What is a headache?
Headaches are one of the most common afflictions, with more than 90% of adults experiencing headaches at some point in their life. There are many different presentations of headaches, including debilitating migraines with nausea and vomiting, tension headaches, cluster headaches and stress related headaches. As of 2011, there are over 270 recognised categories of headaches and counting.
What causes headaches?
Each Headache is unique. What works to resolve one person’s headache may not work on another, even though the symptoms are identical. There are many factors that cause a headache or migraine, ranging from stress, trauma, jaw dysfunction, hormonal changes, degenerative changes, muscle tightness, significant life changing events or pathology.
How can The Headache, Neck & Jaw Clinic help me with headaches?
At the Headache Neck & Jaw Clinic, our skilled clinicians will identify exactly what is causing your headache. The pain you actually feel in your face, eyes, jaw or temple (to name a few spots) is the site of the pain, and more often than not, the source of the pain lies elsewhere. Based on information gained from our detailed examination, our physiotherapists will illustrate clearly to you what individual structures are causing your headache by actively changing the quality of your pain there and then during the treatment.
How can I tell if treatments are working?
To understand your individual headache, we analyze in depth 4 key properties of your headache:
- The Location of your pain; left or right side or both
- The Frequency of your headache; how many headaches do you get every week, month and year
- The Duration of your headache: how long does each headache last for
- The Intensity of your pain: a map of how severe your pain is through the various stages of your headache
By measuring the change in these properties, it is possible for you to track the progress of your treatment. i.e. improvement is noted if you used to have a 7 out of 10 headache/migraine that lasts for 48 hours every fortnight, and this fortnight after treatment, you have a 5/10 headache that only lasts 12 hours.
Had treatment elsewhere and it didn’t work?
One major obstacle chronic headache sufferers have is the lack of faith that they will ever be able to change their headache. Most headache sufferers have sought help from their GP, chiropractors, physiotherapists, osteopaths, acupuncturists, crystal healers etc. and haven’t had any ongoing success (not even considering the amount of money spent). All of these professions (except one) have good skills to clear simple muscular headaches and if you had a simple muscular headache, it would have worked for you too.
The problem is, once your headache moves from a simple muscular headache to a chronic headache, the Central Nervous System (CNS) becomes involved, meaning your nerves are now continually sending the wrong messages to your brain, and pain becomes your default setting (this is called Central Sensitisation). We now need to take a different approach to your treatment, and change the way your brain (brainstem to be technically correct) interprets the information it’s receiving. That’s the difference between The Headache, Neck & Jaw Clinic, and generalist physiotherapy.
More information about Central Sensitisation
The easiest way to describe Central Sensitisation is over a 2 day seminar, but we will try to do it in a few paragraphs. The base of the skull and upper neck has an intense concentration of sensory nerves that innervate the muscles, discs, ligaments, joints, skin and blood vessels that influence head movements, posture and shoulder movements. All these nerves converge in an area in the brain stem called the cervical nucleus.
The second player is the Trigeminal Nerve, a nerve that originates in the brain and has branches that look after your temple, sinuses, inner ear, eye sockets, jaw joint, teeth, chewing muscles, hard palate, blood vessels and eustachian tube. There are so many impulses coming along this nerve that there literally isn’t room in the brain to process them all, so they are outsourced to the brain stem, where they are processed in the same factory as the nerves from the neck and shoulders, called the Cervico-Trigeminal Nucleus.
There are over 20,000,000 nerve signals that travel from the neck, head and face every minute to the brain stem and most of this is normal stimulus which is processed here and disregarded. If you (for example) break a tooth, a stress signal travels to the brainstem which is recognised as a noxious stimulus and a pain signal is sent to your brain to alert you of a problem. This nerve keeps triggering pain signals until you take appropriate action, and when you do, the brain sends a signal back to the nerve in the tooth to tell it the crisis is over and to calm down, this is called Pain Inhibition i.e. the brain inhibits the pain.
The nerves that carry pain signals to your cortex carry signals from the neck and the head, and when the neural system is compromised from trauma or adverse stress, the brain loses the ability to tell whether that pain is coming from the neck or the head and expresses itself as headache. The stress signal travels from the neck via the cervical nucleus and then the pain signal travels outwards via the trigeminal nerve. This is called Referred Pain.
The CNS has a threshold of how much stress can go through it before it triggers a pain response. Most of the 20,000,000 signals that go through the nucleus fall well short of the intensity required to trip a pain response. i.e, you can sit still to watch a movie for 2 hours without pain. When the CNS becomes sensitised, the frequency and intensity of incoming nerve signals remains exactly the same, but the threshold of what is perceived as noxious is much less, so pain is triggered from a smaller stimulus. i.e. you get a headache after 10 minutes watching the same movie in the same seat. Same feedback; different response due to the CNS being sensitised and over-responsive. To make matters worse, the Pain Inhibition pathway becomes compromised, so there is no self-regulation of the pain signals. That is the difference in treatment approach at The Headache, Neck & Jaw Clinic; we can identify whether your CNS is sensitised and use correct and safe techniques that restore normal thresholds centrally to control your headache.
Get a headache every cycle?
"My headache is hormonal. I get a headache every cycle, you can’t change that...". You’re right, it is hormonal. But your sister or workmates or plenty of other women go through exactly the same hormonal changes every month and don’t get headaches. Dilation of the blood vessels is the likely trigger, and for whatever the reason your Central Nervous System (CNS) is sensitised, the normal 4% change in diameter of these vessels is perceived as a noxious stimulus and a headache is triggered. Treating the cause and desensitising the CNS will change the source of the headache. Blood vessels will still dilate as a response to hormonal changes, but the response won’t trip the threshold and trigger a headache.
How many treatments will I need?
It is impossible to know how much treatment is required. Most people will report a change in symptoms after the first treatment and our physiotherapists expect to see a change in the frequency, intensity and duration pattern after 3 or 4 treatments. If there is no change after 4 treatments, we reassess the value of our intervention.