01 Mar Does a Physio Have a Role In Headache Resolution
Headache and the Cervical Spine
Headaches appear in many forms and affect people from all walks of life. 300 different types of headache have been classified, resulting in one of the greatest number of differential diagnosis in medicine.
Until recently, treatment has largely relied on medication to relieve the debilitating symptoms. These symptoms can range from the annoying (background discomfort, poor concentration and irritability associated with some tension headaches) to the very severe (nausea, dizziness, depression and sensitivity to light and noise associated with migraine).
The common onset, distribution and course of the many different varieties of headaches mean that they cannot be considered in isolation. One area of headache influence and particular interest to physiotherapists is the neck, or cervical spine- the cervicogenic headache.
Contained within the first three vertebrae of the neck is a major nerve centre that interprets information from the local joints and muscles as well as the sensory nerves from the head and face – The Trigeminocervical Nucleus.
This means that any factor that influences the upper neck vertebrae can potentially result in a headache. Influencing factors include fatigue of supporting muscles, poor work posture, arthritis, and trauma such as whiplash sustained in motor vehicle accidents.
Physiotherapists recognise that the role of cervicogenic dysfunction is often underestimated and indeed ignored in the management of headache and migraine. What is important to us is that all who are affected by headache and migraine have access to a skilled assessment of their upper neck so that relevant disorders are identified – so that headache or migraine is not a life sentence.
Assessment by a physiotherapist can determine whether the neck is influencing the headache. If it is involved, appropriate treatment can result in relief from symptoms and may totally resolve the pain of chronic headache sufferers.
According to the International Headache Society the key diagnostic feature of Cervicogenic Headache is temporary reproduction of usual head pain when examining the upper neck. However reproduction alone does not confirm neck involvement.
It is possible under certain circumstances, to reproduce the pain of headache when examining the upper neck and it is not the source of headache or migraine. Dean Watson has developed the Watson Headache Approach™ over the past 22 years. This approach has evolved from his experience of more than 22,000 hours with over 7,500 headache and migraine sufferers.
At Noosa Sports & Spinal Physiotherapy some of our Physiotherapists have been trained in the Watson Headache Approach™ – a method of examining the small movements of the top three spinal segments – to firstly determine cervicogenic headache and secondly treat the cause of the headache.
- If a headache or migraine is coming from a spinal disorder it will be from one or more of the top three spinal segments and it is usually stiffness orloss of function.
- The fundamental and most powerful feature of the Watson Headache Approach is the reproduction and resolution of usual head pain and/or associated symptoms when examining movements of the upper three spinal segments.
- Reproduction and resolution of usual head pain and/or associated symptoms confirms a neck disorder as the source of headache-migraine condition. This is a crucial step as it takes the guesswork out of whether treatment can be recommended.
- This diagnostic accuracy is unparalleled in manual therapy and significantly improves the chances of a successful outcome because treatment can be directed at the appropriate segments.
- Treatment involves reproducing the pain or symptoms by gently stressing the affected segment and sustaining this pressure until there is a complete reduction or plateau in symptoms.
- These treatments are unique to the Watson Headache Approach™.
The Watson Headache Approach™ does not involve manipulation of the vertebrae – it is a sustained technique of mobilising the stiff or affected segments C °-³.
Recent and substantial research has shown that migraine, tension headache, cluster headache, menstrual migraine all share a common disorder and that disorder is a sensitised brainstem.
This suggests that perhaps the many different types of headache and migraine are not separate conditions, but just different expressions of a sensitised brainstem.
Most migraineurs occasionally tolerate a lesser headache resembling a tension headache whilst some troubled by tension headache can experience a more severe headache similar to a migraine, reinforcing the idea that headache and migraine conditions are born from the same disorder and research suggests that this disorder is sensitised brainstem.
One indisputable neuro anatomical fact is that the brainstem is influenced by information from structures – ligaments, capsules, joints – of the upper neck. Therefore abnormal information from disorders of these structures has the potential to sensitise the brainstem.
Research by Dean Watson has demonstrated that reproduction and lessening of usual head pain desensitises the brainstem. This is how the ‘Triptans’ (the heavy duty anti migraine medication) aborts a migraine attack – they desensitise the brainstem.
Given that the underlying disorder in headachemigraine is a sensitised brainstem, undoubtedly it is more powerful to identify the reason for the sensitisation of the brainstem and eliminate it. Physiotherapy using the Watson Technique decreases the sensitisation of the brainstem in the long term – thus helping chronic headache sufferers gain resolution of their symptoms.
Currently the Watson Headache Approach™ is the only manual therapy approach which has been shown to desensitise the brainstem – the fundamental disorder in headache and migraine conditions.
The Watson Headache Approach™ has been taught internationally for over 15 years and is now practised in over 22 countries. This approach is recognised for its unrivalled accuracy and is unparalleled in the assessment and management of relevant neck disorders of the upper neck in headache and migraine.
The Watson Headache Approach is a not only a non invasive, inexpensive, and radiation free method of confirming disorders of the upper neck as the reason for sensitisation of the brainstem but also provides a drug free treatment approach for long term improvement.
At Noosa Sports & Spinal Physiotherapy Our Physios are trained to safely and effectively examine the upper cervical spine in headache and migraine syndromes using specific techniques mobilising the affected segments.
Treatment may also include massage of tight muscles, stretching and neck strengthening exercises, as well as postural correction and advice. These techniques have proven very successful for many long term sufferers. All HNA Physiotherapists are highly skilled in assessing and diagnosing Cervicogenic Headaches and Migraines.
We offer a complete solution to your patients’ affected by headache including treatment, postural correction and specific rehabilitation.
Please contact Noosa Sports & Spinal Physiotherapy Centre for further information on our services.
Information compiled by HNA Physiotherapist Kelly J Woosnam and The Watson Headache Institution. References available on Request.