  • Joint mobilisation and stretching;
  • Massage;
  • Dry needling; and
  • Most importantly your therapist will give you appropriate exercises so as to prevent its return, and establish appropriate self – management strategies to keep you as headache-free as possible.

If you see yourself in the picture described above, why not make an appointment to see an OPSMC physiotherapist specialising in the management of headaches?

To learn more about Gary Cairnduff visit

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