Headache

There are many types of headache, below are just three that can often be helped with physiotherapy:

• Cervicogenic headache means literally “headache which originates from the neck”. This is a condition which many people experience. It may arise from the joints or the muscles of the neck/shoulder and upper back, but is most often from the upper three vertebral levels of the neck. It may be related to an injury, such as whiplash, or due to poor postural alignment. Examples of bad posture include sitting slouched over the iPad, cycling long distances, or having the head turned to read documents beside the computer.
• Migraines are particularly disabling, in that sufferers may be unable to function normally during one. There is sometimes a neck or “cervical” component to migraine, along with hormonal, genetic and/or environmental factors.
• Tension or Stress headaches are often from the muscles of the neck which are “on” more than they should be for periods of time. This may be due to a tendency to “grip” with neck and shoulder muscles during times of stress.

The neck (cervical spine) is made up of vertebrae (bones) which are connected to each other by discs and facet joints. During certain movements or sustained postures force can be placed on the joints, muscles and nerves in the neck, giving rise to neck pain and headache. Any of the structures of the top three vertebrae (i.e., joints, muscles, ligaments and nerves) can refer pain into the head. You may not even have neck pain, but the headache can still be from the neck.

If there is every indication that your headaches are coming from your neck (cervicogenic), there is no need to rush to have an MRI of your brain. If you, your doctor or your physio have any concerns about you not responding to physiotherapy treatment, then such imaging is something that might be considered.

The aim of physiotherapy treatment is to free up tight muscles/joints of the neck and upper back, so that movement is as normal as possible. There are many ways to do this, and physiotherapy may include any or all of the following: postural education, exercises to promote flexibility and neck muscle strength, massage, gentle mobilisation of the joints of the neck (at Macquarie Street Physiotherapy we do not use forceful manipulation), dry needling, and core exercises. (Why core exercises? Core exercises are important, as they teach you to use your trunk muscles to hold you up, instead of your neck muscles).

If you have headaches that start in the night or are there when you wake up, you may need to look at your pillow. Ideally it keeps your head and neck in a neutral position, so not too high or low. Most adult necks do not like prone (tummy) sleeping, and hence lead to headache.

Next time you feel that “tension” or “afternoon” headache starting, consider that it might actually be arising from your neck. Take a look at your posture, and consider how long you have been sitting for. Maybe it’s time to get up and walk around. Try to avoid prolonged turning (e.g., talking to a friend on the bus) or tipping the head (e.g., a phone to the ear). If you read on the train, keep the book/tablet/phone up at eye level not on your lap. Keeping the upper back flexible helps, as does generally keeping fit and mobile.  If you are still experiencing headaches and you live or work near the Sydney City CBD please call Macquarie Street Physiotherapy on 02 9221 1604 to make an appointment.