All posts in Headaches

Neck pain with Headaches

Neck pain with Headaches

Headaches are experienced by most of the population at some point in their lives. For most they are minor and fleeting, and for others they pose an ongoing problem, having complex underlying causes. Types of headaches vary greatly and determining their root cause can be difficult. Having a greater understanding of how these types of head pain are categorised, can at least provide a starting point for minimising the impact headaches have on daily life.

Headache classification

One thing that is certain for all headaches, is that the pain is not felt from the brain. The brain receives pain signals from the nervous system, yet it is one organ of the body that does not have pain receptors. Rather it is the interactions between blood vessels and surrounding nerves in the structures in the head, neck or elsewhere, that send pain signals to the brain, which make a headache felt.

These pain sensations come in a variety of styles, so classifying types of headache is important in determining the appropriate treatment. There are two main categories of headaches, those being primary and secondary. The most common headaches are primary where the headache is the cause of the pain, as opposed to a secondary headache where there is an underlying medical condition.
Infection such as meningitis or a brain bleed due to trauma are examples life threatening secondary headaches. They can also derive from less severe conditions, for example medication overuse and issues relating to the structures of the head, such as the sinus region. Conditions of the head, neck, and even the the stomach or intestines, that are inflammation, trauma, illness or disease related, may also cause headaches.

As one of the most common ailments we experience, the symptoms and pain experienced will vary greatly. Although types of headaches are classified into groups, this is only a rough guide. There is much crossover regarding symptoms between one category and another, which makes headaches difficult to diagnose. This is where some deductive reasoning comes into play in differentiating one type of headache from another, especially considering there are over two hundred documented types of headaches.

Main types of headache

Tension, migraine or cluster are the main types of primary headaches. Migranes can be very debilitating, and often are accompanied by other symptoms such as nausea, vomiting and are often only felt on one side of the head. They can also be accompanied by an aura, which is a visual disturbance such as seeing sparkles or dots. There may also be feelings of anxiety, sensitivity to light or sensations that effect the limbs or stomach.

Unlike a migraine where these sensations can forewarn the onset of a headache, the cluster comes on suddenly, yet departs as quickly as it arrived. As they are one of the most painful headaches, it is fortunate that they are not as common. The name for this type of headache derives from them appearing as a cluster of short but intense pain, that occur in cycles over a period of a few weeks or months.
These characteristics help differentiate between a migraine, cluster and the most common of all headaches, which relates to tension. A tension headache is less severe and often caused by muscle contraction in the head and neck region. It presents as a tightness or pressure across the forehead, like a tight strap, with pain described as a dull ache. A sensitivity to loud noises, muscles aches on the side or back of the head, or even tenderness when touching the scalp, neck or shoulders, can be other indicators of this type of headache.

Developing tension headaches can be due to stress, anxiety or strain on the muscles over a long period of time, such as staring at a computer screen, especially one that has not been ergonomically positioned. Sitting for extended periods, lack of sleep, poor eating habits or chronic stress can all contribute to tension headaches.

Cervicogenic Headaches

So neck strain is one of many sources of a primary type tension headache. Yet the neck can also be the source of referred pain from a type of secondary headache, known as cervicogenic headaches, with ‘cervicogenic’ meaning originating from the neck. This upper most section of the spinal cord, known medically as the cervical spine, also involves the connected muscle, tendon and nerve structures that surround the neck and head region.

As cervicogenic headaches can refer pain to the head rather than being felt in the neck, it can sometimes times be hard to differentiate them from other types of secondary headaches. The names of these secondary headaches are prolific, but often have descriptors preceding the word ‘headache’ that indicate the root cause, for example ‘caffeine’, ‘pregnancy’ or ‘medication overuse’. For other types of secondary headaches, determining less obvious causes is something that can be assisted with the help of both the patient, and the health professionals involved.

Head pain and deductive reasoning

Sometimes the headaches we experience can be explained by a simple cause and effect. Overindulging in wine, staring at a screen for too long or lacking hydration are all self apparent causes for a basic headache. Then in hindsight, avoiding these triggers can then be the best prevention.
Some causes though will require a little more detective work, and a diary can be very helpful for when the headache is evaluated in a consultation. This record should contain a history of the headaches, with a date, a start and finish time, along with any other symptoms that accompany the pain, such as a fever, an upset stomach or the location of muscular aches. A description of the type of pain, such as ‘throbbing’ or ‘sharp’ can be added, as well as the pain severity on a scale of one to ten, ten being to the point of being incapacitated.

Further detail can be added to the diary such as foods or liquids consumed, including medication or supplements being taken. Quality of sleep, physical or emotional stressors at home or work, daily activities and conversely time spent at a desk inactive, are also important in pinpointing any potential triggers.

Even with these records, primary headaches are more difficult to tackle compared to secondary headaches, as determining the root cause of migraines and cluster headaches is often unclear. However when a headache is due to tension or referred pain from bone or soft tissue of the neck, physiotherapy treatment can offer some assistance.

Headaches relating to physiotherapy

Determining whether a headache is originating from the neck region, may or may not be obvious as symptoms for each type of headache overlap. For example a tension headache and a cervicogenic headache can both be accompanied by pain in the scalp, neck and shoulders.

How a headache differs may help in its diagnosis as to which type of headache is being experienced. For example a cervicogenic headache may be felt at the back of the head, the top of the skull, forehead, temple or behind the eye, as opposed to a tension headache where a band like pressure is felt across the forehead, back or sides of the head.

Unlike a tension headache a direct connection with the neck may not be experienced with a cervicogenic headache, instead there may be feelings of dizziness, nausea or poor concentration. Either of these headaches could start or be increased in severity by head movement or a prolonged posture, and a reduced range of motion of the neck may also be an indicator.

The underlying cause of a cervicogenic headache can either be a problem with the vertebrae immediately below the skull or the soft tissues of the neck. It could also be due to a strain or injury, and even long term conditions such as degenerative disc disease of the neck’s vertebrae.

To make matters more complex, what appears to be a cervicogenic headache, may in fact be occipital neuralgia. This is when the nerves that run from the top of the spinal cord and up through the scalp, become inflamed or damaged. Regardless of the type of headache, a physical examination provides a starting point from which further investigation may involve X-rays, scans and imaging to provide a clearer view of the neck’s structures. If nerve pain is experienced as part of the headache, a nerve block injection may be organised where appropriate, to help diagnose the cause and treat the condition.

Treatment of neck related headaches

Any neck treatment is a delicate matter because of the complexity of its structure. The vertebrae of spine at this point are smaller than those lower down the back, and so support of the head relies on a complex layering of muscles. Muscles closest to the spine are shorter, typically connecting one bone of the spine to another, while further away from the spine, muscles are generally broader and longer, spanning more joints and connecting more parts of the body. As such any of these can be injured as can the connective tissues, such as ligaments and tendons. Further to this the cartilage that assists in the smooth action of the neck can degenerate, as can the joints through arthritis which can lead to headaches and neck pain.

The complex interaction of nerves and bone joints at the junction of the upper spine and skull provides multiple points of potential injury as well. Nerve compression can cause inflammation and pain, whilst the upper spinal vertebrae are susceptible to compression and movement injuries such as bone spurs or a bulged disc, that can in turn impinge nerves. Thankfully nerve pain from the spine can be mapped, as general areas of the skin are mostly supplied by a specific nerve, that can be traced back to its root in a spinal segment. For example the second and third vertebrae of the cervical spine cover the areas or ‘dermatomes’ on the back half of the head. So head pain felt in these areas may provide an indicator to damage within the second or third vertebrae.

With physiotherapy, an assessment can help differentiate which type of headache is being experienced, and where appropriate, treatment can be very effective in managing headaches of a neck related origin. A physiotherapist can assess the joints of your neck, associated muscle and nerve structures, to identify any abnormalities. Along with the diary, any previous trauma to the neck region, such as whiplash, can also be taken into consideration.

Treatments

Depending on the specific presentation and symptoms of neck related headaches, physiotherapy management may include joint or soft tissue mobilisation and exercise. Joint mobilisation can be used to help unlock or loosen stiff vertebrae, whilst dry needling, massage and the prescription of strengthening exercises can address tight or weak muscles, and restore stability to the neck area. A physiotherapist can also look at posture and general ergonomic improvements, as these can have a significant impact on headache development and its recurrence.

Ongoing management can involve postural advice and correction, which could include an ergonomic assessment or general advice regarding the setup of your work place. To compliment the hands on therapy and exercise prescription provided by a physiotherapist, stress and tension management may also include assistance in seeking out relaxation techniques or taking up classes such as yoga, that incorporate meditation.

Short term Flare ups

For short term flare ups a hot or cold pack can be used until your next appointment. The use of over the counter pain medication should be in moderation, for example less than three days a week, and preferably after advice from your physiotherapist or doctor. Too much medication can cause what is known as a ‘rebound headache’. This is where medication is taken to cope with the head pain, that reappears after an analgesic or painkiller used for a headache, wears off. So paradoxically the headache is the result of withdrawal from the very drug, that is supposed to stop the head pain.

Ultimately treatment for a headache should lead to self management through understanding of the stressors that initiate a headache. Broader lifestyle changes such as a balanced diet, regular sleep and exercise can also have a positive influence of the recurrence, duration and intensity of a headache, be that neck related or otherwise.

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Neck Pain Victoria – Text Neck?

Neck Pain Victoria – Text Neck?

Are our devices giving us neck pain?

There are millions of people right now looking down at their smartphone or tablet. Do you ever stop to think about what this might be doing to your neck and upper back?

At Saanich Physiotherapy and Sports Clinic, we are seeing a huge increase in the amount of neck, upper back, shoulder and arm pain which is all related to posture when using devices. From texting on the smartphone to watching TV on the tablet in bed, we are all guilty in some way. And sadly, we are seeing more and more children coming in with these issues too.

Consider how much your head actually weighs. On average, it weighs 4.5-5kg. When sitting or standing upright, this weight is supported by the lower neck vertebrae, intervertebral discs, muscles and ligaments. When you then lean your head forward when looking at your smartphone, the relative weight of your head on your neck muscles can increase up to 27kg! Just by looking down at your phone, you can increase the force on your lower neck by 5 times!

When maintaining this position for a period of time, the muscles will fatigue and stop working, meaning that the force of your head is now being held up by small ligaments, the neck joints and the discs in the neck. It is no wonder people are having more and more neck pain.

The term “Text Neck” is becoming more commonly accepted as a diagnosis for neck pain caused by prolonged use of smartphones and tablets. If left untreated, this massive increase in force in the lower neck and lead to headaches, increased arching of the spine, general pain and tightness and arm pain from irritating nerves in the neck. It can also cause weakening of the muscles in the neck which can lead to ongoing pain, stiffness, headaches or arm pain in the future.

With the increase in children having smartphones and even the use of tablets in school, there are becoming more and more postural issues arising which is definitely a concern for ongoing and long term neck and upper back problems later in life.

Text Neck can be treated. Your Physiotherapist may use joint mobilizations, soft tissue massage, taping or even dry needling to help restore normal movement within the joints and muscles.

However, it is imperative that you strengthen the muscles in the neck and upper back to prevent long term issues. Your Physiotherapist will tailor a program for you to complete at home or might even recommend core conditioning or yoga classes for a supervised strengthening program.

If you, your children or another family member or friend are guilty of using their smartphone or tablet too much and are noticing pain or discomfort in their neck, upper back or arm make sure you book an assessment with your Physiotherapist sooner rather than later!

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Vestibular Rehabilitation

Vestibular Rehabilitation

By Vanessa Service, Physiotherapist

What does my vestibular system do?

Your vestibular system’s job is to process sensory information that is required to control balance and eye movements. This means that information from the inner ear, the visual system, and from the muscles and joints is analysed by the brain. Integrating this information allows you to1:

– Maintain clear sight while you move your head,

– Figure out the orientation of your head in space in relation to gravity,

– Identify how fast and in which direction your are moving, and

– Make fast and automatic adjustments to your posture so you can maintain balance (stay in your desired position).

In other words, your vestibular system coordinates your movement with your balance, allowing you to navigate through and adapt to the world. It is this process that allows you to walk down the sidewalk, to step off a curb, to sit down and stand up again and to turn your head while walking. Anytime your head moves through space you’re depending on your vestibular system.

What are vestibular disorders and what are the symptoms?

If the vestibular system encounters disease or injury, such as a viral infection or head trauma, the result may be a vestibular disorder. However, aging, some medications, and genetic or environmental factors may also cause vestibular conditions.

Symptoms of damage to the vestibular system may include:

– Vertigo (a sense of the world spinning around you)

– Dizziness (feeling lightheaded or floating/rocking in space)

– Imbalance and special disorientation (stumbling, staggering, drifting to one side while walking)

– Difficulty with changes in walking surfaces

– Tinnitus (ringing or buzzing in the ears)

– Discomfort in busy visual environments (such as the grocery store) or when looking at screens/television

Examples of vestibular disorders include:

  • Benign paroxysmal positional vertigo or BPPV (a common condition where loose debris or “crystals” collect in a part of the inner ear)
  • Vestibular neuritis or labyrinthitis.
  • Migraine associated vertigo
  • Concussion
  • Endolymphatic hydrops
  • Acoustic neuroma
  • Meniere’s disease

How can a vestibular physiotherapist help?

The effect of a vestibular condition on a person’s life can be profound. Dizziness and balance problems are often a barrier to activities of daily living, to independence, and to engaging with the community. This negative impact on daily function and socialization may also contribute to anxiety and depression. As such, appropriate management of vestibular conditions is an essential component to improving quality of life for individuals and families affected by vestibular disorders.

A vestibular therapist will interview you about the history of your symptoms and perform a series of vestibular, balance, and visual tests. Treatment will depend on what is found in the assessment. For example, if you are diagnosed with BPPV, your therapist will perform a manoeuvre to reposition the associated crystals. Other vestibular disorders are treated with specific exercises and strategies that your vestibular therapist will teach you and help you progress through to reach your specific goals.

Although for most people a vestibular disorder is permanent, an exercise based plan can be designed to reduce dizziness, vertigo, and balance and gaze stability problems1. This is made possible by your brain’s incredible ability to adapt its other systems in order to effectively compensate for an improperly functioning vestibular system. Vestibular rehabilitation is a non-invasive and drug free intervention that helps to promote and maximize the amount of compensation that occurs. Current research supports the use of vestibular rehabilitation in the management of vestibular conditions2, demonstrating reduced dizziness, balance issues, and increased independence with regard to activities of daily living 3. Additionally, no adverse effects associated with vestibular rehabilitation have been reported2. As such, vestibular rehabilitation can provide a pathway to improved quality of life for those living with a vestibular condition.

References:

1. About Vestibular Disorders (n.d) Retrieved from https://vestibular.org/understanding-vestibular-disorder

2. Hillier SL et al., Vestibular rehabilitation for unilateral peripheral vestibular dysfunction, Cochrane Database of Systematic Reviews 3, 2011.

3. Cohen HS, Kimball KT Increased independence and decreased vertigo after vestibular rehabilitation. Otolaryngol Head Neck Surg 2003 Jan;128(1):60-70

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Understanding why we get Back Pain

Understanding why we get Back Pain

Figures suggest that around 80% of people experience back pain at some time in their lives. Back and neck pain can be very debilitating so how a physiotherapist manages back pain treatment is essential to secure a positive result. Back pain can be localised in and around the spine, but can also be experienced as sciatic pain. Headaches and migraines are also commonly caused by neck issues.

Exercise is important
Exercise is gaining recognition as playing a vital role in the long term recovery and in preventing many musculoskeletal injuries, including back and neck pain. Exercise compliments physiotherapy treatment management and achieve long term results when trying to prevent and rehabilitate pain and injury by correcting the underlying causes, not just seeking to stop the pain.

The underlying biomechanics that cause back and neck pain
Most back pain is caused by excessive loading placed on muscles, joints, ligaments, spinal discs, etc. due to poor core stability. Core stability is traditionally defined as; an individual’s strength and control of their lower back, pelvic and abdominal muscles in order to maintain optimal postural alignment of the lower back and pelvis.

However it is important to also include the shoulder girdle and rib cage, as the lower back and pelvis do not operate in isolation, and muscles throughout the torso must act in a coordinated manner in order to maintain optimal postural alignment and also to initiate biomechanically efficient upper and lower limb movements.

A good analogy to help understand core stability is to consider how a tent is supported. A tent is held upright by a rigid tent pole. The bones of your spine act like a tent pole, however your spine is not rigid, so it relies on the support of ligaments and deep stabilising muscles to hold adjacent vertebrae and to help maintain optimal postural alignment i.e. stabilise the spine. If the muscles that stabilise the spine, pelvis, rib cage and shoulder are weak or are poorly controlled then your spine will tend to collapse, just like a tent pole made from a piece of spaghetti. There are many muscles that attach directly onto the spine, pelvis, rib cage and shoulders. These muscles move our torso and limbs and also assist with stabilising the core, acting in a similar way that guide ropes help to keep the tent pole upright. If a tent had guide ropes that pulled more on one side than on the opposite side then the tent would lean, so too, if the muscles on one side pulled more than the other due to imbalances in strength and/ or flexibility, or these muscles compensate for weak stabiliser muscles then they will pull your body into a poor postural alignment. One very important difference to note is that a tent only requires “static stability” i.e. support to maintain a single stationary position, whereas, the human body must have “dynamic stability” to provide support and maintain optimal alignment of their core and limbs whilst moving in many different ways to participate in sport, work and daily living activities.

How a physiotherapist corrects biomechanical faults
Physiotherapists conduct a comprehensive physical assessment and then use this information to design a personalised exercise program to improve posture/ biomechanics, core stability, flexibility, functional strength, cardiovascular fitness, balance and coordination. Programs focus on achieving long term results by correcting the underlying biomechanics causes of your pain, improving the strength of muscles that support your back and neck and teaching efficient movement for your specific sport, work or daily living activities. Expert supervision by an Physiotherapist ensures that each client completes the exercises with good technique to prevent further injury, to ensure that the exercises are effective, and also to ensure that progressions are made at safe and appropriate times.

 

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