Firstly, there are many types of headaches and causes, this short blog covers the more common presentations we see and is not meant to be a complete guide. Headaches are the 3rd most common disabling condition affecting the world's population. Up to half of the population will have experienced a headache in the last year. (The Journal of Headache and Pain).
The international headache society has an International Headache Classification System. Classification of headaches is important to receive the right treatment. For example 50% of people diagnosed with migraines don't actually have migraine type headaches and are potentially receiving the wrong treatment for their headache.
Headaches fall into a few main categories and subcategories.
Primary Headaches.
1. Migraines. These can occur with or without an Aura (sensory disturbances such as flashes of lights, blind spots, vision changes and tingling in your hands or face.)
- Migraine without Aura. These are more common and probably more disabling. There is often a hormonal association (menstrual-related migraines); they can last from 4 to 72 hours. To classify as this sort of migraine, you would have at least 2 of the following headache symptoms; A throbbing sensation, Unilateral (a headache on only one side of the head), moderate to severe pain, and a headache aggravated by normal physical activity.
You should also have at least one of these symptoms, 1. Nausea/vomiting and/or 2. Photo/phonophobia (a sensitivity to light or loud noises)
Treatment with a class of drugs known as Triptans can have good effects during the acute attack.
- Migraine with Aura. Patients with this sort of migraine will experience an Aura for up to an hour before experiencing symptoms as per migraine without aura listed above. It is considered a risk factor if your aura last longer than an hour and you should see your doctor if this happens. There is an association between these sorts of migraines with prolonged auras and cerebral infarction (a type of stroke). So its very important to get a correct diagnosis.
2. Tension Type Headaches (TTH). These headaches occur episodically or chronically. They are generally characterised by mild to moderate pain. They can last from a half hour up-to 7 days. They will be felt on both sides of the head. Physical activity normally doesn't make them worse. No nausea or vomiting is experienced but the sufferer may experience photophobia or phonophobia.
3.Cluster Headaches. These may mimic migraines to some degree but have a few different symptoms. They affect men more commonly. They are severe, unilateral (one side of the head) and can include pain around the eye, tearing from the eye, sweating, swelling around the eye, a runny nose, and a drooping eyelid. They can last from 15 minutes up to 3 hours. They can occur up to 8 times in a day (hence the term clusters). The patient may also be quite agitated as well.
Cluster headaches respond very well to Non Steroidal Anti Inflammatory Drugs (e.g. Ibuprofen, Nurofen, Advil)
Secondary Headaches.
These are headaches that are secondary to head and neck trauma, cranial or cervical vascular disorders or secondary to things like infection, substance withdrawal, cranial and facial structures and also pyschiatric disorders. Within this category comes cervicogenic headaches, or neck based headaches. These headaches will be characterised by a reduced range of motion in the neck ( a stiff neck!), not throbbing, pain on one side and a lack of effect from migraine medications.
Sometimes headaches have a more sinister cause, this is rare thankfully, but highlights why we should get a diagnosis and further investigations if required.
Headache Treatment Options.
1. Get a diagnosis! Go to a primary healthcare practitioner such as an osteopath or medical doctor to get a proper diagnosis. If the treatment is deemed out of the scope of practice for your osteopath they will refer you to your general practitioner.
2.Medications. Depending on the type of headache you have there are various medications that may provide relief and some headaches have prevention medication. Talk to your Doctor about your options.
3.Manual Therapy. There is fairly strong evidence for the use of manual (hands on) therapy for cervicogenic headaches.
4.Lifestyle and Relaxation advice. Your osteopath may be able to identify some areas of your lifestyle and exercise regime that may be contributing to your headaches as well and give some advice on modification of these factors.
So if your not sure about your headaches or have started experiencing headaches get them checked out today.
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