The head work behind Your headache!

The effects of headaches go a lot deeper than just the pain in the head. People suffer from a large amount of psychosocial factors, such as functional disability and loss of concentration, making work and studies a nightmare. They have a decreased productivity and emotional handicap which has a negative impact on close relationships and can lead to anxiety, anger and eventually depression. I mean when you are in pain you become miserable, and nobody wants to be around miserable people or even worse…..be that miserable person.

But there is hope, through a multi-disciplinary approach a lot of headache sufferers can be helped to lead normal, productive, happy lives.

Ok let’s talk a little bit about headaches. Firstly you get Primary headaches, which are not associated with other diseases and are the most common kind and then you get Secondary headaches, which are a symptom of an underlying ominous disease. Obviously these types of headaches are a lot more serious and here is the “Red Flag” list of things to look out for:

Red Flags

• Sudden onset of a new severe headache
• Progressively worsening headache
• Onset after exertion, straining, coughing or sexual activity
• Onset of first headache after 50 yrs old

If you have any of these symptoms please go and see your doctor immediately as your headache could be a warning sign of something a lot more serious!

Primary Headaches

Why do we get headaches? How does it all work?

Well there are a lot of different triggers, both internally as well as externally that can lead to a headache. i.e. Muscular, Vascular , Temporomandibular joint (TMJ) or cervical dysfunction, stress, posture, certain foods, dehydration, sinuses, bright light, alcohol, hormonal changes, sleep disturbances and the list goes on.

These triggers are not necessarily what are causing the pain they just set it off, like a landmine. I was at a headache lecture the other night and the doctor explained it like this.

In your brain you have the trigeminocervical nucleus ,and what that big fancy name does is that it’s the principle centre of the head and neck involved in the transmission of nociceptive information .i.e “the headache generator”

So basically what all these different triggers do is sensitize the “headache generator” more and more until eventually it explodes like a landmine and sets of a headache. They have also found that in chronic headache sufferers the “headache generator” part of the brain is more sensitive to the incoming messages from the different triggers than non sufferers. So what we need to do to prevent these headaches from developing is to try and desensitize the “headache generator” by cutting down the amount of stimuli it is receiving from the triggers. But in order to do that you firstly have to identify your own individual triggers.

A good way of doing this yourself (and I highly recommend this), is to keep a headache diary, in order to discover your own individual headache pattern.

• Date
• Time
• Duration
• Rate Intensity (1 to 10)
• Possible triggers
• What relieved headache
• Ability to function

This will help you start picking up trends and understanding your headache better.

Two of the major internal triggers are firstly Muscular .i.e. trigger points (a hyperirritable spot in a taut band of muscle) mainly in the head and neck muscle groups, causing the Tension type headaches. Secondly the Vascular system, where the arteries in the scalp and skull vasodilate causing Migraines. Some migraine suffers experience either a visual disturbance, vertigo, numbness, weakness etc, prior to the onset of a headache. We call this an aura, which is caused by the blood vessels in the brain vaso-constricting. It is still unclear why this happens prior to the onset of these migraines.

Stress, Ergonomics and Posture are very big external triggers that need to be looked at and corrected.

Physiotherapy plays a major role in treating both the internal as well as external triggers along with a multi-disciplinary team of course. Helping to correct the muscular system and looking at correct ergonomics and posture as well as core stabilising exercises and manipulation therapy have been proven to give lasting relief to headache sufferers.

A lot of people turn to the medicine cabinet when a headache is knocking on the door to try and mask the pain. The medications used are either Preventative or Rescue medication. Rescue medication you take once you already have the headache e.g Simple analgesics (Asprin, Paracetomol), Triptans (Imigran, Maxalt) etc

Preventative medication on the other hand you take before the headache starts and is only prescribed for severe, regular headaches when nothing else is helping. Some examples are Trepiline(Anti-depressant), Epilum, Atenolol(beta-blocker) .

The problem with all these drugs is that some people don’t respond to them and many of them have really bad side effects. If patients get depend on the medication and are using them regularly they can also develop Medication Overuse Headaches which a lot of the times are worse than their original headache that they started with.

Myself being a physiotherapist, I believe that medication has a role in headache treatment but there are many other ways than just “popping a pill'(which just masks the pain and doesn’t deal with the true cause of the problem) to cure your headaches.

For instance I was at another course where the lecturer explained just by advising his patients to drink more water [(30ml/kg body weight /day) so if you weigh 60kg you should drink 1.8L of pure water a day] and keeping their blood glucose levels constant (by eating more low GI foods and smaller, regular meals during the day), almost all of their headaches had improved. Something small to think about…

Thank you for taking the time to read through this article. I hope it has benefited you in better understanding your headache and how to treat it.

Andrew Savvides
Physiotherapist
physiopro.co.za/