Headaches
Tension headaches
These are caused when the neck muscles and muscles of the scalp become tense causing them to contract. This may be due to stress, prolonged or awkward head and neck positions when sitting, working or sleeping, depression, anxiety or following a whiplash-associated injury. They are the most common type of headache, and can significantly affect an individual's performance, quality of life and mood. Headaches that are found to originate from the neck and or shoulders are also termed 'cervicogenic headaches'.
They are often described as dull, vice-like headaches, presenting diffusely over most of the scalp, but commonly worse at the temples and the base of the back of the head near the neck. Muscular trigger points are often found on examination in the neck, shoulders and base of the skull, which are painful 'pressure points' that can reproduce the headache when pressure is applied to the area.
Tension headaches can therefore respond well therefore to physiotherapy intervention, working directly into the muscles and trigger points found to be at fault, along with providing advice and education (such as postural advice, use of heat, stretches, neck exercises and relaxation techniques), as to how to prevent these from happening again. Acupuncture can also be very effective in reducing the pain, tension and muscle spasm associated with cervicogenic headaches.
If you are experiencing headaches that are unusual to you, which cause you to be worried or feel unwell, or your headaches are accompanied by any of the following symptoms, please make an appointment with your GP immediately: dizziness, double vision, difficulty swallowing, altered speech, sudden fainting, nausea, uncontrolled eye movements, weakness in any of your limbs and problems with balance and co-ordination.
Cluster headaches
These occur in specific, localised areas (usually on one side of the head), generally without warning and they can be extremely severe in terms of the level of pain experienced. Pain is usually reported around the eye or one temple, sometimes spreading to other locations on the same side of the head. The headaches can last between 30 minutes and 2 hours, peaking 5 minutes after its onset. Associated symptoms may include a droopy or red eye-lid on the side of the pain, and you may feel agitated and unable to lie down or rest when experiencing this type of headache.
Attacks usually occur in 'bouts', often at the same time of the day. Symptoms may present only every couple of day, or may be as frequent as up to eight times a day during a bout. Such attacks may be experienced for a few weeks or months at a time, and generally sufferers can have one or two bouts of these attacks per year.
It is proposed that there may be certain 'triggers' that lead a person to developing this type of headache, though the exact cause is not yet known. It is thought that sudden releases of chemicals such as serotonin and histamine, in response to individual triggers such as hot rooms, perfumes, bright lights and alcohol, may be involved. Another suggestion is that the hypothalamus in the brain is responsible, given its role in controlling the body's daily rhythms, and the likelihood of cluster headache attacks occurring around the same time of the day during a bout.
As the cause is believed to be related to a chemical response within the brain, the treatment for this condition is often through the use of prescribed medicines, including the use of oxygen. These do not offer a cure, but help to reduce the level of intensity of the attacks, and the length of time they last. A GP may also refer an individual with severe cluster headaches to a neurologist for a specialist examination and opinion.
Unfortunately, physiotherapy cannot prevent cluster headaches from occurring. However, relaxation techniques can be taught by a physiotherapist or another suitably-qualified professional, in order to equip individuals with the ability to relax during an attack and potentially reduce the level of pain and anxiety experienced. Anecdotally, acupuncture has been found to be of benefit to some sufferers. This may be by way of balancing the flow of blood and energy through the head, relaxing the surrounding muscles, and influencing the levels of serotonin the body produces.
If you are experiencing headaches that are unusual to you, which cause you to be worried or feel unwell, or your headaches are accompanied by any of the following symptoms, please make an appointment with your GP immediately: dizziness, double vision, difficulty swallowing, altered speech, sudden fainting, nausea, uncontrolled eye movements, weakness in any of your limbs and problems with balance and co-ordination.
Migraines
These types of headaches can affect anyone of any age, but are more prevalent in females than males. It is estimated that 1 in 7 people in the UK suffer from migraines at one or more stages in their lives. Attacks may be temporary over a short period and then disappear, frequent with attacks occurring every week, or may be a persistent problem throughout an individual's life. Persistent migraines can be disabling to the sufferer, affecting their daily life and work.
Two types of migraines exist, a migraine with an aura (a warning sign before the migraine develops), and those without an aura.
Auras can vary between individuals, but common warning signs before a migraine develops include visual disturbances (such as flashes of lights, temporary blurring or loss of vision), pins and needles in the hand, arm and / or face / lips, speech alteration and sudden food cravings. Auras usually last several minutes before the migraine itself starts, but on occasion can last up to an hour. Even though some individuals do not experience an aura, commonly migraine sufferers know that they are going to develop a migraine, sometimes several days before its onset.
Symptoms common to both types of migraine include a throbbing headache (one sided or on both sides), nausea, vomiting, poor concentration, sweating, frequent urination, a feeling of being hot or cold, and commonly individuals develop a temporary sensitivity to bright lights and noises, requiring them to lie down in a dark room.
Migraines can last for between 4 and 72 hours, rarely continuing longer than this. Occasionally however, migraines can become persistent and occur for up to (and over) 15 days out of every month. These cases are severe, can lead to depression and anxiety and require careful management by a GP as continued use of strong migraine medication may lead to medication over-use. Persistent or chronic migraines may also be a symptom of other more serious underlying medical problems and therefore sufferers must consult their GP with such symptoms.
Though the exact cause is not known, it is believed that migraines may be a result of altered serotonin levels which causes blood vessels in the brain to widen. Triggers for this chemical reaction may be stress, altered sleep patterns, certain smells, certain food types or alcohol, bright lights, hormonal changes (during the menstrual cycle), dehydration or sudden strenuous exercise.
Migraines can be managed using specific medication, avoidance of known triggers, relaxation techniques, and acupuncture has also been found to help some sufferers.
If you are experiencing headaches that are unusual to you, which cause you to be worried or feel unwell, or your headaches are accompanied by any of the following symptoms, please make an appointment with your GP immediately: dizziness, double vision, difficulty swallowing, altered speech, sudden fainting, nausea, uncontrolled eye movements, weakness in any of your limbs and problems with balance and co-ordination.
Jaw pain
Problems arising from the jaw area can cause symptoms which may include pain in the jaw, ear, neck and head, clicking, popping, and/or reduced jaw / mouth opening and, in extreme cases, the jaw can 'lock'. At best this condition can be distracting, but in more severe cases when the jaw is unable to move, it can be highly distressing to the individual and significantly affect their ability to bite and chew, yawn, speak, and function normally throughout their day.
The problem is usually caused by a dysfunction of the temperomandibular joint (TMJ). This is the hinge joint that is formed by the jaw bone (mandibular bone) and the temporal bone of the skull. This joint enables you to open and close your mouth and to move your mouth / jaw backwards and forwards and side to side.
Problems arise from this area when the normal movement of the TMJ is altered. This may be due to changes in muscular tension around the neck and jaw, a direct blow to the jaw, or from problems with the cartilaginous disc within the joint itself.
Predisposing behaviours/causes can include:
- Teeth grinding
- Habitual chewing of nails, generally using one side of the mouth
- Chewing gum regularly, habitually on one side of the mouth
- Direct blow / trauma to the jaw itself
- Trauma to the head / neck e.g. whiplash causing increased muscle tension around the neck / jaw
- Misalignment of the teeth
- Stress, which may increase facial, jaw, neck and/or shoulder tension
- Work-related postures such as cradling the phone between head and shoulder, or poor ergonomic set-up of your desk at work
- Jaw joint degeneration (arthritic changes)
Pain from the TMJ can feature as facial pain, jaw pain, toothache, headache and/or neck ache and may present with or without clicking from the problematic side of the jaw. Clicking may be present only upon chewing, or may only occur first thing in the morning when the individual begins to open their mouth after sleeping.
Dental sources of jaw pain can generally be successfully managed by your dentist, who will look at your teeth for signs of wear and any internal derangement, and examine your jaw and the associated muscles. Your dentist may be able to issue you with a mouth guard to wear during the night if it is determined that you grind your teeth when you are asleep. Other non-muscular causes of jaw pain may also arise from tooth cavities, broken teeth, infections, abscesses, tumours, swollen glands in the neck and sinus problems. It is important therefore that you first see your GP / dentist as soon as possible if you experience an insidious onset of jaw or facial pain.
Muscular overuse and tension of one side of the jaw / neck compared with the other side, including tension and spasm arising from whiplash associated disorders can be managed successfully by a physiotherapist who is experienced in dealing with TMJ problems. Physiotherapy treatment for TMJ disorders may include soft tissue and muscular trigger point release of the areas responsible for the joint dysfunction, along with specific joint mobilisation, a programme of corrective home exercises and, in some cases, the use of Acupuncture to help with pain relief and release of muscle tension. Bowen Therapy has also been found to help with TMJ disorders when muscle tension is thought to be the underlying cause.
Postural management, ergonomic modifications and stress management may also be areas that need to be addressed in order to successfully treat TMJ problems.
Jaw and facial pain can also arise from irritation of one of the 'cranial nerves', more specifically the trigeminal nerve, which leads to a condition known as 'trigeminal neuralgia'. The trigeminal nerve controls the muscles required for chewing, and sensory information is carried along the nerve from the face to the brain. Pain is often described as sudden bursts of sharp, stabbing pain from the lower portion of one side of the face and may involve the side of the nose, jaw and cheek. Although the pain generally only lasts from a few seconds up to a couple of minutes, it may occur repeatedly throughout the day and night and can therefore be debilitating. Severe cases can lead to sleep deprivation, depression and malnutrition.
Trigeminal neuralgia tends to affect individuals over 50 years of age, women more commonly than men, and there are a number of proposed causes
- Irritation of the trigeminal nerve root from compression of an abnormal blood vessel nearby
- Damage to the nerve from dental surgery or direct trauma
- Multiple Sclerosis
Once irritated, external triggers such as shaving, applying makeup, smiling and eating can give rise to pain from the trigeminal nerve. Diagnosis is based upon the reported symptoms from the individual.
Management is generally through medication for pain relief and / or muscle relaxants, which can be prescribed by your GP. Pain relief may also be gained from acupuncture, relaxation techniques and from the use of a TENS machine.
If you experience other symptoms along with your jaw pain, such as difficulty swallowing, blurred vision, sudden headaches, nausea / vomiting, sudden weight loss, night sweats, or if you feel generally unwell alongside any of these symptoms, you must arrange to see your GP urgently.
