Headache Treatment

What is Headache?

What is a Headache? We have all been there, busy with life and all the sudden out of nowhere we experience an excruciating headache. For some, headaches are no more than an annoyance. They can power through it functioning just fine. On the other hand, others suffer from debilitating headaches that when they occur their life stops in its tracks. So, what are headaches and why do we get them?

There are three specific categories of headaches, but in general terms, a headache is when we experience pain anywhere from our neck up to and around the head. According to the International Headache Society the three major headache categories are[1]:

  1. Primary headaches-tension, cluster, and migraines
  2. Secondary headaches-the cause is “secondary” meaning there are other underlying medical conditions like infections (meningitis or infected teeth), concussions from head trauma, or even bleeding on the brain
  3. Cranial Neuralgias, facial pain, and other forms of headaches-this category specifically relate to an inflammation of one of the 12 cranial (head) nerves.

What causes headaches?

Surprisingly, our brain does not have any pain nerve endings. So, headaches are not specific to the brain, but instead the surrounding tissue. There are many different causes of headaches, below is a list of a few triggers:

  • Dehydration
  • Drug abuse or withdrawal
  • Food sensitivities or allergies
  • Hangovers
  • Illness
  • Infection
  • Inflammation or irritation of nerves
  • Menstrual cycles
  • Poor posture
  • Side effect of a medication
  • Stress
  • Trauma

Tension headaches are the most common form of headaches. They start in the back of the head and may run all the way up and around to your eyebrows. Researchers are still not fully clear on what causes tension headaches, but in general, research shows when our bodies are under stress, both physical and/or emotional, we contract our muscles.

With the sustained contraction of our muscles due to stress or poor posture, they become tight, irritated, inflamed, and may go into spasm which causes pain. The cause of tension headaches may be poor posture and the muscle imbalance of over and underworked muscle groups. Tension headaches are not debilitating, but more or less a nuisance. Tension headaches do not have auras nor do they create nausea or vomiting.

Cluster headaches are just that, multiple headaches that occur daily for a week or so and they usually occur around the same time every day. Unlike tension headaches, cluster headaches are believed to be more related to chemical changes in the brain. Under imaging, research shows abnormal activity within the hypothalamus (base of the brain).

Interestingly enough, cluster headaches they tend to be hereditary. They also may be triggered by changes in your sleep pattern or sensitivity with certain foods.

Migraine headaches can be debilitating. Typically, a migraine headache has precursor warning signs like light sensitivity, nausea, seeing auras, blind spots, or vomiting. The pain from a migraine headache is typically on the inside of the brain, and it can last anywhere from a few hours to a few days.

The exact cause of migraines is still unknown to researchers. It is believed the brain goes through a neurological and chemical changes which may affect blood flow. The good news is most people who have experienced a migraine, after the first time or two, they recognize the warning signs and can quickly act to minimize the severity. Unfortunately, in most cases, they cannot stop a headache altogether.

Secondary headaches are complex because there is an underlying medical issue causing the headache in the first place. The International Headache Society has certain categories for this type of a headache, and they are:

  • Neck and Head trauma-concussions, whiplash, swelling
  • Blood vessel problems-stroke, aneurysm, carotid artery inflammation
  • Non-blood vessels of the brain-tumors and seizures
  • Medications and drugs, including withdrawals-blood pressure, birth control, taking over-the-counter meds too frequently (acetaminophen, aspirin, ibuprofen, Excedrin)
  • Infections-meningitis, pneumonia, influenza, encephalitis
  • Changes within body’s environment-dehydration, blood pressure, hypothyroidism
  • Problems with ears, eyes, nose, throat, teeth, sinuses, and neck-glaucoma, sinus infection, dental pain

The final category for headaches relates to specifically to cranial (head) nerves. How and why our cranial nerves become inflamed is unknown. This type of head can be excruciating.

The three most common forms of cranial neuralgia are related to the following nerves:

  • Trigeminal-pain in the eyes, cheeks, and facial area
  • Glossopharyngeal-pain in the throat, tongue and ears
  • Occipital-behind the eye


Symptoms will vary depending on the type of a headache. Tension headaches typically involve symmetrical pain (entire brain) from the back of the head all the way to the eyebrows. Pain can range from mild to severe and may be constant or throbbing.

Cluster headaches can be mild to severe. The biggest difference is they occur in a series of days usually around the same time and last about 1 to 2 hours. After a week or so, they dissipate and may not come back for months or years. The pain associated with these headaches can be mild to intense.

Migraines are intense and can be debilitating headaches. Not always, but typically they are asymmetrical, meaning they occur on one side of the brain. With most migraine suffers, they have warning signs such as auras, light sensitivity, nausea, or even vomiting.

Pain usually starts off as throbbing and may even be intense behind one eye. The pain will intensify with activity or in response to exposure to bright light or loud noise. For some, they may experience dizziness, nausea, or vomiting. The pain can last a few hours up to a few days.

Secondary headache symptoms vary widely depending on the underlying cause of a headache. They can range from throbbing to moderate or severe in intensity and may have a quick onset especially if related to trauma. If you experience any of the following symptoms, seek medical attention immediately:

  • Severe nausea
  • Vomiting
  • Seizures
  • Inability to move a limb (arm or leg)
  • Slurred speech
  • Confusion
  • Loss of eye sight
  • Fever

Neuralgic headaches are most commonly associated with extreme pain. This nerve pain has been described as intense and feels like a lightning bolt. Activities that may trigger the nerve pain including excessive chewing (gum), cold air on the face, light touch to the face, or even talking.

How are headaches diagnosed?

Correctly diagnosing the cause of a headache is important for proper treatment. Most headaches can be diagnosed conservatively meaning through a medical history review and physical exam.

In severe cases, there may need to be more testing to properly diagnose a headache, especially in the secondary and neuralgic categories. Further testing may include:

  • Blood work-checking for infections or thyroid problems
  • CT Scan-cross sectional view of your brain, to rule out serious diseases
  • Eye exam-rule out glaucoma or another optic nerve injury
  • MRI-a deeper and clearer image than a CT scan; can view the spine and neck better
  • Spinal tap-looking for infections of the brain or spinal cord
  • X-Ray-to view the sinus cavity
  • Urinalysis-checking for diabetes

Treatment of Headaches

Treatment varies depending on the diagnosis. Tension headaches are the most common form of headaches which means response to conservative treatment is great. Tension headache sufferers respond very well to physical therapy (PT) which doesn’t involve medications, injections, or surgery.

Just taking over-the-counter (OTC) medication alone does not resolve the problem. Most tension headaches are caused by poor muscle tone and poor posture. The OTC medication may resolve the pain, but it does not resolve the issue.

If you experience chronic headaches, seek treatment from your local PT. He or she can help you find the origin of your headaches and provide you with long-term management tips to either prevent or minimize their effects.

As a consumer of health care, you have a choice in finding the right PT provider for you. Do your homework and search for a health care provider with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.

In most states, you can be seen by a PT first, without a physician’s order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.

Your physical therapist will complete a full examination including:

  • Review your medical history with you
  • Questions around onset, severity, cause, or what makes it better or worse are asked
  • Assessing your neck, spine, and head for bone, joint, muscle, tendon, ligament, and nerve injuries, tone, or misalignment

After your complete assessment, your PT will establish a treatment plan with you. The primary goal is to get rid of or minimize the effects of, your headaches. He or she will focus on improving the mobility of the neck, strengthening muscles for improved posture, and may even look to make a modification of your activities at work or with hobbies you love to do.

Not all headaches types are treatable by a physical therapist. With cluster, migraine, neuralgia, and the secondary headache category, most often medications or injections may be needed to help resolve the symptoms. If your physician suspects the musculoskeletal system has a cause and effect with your headaches, then PT may be prescribed.

For example, concussions where whiplash is involved, physical therapy has been shown to have a significant impact on minimizing the symptoms and helping with recovery through treatment of the neck and spine.

Also, some people have responded well to PT with neuralgia headaches. Most often, PT would be in conjunction with treatment by your physician. Your PT will work to reduce pain through ice or electrical stimulation. Also, your PT will work on proper muscle balance and tone in and around the neck, head, and facial area. He or she may also work on biofeedback to help reduce unwanted muscle tension in the upper back and neck area.

Next Steps

Headaches can be not only annoying but debilitating. If you experience frequent headaches or headaches that are debilitating, visit with your local health care provider. The sooner you address your symptoms, the more likely conservative care will work for you.

Remember, you have a choice in finding the right PT for you. To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating headaches.

[1] http://www.medicinenet.com/headache/article.htm

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