Tension Headache / Cervical Headache
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Tension-type headaches are a common headache that are often caused by mild-to-moderate pain, which are commonly described as “tight band around the head”. Headache complaints are commonly accompanied with impaired posture. About 15% to 20% of chronic/recurrent headaches are diagnosed as cervical headaches and are related to musculoskeletal impairments. There is often, associated tension in the posterior cervical muscles, pain at the attachment of the cervical extensors, and/or pain radiating across the top and side of the scalp.
Most people who experience tension headaches also have episodic headaches. These headaches usually occur one or two times per month on average. However, tension headaches can also be chronic.
Headaches usually involve a cycle of pain, muscle contraction, and decreased circulation which leads to decreased function and potential joint and soft tissue impairments. Cervical headaches are usually caused by many factors.
- they are often accompanied by a soft tissue injury or often because of faulty or sustained postures, nerve irritation or impingement (where the greater occipital nerve emerges through the neck extensor muscles where they attach at the base of the skull), or a sustained muscle contraction, which usually results from bad posture or emotional tension, leading to ischemia.
- they may also be related to temporomandibular joint dysfunction or there may be vascular or autonomic involvement as related to a migraine or cluster headaches.
Moreover, tension-type and migraine headaches are commonly triggered by stress and can trigger other types of headaches or even make them worse.
Signs and symptoms
To develop an effective plan of care that will manage the headache, it is important to differentiate cervical headaches and other related impairments in the musculoskeletal system from other kinds of headaches (such as migraine or cluster headaches).
The following history and symptoms are usually associated with cervical headaches:
- unilateral headaches or bilateral headaches with one side predominant
- neck or suboccipital pain that spreads into the head
- intensity can fluctuate between mild, moderate, or severe
- precipitated by sustained neck postures or movements
- more prevalent in female but no familiar tendency
- may be precipitated by stress, which is also common with other types of headaches)
- may be related to postural or lifestyle stress, degenerative joint diseases, or trauma
Musculoskeletal impairment includes:
- Joint impairment in the upper cervical spine (pain and motion restrictions)
- Impaired muscle performance
- Impaired shoulder girdle/scapula posture with related muscle imbalances
- Impaired neural tissue from pressure or inflammation in the upper cervical/ suboccipital region
- Impaired lumbar posture with related muscle imbalances
- Impaired neuromotor control
General management guidelines
Management is directed towards reversing the physical impairments which includes stress management, posture correction and the prevention of future episodes.
- Pian management: – modalities, massages, and muscle setting exercises are used to break into the cycle of pain and muscle tension.
- Mobility impairment and impaired muscle performance: – examine the flexibility and strength of the muscles in the cervical, lumbar spine, upper thoracic and shoulder girdle and develop an effective exercise program that will improve and regain a balance in the flexibility and neuromuscular control in conjunction with the posture correction and training.
- Control and support from the deep/core muscles is the foundation of management; increase joint mobility in the cervical spine and flexibility in the suboccipital muscles to relieve the tension in that region as well as to be able to activate and train the deep cervical flexors for control of capital flexion and cervical retraction.
- Utilize cervical stabilization exercises and emphasize tonic holding of the core muscles in isolation from the global muscles
- Train the lower trapezius, rhomboids and serratus anterior muscles in the tonic holding postures. This is to improve control of scapulothoracic posture.
It is important to learn relaxation techniques and ways to respond to stress if headaches are due to stress or anxiety, and if the person is in tension-producing situations. Relaxing techniques, ROM and muscle-setting techniques and proper spinal mechanics are taught.
- Study has shown that manipulative therapy and a low-load exercise program, in combination with postural correction exercises (which progresses to isometric resistance and flexibility exercises) helps to reduce headache intensity as well as the frequency. These exercises consisted of training the postural control of longus colli and other deep neck flexors, as well as serratus anterior and lower trapezius muscles.
Call Curezone physiotherapy, Mississauga today to get assessed and treated by our Physiotherapist for your Cervicogenic Headache assessment!!!