Tension Headache:

Definition: mild to moderate pain commonly presenting around the head like a tight band

Symptoms:

• Dull achy head pain
• Bilateral across forehead and / or sides and back of head
• Feels like pressure, squeezing or band tightness across head
• May last anywhere from 20 minutes to a few days

Common causes:

• Neck and scalp muscles become hypertonic or strained
• Head injuries (past or current)
• Stress / Anxiety
• Insomnia

Examination

• Palpation to head and scalp muscles revealing hypertonicity and tenderness
• Passive / active range of motion restrictions may be found in cervical joints
• No Aura symptoms

Treatment / management

• Manual therapy to head and scalp muscles
• Manual therapy to cervical joints (articulation, manipulation)
• Apply heat or cold pack to areas of head
• Medication if needed

Prognosis:

Good. Most tension headaches will resolve within a week

Migraine

Definition: a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision lasting anywhere from 4 – 72 hours.

A) Migraine with aura:

• Visual hallucinations such as flashes of light or blind spots

B) Migraine without aura:

• Is characterized by the regular symptoms of migraine in the absence of aura symptoms

Signs and Symptoms:

• Throbbing or pulsing pain on one side of head (Unilateral)
• Sensitivity to light and sound
• Nausea and vomiting
• Visual aura (flashes of light, blind spots)
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)

Common causes:

• Stress
• Alcohol, coffee, tea, Red wine, Chocolate, nuts, cheese
• Hormonal (menstruation)
• Red wine, chocolate, nuts, cheese)
• Bright lights, strong smells

Examination:

• Case history – frequency of attacks and how many attacks have occurred since onset. A minimum of 5 are required
• Active / Passive cervical range of motion is often decreased
• Palpation of cervical erector spinae and fascial muscles commonly hypertonic
• Blood tests may help rule out other pathologies (infection)
• Blood pressure is recommended for patients over 50 with a new Headache
• MRI or CT (head/neck) may be indicated in patients experiencing their first attack who have focal neurological deficits or altered mental status to rule out a serious pathology (Tumour)

Treatment

• Manual therapy to release restricted cervical joints and hypertonic muscle strains
• Identify and control / manage triggers
• Rest, sleep
• Stress management
• Management with GP to help document frequency of attacks

Prognosis:

• Fair to good depending on symptoms and causes. Commonly subsides within 3 days

Cervicogenic headache

Definition: Refers to a headache of upper cervical origin and experienced in one or more regions of the head and face

Symptoms:

• Unilateral
• Usually begins in the occipital region, and can radiate to the parietal region, or behind the eye
• Accompanied by dysfunction in the upper cervical segments
• May occur with trigger point palpation in the head or neck
• Aggravated by sustained neck positions
• Constant ache, which can be sharp on movement
• Moderate to severe intensity
• Can last 3hrs – 1 week

Caused by:

• Convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus
• Upper cervical facet sprains
• Upper cervical muscle strains, hypertonicities, myalgia
• Trauma to upper neck
• Poor desk ergonomics at work / study

Examination

• Active / Passive range of motion of upper cervical region may be decreased
• Palpation tenderness of Cervical erector spinae, sub – occipitals, occipitalis, trapezium
• Resisted Isometric testing – weakness of neck extensors
• Posture (may present with a forward head posture)

Treatment

• Manual therapy (joint mobilization and articulation) focussing treatment on upper cervical spine segments.
• Manual therapy to muscles Cervical erector spinae, sub – occipitals, occipitalis, trapezium (soft tissue massage, stretching, Muscle Energy techniques)
• Muscle Isometric holds of Cervical erector spinae, sub – occipitals, occipitalis, trapezium
• Teaching postural awareness and education surrounding workplace ergonomics
• NSAIDS (Advised from Medical doctor)
• Nerve block to upper cervical segments (Specialist, radiologist)

Prognosis 

• Fair to good in most cases where the cause is muscle and / or joint related. May last up to 3 hours or one week and be re occurring.

Sinus Headache

Definition: A secondary headache caused by pressure within the sinus cavities of the head, usually in connection with a sinus infection.

Symptoms:

• pain, pressure and fullness in the cheeks, or forehead
• Swelling in the face
• Pain worsens when leaning head forward
• Blocked nose
• Runny nose
• Feeling of fullness in the ears
• Achy feeling in the upper teeth
• Postnasal dripping

Caused by:

• Infection in sinuses
• seasonal allergies (through the production of mucous)
• common cold
• Nasal polyps, abnormal growths in the nose or sinuses. These can block mucus from draining and cause sinus headaches

Examination:

• Case history (looking for symptoms)
• Physical exam: sinus tapping listening for fullness, observing for swelling, asking patient to lean forward, and observing for exacerbating symptoms
• Imaging (CT/ MRI scans)
• Nasal Endoscopy

Treatment

• Nasal Decongestants
• Washing out sinuses with a saline / water solution (bottle / Netty Pot)
• Apply a warm compress to painful areas of the face
• Antihistamines
• Inhale steam from boiled water
• Surgery to remove any structural blockages

Prognosis

• Fair to good, may last up to a week. Consult your doctor if symptoms persist

TMJ (Temporal mandibular joint) Headache

Definition: TMJ disorder leading to a headache in the face, head and orbital bone area

Signs and symptoms:

• Pain in TMJ, face, temples and over the eyes
• Painful to open jaw or chew food
• Clicking sounds from jaw area
• Unilateral or bilateral

Caused by:

• Grinding or clenching teeth (Bruxism)
• Hypertonicity of jaw mastication muscles
• SCM hypertonicity
• TMJ dysfunction

Examination:

• Case history, symptoms
• Active / Passive TMJ range of motion testing
• Palpation of masseter, temporalis, supra/infra hyoid, mylohyoid

Treatment:

• Manual therapy to TMJ and surrounding musculature
• Eating soft foods
• Medications for pain relief
• Botox

Prognosis:

• Good using conservative methods by releasing hypertonic musculature and improving range of motion in TMJ

Cluster Headache (M>F 20-50)

Definition: severe unilateral orbital headache lasting minutes to a few hours. Commonly short lived but can last up to 3 hours. May occur once a month. More severe than a migraine but does not last as long. Attacks seem to be linked to the body’s circadium rhythm therefore occurring at the same time of day or night.

Symptoms:

• Excruciating pain behind or around one eye
• Unilateral
• Excessive tearing on affected side
• Few minutes to 3 hours
• Often occurs at the same time during the day or night
• Forehead and facial sweating on affected side
• Nasal congestion
• Contraction of pupil or eyelid drooping

Caused by:  

• A nerve located in the head near the temple in front of the ear called the Trigeminal nerve is triggered causing symptoms in the side of face and head.
• Certain foods
• Alcohol
• Smoking
• Strong smells
• Bright lights

Examination procedure:

• Physical exam based on history, findings, and symptoms

Treatment:

• Medications for prevention and during an episode (discuss with Medical Doctor)
• Oxygen therapy

Prognosis:

• Chronic patients will manage the condition through medication and avoidance of triggers

Thunderclap headache (Subarachnoid haemorrhage)

Definition: Sudden and severe onset headache commonly associated with bleeding in and around the brain (Subarachnoid hemorrhage)

Symptoms:

• Sudden and severe sharp pain in head
• Peaks after one minute
• Nausea
• Vomiting
• Photophobia (eye discomfort in bright lights)
• Altered consciousness
• Fever
• Seizures

Caused by:

• Trauma
• Ruptured blood vessel in brain
• Aneurysm
• Blood clot in brain
• Cerebrospinal fluid leak in and around brain
• Arteriovenous malformation

Examination procedure:

• CT angiogram scan
• MRI magnetic resonance angiography
• Spinal tap (Lumbar puncture) tested for signs of blood or infection

Treatment:

• Hospital emergency. The goal in a sub arachnoid hemorrhage is to stop the bleeding.
• Surgery: A clip may be attached to the blood vessel to stop the bleeding or a endovascular coil to manage an aneurysm.

Prognosis:

• One third of patients with Sub arachnoid hemorrhage will survive with good recovery. One third will survive with a disability or stroke and one third will pass away.