Those who suffer from headaches and migraines may relate to feelings of frustration and helplessness. Nobody can see the headaches, but you can certainly feel them. Nobody can explain why they are there, or how to cure them.
As a physiotherapist working as a Pain Specialist, headaches are something I come across on a daily basis in clinic. Most patients initially come to see me with other issues, and their headaches end up being a by-product of conversation which I then go on to address.
Lets face it, who would think to book in to see their physio for headaches?
It’s bad enough when people suffer from back pain and feel they have to practically be in a wheelchair before they eventually seek help as a last resort. Usually it is the fear of not being ‘bad enough’ to warrant treatment, or no being sure if its something a physio can help with.
Headaches are so prevalent in society that people accept that they have them, and they are stuck with them. But rather than seeking the ’cause’, they spend their time seeking the ‘cure’.
No matter what the symptom in our bodies, there is always a root cause. Not knowing the cause, doesn’t negate it’s existence. When suffering from pain, you will experience good days and bad days. You don’t get bad days without reason. There is always a reason – you just don’t know it.
When you suffer from pain, especially chronic pain, you are stuck in its existence. You feel it, you suffer it, your mind is consumed by it. This pain drives you to the GP, to friends, to Google in the hunt for the cure. It is this desperation which has probably driven you to be reading this article in the first place.
Trust me, you will not find the cure yourself. Some things are best left to the experts.
The Headache Specialist
Who is a specialist? Your GP – he’s a doctor, of course he is the specialist? Or a consultant – now that is definitely your specialist isn’t it? Nobody has Headache Specialist on their door.
When you have suffered such a debilitating or persistent pain, you see the specialists and they don’t find you the cure. Now you’re thinking it MUST be something more serious. A bit of Googling reveals how it must be The Big C (Cancer), a brain tumour, MS, fibromyalgia, your eyes, your teeth, or pretty much anything else it throws out at you.
Some people keep going back to the specialist for answers. The more they go back to the ‘specialist’, the more tests they do. More inconclusive tests inevitably means they must be missing something.
Physiotherapists treat pain every day and this is our speciality. Admittedly, like any other profession or trade, some physios are better than others. I would always suggest going off recommendations – find somebody you trust.
As a Musculoskeletal Pain Specialist – my expertise is understanding the cause of your pain, and helping you to understand why it exists and where it comes from. Only then can we improve your symptoms.
Why can’t anybody find the cure for your headaches & migraines?
Quite frankly, that answer is usually 1) nobody is looking, 2) they are looking in the wrong place, or 3) you are not accepting what they are telling you.
Our whole body is covered by dermatomes – these are cutaneous distributions on the skin which are innvervated by a particular nerve. Our whole body is covered by these dermatomes.
When a patient presents with pain down the side of their calf, or a tingling little finger – this often means nothing to them, but correlates directly to a nerve root L5 and C8 respectively. These dermatomes also exist in the neck, head and face.
There are nerves from the neck (C1-3) and 12 cranial nerves which can be linked to your headaches. But the headaches themselves are referred symptoms, and secondary to what is irritating the nerve in the first place.
Remember, it isn’t irritated for no reason. Why you and not someone else. Why today and not tomorrow. Why a bad day and not a good day.
Pain can also be referred to the head by muscles. The diagram below shows how different muscles in the back, shoulders, neck and face can refer pain to the head.
The brain often doesn’t know where it hurts. The nerves from the body all feed into the same spinal cord and your brain interprets where it thinks this is coming from – not always very accurately. Most people will be familiar with the understanding that appendicitis is felt in the lower abdomen, heart attacks refer pain down the left arm/face, sciatica is pain felt down the leg. This is where we ‘think’ we feel pain.
But what if…
As physiotherapists, we spend all day treating the human body. We are with patients for 45-60 minutes, and spend time listening to their story.
People will describe their pain in all sorts of different ways – I can’t remember the last time I heard a ‘new’ description I hadn’t heard before. Common descriptions are; sharp, shooting, stabbing, burning, throbbing, twinging, tingling, nagging, bone pain, dull ache, niggly toothache…
Headache symptoms typically include tingling in the face, tongue or throat, nausea, visual disturbances, zig zaggy sensations, headaches at the front, sides or back of the head, sinus symptoms, grinding of teeth, jaw pain, and more…
Different causes of pain will give you different types of pain. This detail helps us to identify the cause of your symptoms.
But what if it is something more serious you may ask? Firstly, what is your definition of serious? Secondly, when things are consistent with something more sinister, then we will refer you onto a specialist in that area.
On a number of occasions we have picked up on the symptoms of cancer, parkinsons disease (PD), multiple sclerosis (MS), and a whole range of medical conditions which had gone un-diagnosed by other healthcare professionals. This was because we spent the time listening to the patient, truly understanding their symptoms, diagnosing their condition, then sending them for tests to get the confirmation and medical diagnosis.
My colleagues and I have worked in a broad range of clinical backgrounds prior to working as specialist physiotherapists in private practice. We have experience working in intensive care, post-op rehab, stroke/neuro services, emergency trauma care, A&E and more. We have seen strokes, tumors and neurological conditions, so we know what we are looking for.
Rest assured, we can often put your mind at ease that your symptoms are not in-keeping with more sinister pathologies. Obviously, if we are concerned we will sign post you on for the relevant tests or scans – these can be done on the NHS or privately.
The headache story
Every symptom has a story – the preface, beginning, middle and the present page. As mentioned earlier, symptoms have a root cause – in our analogy this is found in the preface; the things happening in life before the symptoms began. Remember, there is a cause for the symptoms, and this cause must precede the symptoms.
The preface could include stress, traumatic events, significant changes in your life, starting a new job, a break up, work stress, young children, bereavements, other injuries, medical conditions, car accidents… plus more. Not necessarily things you consider relevant, but let us be the decider on that.
Symptoms then have a journey, the good and bad days, the good and bad periods, the aggravating factors, the triggers, and the things that make it feel easier. The detail in this journey helps us understand the ’cause’ of your symptoms, diagnose your symptoms, and formulate a treatment plan.
The most common cause of headaches
Almost every patient we see in clinic with headaches, experiences their headaches secondary to muscular issues in their upper neck, TMJ, throat or face.
This however, still has it’s ’cause’ – we will work with you to discover this. Most commonly it is very simple and obvious (to us). GP’s and consultants often ‘medicalise’ everything, and this is why they cannot find a diagnosis for your headaches – they are looking in the wrong place. Remember reading this earlier:
Why can’t anybody find the cure for your headaches & migraines?
Quite frankly, that answer is either 1) nobody is looking, 2) they are looking in the wrong place, or 3) you are not accepting what they are telling you.
If you are reading this and still dismissing the concept that there could be a relatively obvious cause, and there is somebody here that can help – then you may just be someone not accepting what the specialist here is telling you. Maybe you know best and you do have that brain tumor after all, but you will still believe it is something serious even after a brain scan.
Test yourself at home
Here is a basic but simple test you can try at home:
- First, ask a partner to stand behind you and place their hands on the back of your head.
- Now ask them to run their thumbs gently down your back of your head
- When they reach the base of your skull – get them to press firmly to feel where the skull ends and the squidgy part starts at the top of the neck.
- Ask them to work along the base of your skull around to the back of your ears, following that base of your skull around until they are under your ear.
- Now press into your temples, and the sides of your jaw.
Any unpleasant surprises in any of these areas? Any pain and shouting because ‘they are pressing too hard’? At most, there should be ‘pressure’. Any ‘pain’ means this is likely the source of your problems. If your lucky, it will even give you headaches or pain referring somewhere else – don’t worry, this is a good sign. It means you have found a problem!
This test isn’t definitive, so don’t worry if you don’t feel any pain. These are just the easiest to find places you can test yourself at home. It may just be your partner is pressing in the wrong place, or your symptoms are coming from somewhere else.
Is physiotherapy treatment effective?
Yes, patients often find our input extremely effective. Patients have suffered for years with headaches, and they have then resolved within weeks with treatment.
Obviously there is no guarantee, and we can never say 100% that treatment will be effective – nobody can. But we certainly won’t continue treatment if we do not think we can help.
The number of sessions people need varies, because every case is individual. Some can be 3-4, others could be longer. We always try and equip you with home exercises, education and advice so you can continue the treatment at home between sessions.
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