Headache & Migraine: Physiotherapy Management

Is that pain in your head really a pain in the neck? Do you suffer from persistent headaches when sitting at your desk at work? Or does your headache come on when there is added stress in your life? Maybe when you get a migraine you’re in bed for the next 2 days?

These are all common descriptions physiotherapists hear when they treat someone who suffers from headaches or migraines. They are an incredibly common problem – up to 47% of the global population suffer with headache, and an estimated 10-15% suffer with 1-year prevalence of migraine according to the World Health Organization. They also create significant socio-economic burden due to the volume of time taken off work.

Some of the most common forms of headache include cervicogenic headache, tension-type headache, and of course, migraine. Cervicogenic headaches are ones that originate from the cervical spine (neck), whilst tension-type headaches are related to muscle tension in the forehead, face and neck. Migraines are a neuro-vascular cause of headache and relates to altered activity of the brainstem and nerve tissue. They usually have unique characteristics of sensitivity to light and sound, nausea or vomiting.

Your physiotherapist will be able to diagnose your specific type of headache according to key characteristics such as;

quality and area of pain
severity of pain
chronicity (length of time you’ve suffered headaches) and length of each episode
regularity of episodes
the presence or absence of light/sound sensitivity.

Evidence strongly supports physiotherapy intervention for all three forms of headache. In the past there has been some controversy and debate when it comes to intervention for migraine, but recent research suggests the joints, muscles and nerve tissue in the neck may have a significant role to play when it comes to migraines – indicating physiotherapy management as an option.

Medical management of migraine includes non-steroidal anti-inflammatories, corticosteroids or the migraine-specific group of medication known as the triptans. Some patients report excellent results, however, quite a few report no improvement with medication, and some even report worsening symptoms!

Another intervention that has been experimented with in recent years is botox injections into the muscles of the forehead and neck in chronic migraine sufferers, paralyzing the muscles – however research shows only “small to modest” benefit and this must be repeated every 12 weeks.

In most cases, physiotherapy alone offers an effective solution for tension headaches.

Correct diagnosis– On your first visit, we can establish a correct diagnosis to direct the most effective care to your headache. Establishing the correct diagnosis early is imperative as several injuries have similar symptoms yet have different treatment protocols. Early treatment will be focused on reducing pain and regaining normal neck range of motion.
Improving neck joint mobility– Using manual therapy techniques to improve upper neck joint mobility and muscle flexibility will aid your symptoms
Improving your posture– Your headaches and migraines can be improved by improving your posture. Poor posture can lead to strain on your back and neck muscles possibly leading to headaches and migraine.
Pillow assessment– A cervical pillow assessment can help ensure that you have the proper pillow to obtain an optimal neck position during sleeping.
Workstation /work desk set up– Sitting incorrectly at your desk, having the computer screen at an incorrect height could be some of the leading causes of headaches and migraines
Strengthening program– The physiotherapist will then prescribe an exercise program to improve the strength and coordination of your deep neck stabilizers and upper back muscles, which are important for preventing re-injury.

If you are someone who suffers from headache or migraine then come and see a physiotherapist for a thorough and careful assessment followed by outlining an appropriate treatment regime to manage and resolve the condition.

Sun City Physiotherapy Locations

TMJ Dysfunction Part 2

TMJ / Jaw

Argh! You woke up with another headache, and your teeth hurt from clenching yesterday at work, as you just met another stressful deadline. As you massage your temples and face, which actually feels relieving, your significant other tells you about your loud teeth grinding last night. As you look in the mirror while brushing your teeth, you are always intrigued by how your jaw “wiggles” side to side when you open your mouth. It’s done that for years but hasn’t created any other problems to your jaw function. Sound familiar? You are presenting with Myofascial Pain Dysfunction (MPD) of the Temporomandibular Joint, the TMJ.

The TMJ is the ball and socket joint that connects the Mandible (jaw bone) and the Temporal bone (one of the bones of your skull). It’s the small joint located in front of your ear. There is a cartilage cushion in between the ball and socket, referred to as the Disc. The disc is supported by special Ligaments, which keep the disc in place. Movement problems of the disc can be responsible for creating many symptoms in the TMJ, such as clicking, crepitations, locking, muscle spasm, and pain. There are several muscles which support and control movements of the TMJ. Symptoms can often be related to these muscles. These include temporal pain, headaches, muscle spams, tinnitus and ear pain, and even teeth pain.

TMJ Disorder/Dysfunction, or TMJD/TMD, is seen more commonly in women than men. There is a 3:1 incidence in females to males, and can include one or both jaw joints. In most instances, the dysfunction is a result of an imbalance or change in the normal function of the bones, ligaments, muscles, disc, or nerve components of the TMJ complex.

MPD can be due to various causes of increased muscle tension and spasm. In some instances, MPD can be a physical manifestation of psychological stress. Often, there is no disorder of the joint itself. There is often a history of facial pain and temporal headaches, secondary to Nocturnal (night time) jaw clenching and Bruxism (teeth grinding). Dental issues may have influenced symptoms over time. This might have lead to the use of a nighttime splint. There may also be ear pain, fullness, or tinnitus. Erratic movement patterns of the jaw during opening and closing are related to lack of neuromuscular control, which requires re-education through physical therapy.

The TMJ specific muscles involved in MPD are the Temporalis and Masseter. The temporalis is a fan-shaped muscle that fills the temporal space, and inserts onto the mandible. Its function is to raise the mandible to close your jaw. The masseter is a thick and strong muscle attached at your cheekbone and runs to the angle of the mandible. Its function is to also raise the mandible to close your jaw. Try this: clench your teeth several times and press your fingers firmly on your temples; now on your cheeks. Did you feel tenderness? Aching? Maybe even a sensation like a toothache? WHAT IS THE SIGNIFICANCE? These muscles become subjected to fatigue and overuse with prolonged and persistent clenching and bruxism, which leads to MPD symptoms. It’s like these muscles are running a marathon without rest, everyday!

Proper assessment, diagnosis, and successful treatment rely on a skilled physical therapy practitioner, with expertise in TMJ management. Treatment of MPD is focused on desensitizing muscles through hands-on mobilization, restoration of normal functional movement pattern through exercise, and providing education regarding prognosis and self applied maintenance. Treatment may also include other muscle re-education techniques such as Intramuscular Stimulation (IMS). We look at other mechanical influences such as neck disorder and posture, to assist in maximizing treatment management. At times, we often work with your oral practitioner (dentist, orthodontist, oral surgeon), and other practitioners who deal with behavioural modification, to optimize results.

Vince Cunanan is a TMJ Specialist and registered physiotherapist and associate at Sun City Physiotherapy Downtown Kelowna. He can be contacted at downtown@suncityphysiotherapy.com.