Category: Headache

Physio Hacks Headaches and Migraines

10/6/2020

Headaches are a diagnostic challenge. That is because neck headaches and migraine often show similar features ⁽¹⁾. Neck headache symptoms show up similar to migraine headaches, tension-type headaches or even cluster headaches⁽²⁾.

Scientists at the 3rd edition of the International Classification of Headache Disorders identified 14 different types and subcategories of headache classifications⁽³⁾. It was agreed that a overlap between tension type headache, migraine and cervicogenic headache is present making diagnosis difficult. This is because diagnosis is based on the patient examination. There is no gold standard test or scan.

Combining lots of research results ⁽⁴⁾ not only showed overlap of different kinds of headache including the "big three" of migraine, tension headache and neck headache, but also in their biology. This notion of overlap is long recognised by eminent researchers ⁽¹⁾.

Brainstem sensitivity is becoming increasingly recognised as a common denominator across migraine⁽⁵⁾. This may implicate the neck in these presentations.

Click the play button below for video.

HANDS ON TO TURN MIGRAINE ON ITS HEAD

The good news is a manual diagnosis approach of neck related head pain used at this clinic, called the "Watson Approach” sorts this out. An experiment using this manual examination reproduced identical head pain in 100% of tension type headache sufferers and 94% of migraineurs even outside their migraine episode. There were no side effects nor flare ups. Therefore this hands on approach is safe and useful to determine if the neck is involved.⁽⁶⁾

Impressively this manual therapy technique not only reproduced the pain of migraine, but released it and this corresponded to measured changes in brain reactivity (nociceptive blink reflex)⁽⁷⁾.

The application of these Manual Therapy techniques has already made very positive impacts on the lives of head pain patients at Peak MSK.

References

Goadsby PJ and Bartsch T, Headache Currents, no. 10 (2005): 42-48.
Rothbart P, Can J Diagn, no. 13 (1996): 64-6. 71-6.
International Classification of Headache Disorders, 3rd edition (2013): Cephalalgia 33:629-808.
Von Piekartz H, Manuelle Therapie, no. 18 (2014) : 134-143
Tajti J, Szok D, Párdutz Á, Tuka B, Csáti A, Kuris A, Toldi J, and Vécsei L, J Neural Transm, no. 119 (2012): 557-568.
Watson DH and Drummond PD, Headache, no. 52, (2012): 1226-1625.
Watson DH and Drummond PD, Headache, no. 54, (2014): 1035-1045.

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Slow Boats, Merry-go-rounds and Dizziness

28/5/2020

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The neck joints and muscles support the head, move it and our visual fields through space. Not just is the neck joint a pillar of support for the head but it is part of a complex navigation system giving vital data to the brain on movement, direction and speed of us and the world around us.

neck joints and muscles as sensors

Disequilibrium, Disorientation
Headache, Heavy head, Tilting
Neck pain, Ear pain, Tinnitus
Joint stiffness, Swaying
Pain

All of the above can be part of a neck problem and Neck Dizziness or what we call Cervicogenic Dizziness.

Dizziness or vertigo can come from many other potential sources. These include nervous system problems (neurological), heart and circulation issues (cardiovascular) and inner ear labyrinth disturbances ( peripheral vestibular). One form of inner ear vertigo we can treat is BPPV- Benign Paroxysmal Positional Vertigo. You can find more about this here on one of our other blogs.

Cervicogenic Dizziness is a sensory illusion of motion and disequilibrium. It is common, however people are unsure of what the symptoms mean, let alone that the neck is the source of this dizziness. It is important to correctly identify it and treat it as it does not settle without help. It can be associated with migraine like symptoms, headaches, neck sprain or strain, concussion or whiplash.

Some clues to diagnosis are:

dizziness with head neck postures or certain movements.
association with neck or head pains and relief of the dizziness when they pass.
fluctuating levels of dizziness that last minutes to hours
symptoms that come on about the time of neck injury.

Diagnosis is a process of elimination. There isn't a special test or scan to tell us if it is Cervicogenic Dizziness so examination by the physiotherapist or General Practitioner is to rule other causes out.

Physiotherapy Treatment is effective by doing the following.

build healthy neck muscle activation and stabilisation patterns.
reduce neck stiffness and pain.
retrain the ability of the head and neck to re-find set positions.
for some people the rehabilitation of the inner ear balance sensors is part of treatment. (1)

Below is an example of a patient retraining head position accuracy. The video has been sped up.

Results from treatment are usually always positive. Those who struggle to improve do well with management that includes other causes for dizziness or where there are compounding illnesses or musculoskeletal issues.

Reference:
1. Wrisley DM et al. 2000. JOSPT, 30:12. 755-66

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Bruxism, teeth grinding, face bracing – Know the facts. Re-Take control.

12/3/2020

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Teeth grinding is commonly remarked upon by people who suffer head, neck or jaw problems and we can observe its effects in our patients. It affects up to almost a third of the population⁽¹⁾. We clinicians call this bruxism and it is defined as abnormal mouth activity with increased muscle activity.

If you suffer difficulty opening and closing the mouth, jaw clicks, jaw locking or stiffness/heaviness of the face or jaw, these put you at greater chance of having it. A recent German physiotherapy study confirmed that the presence of bruxism does make neck and jaw pain and disability worse⁽²⁾.

Whether this occurs in your waking hours or during sleep, it is the same subconscious mechanism and points to complex brain functioning and many other factors. Some of which can easily be changed with lifestyle choices, such as smoking, alcohol.

Bruxism is the perfect storm
of lifestyle, psychological, dental and nerve system factors.

The science tells us that while bruxism won’t cause neck pain, it can be linked in to making neck muscles and joints more sensitive, and for some this sensitivity also means a painful neck or jaw⁽²⁾. So, potentially this increased sensitivity of the face and head will enable the neck to be painful in the absence of specific joint or muscle signs.

Our musculoskeletal physiotherapy approach considers what we can easily change. That is changing habits, training clenching awareness and reducing muscular tone, tension and shortening. This approach is both hands on and exercise based, and is therefore reliant on getting the patient involved in their own care.

Physiotherapy examination looks at the triggers to clench, the sensitivity of the nerve system and the biomechanics of the head and neck. We provide exercises and strategies to break up the clench frequency and to improve coordination of the jaw and head. Manual treatment of the joint that joins the jaw to the head (TMJ), upper back and neck will relieve pain and improve movement.

Please forward this to anyone who may benefit from reading this.

Manfredini, D., Winocur, E., Guarda-Nardini, L., Paesani, D. & Lobbezoo, F. 2013. J. Orofac. Pain.: 27(2), 99-110.
von Piekartz, H., Rösner,C., Batz, A., Hall, T. & Ballenberger, N. 2019. Musculoskelet. Sci. Pract.: 45, 102073.

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Physio Hacks Headaches and Migraines

Slow Boats, Merry-go-rounds and Dizziness

neck joints and muscles as sensors

Bruxism, teeth grinding, face bracing – Know the facts. Re-Take control.

Bruxism is the perfect storm
of lifestyle, psychological, dental and nerve system factors.

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

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Physio Hacks Headaches and Migraines

Slow Boats, Merry-go-rounds and Dizziness

neck joints and muscles as sensors​

Bruxism, teeth grinding, face bracing – Know the facts. Re-Take control.

Bruxism is the perfect storm of lifestyle, psychological, dental and nerve system factors.

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

Archives

Categories

Contact Us

Support

Connect With Us

neck joints and muscles as sensors

Bruxism is the perfect storm
of lifestyle, psychological, dental and nerve system factors.