Headache

Headache is listed as the third most common chronic pain disorder in the Western World.

As such, an in depth of knowledge and understanding of the different forms of headache is essential to;

• Diagnose benign headache subtype (primary headaches)
• Exclude pathological headache (secondary headaches)
• Educate patients about primary headache aetiology
• Manage the symptoms AND underlying causes using the latest evidence-based strategies

To exclude pathological headache in any patient, the focus should start with five pertinent questions;

1. Have you had headache symptoms in the past?
2. Are there any other new symptoms? Changes in vision, sensation, balance or strength?
3. Are the headaches worse with; bending forward or coughing?
4. Has there been a change is character, frequency, or severity?
5. Has there been a change in your mood, personality, memory or thinking ability?

Intracranial masses and vascular pathologies are the two most concerning causes of pathological headache in patients who might seek management from a Chiropractor. These patients are outside the scope of chiropractic management and should be referred to their primary General Practitioner immediately.

Tension headache and migraine headaches are the most prevalent primary headaches that will present to a Chiropractor, making up 38% and 10% of presentations respectively. Understanding the key clinical features of each headache will help differentiate between the two.

Attributes of Tension headache:

• Mild to moderate severity
• Pressing or tightening sensation
• Commonly bilateral
• Not worse with exertion
• No nausea and/or vomiting

Attributes of Migraine headache:

• Last for 4 to 72 hours in duration
• Unilateral or bilateral head pain
• Pulsing or throbbing sensation
• Exacerbated by exertion
• Nausea and/or vomiting
• Photophobia and/or phonophobia
• May have aura symptoms; visual changes, sensory and/or speech changes.

How can Chiropractic management help?

Given the large influence  neck dysfunction has on headache sufferers due to its close proximity to the head, management should be focused on:

1. Patient education; understanding the aetiology and implementing a prevention rather than cure strategy
2. Identifying and correcting dysfunctional cervical movement; via a targeted manual approach (soft tissue therapy, focal muscle compression, joint mobilisation and spinal manipulation)
3. Strengthening and maintaining improvements via patient specific home exercises (deep neck flexor activation exercises, sensorimotor control exercises, and joint position sense exercises.)