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Treating Your Headaches – Specificity Matters

Headaches come in many shapes and sizes. Being precise and being targeted matters if your goal is to nip your headaches in the bud instead of having to rely on the Tylenol or Excedrin everyday.

Treating headaches doesn't have to be complicated

People often feel that their only options for headaches are to simply deal with it or to rely on medications to make things manageable. The reality is that headaches can be complex, but being thorough in assessing lifestyle habits and personal history, as well as doing a thorough physical exam, can go a long way in identifying the primary driver of your headaches. Don't get us wrong – the evidence does support that certain types of headaches (e.g., certain types of migraine) respond favorably to medication. Ultimately, though, if you are tired of dealing with your headaches and don't want to have to rely on medications and their associated side effects, many types of headaches can be managed with other means.

Things to keep in mind with headaches

Not everyone's headaches are the same. If your lamp won't turn on in your living room, you can try to change the bulb. It might work – you might have light. Problem solved... Until it's not. If one bulb change doesn't work, you might try a second new bulb, but I'd bet you're not going to pop a third lightbulb in that lamp. Maybe a light switch controlling the outlet got turned off. Maybe the breaker switch flipped off. We routinely see people come to us with headaches that have just been changing the lightbulb (i.e., taking an OTC medication that kind of-sort of helps a little bit for a couple of hours) for months (or longer!). Headaches come in many shapes and forms and can be caused and influenced by a number of different anatomic structures and physiologic processes. Thus, treating headaches needs to be targeted. In this post, we're going to dive into a couple of types of headaches we commonly see and talk about what we do to get the light back on (or in other words, what specific things we do for treatment).

Identifying the cause – different type of headaches

Again, headaches themselves can be complex – if you need proof, check out the table of contents (below) from a fairly recent International Headache Society paper outlining the types of

headache. However, a good history – getting to understand you and your normal life, activities, etc. – coupled with a thorough physical exam can often indicate what seems to be the primary cause of your headache. Identifying "the thing" makes treating it much easier. Further, seeing a qualified professional can help to screen for the more concerning, more sinister etiologies of headache (like the mention of vascular-related headaches). Some of the common types of headache that we see in the clinic and can often help get well managed quickly include:

*Cervicogenic headaches, or headaches from the upper neck

*Tension-type headache

*Concussion-related (trauma-related) headache

Treatments for headaches

Some of the common types of headaches that we see that are often best managed by seeing a physical therapist include tension-type headaches and cervicogenic headaches (i.e., headaches stemming from the upper cervical spine). While exercise, for both of these types, is well supported by the research, the type of exercise is very important. For example, with headaches derived from stiffness or irritation of the upper neck are likely to incorporate specific mobilization-based exercise to target the upper neck, whereas tension-type headaches are likely to incorporate upper back/base-of-neck mobility exercise with a bigger focus on muscle conditioning and endurance.

Perhaps as importantly, manual, or hands-on, mobilization and manipulation treatments have been shown to be effective with managing the symptoms associated with these types of headaches. Again, specificity is key. For tension-type headaches, manual treatments may include some combination of non-thrust mobilization and thrust manipulation of the thoracic spine (i.e., upper back) and lower neck; soft tissue mobilization (e.g., dry needling, manual soft tissue mobilization, etc.) of the upper traps, levator scapulae, and the deep paraspinal musculature of the upper back and neck regions appear helpful in managing symptoms. On the other hand, management for cervicogenic headaches looks quite different – we often perform a combination of non-thrust mobilization and manipulation of the upper neck and may include soft tissue mobilization to include dry needling of the suboccipital muscles and upper cervical paraspinal muscle groups.

If headaches are something you've dealt with and want help with, let us know! Check out our website to learn more and to get in contact with us.



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