What is a headache?
A headache is a symptom, described as pain in the face, head, or neck and is one of the most common nervous system disorders. The main classification divides headaches as:
- Primary (such as tension or migraines)
- Secondary, attributed to an underlying condition, or
- Painful cranial neuropathies (more commonly known as a shooting or burning pain)
It is advisable to see your GP for an initial consultation if you have a new, severe or unexpected headache. They will be able to assess whether your headache is possibly a symptom of another condition or if it is one of the primary types. If they have any concerns they can refer you to a consultant for further investigation.
What are primary headaches?
Tension-type headache is the most common but least studied type of primary headache: it can affect 90-95% of the population at least once in their lifetime.
Peripheral pain mechanisms and central sensitisation are most likely to play a role for most of the episodes. A migraine instead is considered a neurovascular pain, but it is unclear if the triggering factor is as a result of an increased or decreased pressure in the neck region. Typically, migraines are commonly associated with symptoms such as increased sensitivity to sounds and light, nausea and vomiting.
Migraines are the most studied primary headache, even if it counts only for the 10-15% of the cases. Migraines alone have a huge impact on the UK economy, accounting for £8.8 billion in loss annually.
Migraine Characteristics | Tension-related Characteristics |
 |  |
|
|
The benefits of physiotherapy and acupuncture in the treatment of headaches
At present, extensive research has been undertaken in the form of a random controlled trial (RCT) highlighting the benefits of acupuncture in the treatment of headaches.
Western acupuncture involves (sterile) needle insertion in specific points of the body with the aim to release tension and stimulate the production of pain-relieving endorphins. Although it uses the same points as tradition Chinese acupuncture, it does not share the same theoretical explanation on its positive effect on pain. Westernised acupuncture is widely used across the UK and its effect on migraines and tension-related headaches has been proven to be hugely successful, justified by several articles and systematic reviews.
Although this is currently the most researched modality, that’s not to say that other techniques within physiotherapy are not as beneficial and should be considered as an option especially when headaches are poorly managed with medications.
How physiotherapy can help
Physiotherapy is effective in the treatment of tension-type headaches as the evidence suggests they seem to be linked with myo-fascial tension and/or cervical (neck) dysfunction.
Physiotherapy offers a wide range of techniques to help relieve pain caused by headaches including muscle release techniques, joint manipulation/mobilisations, and exercises.
Cervical range of motion restrictions, postural dysfunction and myofascial trigger points are probably the most common findings in patients experiencing neck and head pain.
Physiotherapy techniques provide a broad range of mechanical and proprioceptive inputs that help the central nervous system modulate pain and regulate muscle tone/tension. As physiotherapists, we can adjust our patient’s treatment by selecting the appropriate range of techniques, based on the individual needs of each patient. Guidance can include a range of exercises, and cognitive and lifestyle adjustments.
Our London physio practice has several acupuncture experts.
Further successes…
Acupuncture has also been found to be successful in relieving chronic lower back, neck and shoulder pain, as well as pain due to osteoarthritis in a review that included 39 studies and 20,827 patients. The effect on pain was clinically relevant and appeared to subside for longer periods of up to and over 12 months.
See NICE guidelines Dec 2021 for further details with regards to headaches which includes any guidance, advice and quality standards.
Article by Stefano Colaci, Chartered Physiotherapist. Stefano is based at our London City clinic. Email enquiries@londoncityphysiotherapy.com or call 020 7236 3334 to book an appointment.