Where do we provide headache treatment in Sydney
We provide headache treatment within the comfort of your own house. Our home based physiotherapy services bring headache treatment services straight to you. Our therapists have all the tools, skills and knowledge to provide headache treatment at your house and it would be no different to attending a clinic.
A headache is the symptom of pain anywhere in the region of the head or neck. As of 2016, there were over 300 different types of headaches identified in the literature with this number continually increasing. The most recent international classification for headache disorders identified four main primary headaches which included, migraine, tension type headache, trigeminal autonomic cephalalgia’s and other primary headache disorders.
A migraine is classified as a headache disorder manifesting in attacks lasting 4-72 hours with typical characteristics of one sided headache, moderate or severe intensity, aggravated by routine physical activity and association with nausea and/or photophobia or phonophobia (light or sound sensitivity).
Tension type headaches are the most common headaches in our society and are experienced by up to half of adults in a given year. The next most common headache is a migraine.
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Causes for Headache
Every individual may have a different reason for his or her headache/migraine. In many cases individuals undergo detailed examinations which include scans of the brain and neck to importantly rule out pathology. Although in many cases the results are negative this is an extremely valid and necessary first step. After getting the “peace of mind” that scans were negative, individuals suffering from headaches and migraines can sometimes be left in the dark as their symptoms persist.
It is now understood that migraine and headaches are the result of neurological malfunction that is thought to originate in the brain stem. The brainstem is a small but extremely important part of the brain. It allows the nerve connections of the motor and sensory system to pass from the brain to the body. The brainstem is also continuous with the spinal cord and is the location of the trigemino-cervical nucleus. Leading theories regarding the cause for migraines relate to hyper-excitability or a disorder of the brainstem which triggers the migraine.
At the start of an attack, chemical changes are thought to develop in the brainstem which triggers a series of reactions causing the brain to respond abnormally to otherwise normal signals. The result from this hypersensitive response could be migraine.
There may be a wide range of factors which may be influencing headaches and causing hyper-excitability. These include stress, hormones, muscle tightness and degenerative disease.
Management for Headaches:
Leading authorities are now recommending that the optimal management for individuals suffering from headaches is multidisciplinary care which involves various health professionals all working together to help the individual.
Management typically starts with pain medications prescribed by a General Practitioner or Neurologists however symptoms may continue to persist. There have been over 250 catalogued treatments for migraine and in many instances the large number of treatments can leave individuals with greater confusion as they contemplate what may benefit them.
What can we do at Allied Health 2U to help with your headache?
At Allied Health 2U, our physiotherapist will aim to identify the underlying cause of your headaches. As a result of a neurological process which occurs in our brainstem called convergence where one of the nerves within the brainstem called the ‘trigeminal nerve’ overlaps with one of the nerves of the upper neck, the pain which we experiences around different areas of our face or head may in fact be “referred” or come from a different location. Using the Watson Headache Approach® and by undertaking a systematic and detailed examination our practitioners will aim to identify the underlying nature of symptoms and explain the plan for attacking your headaches.
How will you know if the headache treatment is working?
By undertaking a detailed examination we analyse key properties of your headache using well researched methods. It is a good idea to keep a close eye on the properties below as they will help in the initial examination. You can order your headache/migraine patients booklet which will prompt you to answer some of the measures below:
- Distribution of pain: left or right, small or large area?
- Frequency of your headache? Number of headaches every week, month and year?
- Intensity of pain: severity of your headache at different stages
- How long does headache lasts for?
- Use and frequency of medications?
- Triggers? E.g. exercise, food, sounds, light?
By closely examining the above measures, it is possible to track the progress of your treatment. E.g. If your worst headache is a 9/10 occurring once a month and prevents you from going to work changes to a 3/10 with treatment and allows you to go to work next month then an appreciable change can be seen.
Other headache treatment options?
As mentioned earlier the best management for individuals with headaches and migraine is through multidisciplinary care. Health practitioners who may form part of the multidisciplinary team may include, GP’s, neurologists, ear nose and throat surgeons, chiropractors, osteopaths, physiotherapist, pain psychologists, acupuncturist, naturopaths or dieticians. These professionals are not even the start of the myriad of health options which are available for headache and migraine suffers.
From all these professionals there are only a handful who are experts at recognising the potential effectiveness of musculoskeletal anomalies involved in headaches and migraine.
At Allied Health 2U our physiotherapists are specifically trained at uncovering the involvement of musculoskeletal structures which can sensitise the brainstem and be a source of headache’s and migraines. Our detailed musculoskeletal examination and treatment is what differentiates us from thousands of other physiotherapists, chiropractors and osteopaths.
What is sensitised and how can this be relevant?
Your central nervous system is sensitised. Our central nervous system is comprised of the brain and spinal cord in comparison to the peripheral nervous system which includes all the nerves that are outside of this domain.
Central nervous system sensitisation is complex but we will try our best to explain with the following analogy.
Imagine you have a large bucket in front of you, inside this bucket we can fit many things such as sand, water, rocks, pebbles, pencils and your phone. Think of the bucket as your central nervous system and the items as the inputs that flow into the central nervous system. Inputs in our everyday lives can include, light, sound, smells, emotions such as anger, inputs from ligaments, blood vessels, discs, joint capsules and many more. In fact there are billions of nerve signals flowing into and out of the central nervous system at any point in time. Now imagine what can happen if instead of a large bucket you tried to fit everything into a small bucket i.e. your central nervous system was sensitised! The consequence would be that the bucket would overflow and if the bucket overflows this would be interpreted by our brain as pain.
Interestingly we also have a natural inhibitory input pathway in our central nervous system, these are signals which help to dampen pain signals sent to your brain. Unfortunately in states where the central nervous system is sensitised this pathway does not quite work as well and therefore can reduce the pain threshold i.e. the bucket is now smaller and has less capacity to handle all the ‘inputs’.
IMPORTANTLY keep in mind that central nervous system sensitivity can change quite quickly, even from minute to minute. This is why some of the common headache medications such as the triptans have such good effect and people often say “if I get to my medications quickly enough it can stop the headache”. They work to desensitise the brainstem by stimulating a neurotransmitter found in the brain called serotonin.
Central nervous system sensitivity may also be the reason why some females experience a headache every menstrual cycle or every mid cycle. Hormonal changes which occur during these stages of the menstrual cycle are also inputs which can result in our central nervous system reaching a threshold and therefore triggering a headache or migraine.
How many treatments are required?
Every individual and every headache is unique therefore each individual will require a different number of treatments; however, we will generally be able to ascertain whether our treatment is effective within the first 4-5 sessions. If there is no effect or little effect within the first 4-5 sessions then it is unlikely that musculoskeletal inputs are playing a role in your condition and we will refer you back to other health care providers.
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- Eross, Eric., David, Dodick, and Michael Eross. “ The sinus, allergy and migraine study (SAMS).” Headache: The journal of head and face pain 47.2 (2007): 213-224.