Headache

What We Know

This is Self Care Toolbox: My Physical Therapy Soapbox, a newsletter for all bodies over 40. It’s a place for me to mix in a little current research with years of working with real humans as a physical therapist. (You can read about my background and credentials here.)  It’s my attempt to help you make everyday decisions about your health and routines so that you can take some of the mystery and frustration out of the aging experience.

·      Week 1: We will begin by defining a concern or condition and providing some background and a quick overview of the research. I’ll also give you some tips on how to do your own assessment of your health in this area.

·      Week 2: We will focus on providing concrete steps you can take to address this area of your health. The PTs who work in my practice have specialized training in a variety of fields, so I’ll be calling on them when we’re discussing topics they really know. I’m also active in the American Physical Therapy Association, so I’ve been fortunate to build relationships with experts in the field. I’ll be asking them questions, too, and passing along their advice.

·      Week 3: We will follow-up. I may provide additional steps or exercises. I’ll urge you all to use the comments to ask questions or let us know about your progress. My hope is that this newsletter will build a community: a group of people coming together to discuss healthy aging. 

Headaches

What we know:

Today we’re going to have a little chat about headaches.  Be forewarned: I completed a doctoral teaching project on headaches.  It was a while ago, but the passion – and nerdiness- persists.  I have a weekly feed from NIH so I can see all the new craniofacial (head and face) and headache research articles. 

I believe that the general public doesn’t know that there are non-pharmaceutical (without medication) ways to treat headaches and that not all headaches are the same.   That being said, many headaches respond similarly to the correctly prescribed (which treatments) and dosed (how much treatment) self-care.  

Headaches impact a lot of people.  Approximately 50% of all individuals will suffer from headache at some time in their life, and by the Global Burden of Disease Study determined headache to be the 2nd leading cause of disability in the world.  As many as 46% of people never seek medical attention for headache, even when episodes are debilitating. Interestingly, a 2005 study showed that 63% of medical schools limited their study of headache to a one-hour lecture.  Even many Family Practice and Neurology residency programs offered less than 5 hours of headache training or case presentation, with no plans to increase.

There are 2 main types of headache - primary headache and secondary headache.  “Primary headache” means that the headache itself is the diagnosis, and secondary headache is caused by something else – consider high blood pressure, brain tumor etc.  Because secondary headaches are usually caused by something much more sinister than the symptom (headache,) it is prudent for individuals to have a medical screening of their headache, especially if any of these conditions are present:

·      older than age 50 and first time headache,

·      significant change in the quality or intensity of headache,

·      neurological  signs like confusion or changes in consciousness,

·      sudden abrupt, split-second onset,

·      presence of disease like AIDS,  cancer.

The good news is that the majority of headaches (>90%) seen by PTs or primary care physicians are primary headaches. 

In physical therapy,  we treat most common types of primary headaches – migraine and tension-type  headache,  and we also treat a not-so-ominous type of secondary headache called cervicogenic (“coming from the neck”)  headache.   Often, by the time a person presents for medical attention of headache, that individual is already experiencing multiple or overlapping types of headache.  If headache persists without treatment,  it can develop  into chronic daily headache,  a headache that is present greater than 15 days per  month.  If this occurs, it  becomes more  difficult to treat because treatment  involves not only treating the headache but also helping your body’s pain interpretation system get healthy again.

Following is a basic chart outlining presentation for different headache types.  This is only a basic reference; many headaches  are mixed.  There are similar features headache to headache, especially migraine and cervicogenic, and many who have suffered headache for  many years have tension-type headache on top of another headache.  Note that some medical professionals believe that all primary headaches are migraine, varying in intensity. 

Many individuals who experience headache also experience other symptoms such as eye, ear or face pain, dizziness, mental fogginess and/or neck pain.  As we move through this series, I hope to help you understand why these symptoms are not unusual and how they can also resolve in response to these treatment  strategies.

We will  discuss  in our next publication why CLASSIFICATION MAY NOT MATTER in the self-treatment of headache.

The second week of this series will answer the question,

Headache: What Can We  Do About It?  

Before next week, I encourage you to comment.  Do you or someone you know suffer from headaches?   If so, were you able to classify them based on the chart?  What tools have been helpful to treat headaches?  Has anyone ever addressed overall non-medication treatment to either resolve headaches entirely or drastically reduce their frequency?