Physical Therapy for Headaches

Most headaches have a muscular component and sometimes muscles can be prime origin of the headache symptom. Both migraine headaches and chronic tension type headaches will have a myofascial trigger point in the muscles. We will concentrate on how the myofascial trigger points are associated and can create headaches.

Most of us are familiar with the classic presentation of headaches. But there is little to distinguish a migraine headache without aura from a chronic tension type headache, (CTTH). One sided pain of the head, aggravation of the headache by routine physical activity, nausea and vomiting, photophobia and phonophobia are described as symptoms of a migraine without aura and the CTTH. The chronic daily headache, (transformed migraine, CTTH, new daily persistent HA (NDPH), and hemicrania continua), pathogenesis is considered to include peripheral and central nervous system sensitization. Peripheral sensitization of muscle receptors in pericranial muscles is a possible mechanism of this sensitization, (2) The cervicogenic HA has myofascial trigger points of the posterior cervical and suboccipital muscles. It is estimated that the cervicogenic HA accounts for 15-20% of all chronic & recurrent HA. (3,4)

Janet Travell found and documented the myofascial trigger points referral pattern of muscles throughout the body. But is the cervico-occipital, cervico-scapular, cervico-thoracic, cervico-clavicular and the muscles of mastication that are of particular interest because these muscles refer directly to the areas of the head, (1). Note the referral patterns below.

Travell showed that the myofascial trigger point when active or latent will cause a loss of range of motion, weakness of the muscle, lack of coordination of the agonist and antagonist muscle movements, joint compression as well as neural compression.(1) These will all result in aberrant peripheral and central neural input resulting in sensitization. It is this mechanism that the trigger point can cause the CTTH or contribute to the transformed migraine, new persistent daily headache (NDPH) and the hemicrania continua headaches.

Kulp Physical Therapy and Massage will evaluate and treat each muscle, eliminating the trigger point and associated joint and motion dysfunction. Kulp PT will also address resulting postural deficits through postural exercises, ergonomic posturing and orthotics. Parafunctional activity education as well as relaxation and breathing exercises are also used to stop the re-occurrence of a headache. The home exercise program including stretching and strength building exercises are a key component to the patient getting better.

Treatment of the myofascial trigger point includes manual trigger point compression, spray and stretch technique, manual stretching, myofascial stretching and passive stretching. Modalities of ultrasound and electrical stimulation, (including the use of phonophoresis and iontophoresis), have shown effectiveness in reducing the myofascial trigger point.

Kulp Physical Therapy and Massage has focused specifically on utilizing manual myofascial trigger point treatment, joint mobilization, movement system impairment exercises and neural tension techniques in the treatment of headaches and has two nationally certified manual therapists to help headache patients.

Take a few moments to inquire how Kulp Physical Therapy can help 585-742-8270.

(1)Travell JG, Simons DG. Myofascial Pain and Dysfunction, The Trigger Point Manual, Vol. 1. Baltimore. Williams and Wilkins. 1993

(2) Ferguson LW, Gerwin R. Clinical Mastery in the Treatment of Myofascial Pain. Baltimore. Lippincott, Williams and Wilkins. 2005.

(3) Nilsson, N. The Prevelance of cervicogenic headaches in a random population sample of 20-59 year olds. Spine 20: 1884-1888, 1995.

(4) Pfaffenrath, V, Kaube, H Diagnostics of cervical headache, Functional Neurology 5: 157-164, 1990.