Want to know something really interesting?
I don’t remember learning a single thing about headaches/migraines in PT school. Now, I am close to ancient, so I’ll give the benefit of the doubt. I also remember skimming over hallux valgus (bunion), which happens to be something else I’ve seen a lot of in my career.
Fortunately, I explored continuing education while in school to earn my Doctorate and became privy to the frequency and severity of headaches/migraines as a student and aspiring manual physical therapist. I went on to become credentialed in Manual Therapy (COMT to be exact) which started my obsession with treating this nagging pain.
Today, as a Physical Therapist specializing in headache treatment, I’ve had the privilege of assisting individuals on their journey towards relief from debilitating head pain. What always shocks people the most is the idea that there might just be a solution aside from strong drugs with side effects or lying in bed for 2 days. For clarity’s sake, today a headache is classified as a migraine when one has more days in a month with head pain than not. That has not always been the case– when I first started studying head pain we thought migraines had vascular deficiency. Today, we know that to not be true.
Understanding the nuanced differences between headaches and migraines is not only pivotal for effective treatment but also sheds light on the staggering prevalence and impact of these conditions in the United States.
Way Too Common
Headaches are not merely occasional discomforts; they are pervasive health concerns affecting millions across the nation. According to the World Health Organization (WHO), headaches are one of the most common nervous system disorders worldwide, with nearly half of all adults experiencing a headache in the past year [1]. In the United States alone, statistics from the American Migraine Foundation reveal that over 15% of the population, translating to approximately 38 million individuals, suffer from migraines [2] . Moreover, tension-type headaches, another prevalent form, affect nearly 30% of the adult population [3].
Incidence Rates:
Beyond prevalence, understanding the incidence rates of headaches provides further insight into the magnitude of the issue. Migraines, in particular, are not sporadic occurrences but recurrent episodes that significantly impact daily functioning. Studies indicate that approximately 12% of Americans experience migraines, with women being three times more likely to be affected than men [4] . Moreover, migraine attacks can be frequent, with some individuals experiencing multiple episodes per month, leading to substantial disability and economic burden [5].
The Impact on Quality of Life:
Beyond the statistics lie the personal stories of individuals grappling with the profound impact of headaches and migraines on their quality of life. These conditions extend far beyond mere physical discomfort, infiltrating various facets of daily living, including work, relationships, and mental well-being. Chronic headaches can lead to absenteeism, reduced productivity, and heightened healthcare utilization, imposing a substantial burden on both individuals and society as a whole.
Unveiling the Complexity
The most important concept I care for my patients to understand as it pertains to their headaches is the “root cause.” When you know what is driving dysfunction, it’s easier psychologically and didactically to manage the symptoms without the potential for spiraling due to another day of disability.
To grasp the differences, let’s explore the anatomy of the head and neck. The skull houses the brain, while the cervical spine supports it, comprising vertebrae, discs, muscles, and ligaments. Any dysfunction in this intricate system can manifest as headaches or migraines.
One of the most common sources of head pain comes from the C2-3 vertebral joint due to it being a transition zone between the part of the cervical spine responsible for the majority of rotation versus the part responsible for sidebending. Both the joint, its support structures like the ligaments and musculotendinus structures can elicit pain if altered in any way from optimal.
Another common source we see, especially since 2020 with the boom in work from home, are heads stemming from muscles in the neck and upper back. Postural deficits like forward head, rounded shoulder and even straining through the eyes can contribute to overuse in the muscles responsible for helping us stabilize our gaze.
Headaches Aren’t All Equal
Headaches are a common complaint characterized by pain or discomfort in the head or neck region. They can be primary, stemming from overactivity or problems with pain-sensitive structures in the head, or secondary, arising from underlying conditions like sinus infections or head injuries.
Presentation of Headaches:
- Tension-Type Headaches: Often described as a dull, achy sensation around the head, these headaches may cause tightness in the neck and shoulders.
- Cluster Headaches: Intense, piercing pain typically around one eye or temple, occurring in clusters over weeks or months.
- Cervicogenic Headaches: Originating from the neck, these headaches radiate to the head and may be triggered by neck movements or sustained postures.
Physical Therapy Treatment Options for Headaches:
- Manual Therapy: Techniques like massage, trigger point dry needling, joint mobilization, and manipulation to alleviate muscle tension, improve range of motion as well as address central sensitization issues.
- Strengthening and Neuromuscular Re-education: Targeted exercises to improve posture, strengthen neck muscles, and correct imbalances.
- Patient Education: Education on ergonomics and posture to reduce strain on the neck and head, lifestyle modifications and stress management.
Migraines: Deciphering the Complexity
Migraines are neurological in nature, involving abnormal brain activity, and often have a genetic component. They tend to be more debilitating than headaches, with symptoms lasting hours to days.
Presentation of Migraines:
- Aura: Some individuals experience visual disturbances or sensory changes before the onset of pain.
- Throbbing Pain: Typically unilateral, accompanied by nausea, vomiting, and sensitivity to light and sound.
- Prodrome and Postdrome: Preceding and following the migraine attack, individuals may experience mood changes, fatigue, or difficulty concentrating.
Often, the first line of treatment for headaches that later become categorized as migraines include medications. At a local hospital in Cincinnati, the first line of treatment for kiddos struggling with headaches/migraines is as generic as the come: Maxalt (sodium tablet), Gatorade and NSAIDs. Sometimes medications also Include pain relievers, triptans, and preventive medications to reduce the frequency and severity of attacks.
Highly important for all sufferers of head pain is stress management, regular exercise, adequate hydration, and avoiding triggers like certain foods or environmental factors. While these might be easy to control some times, they are not always, so helping an individual identify the greatest cause is a big part of evaluation and treatment. Learning to control physiological responses to stress and pain through techniques like deep breathing and progressive muscle relaxation is a HUGE part of our treatment.
Bridging the Gap
In light of the staggering prevalence and incidence of headaches and migraines in the United States, it becomes increasingly imperative to foster greater awareness, understanding, and access to comprehensive care. As a Physical Therapist committed to empowering individuals on their wellness journey, I strive to navigate the fine line between headaches and migraines, offering tailored interventions to alleviate symptoms and improve overall well-being. Together, let us embark on a journey towards a headache-free future, where individuals can thrive and live life to the fullest.
About the Author
Dr. Sarah Crawford, the founder of Anchor Wellness Center & Anchor Wellness Inc. With a Doctorate in Physical Therapy and certifications in Orthopedic Manual Therapy, Myofascial Trigger Point Therapy, and Pilates Instruction, Dr. Crawford is a dedicated advocate for holistic wellness. Her expertise drives the mission of Anchor Wellness, guiding individuals towards optimal health and mobility.
References:
- World Health Organization. (n.d.). Headache disorders. Retrieved from https://www.who.int/news-room/fact-sheets/detail/headache-disorders
- American Migraine Foundation. (n.d.). Migraine facts. Retrieved from https://americanmigrainefoundation.org/resource-library/migraine-facts/
- National Institute of Neurological Disorders and Stroke. (n.d.). Headache information page. Retrieved from https://www.ninds.nih.gov/Disorders/All-Disorders/Headache-Information-Page
- Lipton, R. B., Stewart, W. F., Diamond, S., Diamond, M. L., & Reed, M. (2001). Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache: The Journal of Head and Face Pain, 41(7), 646-657.
- Burch, R. C., & Loder, S. (2015). Migraine: Epidemiology, burden, and comorbidity. Neurologic Clinics, 33(2), 215-228.
