It seems everyone, at some point, gets a headache. Some can be as simple as a slight tinge of pain in the temples that comes and goes. Others can be so debilitating that they sentence you to a dark bedroom for hours or even days at a time.
Complaining about having a headache can seem as American as baseball and apple pie, but if headaches become a way of life — or worse alter the very course of your life — the solution will likely be more than just popping some Tylenol.
What's causing the pain?
If you do a Google search about headaches, you'll be presented with literally thousands of search results. It's enough to give you a headache!
And sometimes the "causes" for a headache can be as strange and frustrating as the headaches themselves. But while headaches are incredibly common, they don't have to be mysterious.
"Headaches don't just happen," said Craig O'Neal, Vice President of Clinical Excellence at Results Physiotherapy. "Pain is usually caused by something in the body, and headaches are no different. The key is to discover why the pain is happening — good, old fashioned investigative Q&A. Determining the source of a patient's head pain is the key to getting them better."
When a migraine isn't a migraine
Headaches can be caused by many things, but it's usually either a problem in the muscles and/or joints, or a chemical imbalance in the brain.
Technically, only "chemically enduced headaches" — or when something wrong with the brain itself — are "migraine headaches."
Just because a headache is severe does not mean it's a migraine: The pain for both types of headaches can be equally debilitating.
Why is this important? Well, if the problem lies in a chemical imbalance in the brain, physical therapy won't help you get better. A neurologist will ultimately be the best person to speak with. A neurologist, armed with the right diagnostic information, can rightly prescribe medications to lessen pain caused by a migraine, while he tries to discover the best way to get your brain's chemicals back in the right balance.
But the tricky thing about headaches is that many of the symptoms of a migraine are idential to those caused by muscles and joints being out of their natural position. And, just because a headache is severe does not mean it's a migraine: The pain for both types of headaches can be equally debilitating.
"While many people do struggle with migraine headaches," says O'Neal, "most headaches are caused from problems in the muscles, joints and ligaments. These problems send signals to the brain, which causes pain in the head. And despite the fact that many chronic headache patients struggle for years with no solid diagnosis, we've discovered that most of the time the causes are very common, and easy to diagnose and treat."
Which type of headache do you have?
So if you rule out a migraine, all other headaches fall into these into two categories: Cervicogenic headaches and posture-related headaches.
"Cervicogenic headaches are caused by some sort of disorder in the neck," explains O'Neal. "A cervicogenic headache is usually located on one side of the head, like a migraine, and it is usually triggered by certain neck movements."
"Because so many of us now work at a computer desk, posture-related pain is extremely common. Sitting for hours at a time in a desk chair, hunching your shoulders and squinting into the screen, these are things that are almost certain to cause a posture-related headache."
Posture-related headaches come from repeatedly sitting or standing in ways that are not natural for the body. Over time, muscles simply get worn out from the stress caused by misuse — they get sore and cramp, sometimes even cause knots.
Eventually this causes the body to compensate, shifting the responsibility to other muscles and joints. That compensation causes joints to move in ways that are not natural, which pinches nerves and causes pain.
"Because so many of us now work at a computer desk, posture-related pain is extremely common," reports O'Neal. "Sitting for hours at a time in a desk chair, hunching your shoulders and squinting into the screen, these are things that are almost certain to cause a posture-related headache."
In other words, if your head hurts, it's often not from something that's wrong in your head. The pain signals are being sent — or referred — from another part of the body that is pinching a nerve or cramping a muscle due to its misuse or overuse.
When medications usually aren't the answer for headaches
Because the symptoms of migraines and cervicogenic/posture-related headaches are often identical, patients will often think they have a migraine and therefore seek out the wrong type of help.
And, often, receive the wrong kind of treatment—which can lead to expensive and sometimes even harmful consequences. Many well-meaning doctors, not knowing what else to try, will prescribe oipiod medications to help relieve their patients' symptoms.
This has led to an epidemic of obiod abuse in America: In 2012, health care providers wrote 259 million prescriptions for opioid pain medication, enough for every American adult to have their own bottle of pills. And fully one in three patients who take opioids end up struggling with addiction.
According to the APTA, every day, more than 1,000 people are treated in emergency departments for misusing prescription opioids.
John Moore, from Hendersonville, Tennessee, had a frightfully familiar experience. “I’d had 'migraine' headaches for ten years and I was being treated in a lot of different ways. At first it was just medication for the headache and then they became progressively worse and I really wanted something to kind of stop it. I had been seeing a neurologist and I had taken a lot of powerful medications. A lot of them made me feel really bad. Eventually I was getting nerve block shots that gave me some relief, but it had some side effects, too."
Not all physical therapy for headaches is the same
Many people who struggle with headaches have been sent to traditional physical therapy, and did not see the results they were hoping for. That's usually because headaches can be caused by a combination of musculoskelatal issues that often are not obvious to most physical therapists, who are usually primarily trained in post-operative rehabilitation.
In addition, the drudery of standard "exercise only" PT often causes patients to give up on solutions that can actually help them quickly overcome their pain and get back to living their life.
Manual therapy works in ways that are uniquely powerful for head pain, where issues can be complicated and misdiagnosed, and patients often get discouraged after seeing so many doctors who don't know how to help.
"For ten years and I had tried physical therapy once and got minimal results out of it," said Moore. "[It] was really and truly like taking a lot of medication."
Moore says that he spent a decade, going from one doctor to the next, and none of them seemed to know what was wrong. "You know, we all have aches and pains particularly as we get older and that seems to be a part of life, but [it's terrible] when something gets to where it impacts the quality of your life and nobody seems to really pay attention to it," said Moore.
But not all PT is the same. The "Results difference" is in what the medical field calls "Manual Therapy: a specialized aspect of PT, in which uniquely trained therapists primarily use their hands to diagnose and treat pain. This type of treatment directly effects the movement of joints — but studies prove it also has powerful effects on a patient's psychological, neurophyysiological and biochemical health.
Manual therapy is especially effective for headaches and other head-specific pain, where issues can be complicated and misdiagnosed, and patients are often discouraged from seeing so many doctors who could not help them. This includes TMJ, vertigo and myofascial pain, among others.
"I had tried physical therapy once before and it helped a little bit," said Moore, "but it was totally different with [Results] because my therapist found the trigger point and I didn’t even know where it was, you know. [The trigger point was] on my back right behind my shoulder blade."
"I hardly ever have a migraine headache anymore, said Moore, choking up with emotion. "It was because she listened, she knew, and she put the pieces together, and was very put together and professional. She went to work and solved my problems!”
Getting to know all about you
One of the common complaints people often have about physical therapy is that they hardly ever see their therapist. Patients often feel as though they are moved into and out of the clinic as quickly as possible, handed a long list of exercises to do at home, and are quickly sent on their way to figure things out on their own.
To be successful in manual therapy, the therapist must take the time to get to know the patient, and spend time with them on every visit to the clinic. They must also be specially trained to diagnose hidden issues that may be causing pain, particularly in the case of headaches. That's why Results physical therapists receive over four times the national average for physical therapists.
“For them, it’s a calling. It’s not a job, it’s a passion," said John, smiling. "The quality of the guys they have working there and the people they have working there is what makes it a great place."
"Our therapists are very well trained, but just as important, they are very relationship-driven," explains O'Neal. "They take the time to understand what the patient is feeling, what their goals are for recovery, and then keep asking questions all the way through their treatment plan. That's important for all therapy treatment, but especially so with headaches, because very often the patient is the only person who can help me understand what is going on with their body. If I don't take the time to ask, they won't know to tell me."
Having gone through almost every other headache treatment option, Moore said this sort of approach made the different for him. “For them, it’s a calling and It’s not a job, it’s a passion," said Moore, smiling. "The quality of the guys they have working there and the people they have working there is what makes it a great place. There’s something really special about [Results Physiotherapy].
"Its one of the most unique experiences I’ve ever had because I went in and I trusted this person, they demonstrated professionalism, knowledge, and helped me. They impacted the quality of my life, which was the biggest thing. So if I could say anything to anybody that’s struggling with headaches, whether it’s migraines headaches or just chronic headaches, Results really impacted the quality of my life. It changed the way I do things. I’m really grateful for those folks and you can tell it comes from my heart, I hope.”
"There’s something that’s a little bit shameful, I think, to have to go get somebody to help you with your leg or your arm or your neck, but they take all the shame out of it. I’ve just really fallen in love with those people.”
“My therapist built a care plan, and laid down what we were going to do for the next ten weeks. I started out seeing her two to three times a week because my headaches were so severe, but eventually we were able to taper off to the point where I was able to walk away. You talk about functional outcomes, it changed the quality of my life. I keep coming back to that because, you know, when you get up and you’re fretting how you’re going to feel today and how you’re going to have to take pills to make you feel better. Then, you get up and it’s not even on your mind. It changes the quality of your life and improves everything.
"That’s a real genuine outcome for me.”