Tension Type Headaches are the most common type of headache, being episodic, gripping/vice like, non pulsating, mild to moderate intensity pain, which are usually bilateral (both sides), and band like, being initially experienced in the frontal (forehead) or occipital (lower back of skull) regions of the head. Tension type headaches are not aggravated by normal daily exercise, and often respond to over the counter analgesics (pain killers). On occasion, photophobia (severe sensitivity to light) or phonophobia (fear of loud sounds) may be present. The headache may last from minutes to days. In chronic cases, headache, will be more frequent, may be constant, and mild nausea (involuntary inclination to vomit) may be present.
The exact cause of tension type headaches is unknown, although there are known associations with tender, contracted muscle, and emotional or social stressors. Manual therapy will address the muscular skeletal system of the neck, back and head. There will also be an aim to identify any additional factors which may influence the symptoms present, e.g. posture. Identifying emotional stressors, e.g. work, looking after children, which may help someone suffering tension type headache to make changes to reduce stress levels, and therefore headache frequency/intensity, suffered. Exercise, yoga, and relaxation techniques may also be beneficial, and advised.
Cervicogenic headache is pain referred to the head from structures in the neck, i.e. it is a secondary, not primary, headache. Structures implicated may be varied, including muscles, joints, ligaments, and intervertebral discs. The pain is usually hemicranial (covering one side of the head), originating at the base of the skull, and may be unremitting and severe, to the extent that a patient may attend A&E.
Simply put, referred pain is pain experienced in a region away from where the pain stimuli is located. The pain is referred via the complex sensory interactions of the nervous system, with the brain effectively "misinterpreting" where the pain signal comes from. In the case of cervicogenic headache, the pain felt in the head is referred to the region due to sensory nerve fibres from structures in the upper cervical (neck) region converging in the trigeminocervical nucleus with fibres from the Trigeminal nerve. The Trigeminal nerve is a cranial nerve which supplies, among other functions, sensation to the areas of the head where the pain is experienced.
Manual therapy for cervicongenic headache will include treating the mid/upper neck, and addressing any areas of your body, particularly your back, which may play an indirect role in your symptoms. Postural, ergonomic, or any other advice will be provided as needed.
As well as the above headaches, there may be involvement of the Temporomandibular joint (TMJ)/jaw in headache symptoms, or headache may be a symptom of TMJ dysfunction. Bruxism (teeth grinding and jaw clenching) may result in headache either, for example, due to muscular tension resulting from bruxism, or resultant TMJ dysfunction. The causes of bruxism are many and varied from stress and anxiety, to some medications. While the underlying causes of bruxism may be difficult to address and/or out of the scope of Osteopathy, dependent on what is the underlying cause, the physical side of bruxism, e.g. tense/tight muscles of mastication (chewing), the TMJ, and any associated neck and upper back issues, can be treated, along with providing self help exercises/advice, the aim being to reduce intensity and/or frequency of teeth grinding.
Headache diagnosis can be complex, as different types, e.g. migraine and tension type, may coexist, or be suffered by, the same person. Therefore, questions during case history taking as to whether these headaches are new, or different (including what aggravates or relieves them) from, headaches you have suffered previously, as well as their character, intensity, and area of pain, and whether there are any other symptoms associated with the headache(s) are important.
For further information on headaches, please see the International Headache Society website.