How to Recover Quickly from a Quadriceps Strain

mta_quadstrain

http://marathontrainingacademy.com/quadriceps-strain

Marathon Training Academy

November 15, 2016

After straining your quadriceps, you remain at a higher risk of injury. In this guest post for Marathon Training Academy, you will learn which strategies to implement as you work through your rehabilitation and your return to activity.

Muscle injury. Man with sprain thigh muscles

A quadriceps strain, also known as a quad pull or thigh strain, is a relatively common running injury.

Strains can range from a mild discomfort to a full blown tear of most of the muscle which can result in severe pain and the inability to run or walk. The injury typically happens when one or more of the quadriceps muscles become overloaded.

In this pose you will discover the factors that increase your risk of straining your quadriceps, and learn specific strategies to implement during your rehabilitation and return to activity. Continue Reading

How to Self-Treat IT Band Pain with a Mini Plunger

Pain in the lateral (outside) leg or knee is commonly associated with a condition known as Iliotibial Band Syndrome (ITBS).  (Iliotibial Band Syndrome is also known as IT Band Syndrome, ITB Syndrome, or IT Band Friction Syndrome.)  Pain can range from the lateral side of the leg up toward the hip area to just below the lateral side of the knee joint (where the head of the fibula bone begins).  The pain can be very debilitating to the point that running or hiking activities have to be stopped.  Even walking can be difficult.

Although ITBS can be very painful, it can be easily self-treated if you handle your pain and symptoms quickly.  For many years, I have taught people how to use a mini plunger as a method to provide a suction force for self-treatment.  In this video, I demonstrate how to utilize a mini plunger as a “cupping” technique to self-treat IT Band Syndrome.

Cupping is a method or technique to massage and mobilize tissues such as muscles, skin, fascia, and tendons.  The exact treatment effect is unclear, but presently the research indicates that it helps to reset neural pain receptors and stretch receptors.  Thus, reducing pain and allowing for improved movement.

Cupping has been around as a treatment technique for thousands of years.  The research on cupping is interesting and for the most part, concludes that cupping is helpful in pain management.  There are some indications that the “suction” may lead to improved blood flow to an injured area which could speed up healing times.  Other health claims of the benefits of cupping haven’t been adequately proven in current research.

Traditionally, cupping has been performed with glass cups by using a flammable paper to quickly “burn” the oxygen in the cup which causes a suction force.  There are now many types of plastic or silicon cups that can easily be purchased online.  CupEDGE Massage Tools are what I use and recommend.  Fancy cups are not necessary.  The cups can be more convenient, but even a small sink plunger will do.

Have you tried cupping to treat ITBS?  If so, what was your experience like?  Additional discussion can help others to manage this condition more effectively.  Please leave your comments below.

For more information on how to self-treat ITBS, please refer to the following:

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Cupping, Should Runners Try it Too?

mta_cupping

http://marathontrainingacademy.com/cupping

Marathon Training Academy

October 17, 2016

In this guest post for Marathon Training Academy, you will discover what cupping actually is and how to use it to massage and mobilize tissues in order to reduce pain and improve movement.

calfactivemobilizationusingacup

The 2016 Rio Olympics brought new light to an old treatment–cupping.  The world stared as athletes like Michael Phelps proudly displayed his petechia for the world to see.

Petechia is the medical term for the purplish bruise that can form with certain types of cupping techniques.

After seeing so many Olympic athletes with bruises this year, the rest of us were left wondering about this trend of using cupping as a medical treatment or sports enhancement treatment.  Does cupping really work?  Can I utilize cupping as a self-treatment method for common running related pains?  Continue Reading

Q & A: A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis)

Q.  I have been diagnosed with Myasthenia Gravis.  It’s affecting my speech, swallowing, and general head, neck, and arm strength.  Are there certain activities that I should modify or avoid?  Which type of exercise can I perform in order to improve my function?  Owen

A.  Thanks for your question, Owen, as it presents an opportunity to discuss a very devastating autoimmune disease, Myasthenia Gravis (MG).  Your willingness and desire to maintain your strength and physical function despite the disease is an encouragement to others who may be suffering as well.

Approximately 50 million Americans (20 percent of the population or one in five people) suffer from autoimmune diseases.  Women are more likely than men to be affected.  Some estimates state that 75 percent of those affected are women.

Myasthenia Gravis (MG) is one of many different types of autoimmune diseases such as Rheumatoid Arthritis (RA), Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS, which is also known as Lou Gehrig’s Disease).

An autoimmune disorder occurs when the body’s immune system attacks and destroys different parts of the body because it has confused itself with a foreign body or invader.  The body’s own immunogenic response against itself is a challenging and difficult problem to fix.  Although there are many different and evolving treatment methods, most (if not, all) autoimmune disorders are not curable.

manwithhishandonthroat

In the case of MG, it’s considered a neurologic autoimmune disease because the immune system attacks the nerves that control certain muscles of the body.  Symptoms of MG vary wildly and sometimes can be quite severe.  Symptoms may include:

  • Muscle weakness
  • Drooping of one or both eyelids
  • Double vision
  • Altered speech
  • Difficulty swallowing
  • Problems chewing
  • Limited facial expressions
  • Weakness in your neck, arms, and legs.  (If the neck is weak, it may be hard to hold up your head.)

Proper medical management is critical in all cases of autoimmune diseases.  Those diagnosed with MG (or any other autoimmune disease) should always be medically managed by a specialist in the disease.  In most cases, management of MG will be overseen by a neurologist (preferably, with experience in treating MG and other neurologic autoimmune diseases).  

In order to best address any autoimmune disorder, a multifactorial approach to managing the disease should be implemented.  Although the condition may affect one specific aspect of your body, a healthy and balanced body will always function better and be more resilient to fight and thrive in spite of the condition.  In addition, it’s important that you and your loved ones learn as much about the disease as possible.

A Holistic Approach to Managing Autoimmune Disorders (Myasthenia Gravis):

  • Medical/Physician Management.  Depending on the condition and triggering events, this may include pharmacological management or surgical intervention.  In the case of MG, the trigger may be a tumor in the thymus gland.  Your physician may order a CT Scan of your chest to screen for a tumor.
  • Speech TherapyOften with MG or other autoimmune disorders, you may develop difficulties with swallowing.  I highly recommend that you work with a Speech Therapist (ST).  Speech therapists are highly trained medical professionals that specialize in treating disorders that affect swallowing, speech, and cognition.  They can use very specific treatment modalities from exercise to diet modification.  Neuromuscular electrical stimulation (NMES) can be utilized to help the muscles responsible for swallowing improve in strength and coordination.
  • Nutritional Management.  Consume foods that promote a low inflammatory diet, including a diet high in Omega-3 fatty acids and other natural herbs (like garlic and turmeric) which can naturally lower inflammation.  Consuming food that helps to support the immune system is important because the nervous system is affected by MG and other autoimmune diseases.  This includes a diet high in Omega-3 fatty acids and having adequate Vitamin D3 levels.  Include foods that support the nerves and are typically high in good fats such as avocados, coconut oil, and healthier fish (such as sardines and wild caught salmon).  If you’re experiencing difficulty with swallowing, be sure that your food is prepared in such a way that you can safely eat and that it’s in accordance to advice from your speech therapist.
  • Weight Management.  It’s important to manage your weight effectively.  Excessive body weight can cause additional stress on the body.  Whenever possible, work toward optimizing your health.  This includes maintaining a healthy body weight.  Depending on the autoimmune disease and your body in particular, this may also mean maintaining enough body weight.
  • Activity Modification.  As the disease progresses, it’s important to understand how your body is functioning, and then learn how to adapt to manage the disease.  Unfortunately, certain activities and how you perform them will need to be modified or avoided.  Learn to pace yourself and take more frequent rest breaks.  Adequate night time sleep is also critical.  If any of your joints are affected, learning to limit the use and strain on them will be important.  Utilize adaptive devices (such as a cane) in order to limit the strain placed on your body during activities.  An assistive device will allow you to be mobile and will reduce your risk of falling.
  • ModalitiesThis is a broad category, but there are many ancillary treatments that can be utilized to help you feel more comfortable.  The good news is that they rarely have associated side effects.  In general, the application of heat, cold, or over the counter (OTC) topical agents, such as Arnica Montana (an herbal rub) or Biofreeze, may help you to manage pain and stiffness.  Gentle massage and TENS (Transcutaneous Electrical Nerve Stimulation, a form of electrical stimulation performed by a physical therapist) may also be beneficial for pain relief.  TENS is different than the neuromuscular electrical stimulation (NMES) used by speech therapy.  TENS is used for pain control only.
  • Limit StressOften in cases of autoimmune disorders and in particular, MG, poor stress management will lead to worsening symptoms.  The ability to effectively manage stress will be critical in managing your symptoms.  There are many different methods to help you manage stress more effectively.  Common methods include:  meditation; journaling; deep breathing; Tai Chi; and yoga.  You may also need to reconsider certain friendships and relationships in your life.  The key to effectively managing stress is to find an enjoyable activity, and then stick with it.  This is a process–a journey (not a destination).
  • Exercise.  Implementing exercise in order to promote general health will not only help you to feel better, but it will optimize your well-being during this very difficult time.
    • Strength TrainingStrength training is encouraged, and the exercise program should be established by a professional who is familiar with managing MG.  All exercises should be performed in a slow and controlled environment within the available range of motion (ROM).  Maintaining muscle mass through strength training is critical and should be performed only one to two times per week to minimize any risk of over fatigue.
    • Endurance Training.  Endurance training is critical for general health and should be included as part of a comprehensive exercise program for individuals with MG.  Focus on less impact activities such as bicycling, rowing, and water aerobics.  Avoid excessive fatigue.
    • Flexibility TrainingFlexibility training is important for everyone as part of a healthy lifestyle.  Take every joint through a full ROM at least once a day.  I highly encourage a regular two to three times a week flexibility program in addition to a daily ROM program.  Tai Chi and yoga both also address aspects of strength and balance and are wonderful for managing stress.  Other options include:  Pilates; water aerobics; and a stretching routine.
    • Aquatic Therapy.  Water can also be very useful in pain control and help with relaxation.  Many find that performing a regular exercise program in an aquatic environment can satisfy most exercise needs, including flexibility and strength.

Managing an autoimmune disorder, such as MG, is difficult and everyone’s journey will be different.  Your specific treatment protocol should be individualized based on your specific condition, how the symptoms are affecting you (which will vary over time), and your current health status.

Thanks, Owen, for the question.  I hope you find this information to be helpful as you manage your condition.

What has your experience with managing autoimmune disorders been like?  Are there any treatments that have or have not worked well for you?  Additional discussion can help others to manage these difficult diseases as well.  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

When to Return to Running after Experiencing Low Back Pain

mta_returntorunning

http://marathontrainingacademy.com/return-running-experiencing-low-back-pain

Marathon Training Academy

September 13, 2016

In this guest post for Marathon Training Academy, you will learn why initial activity and exercise are critical when treating low back pain (LBP) and how to determine if you are ready to return to running after experiencing an episode of LBP.

WomanWithLowBackPain

Low back pain (LBP) can be so severe and debilitating that it can completely derailing your training. It’s hard to run if your back, buttocks or leg hurts. You either won’t try to do it or you try to suffer through it only to be rewarded with worsening symptoms later on. However, initial activity and exercise are critical when treating LBP. Continue Reading

Got Text Neck?

With the ever increasing obsession over portable technology devices, it isn’t surprising that cases of “text neck” are also increasing exponentially.  Text neck is a term used to describe pain that is felt in the head, cervical spine (neck), and/or thoracic spine (upper back region) from chronically poor posture associated with using mobile technology such as smart phones and E-readers.  This tends to go hand in hand with “text thumb” (or what was once called “BlackBerry thumb”) pain.

poorposturewhiletexting

With over 90% of Americans currently using mobile phones, it’s not surprising that cases of text neck are skyrocketing.  People are spending hours hunched over their hand held devices.  This is causing chronically poor posture.  This forward head and rounded shoulders posture is responsible for causing headache pain, neck pain, upper back pain, and even shoulder pain.

The average sized head weighs approximately 10-12 pounds.  Imagine bending over or looking down.  At even 30 degrees, the relative weight of the head as felt by the neck and upper back is up to 40 pounds.  Increase the flexion to 60 degrees, and the weight goes up to 60 pounds.  Over time, the extra strain fatigues the muscles of the neck and thoracic spine.  It causes excessive strain on the muscles as well as the ligaments and the discs and joints of the cervical and thoracic spine (ultimately, leading to pain).

When left untreated, you could experience ever increasing levels of pain.  Pain in combination with poor posture can place ongoing stress that can lead to pre-mature degeneration of the cervical spine and development of osteoarthritis and other degenerative conditions.

How to Prevent and Treat Text Neck:

  • Stop Looking Down.  The most obvious treatment for cases of text neck is to address the underlying postural dysfunction.  This means that you should stop looking down at your phone or mobile device.  Try to keep your devices at eye level.  Limit the amount of time spent looking down.  If you tend to spend 30-40 minutes at a time looking down at your device, work toward reducing that time in half.
  • Use Voice Text Options.  To avoid looking down so much, try to use voice text options or hands free options.  This can help limit your time spent looking down at the screen.
  • Reverse the Position.  In today’s society not using a mobile device is a difficult option.  Instead of not using a device or never looking down, be proactive by spending time moving in the opposite direction.  The neck and upper back are meant to move in many directions.  Be sure to extend your neck and thoracic spine frequently throughout the day.  Imagine how good it feels to stretch backward while yawning.  Perform that motion more frequently and after every prolonged period of looking at your device.
  • Perform Cervical Retractions.  After looking down for more than a minute, perform cervical retractions (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 5-10 times.

cervicalextensionexercise_collage_960pxwide

  • Exercise.  Keeping the areas of your body which support your arms, neck, and thoracic spine strong is a critical step in preventing text neck pain.  Focus on the muscles that extend the neck and thoracic spine as well as stabilize the shoulder girdle (including the muscles of the rotator cuff).  Please refer to Rotator Cuff Exercises for two simple exercises that will work your shoulder girdle and rotator cuff muscles while using an exercise band.
  • Focus on Your Posture.  The chronic forward head with rounded shoulders posture associated with text neck causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness and/or dysfunction in the cervical spine and upper thoracic area.  Maintaining proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  Be sure to vary your positions frequently throughout the day.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Massage.  If you are already suffering from trigger points and muscle spasms, massage can be an excellent modality to reduce these symptoms.  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  Utilize a foam roller on a daily basis in order to avoid neck and upper back pain.  Please refer to the following posts for more information:  Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Manual Therapy.  A physical therapist or chiropractor can use manual therapy techniques which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Medications.  Medications can be an effective short term solution for pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Whether you suffer from text neck or you’re experiencing pain from chronic poor postures, these prevention and treatment strategies will help you overcome the discomfort.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.   If the technique helped, continue with it and then implement another strategy.

Which strategies can you implement in order to avoid and/or alleviate the discomfort of text neck?  Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Cervicogenic Headaches: A Real Pain in the Neck (and Head)

Cervicogenic headaches are a certain type of headache in which the head pain is specifically caused by an issue in the cervical spine.  Cervicogenic pain is often a trigger for other types of headaches, such as migraines or tension headaches.  As a physical therapist, I find it more effective to classify cervicogenic headaches separate from tension headaches.  Tension and cervicogenic headaches may be treated similarly, but in many cases, it depends on the actual dysfunction present.

Young man experiencing neck pain against a white background

Cervicogenic headaches are almost always mechanical in nature.  This means that there is a structural or mechanical cause in the neck which is leading to the headache pain.  Since the trigger is mechanical, these headaches can come on very suddenly with certain movements and can also be reduced or eliminated quickly if the correct movements can be initiated.  When the cervical spine is the cause of the pain, you may experience cervical pain, headache pain, and other correlated or referred pain in your upper back or down your arms (even to your fingers).

Cervicogenic Headache Symptoms include:

  • Pain in the front of your head, behind your eyes or side of your head.
  • Pain which begins from your neck and extends to between your shoulder blades or upper shoulders.
  • Pain which is exacerbated or changed by certain neck movements or neck positions.
  • Pain which is triggered by pressure applied to the upper part of the neck near the base of the skull (known as the suboccipital area) or in the upper trapezius area.
  • Pain down one or both arms and can be felt as far as your fingers.
  • Stiff neck.
  • Blurred vision.
  • Nausea, vomiting, and/or dizziness.

Potential Causes for Cervicogenic Headaches

There are plenty of reasons why one might develop cervical derangements or dysfunction.  Examples include:  motor vehicle accidents; sports; falls; sleeping on a poorly fitting pillow; poor posture (especially when texting); and/or carrying items that are too heavy (such as a backpack).  Chronically sustained non-symmetrical postures, stress, and/or a sedentary lifestyle are also potential causes.

The actual pain generating structures of the neck (listed below) also vary wildly and can be difficult to pinpoint.

  • Nerve related injury or pain
  • Muscle spasms
  • Trigger points
  • Facet joint dysfunction
  • Cervical mal-alignments
  • Cervical disc issues
  • Postural dysfunction

Cervicogenic pain and headaches tend to be more common in women than men.  In general, women experience this due to an anatomical difference.  Men tend to have more muscular necks while women tend to have more long and slender necks with less muscle to provide support to the head (meaning that there is less muscle strength for support).

Treatment for Cervicogenic Headaches

In cases of mechanical pain, you should be able to alter and change your neck or headache pain within a short period of time.  The first step is to establish a directional preference by identifying a pattern to the pain.

Which head motions change or alter your neck or headache pain?  Does the pain get worse or does it improve when you turn your head?  What happens when you look up, look down, slouch or sit up straight?  What happens when you repeat this movement?

Determine how your pain responds.  If it spreads away from the spine and down into the upper back or arm, beware that you are moving in the wrong direction.  Stop that particular movement, and instead try the opposite direction.

In my experience, most episodes of cervical and headache pain tend to respond better to cervical extension biased movements and improvements in posture.  Often, gaining extension in the thoracic spine is also critical to treatment.

In order to determine if extension biased (cervical retraction or extension) movements help you, I recommend starting with this exercise (as shown below).  Sit up straight, and retract your chin straight back.  Repeat 10-20 times.

cervicalextensionexercise_collage_960pxwide

Carefully monitor symptoms for peripheralization or centralization.  The rule of thumb for movement:  If the pain worsens by spreading peripherally down the arm into the hand, fingers, down into the shoulder blade/upper back or the headache is worsening, then the condition is worsening.  Stop that activity.  If the pain centralizes and returns back toward the cervical spine, and the headache pain improves (even if the pain in the neck worsens slightly), then keep moving as the condition is actually improving.

If you are unable to help or change the pain in any way, then you may need assistance from a medical provider.  For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Neck by Robin A. McKenzie.

Other Treatments for Cervicogenic Headaches:

  • Exercise.  A primary treatment modality and prevention technique is exercise.  Exercise in general has been shown to be beneficial in treating and preventing cervical pain and headaches.  However, a specific exercise program designed to maintain cervical and thoracic mobility and strength should be the main portion of your treatment.  Focus on your thoracic mobility (particularly, into extension).  Work on cervical stabilization exercises that involve the muscles that support your head and neck.
  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness and/or dysfunction in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension.  Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

  • Massage.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  The foam roller is a wonderful tool to prevent muscle cramping and spasms.  Please refer to the following posts for more information:  Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Other self-mobilization tools.  Many times, a friend or masseuse isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms and can also heighten the pain response.  Take magnesium orally (such as Mag Glycinate in pill form) or apply it topically in order to help mediate the pain response.
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms or mediate the pain response which can help to reduce headache pain.  You can apply a small amount of the topical agent directly over the headache pain area if it’s accessible and not near your eyes.  (Please use common sense.)  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Manual Therapy.  A physical therapist or chiropractor can use manual therapy techniques which can be beneficial in reducing pain and addressing some of the mechanical causes.  However, manual therapy is a passive treatment.  For long term treatment and prevention, an active approach needs to be taken.  I would encourage you to perform proper exercises to insure that you have adequate cervical and upper thoracic strength and mobility.  Also, address any precipitating factors (such as poor posture).
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very good at assisting those suffering with these types of headaches.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Don’t give up hope!  Headache pain is difficult to manage, but with proper care most headache pain can be cured or effectively managed.  Begin by implementing one or two of these treatment tips, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.

If you suffer from cervicogenic headaches, which treatments have worked the best for you? Please share below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Prevention and Treatment Strategies for Tension Headaches

Approximately 15-20% of the population will suffer from headaches at any given time.  Headaches can range from mild to severe with symptoms varying wildly.  It’s one of the top medical ailments for which people seek treatment, and tension headaches are the most common type of headache.  Tension headaches are often related to tension in the muscles of the head, neck, and jaw and are frequently stress related.  The actual physical cause is still not fully understood, but it’s likely linked to how the brain and nervous system perceives muscular pain and stress.  The good news is that tension headaches are very treatable!

Young woman having migraine

Tension headaches are categorized as either episodic (meaning that you experience less than 15 headaches per month) or chronic (meaning that you experience more than 15 per month).  They are nearly as frequent in children and teens as adults.  Women tend to experience them more often than men by nearly two to one.

Tension Headache Symptoms include:

  • The pain tends to wax and wane in severity (sometimes, throbbing or pulsing occurs).
  • The pain is often described as pressure like and is typically felt on both sides of your head.
  • The pain typically impacts the whole head, but it may begin in the back of your head or above your eyebrows.  It’s typically painful around the temple area of your head and/or back of your head and neck.
  • Many describe the pain as a severe tightness (like a vise grip) around the forehead or like a cap or band-like sensation which encircles their skull.
  • The pain tends to come on gradually.  Even at maximum intensity, it isn’t typically incapacitating.  (Most people are able to continue with their daily activities despite the pain.)

Potential Triggers for Tension Headaches include:

  • Stress
  • Anxiety
  • Impaired sleep (fatigue)
  • Low blood sugar from improper eating
  • Hunger
  • Eye strain
  • Overexertion
  • Muscle strains and pain
  • Muscle tension
  • Cervical dysfunction (cervicogenic)
  • Poor posture
  • Hormonal changes and/or menses
  • Foods such as processed meats, gluten, red wine, and dairy
  • Environmental factors such as poor air quality, certain smells, and different chemicals that are inhaled or applied topically on the body.

Treatment for Tension Headaches

In most cases, effective treatment needs to be multifactorial as there are likely multiple triggers causing the headache.  In general, treatment needs to focus on both the prevention of the tension headache and methods of dealing with an active headache as both tend to interrelate.

Prevention for Tension Headaches:

To effectively manage (and ultimately, prevent) tension headaches, effective stress management and elimination of known triggers are primary treatment strategies.

  • Stress management.  Effective stress management should not be overlooked as an important treatment modality.  There are many different methods to help you manage stress more effectively.  Common methods include meditation, journaling, and yoga.  You may also need to reconsider certain friendships and relationships in your life.  The key to effectively managing stress is to find an enjoyable activity, and then stick with it.  This is a process–a journey (not a destination).
  • Eliminate food triggers.  Many foods can trigger headaches.  An effective management strategy will be to identify and then eliminate food triggers.  We may not even be aware of how negatively certain foods affect us.  If you choose to eliminate your trigger foods, you will be amazed about how well you start to feel in general.  Common food triggers include:  red wine, aged meats or cheese, dairy products, and gluten.  Addressing food triggers is a critical step in treatment.  I recommend that you take an IgG food sensitivity test.  IgG is an immunoglobulin antibody found in the body.  This test can help to determine if certain foods are causing your body to react in a negative way.  Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating both tension and migraine headaches.  Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your symptoms are correlated with any food triggers.
  • Eliminate caffeine.  This can be very tough because caffeine tends to be helpful in reducing initial symptoms.  Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches).  Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen.  Eliminating caffeine initially is difficult as it may trigger another headache.  However, long term elimination of caffeine from your diet can be very effective in preventing headaches.  Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.
  • Focus on your posture.  Poor posture is a bane of modern society.  The most common example of poor posture is a forward head with rounded shoulders.  This causes excessive muscular tension throughout the cervical spine, upper trapezius region, and mid-thoracic area.  Over time, this also leads to muscle weakness in the cervical spine and upper thoracic area.  Proper posture allows for the optimal alignment of your spine.  Neurologically speaking, this allows for your muscles to down regulate by reducing tension. Poor posture is almost always associated with muscle knots and trigger points.  My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain is a downloadable .pdf file with my recommended stretches and exercises to address posture.  These simple exercises (with complete instructions and photos) will help you to improve poor posture and can be performed at home.

DOWNLOAD NOW: My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain

How to Treat when you’re experiencing a Tension Headache:

  • Fix your posture.  Poor posture is one of the most common causes of muscle spasming and pain.  This is particularly true if you spend a good portion of your day sitting.  If you’re already experiencing a headache or you feel like one might be starting, I highly recommend that you initiate my stretching protocol (as noted above).
  • Massage.  Many trigger points and muscle spasms will refer pain into the head (which causes the headache).  It’s important to actively and physically address the muscle tension.  This is the time to contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm.  The specific massage technique to use will vary according to your preference.  Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.  This can also be an effective prevention strategy.
  • Foam roller.  The foam roller allows you to perform self-massage and tissue mobilization.  The foam roller is a wonderful tool to prevent muscle cramping and spasms.  Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion.  I highly recommend a foam roller to help aid in your recovery.
  • Other self-mobilization tools.  Many times, a friend or masseuse isn’t available to assist when you need the help the most.  A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary.  You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager.  This tool allows you to apply direct pressure to a spasming muscle.  When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief!
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms.  Most people are deficient in the amount of magnesium they consume on a regular basis.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
  • Topical agents.  Many topical agents can help to decrease and eliminate muscle spasms which can help to reduce headache pain.  You can apply a small amount of the topical agent directly over the headache pain area if it’s accessible and not near your eyes.  (Please use common sense.)  You may find that one product works better than another.  Some of my favorite products in my medicine cabinet include:  Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  • Magnesium bath.  The combination of warm water with magnesium is very soothing and relaxing.  Magnesium is known to help decrease muscle pain and soreness.  Options include:  Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes.  I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  • Acupuncture.  I am personally a big fan of acupuncture.  It is very useful in treating all kinds of medical conditions.  It can be particularly effective in treating headaches, muscle trigger points, muscle cramps, spasms, and pain as it addresses the issues on multiple layers.  Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  • Medications.  Medications can be an effective short term solution to headache pain, but I strongly encourage you to transition off of medications over time.  Many over the counter (OTC) medications contain caffeine which can lead to another type of headache called a rebound headache.  This occurs when the medication wears off and triggers another one. This is common with medications such as Excedrin which contains caffeine.  Other types of medications include acetaminophen, aspirin, Ibuprofen, and Naproxen.  In some cases, prescription medications may be used initially to help you tolerate the pain as you work toward prevention.  Please speak to your physician regarding prescription options.
  • Speak with your Physical Therapist (PT) or Physician (MD).  If you are suffering with headache and muscle tension/pain, there are options.  Please speak to your medical provider to determine if other causes are contributing to the problem.  Physical therapy is very good at assisting those suffering with these types of headaches.  The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area.  In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Tension headaches are a common and debilitating problem.  Although this is not an exhaustive list of treatment options, it offers many different and effective methods for you to consider.  In many cases, the techniques utilized to treat an active headache are also effective in prevention.

In nearly all cases, the frequency of tension headaches can be reduced and eliminated in general.  The key is to acknowledge that you are not powerless when addressing this type of headache.  However, there isn’t just one magic cure for the headache either.  Effective treatment will likely be multifactorial.  Begin by implementing one or two of the strategies, and then assess how well they worked for you.  If the technique helped, continue with it and then implement another strategy.  Create a plan with specific strategies for prevention in addition to knowing beforehand as to how you will treat an active headache.  This will empower you to recognize that you have control and are not destined to have headaches forever.

Can you share any prevention tips or treatment techniques that have worked for you when dealing with a tension headache?  Please leave your comments below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Prevent and Treat Migraine Headaches

Migraine pain is the second most common type of headache (with tension/cervicogenic type headaches being the most common).  Up to 16-17% of the population complains of migraines.  These headaches can be very debilitating.  Migraine pain is often in combination with other forms of headaches.  It can even be triggered by a tension headache or sinus headache.  Migraines can also be caused by menstruation or hormonal imbalances.

ManDizzinessHeadPain

Migraine headaches are just one of many types of headaches.  Migraines sufferers are more common in women.  Certain statistics conclude that women are up to three times more likely to have migraine type symptoms.  Presently, the exact causes of migraines are not well understood.  Migraines are often associated with a trigger, but you can have one or multiple triggers.

Migraines also have a genetic component.  If you have a parent or sibling who experiences migraines, you will have a higher likelihood of developing them as well.  It’s also not entirely known if the familial component to migraines is due to something anatomical in regard to brain or other physiological factors or if the predisposition is based on the living environment or other factors that could be causing the trigger.

There are two categories of migraines.  Episodic is when you experience 14 or less days with a headache.  Chronic is when you have 15 or more headaches per month.

The Four Phases of Migraine Pain:

Although symptoms of a migraine will differ for everyone, symptoms tend to progress through the following four major phases.

Prodromal Phase

This is the pre-headache phase that can occur hours or up to a day in advance.  Initial symptoms and patterns can be found up to one to two days prior to the actual migraine.  Typical symptoms may include:  excessive energy or excitability; possible depression; overly fatigued; irritable; thirsty; frequent urination; and cravings for specific foods.

Aura Phase

Not everyone experiences this phase.  Approximately one in five people will describe feelings of an aura (a visual disturbance) which can include any change in vision from experiencing blind spots, hallucinations, and different arcs of light.  Other associated symptoms include a pins and needles feeling which can be felt in your face or other areas of your body.  You may experience changes in speech.  Many of the initial symptoms can mimic symptoms of a stroke.  (Please refer to signs of a CVA).

Attack Phase

This phase occurs when the pain starts to develop, and it can last hours to days.  Most typically it will be behind your eyes and will affect one or both sides of your head.  Symptoms include:  throbbing pain on one side of your head (although pain can be present on both sides); pain behind your eyes; difficulty performing typical activities; pain that worsens with activity or heat; nausea; vomiting; and sensitivities to light, noise, and smells.

Postdromal Phase

This is the phase after the migraine has ended, but some symptoms linger which can last for hours or up to a day or so.  Symptoms include:  fatigue; sluggishness; lack of mental sharpness; and intermittent pain (particularly, if you move too much or rapidly).

How to Manage Migraine Headaches:

Typical medical management of migraine headaches starts with a diagnosis from a medical doctor.  Your doctor may refer you to a neurologist or specialist for treatment and/or diagnosis.  A thorough examination should be completed.  A CT Scan or MRI may also be performed to check for other more serious pathology in the brain.

Medications are often prescribed and are categorized the following two groups:

  • Acute Medications.  These medications are taken after the migraine pain and symptoms have already begun. These may include both over the counter (OTC) or prescription medications (including opioids or NSAIDS, such as Ibuprofen or Naproxen or even stronger anti-inflammatory medications).
  • Preventive Medications.  The medications are typically taken hours to days prior to the migraine pain and symptoms.  Such medications are prescription based.  A common family of medications used is known as Triptans.  These medications are only for treating migraine headaches and are meant to be taken immediately upon the first sign of one.  They cause the brain to release more serotonin.  This causes the blood vessels in your brain to narrow and reduce swelling which helps to control symptoms.  These medications are often prescribed with other pain medication and/or anti-nausea medications.  The following is a partial list of Triptans:
    • eletriptan (Relpax®)
    • frovatriptan (Frova®)
    • naratriptan (Amerge®)
    • rizatriptan (Maxalt®)
    • sumatriptan (Imitrex®, Alsuma®, Onzetra™, Sumavel™, Zecurity®)
    • zolmitriptan (Zomig®)

In the initial phase of treatment, it’s imperative to have an accurate account of the symptoms, type of pain, and suspected triggers.  This will be an important first step in guiding treatment as in almost all cases successful treatment will be multifocal.

Initially, I always recommend that you start a thorough headache log or diary.  Don’t perseverate over every little detail of your headaches, but you need an accurate account of frequency and triggers.

Often, triggers can occur from hours up to a day in advance.  Log each of your activities and meals for up to a month.  Look for patterns.  Try to establish patterns to the headaches.  When do they occur?  Do certain foods trigger the headache?  Which activities will cause a headache?  What makes the symptoms better or worse?  Are they associated with certain movement patterns, activities or even certain times of the day or month?

Be thorough about what occurred prior to the headache and which treatments helped the most to resolve the headache.  Once you have completed a thorough headache log, the treatment will focus on the following two major categories:  prevention and the actual treatment of symptoms.

Prevention for Migraine Headaches:

  • Exercise.  It’s well documented that mild to moderate intensity exercise can help to reduce or eliminate headache symptoms.  The reason why it’s so effective isn’t entirely known.  It may be because of the endorphin released during exercise, changes in blood flow to the brain, stress reduction, improvement in strength, and/or changes in hormonal regulation patterns.  Regardless, regular exercise is a must.  Find what works for you, and stick with it.
  • Yoga and other forms of similar exercise such as Chi Gong and Tai Chi are all excellent forms of exercise and can help to reduce stress levels which can affect migraine pain.
  • Meditate.  Regular meditation or prayer can reduce stress and lower the frequency of headaches.  Deep breathing can be a form of meditation.  I often perform what is known as box breathing. I breathe in for four seconds, hold the air for four seconds, and breathe out for four seconds.  Then I wait four seconds prior to breathing again.  Repeat this for several minutes and focus only on your breathing.
  • Magnesium.  A deficiency in magnesium is often associated with headache symptoms.  Most people are deficient in the amount of magnesium they consume on a regular basis.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.
  • Vitamin B2 (also known as Riboflavin).  A deficiency in B2 can be associated with migraine symptoms.  Supplementation has been proven to reduce the frequency of migraine headaches.  B2 is important in the production of red blood cells and plays a role in how your body gets energy from carbohydrates, fats, and proteins.
  • Butterbur.  This is an herb that is known to relieve muscle spasms and works as an anti-inflammatory.
  • Adequate Sleep.  Proper sleep is critical.  Poor quality sleep, including too much or too little of sleep, has been identified as a trigger for migraine headaches.  Focus on getting a good quality of seven to nine hours of sleep nightly.  To learn how to maximize your sleep, please refer to Michael Hyatt’s nighttime rituals.
  • Stay Hydrated.  Dehydration can cause migraine pain.  Dehydration can also affect sinus symptoms.  Sinus pain can also be a trigger for migraine pain.
  • Manage your triggers.  Common triggers include:  loud noises, bright lights, dehydration, strong or specific odors, and high altitudes.  Other triggers may be consuming red wine, aged meats or cheese, dairy products, and gluten.  Addressing food triggers is a critical step in treatment.  I recommend that you take an IgG food sensitivity test.  IgG is an immunoglobulin antibody found in the body.  This test can help to determine if certain foods are causing your body to react in a negative way.  Addressing any sensitivities and possible gut or gastrointestinal issues can be very helpful in treating migraine headaches.  This step is often overlooked, although it may be one of the most important.  Please seek assistance from a functional medicine doctor who specializes in headaches and gastrointestinal issues if your migraine symptoms are correlated with any food triggers.
  • Eliminate caffeine.  This can be very tough because caffeine tends to be helpful in reducing initial symptoms.  Chronic caffeine use (particularly in headache suffers) is known to cause rebound headaches (another sub classification of headaches).  Rebound headaches occur when the same substance that helps to reduce symptoms will also cause the next headache to happen.  Eliminating caffeine initially is difficult as it may trigger another headache.  However, long term elimination of caffeine from your diet can be very effective in preventing migraine pain.  Just watch out for over the counter (OTC) medications that contain caffeine as an active ingredient.

How to Treat when you’re experiencing a Migraine Headache:

  • Ice.  Try using an ice pack either on the forehead, scalp or neck, and/or directly over the area with the worst symptoms.  The rule for icing is to apply ice no more than twenty minutes per hour.  Do not place the ice directly against the skin, especially if you are using a gel style Cold Pack.  A bag of frozen peas can be ideal.
  • Caffeine.  Although caffeine ultimately causes more harm than good for headache sufferers, it can be used in the short term to help to reduce symptoms.
  • Find a dark quiet area where you can rest, use a cold compress, and possibly perform meditation or box breathing.
  • Hydrate.  Be sure you are properly hydrated as dehydration will make symptoms worse.
  • Do not exercise.  Exercise is not advised during an actual migraine headache.  However, it’s highly encouraged as a prevention method.
  • Medications.  Be sure to use the medications properly as prescribed by your medical physician.  The ultimate goal is to prevent headaches and lessen the dependency of medication use.  During an actual migraine, the goal is to feel better fast so that you can work on these prevention techniques.  Use the medications as a tool to help you progress through your treatment plan.

Migraine pain is a difficult to deal with and to treat.  In almost all cases, successful treatment and management will be a multifactorial approach and differs for everyone.  It’s important to hear from others on what works to help treat or prevent migraine pain, but don’t be discouraged if his/her treatment doesn’t work for you.  Your goal is to devise a custom treatment plan that will work for YOU.  Each person may progress differently, but many of the approaches are similar.

Be sure to work with medical professionals who you can talk to and trust in order to create a treatment plan.  The focus of treatment should be on prevention and discovering what triggers your migraine headaches.  Ideally, you will be able to reduce and/or eliminate the symptoms while optimizing your health.  Medications should be thought of as short term tools to help you as you come up with a long term solution.

If you suffer from migraine headaches, which treatments have worked the best for you?  Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

Cluster Headaches, the “Suicide Headache”

Cluster headaches are sometimes referred to as the “suicide headache” because the pain can be so severe. They are rightfully named because they tend to occur in “clusters” for days or weeks at a time. They typically cause severe pain which lasts from 30 minutes to two hours, then diminishes or disappears. They can recur as frequent as a few minutes to hours or even up to a day or two later. Four or more cluster attacks may occur in one day, and these attacks can strike every day for weeks or months before going into a type of remission. During remission, no headaches occur for months (and sometimes, even years).

Portrait of a young Afro man suffering from headache in bed at home

Cluster headaches are not something routinely dealt with in a physical therapy setting as the cause of the headache is typically not mechanical, nor is it associated with a trigger that would be amenable to physical therapy treatment. These headaches can be very frustrating as the cause of the headache is not entirely known which makes treatment difficult. In fact, experts are not entirely sure, but believe that the headaches are in some way associated with the hypothalamus (an area of the brain that controls body temperature, hunger, and thirst, and is associated with our internal biological clock).

Although cluster headaches are one of the most painful types of headaches, they are non-life threatening and rare (in general) when compared to other types of headaches. Cluster headaches are more common in men. People of African ancestry are twice as likely to suffer from cluster headaches when compared to Caucasian people. Cluster periods may be consistent and seasonal. For example, they may occur every spring or every fall.

Most people have episodic cluster headaches. In episodic cluster headaches, the headaches occur for one week to a year, followed by a pain-free remission period that can last as long as 12 months before another cluster headache develops.

Cluster Headache Symptoms include:

  • A headache that typically begins several hours after falling asleep and wakes you up at night.
  • You may initially experience a warning signal with a mild, aching sensation on one side of the head.
  • Nasal congestion.
  • Flushed face.
  • Severe pain that lasts minutes to hours which then dissipates only to repeat later that day or the next.
  • Pain is typically associated around one eye and/or one side of your head, but it can radiate to other parts of the head and neck area.
  • Excessive restlessness.
  • Forehead and facial sweating.
  • Redness in the same eye as the headache pain.

Treatment for Cluster Headaches

Unlike many other forms of headaches, cluster headaches have only a few known triggers. Learning to avoid these triggers is an important for prevention and in order to extend periods of remission. Consuming alcohol, experiencing a sudden rise in temperature, and exercising in hot weather are known to trigger attacks. In addition, so can the medication nitroglycerin.

Management of cluster headaches is typically through a neurologist. Medication is typically used to help to manage symptoms. Opioids and other pain relievers are often used. As with migraine suffers, medications from the Triptan family are utilized as well as a medication known as Octreotide, which is an injectable synthetic version of the brain hormone somatostatin.

Local anesthetics such as lidocaine are often given intranasally through nose drops or a spray and seem to be effective. Dihydroergotamine is also given intranasal. Other medications potentially used include:

  • Calcium channel blockers
  • Corticosteroids, such as prednisone
  • Lithium carbonate

Some have found that dosing with melatonin is also helpful in reducing the frequency of headaches.

Besides medication, oxygen therapy is frequently utilized as a form of treatment. This type of therapy involves inhaling 100% oxygen through a mask at a high rate of at least 12 liters a minute. The benefits are usually felt within 15 minutes of starting the treatment.

A nerve block is another treatment to consult with your physician about. A nerve block is performed by a physician who would inject a numbing agent and corticosteroid around the occipital nerve in the back of your head.

Cluster headaches require treatment from a qualified medical specialist such as a neurologist. If you or a loved one suffers from this condition, please seek treatment assistance right away.

Do you or a loved one suffer from cluster headaches? If so, which treatments have worked for you? Please share below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.