In this blog, we’ll explore some of the more common types of headaches we encounter at CSSM. We’ll cover what they are, how to identify them, and how our skilled osteopaths and myotherapists can help alleviate them.
First, we’ll examine two types of headaches that, while distinct, share several similarities: Temporomandibular Joint (TMJ) headaches and tension headaches.
What are tension and TMJ headaches? Tension headaches are the most common type, accounting for approximately 70-80% of all headaches, according to the World Health Organisation (WHO). These headaches are classified into two categories: • Episodic Tension Headaches: occur fewer than 15 days per month, typically lasting between 30 minutes and a week. • Chronic Tension Headaches: occur more than 15 days per month and can last for hours, sometimes continuously.
The causes of tension headaches are varied and include stress, anxiety, fatigue, dehydration, squinting, poor posture, and even a lack of physical activity. They are considered primary headaches, meaning they aren’t caused by an underlying condition.
TMJ Headaches are classified as secondary headaches because they result from dysfunction in the jaw, commonly due to teeth clenching or grinding, with stress playing a significant role. While TMJ headaches are less common than tension headaches, they can often be mistaken for them. Research has shown that TMJ-related headaches were misdiagnosed as tension headaches in 31% of patients in one study.
Tension Headaches: • Pain: dull and persistent pressure or tightness. • Location: typically starts at the back of the head or temples, gradually spreading to the front, creating a band-like sensation around the head. • Tenderness: often felt in the scalp, neck, and shoulder muscles. • Severity: usually not severe enough to impede daily activities.
TMJ Headaches: • Pain: tight, dull, and aching, sometimes throbbing. • Location: often one-sided but can affect both sides depending on the dysfunction. • Trigger: pain is triggered by jaw movement and relieved by jaw relaxation. • Tenderness: notable in the surrounding jaw and facial muscles.
Tension headaches are common and can affect anyone, though they are more frequent in teenagers and adults, with women experiencing them more often than men. TMJ headaches are also more prevalent among teenagers and adults but can occur at any age, and like tension headaches, they are more commonly seen in women. Both types of headaches are closely linked to stress and anxiety.
Next, we’ll look at another common type of headache: the cervicogenic headache.
According to the International Headache Society, cervicogenic headaches are responsible for up to 18% of headache cases. These headaches are often referred from the upper cervical spine, specifically the first three vertebrae and their associated nerve roots. The pain can originate from various structures in this area, including joints, intervertebral discs, ligaments, and muscles.
Cervicogenic headaches typically present with the following characteristics: • Unilateral Pain: usually affecting one side of the head, this pain tends to be of moderate intensity and is generally non-throbbing. • Pain Originates in the Neck: the discomfort often begins in the neck and can radiate to the head. • Variable Duration: headaches can vary in length, with pain intensity fluctuating over time. • Triggering Factors: neck movements or prolonged awkward positions (such as poor sleeping postures or suboptimal workplace ergonomics) can trigger these headaches. • Possible Preceding Trauma: a history of neck trauma might be present before the onset of the headache. • Associated Symptoms: these may include nausea, vomiting, dizziness, and sensitivity to light and sound.
Who is most likely to experience a cervicogenic headache?
Cervicogenic headaches frequently affect individuals aged 30-45, with a fairly even distribution between men and women. Those who lead a sedentary lifestyle or spend long hours at a desk are particularly susceptible. Additionally, poor sleep ergonomics could be a contributing factor—perhaps it’s time to consider investing in a new pillow!
Lastly, we’ll explore migraine headaches.
Migraines are a chronic neurological condition characterised by recurrent episodes of head pain and associated symptoms. They are the second leading cause of disability in the world after low back pain. Migraines often present as a severe, throbbing, or pulsating sensation, typically affecting one side of the head. However, the pain can also be bilateral, and the side may shift between attacks. According to the National Institute of Neurological Disorders and Stroke, approximately one in three individuals with migraines experience an aura prior to the headache.
Migraines can affect both children and adults, but adult women are three times more likely to experience them than men. Several factors can increase the likelihood of developing migraines, though these can vary from person to person. Key risk factors include: • Gender: women are more prone to migraines, particularly around menstruation, pregnancy, and menopause. • Family History: a genetic predisposition can make migraines more likely. • Mood Disorders: conditions such as depression, anxiety, or bipolar disorder can elevate migraine risk. • Sleep Disorders: both insufficient sleep and excessive sleep can trigger migraines. • Caffeine: both the consumption and withdrawal from caffeine can be contributing factors. • Diet: certain foods and beverages, including processed foods, alcohol, cheese, and yeast, may also play a role.
Migraines often progress through four distinct phases, although not everyone will experience all of them. These phases can vary in their presence and severity: • Premonitory Phase: this phase involves non-painful symptoms that occur hours or even days before the headache. Symptoms may include: o Unexplained mood changes o Food cravings o Neck stiffness o Frequent yawning o Digestive issues such as constipation or diarrhoea o Sensitivity to light (photophobia) and/or sound (phonophobia) • Aura Phase: auras can affect visual, sensory, motor, and sometimes movement pathways, manifesting before or during the migraine attack. Symptoms might include: o Visual disturbances such as spots, flashing lights, zigzag lines, or blind spots o Motor issues like slurred speech, difficulty understanding or writing, and impaired cognitive function o Sensory changes such as tingling or numbness o Movement problems like reduced coordination and dizziness • Headache Phase: migraines can range from mild to severe. Severe migraines may require emergency medical treatment. Physical activity and exposure to light, sound, and odours can exacerbate the pain. Notably, some individuals may experience migraine episodes without the accompanying headache and remain symptom-free between attacks. • Postdrome Phase: following the headache, the postdrome phase can leave individuals feeling exhausted, confused, or generally unwell. This phase can last from a few hours to several days. Pain in the cervical structures and imbalances in serotonin levels are significant contributors to migraines. Recent research suggests that migraines without aura and cervicogenic headaches share similar symptoms, indicating that a comprehensive approach is necessary for effective management.
Effective headache management often requires a proactive approach. Early intervention with hands-on treatments from our Osteopaths or Myotherapists, combined with appropriate medication and lifestyle adjustments, can significantly reduce the frequency and severity of headaches. Simply relying on painkillers or ignoring headache symptoms can lead to increased frequency and severity, making them more debilitating over time.
At CSSM, our practitioners perform thorough assessments of the cervical spine and surrounding structures to identify and address contributing factors. We employ a range of hands-on techniques, including soft tissue massage, joint mobilisation and manipulation, dry needling, stretching, and muscle energy techniques. Our ultimate goal is to identify the root cause of your headaches and help prevent them from recurring, ensuring you can enjoy life with fewer interruptions.
In addition to these treatments, we also help identify lifestyle factors that could be contributing to your headaches, such as poor posture, stress, or inadequate sleep setups. Our comprehensive management strategies include exercise prescription, postural strengthening, stress management techniques, and relaxation, breathing, and mindfulness practices. Our aim is to relieve symptoms and create a management plan tailored to your specific needs.
If we suspect a non-musculoskeletal cause for your headaches, we can provide appropriate referrals for further investigation. Distinguishing between different types of headaches is crucial for developing an effective and timely treatment plan.
If you have been experiencing headaches recently, don’t hesitate to reach out to our team for a personalised comprehensive assessment and tailored treatment plan.
CSSM osteopath Eliot Hird enjoys treating neck and shoulder issues as well as sporting injuries and the rehabilitation of those injuries, helping people get back to their sport or hobbies.
“I like treating issues with the neck because I often see a great response to treatment,” he says.
“Shoulders are interesting because they are a complex joint with many common presenting complaints. I like the complex problem-solving aspect of these issues.”
Eliot believes everyone should be able to participate in the sport or activity that they enjoy and finds being able to help a patient get back to the activities that they enjoy through injury management or education is one of the more rewarding aspects of being a health professional.
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