Headaches and Migraines
What is a Primary Headache?
Primary headaches are benign, recurrent headaches that are not caused by an underlying disease, including; tension, migraine and cluster headaches. Diagnoses and creating a treatment plan with your doctor for chronic primary headaches is recommended to manage the severity and frequency of headaches, as well as ruling out more serious underlying causes.
What Are Tension Headaches?
Most of us will experience headaches at some point in our lives, the most common being an episodic tension headache. A tension headache is characterised by mild to moderate pressing, tightening, dull pain on both sides of the head. It can feel like a band tightening around your head. Tension headaches can last from half an hour to several days at a time. Muscle contraction causes tightness and tenderness of the neck, scalp and jaw, which can lead to a tension headache. Daily stress can bring on a tension headache, often experienced at the end of the day. They are the type of headaches we usually refer to as 'just as headache' 1. Tension headaches are not as disabling as other headaches. They can be treated with over-the-counter medication such as paracetamol or anti-inflammatory drugs. Relaxation methods that decrease stress and muscle tension can also reduce the pain.
What Causes a Tension Headache?
Tension headaches are caused by muscle contraction in the head and neck, which may be triggered by:
- Physical or emotional stress
- Sensory overstimulation such as bright lights or loud music
- Bad posture
- Skipping meals
- Sleeping with the neck in a bad position
- Fatigue or overexertion
- Depression and anxiety
Chronic Tension Headaches
If a tension headache lasts for at least 15 days per month, this known as a chronic tension-type headache 2. These are tension headaches that increase in frequency. These headaches are persistent and can be disabling, with pain ranging from mild to severe. People with these headaches often use a preventative medication to manage them. When people over-use painkillers to treat tension headaches, this can cause a 'rebound headache' which is like a chronic tension-type headache. It is essential to know when daily headaches are medication over-use headaches, so you and your doctor can create a treatment plan to limit the use of painkillers.
How Are Tension Headaches Treated?
Typical tension headaches can be treated with over the counter painkillers such as paracetamol or anti-inflammatories. When tension headaches become chronic tension headaches, preventative medication can be prescribed by your doctor.
Daily Stress Reduction
Finding ways to decrease daily stress and muscle tension before a headache strikes is certainly a preferable option. We cannot eliminate daily stress completely, although we can manage how we respond to stressful situations. People who experience frequent headaches benefit from regular structure with a balanced lifestyle. Some of the following daily practices may be useful;
- Moderate exercise helps to release endorphins, the body’s natural pain killers. Exercise can also help you to get a good night sleep which helps to moderate stress hormones adrenaline and cortisol.
- A regular sleep pattern is vital for your body to repair and to maintain its natural rhythms and hormone levels.
- A pleasurable activity that you brings you joy. Laughing also produces feel-good endorphins and improves your immune system and mood.
- Journaling helps to clear negative thoughts which may be compounding your experience of daily stress.
- A balanced diet rich in fruit, vegetables, whole grains and healthy fats help to regulate stress hormones and produce serotonin.
- Drink plenty of water (between 2-3 liters a day). Using an online daily water calculator can give you a more personal recommendation.
- Meditation, breathwork or yoga activate the parasympathetic nervous system, which decreases heart rate and promotes calmness 3.
- Limit intake of alcohol, caffeine and cigarettes as they can trigger or aggravate headaches.
If you experience frequent to daily tension-type headaches, it can be useful to keep a headache diary which records the severity, duration and treatment of your headaches. Recording a headache diary for a couple of months can help your doctor to diagnose your headaches and together you can develop a treatment plan 1.
Complementary therapies that can relieve chronic tension headaches include; massage, acupuncture, physio, chiropractic, biofeedback, deep breathing, and counselling.
How Do I Know if My Headache is a Migraine?
Migraine is a disabling neurological disorder that causes moderate to severe; recurring headaches experienced as throbbing pain typically on one side of the head. There are many different types of migraine, the two most common being a 'common migraine' without aura and a 'classic migraine' with aura. Aura is the sensory disturbance that typically affects your vision temporarily. Colourful lines, zigzags, flashing lights, double vision and blind spots can disrupt your eyesight 4. Other aura symptoms can include disturbances to speech and smell, numbness and tingling in the face and extremities, and confusion. An aura is a warning sign of the headache and other symptoms that can shortly follow. An aura may last between 5-30 minutes before the headache begins.
Classic migraine can be accompanied by nausea, vomiting, dizziness, vertigo, numbness and tingling in the body, and extreme sensitivity to light, sound, smell and touch. 1 in 3 people with migraine will experience aura. People who experience Common migraine without aura do not receive a warning sign before the start of headache pain. However, all other symptoms, such as throbbing pain in one side of the head, nausea, vomiting, and sensory sensitivity, can be the same.
Who Gets Migraines?
Migraines tend to run in families, with approximately 20% of Australians experiencing migraine at some point in their life. In adolescence and adulthood, women experience migraine at a rate of 22% compared to the male rate of 10% over the lifetime. Children are less affected by a rate of 2-5%.
For women, hormones typically play a significant role in their experience of migraine. The onset of migraine may correlate to the beginning of menstruation. Prevalence of migraine increases over reproductive years and decreases after menopause 2.
What Causes Migraines?
There is no consensus among experts about what causes migraines. Common explanations from experts all refer to hyperactivity in the part of the brain that responds to sensory stimulation. Hyperexcitable nerve cells send out impulses to blood vessels in the brain, causing them to swell. This is what causes the throbbing pain 5. Migraines tend to run in families, indicating a genetic link.
Triggers that cause these excited cells to misbehave are commonly:
- Emotional or physical stress
- Alcohol and caffeine
- Changes in hormones
- Menstruation or ovulation
- Certain foods
- Monosodium glutamate
- Too little or too much sleep
- Sensory stimuli
- Weather changes
How Are Migraines Treated?
What works for one migraineur might not work for another. There may be a period of trial and error with your doctor to figure out triggers, suitable medications, and lifestyle changes.
There are pharmaceutical options for pain relief as well as preventative medications. Over the counter, medications such as ibuprofen and aspirin can relieve migraine pain. Stronger prescription medications can be prescribed by your doctor to eliminate or lessen migraine symptoms during an attack, such as triptans, opioids, and anti-nausea drugs. These medications all have possible significant side-effects which your doctor will discuss with you.
Preventative medication is available for people who suffer migraines regularly, which can include anti-depressants, beta-blockers, anti-seizure drugs, Botox, and serotonin antagonists. Other preventative treatment options may also be available.
Complementary therapies are commonly used to lessen the severity and frequency of migraines. Acupuncture, massage, biofeedback, physiotherapy, hydrotherapy, naturopathy, yoga and meditation provide different techniques to manage migraine pain, frequency and triggers. Daily stress reduction practices are also beneficial.
What are Cluster Headaches?
Cluster headaches are a rarer primary headache characterised by sudden, excruciating, boring pain around one eye. It is one of the most severe pains known to humans. The eye can droop, swell and water. Cluster headaches last between 15 minutes to 3 hours and can occur up to 3 times a day for a cycle from one day up to a month. The cycle generally occurs seasonally, often occurring in Spring and Autumn, sometimes being confused for seasonal allergies. The onset of a cluster usually occurs an hour after going to bed. Unfortunately, there is a high prevalence of suicidal thoughts during cluster periods, so diagnoses and an intensive treatment plan are essential.
Who Gets Cluster Headaches?
In Australia, 1 in 1000 people (0.1%) are diagnosed with cluster headaches. Cluster headaches can develop at any age, although most commonly the condition starts in people in their twenties. Men are five more times likely to suffer from cluster headaches than women. Heavy smoking is a common risk factor. If a parent or sibling suffers from cluster headaches, the risk of developing the condition will increase.
What Causes Cluster Headaches?
It is unknown what causes cluster headaches, although there is evidence that abnormalities in the hypothalamus (the bodies biological clock) may play a role. During cluster periods alcohol, strong chemical smells and overexertion may trigger an attack.
How are Cluster Headaches Treated?
Sumatriptan injections or nasal sprays and pure oxygen (administered by a mask) are the most common pharmaceutical options when a cluster headache strikes. Preventative medication is available during clusters, talk to your doctor about these options.
During cluster periods it is recommended to limit alcohol and cigarette intake, get regular sleep and minimise daily stress.
What Do Trigger Points Have to Do with Headaches?
Trigger points are a common cause of muscular pain, stiffness and loss of mobility. They are tight and painful nodules or knots located in the muscular band. Emotional stress, repetitive strain or injury to the muscle tissue is often the cause of developing trigger points. Trigger points can be tender to touch and can be felt underneath the skin. It is important to identify whether the trigger point is referring pain to another area. Trigger points in the suboccipital muscle group are the most common cause of tension headaches. The suboccipital muscles are a group of four muscles located below the suboccipital bone (under the base of the skull). They are responsible for keeping your head balanced on your spine. Trigger points located in the neck, shoulders, face and jaw can also refer pain up to the head, causing or contributing to tension headaches and migraine 6.
Can Massage Help with Headaches?
Massage will not cure your headache, but studies have shown that weekly remedial massage can reduce the severity and frequency of tension and migraine headaches 7,8. Trigger point release, muscle relaxation, and soothing massage strokes encourage deeper relaxation, and release the body’s natural pain killing endorphins. Massaging the head, neck, face and shoulders can smoothen blood flow to affected nerves that may be increasing pain activity in migraine and cluster headaches.
Trigger Point Massage
Studies have shown that trigger point massage therapy is particularly beneficial to release trigger points which may be generating the headache. Trigger point massage aims to release or deactivate these trigger points by applying manual pressure directly to the nodule for a short amount of time (between 20-30 seconds). Using manual pressure, the therapist can generate blood flow to the tissue and reduce the activity of the trigger point 6. The therapist will confirm with the client the amount of pain felt during compression and whether they feel the pain refer to another area such as the head.
Deep Tissue Massage
Deep tissue massage uses long, deep slow, gliding strokes along the tight muscles to relax the deeper layer of strained muscles. The massage therapist will apply oil and use firm pressure to access the deeper layers of the muscle fibres 9. The therapist will use their fingers, knuckles, forearms or an elbow to glide along the tightened muscle to release tension. You are likely to feel some discomfort with deep tissue massage; however, you should let your therapist know if you become too uncomfortable. Deep breathing will allow you to go with the sensations and relax into the massage.
Managing the symptoms of primary headaches requires patience and effort. Once you understand your triggers, you can develop effective therapeutic interventions and lifestyle changes to manage symptoms. Massage provides one of many beneficial practices that can help to manage your headaches and live a fulfilling life.
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2. Headache Australia. (2020). Tension-type Headache - Headache Australia. [online] Available at: https://headacheaustralia.org.au/headachetypes/tension-type-headache/ [Accessed 16 Jan. 2020].
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