Headaches

Headaches

There are four main types of headaches:

1.  Tension headaches (also known as muscle contraction headaches): Tension type headaches are by far the most common type of headache. They are believed to be caused by referral pain from trigger points in the muscles of the neck, shoulders and jaw. They can be brought on by stress, poor posture, misalignment of the neck or over exertion with exercise. Tension type headaches often start gradually and are characterized by mild, steady or dull aching with a pressing/ squeezing, non-pulsating quality. The pressure can be located on both sides of the head, or can feel like a band around the head or the back of the neck. It can also be point specific or feel like you have "brain fog." The area you experience the headache is an indicator of where you may have trigger points and muscle tension. Please see the diagram below for examples.
 
Headache Trigger Points   Upper Back Trigger Points
             

2.  Migraine headaches: Migraines are not yet fully understood, but seem to be caused by changes in the chemicals of the brain control the narrowing and dilatation of blood vessels of the brain. Low levels of serotonin (a brain chemical) may also play a role in widening and tightening blood vessels. Migraine headaches are characterized by severe throbbing, increased sensitivity to light and sound, nausea, vertigo and vomiting and may also be accompanied by ringing in the ears, motor coordination disturbance, double vision or partial blindness, weakness, numbness or tingly sensations. Migraines usually affect one half of the head more than the other. The cause of migraine headaches is not fully understood but some triggers include perfumes/colognes, food sensitivities, loud noises and stress. 

 
3.  Cluster headaches (also known as suicide headaches): Cluster headaches are intermittent in nature, but are extremely intense and painful. They typically start around one eye or one temple then quickly spread to surrounding areas on that side of the head. Their cause is unknown. The pain is mostly located around the facial area and is described as being like stabbing, electric shocks, burning, pressing, crushing, exploding or shooting pain that becomes intractable.
 
4.  Dehydration headaches: Dehydration is one of the most common causes of headaches, therefore rehydration is the appropriate treatment method. Dehydration headaches can also be caused by consuming too much caffeine, which is a natural diuretic.
 

Headache Triggers: 
  • Food allergies
  • Blood sugar imbalances
  • Dehydration
  • Lack of sleep
  • Many medications have headaches listed as a side effect
  • Hormone imbalances or changes
  • Exposure to toxins and chemicals (cigarette smoke, strong perfumes, carbon monoxide, lead, arsenic, cyanide, nitrates, insecticide)
  • Alcohol
  • High caffeine intake or caffeine withdrawal
  • Exposure to strong light (direct sunlight without sunglasses, fluorescent lights) or flickering lights of TV and computer screens
  • Poor posture and ergonomics
  • Stress
  • Muscle Tension and Trigger Points

Our Philosophy and Approach to Headache Treatment

Headaches are a complex problem with multiple contributing factors. We believe that a holistic approach is effective for both short and long term effects. 
 

What exactly do we mean when we say that we “get to the root of the problem” and “do more than provide band-aide solutions?” 

We mean that we don’t treat surface level symptoms without getting to the bottom of the issue as well. In the case of headaches, for example, we seek to understand the underlying causes, in addition to providing immediate pain relief. Not only do we help headaches to go away, but we also help them to stay away. A headache is a symptom, not a syndrome in and of itself. So, treating the underlying condition can usually relieve headaches for the long-term. A symptom, such as a headache, is a way your body asks you to change something, be it your lifestyle, posture, diet or external environment. If you ignore your body’s plea for change your headaches will probably continue to return. A true health solution is needed before a presenting symptom can disappear for good. That’s why we offer safe, effective and natural approaches to help headache sufferers regain and maintain health and wellbeing. 
 

This is only a brief summary of general information about possible causes and triggers for headaches. This information is not specific medical advice and does not replace information you receive from your health care provider. 

 
How Can Massage Therapy Help with Headaches?

Massage therapy has been found to have many positive effects such as reducing the occurrence, duration and severity of headache attacks, especially tension-type headaches. Registered massage therapists use soft tissue techniques to help decrease muscle tension, release trigger points, relieve pain, ease stress and anxiety and promote relaxation. Massage intervention is non-invasive and has no side effects.

Muscle Tension Release

When a muscle is stuck in a contracted position, such as in a tension headache, blood circulation through the muscle is reduced, causing waste products to pool in the area. Therapeutic massage breaks up this blockage and brings blood flow back into the area, thereby restoring normal muscle function and relieving headache pain.  

Myofascial Release

Registered massage therapists can also employ myofascial trigger point release techniques.  

A myofascial trigger point is essentially a knot in a muscle or connective tissue that is painful to the touch and may refer pain elsewhere in the body. In many cases the source of the pain isn't where it hurts. For example, there are trigger points in the shoulder muscles that refer pain up the back of the neck and into the head, especially around the temple and jaw. This trigger point is a major cause of tension headaches. Releasing it and others around the head and neck will likely stop the occurrence of tension headaches. Massage therapy aimed at easing myofascial restriction results in improved circulation and posture, lymphatic drainage and nerve conduction and may even help organ function.
 
Relaxation

Stress affects the balance of the body, which can sometimes lead to headaches. Massage therapy can relax pain, reduce anxiety and improve overall health and quality of life. Improving the body’s response to stress can translate into less frequent headaches. 
 
References:

Finando, Donna and Steven Finlando. Trigger Point Therapy for Myofascial Pain. Rochester, VT: Healing Arts Press, 2005.
Goffaux Dogniez, C, et al. “Appraisal of Treatment of the Trigger Points Associated with Relaxation to Treat Chronic Headache in the Adult.” Encephale. 29.5 (2003): 377-90. 
Ivker, Robert S and Todd Nelson. Headache Survival. New York, NY: Penguin Putman Inc., 2002. 
Joost Dekker, et al. "Effectiveness Of Manual Therapy For Chronic Tension-Type Headache: A Pragmatic, Randomised, Clinical Trial." Cephalalgia. 31.2 (2011): 133-143. 
Milne, Robert D. et al. An Alternative Medicine Definitive Guide to Headaches. Tiburon, California: Future Medicine Publishing, Inc., 1997. 
Quinn, C, et al. American Journal of Public Health. 92.10 (2000): 1657-61.
Teitelbaum, Jacob and Bill Gottlieb. Real Cause, Real Cure. New York, NY: Rodale Inc., 2011.
Travell, Janet G., and David G. Simons. Myofascial Pain and Dysfunction : The Trigger Point Manual. 2nd ed. Vol. 1. Baltimore, MA: Williams & Wilkins, 1999. 

 
How Can Osteopathy Help with Headaches?

Osteopathy is a body work therapy which can be very effective in treating chronic pain, including headaches, and providing greater overall function. Osteopathy applies the knowledge of the structure (anatomy) and function (physiology) of the body to all diseases, disorders and dysfunctions. Osteopathic practitioners use their hands and provide a gentle “manual” approach to identify the causative factor of the problem and restore order to all of the body’s systems (musculoskeletal, respiratory, cardiovascular, digestive, reproductive and nervous). Osteopaths address underlying structural problems in the body that may be causing headaches such as poor posture, misalignments, asymmetry etc. Osteopathic techniques are non-invasive and non-pharmacological.
 

Myofascial Release: A Head to Toe Treatment
 
Osteopathy is a full body treatment focusing on the interconnectedness of the body. 

Well trained hands can “see” the underlying structures that are contributing to headache pain and make adjustments accordingly. For example, the body’s compensation for a subtle structural imbalance in the lower body can often obstruct the flow of blood and nutrients to the head, causing headache pain. Osteopathic manipulation of the muscles, joints and connective tissues can fix postural dysfunctions and restricted range of motion and circulation in the body, thereby relieving tension headache pain. 

Cranial-sacral therapy 
 
 
Osteopaths can also provide gentle manipulation of the bones in the head and the base of the spine to fix structural problems that may be causing migraine headaches. There are almost two dozen bones in the skull that are capable of small movements; the restriction of these movements can cause headaches. In addition to treating headaches, cranial-sacral therapy also restores balance to the entire body.

Research
 
Two separate clinical trials involving patients with neck pain and headaches have found cervical spinal manipulation to improve the pain and impaired ability associated with headaches. Other recent research has also found evidence that spinal manipulations may be effective in preventing migraine and chronic tension-type headaches from occurring in the first place. 

References:
Gallagher, R. Michael. “Headache Pain.” Journal of the American Osteopathic Association. 105.4 (September 2005): 7-11.
http://www.chiroandosteo.com/content/18/1/3
Ivker, Robert S and Todd Nelson. Headache Survival. New York, NY: Penguin Putman Inc., 2002. 
Joost Dekker, et al. "Effectiveness Of Manual Therapy For Chronic Tension-Type Headache: A Pragmatic, Randomised, Clinical Trial." Cephalalgia. 31.2 (2011): 133-143.
Milne, Robert D. et al. An Alternative Medicine Definitive Guide to Headaches. Tiburon, California: Future Medicine Publishing, Inc., 1997.
Teitelbaum, Jacob and Bill Gottlieb. Real Cause, Real Cure. New York, NY: Rodale Inc., 2011.

 
How Can Acupuncture Help with Headaches?

By reducing stress and improving energy flow, regular acupuncture can reduce the pain and frequency of headaches, increase vitality and improve day-to-day functioning. Acupuncture is an excellent option for treating both migraine and tension headaches without pharmaceuticals and their side effects. It can work as the primary method of treatment for headaches as well as in combination with other therapies.

The Treatment Approach
 
Acupuncture uses the theories of Traditional Chinese Medicine to identify and diagnose patterns of symptoms into particular syndromes. TCM is holistic and takes into account the health of the entire body.  The basic premise is that there is a life energy flowing through the body on channels that connect all of our major organs. Pain, such as headache pain, is believed to arise when the cyclical flow of energy becomes unbalanced. Acupuncture uses needles at specific points on or near the surface of the skin to open restrictions along the energy pathways, release restrictions and promote flow. In this way, it stimulates various physiological and biochemical conditions that can cause headaches. Just as one individual’s experience of headaches or migraines is completely unique, so too is each acupuncture treatment plan, determined by the patient’s specific needs. An initial consultation with an acupuncturist is the best way to decide if acupuncture is right for you and your symptoms.

 Recent Research

 Researchers conclude that both tension and migraine headaches can be effectively treated by acupuncture. In one study, people with chronic headaches who received regular acupuncture treatments had 22 fewer headaches per year, 15 percent fewer sick days and 25 percent fewer doctor visits. It has also been proven that a course of acupuncture treatments is more successful in treating chronic daily headaches than medical management alone is. Another recent clinical trial concluded that acupuncture is more effective than mock acupuncture for the treatment of migraine headaches. Those who received traditional acupuncture showed lasting improvement in migraines and were more likely to report a reduction in the perception of suffering from headaches at the end of the intervention period. The number of treatments required will be dependant on the cause of the headaches. On average, patients begin to experience relief of headache symptoms within 3 to 4 treatments, though in severe or chronic headache situations it may take longer. Compared to other headache interventions, acupuncture has been found to be relatively cost effective. 

References: 
Bongaard, Bridget S. "Using Acupuncture For Headache Treatment: Getting The Point!." Alternative Medicine Alert. 11.5 (2008): 49-52. SPORTDiscus with Full Text. 
Facco, Enrico, et al. “Traditional Acupuncture in Migraine: A Controlled, Randomized Study.” Headache: The Journal of Head and Face Pain. 48.3 (2008): 398–407. 
https://www.acufinder.com/Acupuncture+Information/Detail/Reduce+Migraine+and+Headache+Pain+with+Acupuncture 
McCarney, Rob, et al. "Cost Effectiveness Analysis Of A Randomised Trial Of Acupuncture For Chronic Headache In Primary Care." BMJ (Clinical Research Ed.) 328.7442 (2004): 747.
Robbert Van Haselen, et al. "Acupuncture For Chronic Headache In Primary Care: Large, Pragmatic, Randomised Trial." BMJ (Clinical Research Ed.) 328.7442 (2004): 744.
Willich, S.N., et al. "Acupuncture In Patients With Headache." Cephalalgia: An International Journal Of Headache. 28.9 (2008): 969-979.


How Can Naturopathic Treatment Help with Headaches?
 
Headaches can be symptoms of nutritional deficiencies, blood sugar imbalances, allergic reactions, digestive distress, emotional strain and/ or hormonal imbalances. A Naturopathic Doctor can help discover areas of health imbalances and create a comprehensive strategy for treating headaches naturally. 

Diet

Clinical nutrition analysis, including a thorough review of dietary habits (types of foods, drinks, supplements and eating patterns), can be beneficial for headache sufferers. Eliminating food allergies is also extremely useful in combating migraine headaches, however most migraine sufferers don’t know what their food allergies are. Allergy testing and/or an elimination diet can provide this much needed information. A Naturopathic Doctor can then create a tailored meal plan to suit the patient’s individual needs. 

Several studies show that an estimated 30 to 40 percent of people with migraines find a significant improvement by avoiding the food sensitivities that set off their headaches. In fact, one particular study showed that an overwhelming 85 percent of people became headache free when they discovered and eliminated their dietary triggers. Proper hydration is also key.
 

Lifestyle and Stress

Work, leisure, finances, relationships, mental and emotional situations are all factors which influence each person’s lifestyle and state of health. Chronic levels of stress disrupt hormone patterns and can contribute to many health concerns, including headaches. Lifestyle counselling can help with strategies to better deal with tension and overcome obstacles to maintaining a healthy lifestyle for the long-term. A Naturopathic Doctor can provide a personalised treatment protocol to work with individual lifestyle factors to ensure that the patient is able to implement treatment on a consistent basis. This protocol may consist of supplementation with homeopathic and botanical medicine to treat headaches caused by stress and to improve the stress response.

References: 
Ivker, Robert S and Todd Nelson. Headache Survival. New York, NY: Penguin Putman Inc., 2002. 
Milne, Robert D. et al. An Alternative Medicine Definitive Guide to Headaches. Tiburon, California: Future Medicine Publishing, Inc., 1997.
Teitelbaum, Jacob and Bill Gottlieb. Real Cause, Real Cure. New York, NY: Rodale Inc., 2011.

 
How Can Physiotherapy Help with Headaches? 
  
Physiotherapists can play an important role in the treatment headaches, especially those related to a structural disorder of the musculoskeletal system. Physical therapy involves several types of treatment modalities. Research suggests that physiotherapy is most beneficial for patients with frequently occurring tension-type headaches.

 
Manual Therapy 
 
Headache episodes are often accompanied by neck pain or other symptoms. Physiotherapists use hands on techniques to mobilise and manipulate soft tissue to treat neck and headache pain. The benefits of soft tissue mobilization include increased circulation, muscle relaxation and myofascial restriction release.

Dry Needling/ IMS
 
Dry needling involves the insertion of a very thin needle into a myofascial trigger point of a muscle. Acupuncture needles are used, which are even thinner than hollow hypodermic needles, to reduce the risk of bruising post treatment. Dry needling is used for pain relief and muscle relaxation, and can be applied to headache treatment. IMS (Intramuscular Stimulation) is a particular dry needling technique, used to reach deep into the muscle to release its shortening. It effectively opens up constrictions and promotes proper circulation and function but may be painful since no anesthetic is used.

Exercise Therapy 
 
The combination of manual therapy and exercise produces even greater improvements in headache pain, function, quality of life and patient satisfaction in both the short and long term. In the treatment of migraine headaches especially, physiotherapy is most effective for when combined with other treatments such as exercise. A physiotherapist can create a customized fitness program, suited to your specific needs, for you to do at home in between clinical treatments.

Clinical effects of physiotherapy 
 
 
Recent research confirms that manual therapy and IMS are mutually effective in reducing or eliminating both the local tenderness and the referred symptoms of myofascial trigger points, accounting for a 60% reduction rate in headaches. Another report on chronic tension type headaches found physiotherapy to significantly decrease the frequency of headache occurrence. The average number of days with headache per 4 week period was reduced from 16.3 days to 12.3 days in the group studied. Moreover, the positive change had long lasting results; the reduction in headache attacks was maintained throughout the study’s 12 week follow-up period.
 

References: 
Biondi, David M. "Physical Treatments For Headache: A Structured Review." Headache: The Journal Of Head & Face Pain 45.6 (2005): 738-746.  
Finando, Donna and Steven Finlando. Trigger Point Therapy for Myofascial Pain. Rochester, VT: Healing Arts Press, 2005.
Rigmor Jensen, et al. "Team Players Against Headache: Multidisciplinary Treatment Of Primary Headaches And Medication Overuse Headache." Journal Of Headache & Pain 12.5 (2011): 511-519. CINAHL with Full Text. Web. 22 Apr. 2013.
Travell, Janet G., and David G. Simons. Myofascial Pain and Dysfunction : The Trigger Point Manual. 2nd ed. Vol. 1. Baltimore, MA: Williams & Wilkins, 1999. 
 
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