Headache & Migraine

Headache affects up to 40% of the population globally, and of those, approximately 80% are Primary Headaches (not caused by another condition or illness). 

The most common is Tension-Type Headache (TTH) which is felt as a;

• tight, pressing or tightening ache

• involving both sides of the head

• mild to moderate in severity

• lasting 4-6 hours on average

• may be episodic, or chronic (occurring >15day/month for >3 months)

The average age of onset is 25-30, with peak prevalence between 30-39 and roughly equal male:female ratio.

By contrast, Migraine is classified as;

• moderate to severe in intensity

• one-sided only

• lasting between 4-72 hours

• has a pulsating / throbbing quality

• is associated with nausea and/or vomiting, and

• sensitivity to light and/or noise

• aggravated by exercise

Migraine is 3 times more common in women, typically commencing in adolescence, with 20% experiencing an aura (usually visual, such as flashing lights or lines). Mayo Clinic Neurologist Dr Amaal Starling states that "people with migraine are literally the strongest people I know".

Secondary Headaches are classified as being caused by something else, such as those arising from pain-sensitive structures in the neck or jaw, sinuses or teeth, from a vascular or intracranial cause or infection. 

Whilst the International Headache Society describes Cervicogenic (Neck-related) Headache as just one of over 300 classifications of headache, growing evidence confirms what we've observed for many years that neck treatment can often help alleviate many types of headache including TTH and Migraine. It has been shown that gentle manipulation of the upper neck can reduce the sensitivity (or raise firing threshold) of the trigeminocervical nucleus (group of neurons in the brainstem) onto which the scalp nerves involved in head pain converge. In practice, the Watson Approach involves sustained pressures over the upper neck joints which typically reproduce, then ease people's head pains.

Jaw / TMJ Disorders

Disorders of the jaw or Temporomandibular Joint (TMJ) are very common, affecting about a third of us at some point in our lives. It can be caused by trauma (eg. car air bag, collision in sport) or quite insidious, and brought on by a variety of factors including tension & stress, clenching or grinding teeth (bruxism), prolonged dental work, protecting a sore tooth (eating on one side), poor posture, or unhelpful overuse of the jaw itself (parafunction) such as chewing gum, biting fingernails, pens, etc.

Common symptoms of TMD (TMJ disorders) include;

• Pain in front of the ear or in the ear itself

• Pain along the jaw

• Headache around the temple, eye or sinus region

• Toothache (yes sometimes we unfortunately treat people with persistent toothache even after tooth extraction, that is relieved by TMJ treatment)

• Clicking and locking of the jaw

• Difficulty or pain with chewing, or full opening - eg yawning, biting an apple

• Difficulty or pain with speaking, kissing, or facial expression

If you find yourself avoiding hard or chewy foods, whole apples, bread rolls or hamburgers, you may have TMD!

Normally the lower jaw can move laterally 10mm to each side, and open 45-55mm.  Patients with TMD often exhibit aberrant or asymmetrical motion of the jaw, a limitation to opening, and may have a palpable or audible click or clunk on opening and/or closing. This can be caused by an imbalance of the muscles on either side of the jaw, abnormal movement of the articular disc within the joint, or less commonly joint pathology such as osteoarthritis.  

HOW CAN PHYSIO HELP?

Musculoskeletal Physiotherapists are trained to assess the resting position of your neck and jaw, the tension in your masticatory (chewing) muscles, measure your range of motion, palpate to identify the sources of pain, and work with you to devise a treatment plan. This can involve gentle massage techniques or dry needling, joint mobilisation / stretches, and specific exercises to optimise the position and function of your neck and jaw, with your consent every step of the way.

Neck Pain & Dysfunction

Having a pain in the neck can be an innocuous part of life, like getting a cold, but can also be more serious and affect all our daily functions from sleeping, driving, work, lifting our kids, and enjoying recreational pursuits like swimming, surfing and tennis.

Seeing a MSK Physio will answer;

• What have I done?

• What caused it?

• Is it serious?

• Do I need a scan?

• Who do I need to see?

• What can I do to get it right?

• What can you do to help it?

• How long will it take?

HOW CAN PHYSIO HELP?

Musculoskeletal Physiotherapists thoroughly examine your spine, movements and nerve function, as well as your posture and muscle tone, and ask questions to identify factors that are aggravating or perpetuating your symptoms. Questioning and physical testing is usually enough to identify the nature of the problem and treatment plan. Referral for imaging is generally reserved for traumatic injuries (to exclude fractures or instability) or when considering more invasive interventions such as a steroid injections for nerve root impingement. 

Physiotherapists work with you to relieve neck, upper back, shoulder and arm pain, restore movement and allow you to resume your normal activities.  We utilise a variety of manual skills (joint mobilisation and manipulation / adjustments, massage, trigger point therapy, dry needling, muscle and nerve stretches) to complement a program of specific exercises to do throughout the day.  

CONDITIONS WE SEE:

• Acute wry neck

• Arthritic pain and stiffness

• Disc-related neck pain

• Disc bulges / protrusions

• Referred arm pain, tingling, numbness or weakness

• Foraminal stenosis (narrowing where the nerves exit the spine)

• Cervical myelopathy

• Whiplash associated disorders

• Neck-related dizziness

• Neck-related headache

• Post-surgical stiffness (eg tumour resection, discectomy, disc replacement)