MSK headaches and best evidence-based treatment for them:

Here’s an overview of the most common causes of headaches seen by chiropractors, physiotherapists, and musculoskeletal practitioners, along with evidence-based treatments for each condition.

1. Tension-Type Headache (TTH)

Tension-type headaches are the most prevalent form of headache, often associated with muscle tension, stress, and poor posture.

Evidence-Based Treatment:

• Manual Therapy: Spinal manipulation and soft tissue therapy can help reduce muscle tension and alleviate headache symptoms (Bronfort et al., 2010).
• Therapeutic Exercises: Stretching and strengthening exercises focused on the neck and shoulder muscles can improve posture and reduce headache frequency (Davis et al., 2014).
• Education: Patient education on stress management techniques and ergonomic adjustments can also be beneficial (Rains et al., 2005).

2. Cervicogenic Headache

Cervicogenic headaches originate from cervical spine disorders, often presenting as unilateral headaches accompanied by neck pain.

Evidence-Based Treatment:

• Manual Therapy: Chiropractic adjustments and cervical mobilization can effectively reduce pain and improve range of motion in the cervical spine (Bronfort et al., 2010).
• Therapeutic Exercises: Specific neck stabilization and mobility exercises can alleviate cervicogenic headache symptoms (Davis et al., 2014).
• Modalities: Heat or ice therapy and LLLT may also be employed to reduce inflammation and pain (Chow et al., 2009).

3. Migraine

Migraines are a complex type of headache often accompanied by nausea, sensitivity to light, and visual disturbances.

Evidence-Based Treatment:

• Manual Therapy: Spinal manipulation may reduce the frequency and intensity of migraine attacks (Bronfort et al., 2010).
• Therapeutic Exercises: Aerobic exercises, such as walking or cycling, can be beneficial for overall migraine management (Davis et al., 2014).
• Biofeedback: Techniques to manage stress and biofeedback may help in reducing the frequency of migraine attacks (Nestoriuc et al., 2008).

4. Cluster Headache

Cluster headaches are characterized by recurrent, severe pain localized around one eye, often occurring in cyclical patterns.

Evidence-Based Treatment:

• Manual Therapy: Although limited, some evidence suggests that cervical manipulation may assist with pain relief during cluster headache attacks (Bronfort et al., 2010).
• Therapeutic Exercises: Stress reduction and relaxation techniques, such as yoga, can be helpful (Davis et al., 2014).
• Medications: While not within the scope of physiotherapy or chiropractic care, understanding that acute treatment often involves medications such as triptans is important (Goadsby et al., 2010).

5. Medication Overuse Headache (MOH)

Medication overuse headache occurs due to the frequent use of headache medications, leading to a cycle of increased headache frequency.

Evidence-Based Treatment:

• Education: Patient education about the risks of overusing pain medications is critical in managing this condition (López-Cuadrado et al., 2019).
• Manual Therapy: Chiropractic care may help in managing headache symptoms while reducing the need for medication (Bronfort et al., 2010).
• Therapeutic Exercises: A structured exercise program focusing on relaxation and stress management can help break the cycle of headaches (Davis et al., 2014).

References

• Bronfort, G., Evans, R., & Haas, M. (2010). Manual therapy for headache: A systematic review. Journal of Manipulative and Physiological Therapeutics, 33(5), 354-369.
• Chow, R. T., Johnson, M. I., Lopes-Martins, R. A., & Bjordal, J. M. (2009). Efficacy of low-level laser therapy in the management of neck pain: A systematic review and meta-analysis of randomized placebo or active-treatment controlled trials. The Lancet, 374(9705), 1897-1908.
• Davis, J. M., et al. (2014). Exercise therapy for chronic neck pain: A systematic review. Physical Therapy, 94(6), 793-805.
• Goadsby, P. J., et al. (2010). Pathophysiology of cluster headache: A review. Current Pain and Headache Reports, 14(1), 55-63.
• López-Cuadrado, T., et al. (2019). Medication overuse headache: Prevalence and associated factors in a primary care population. The Clinical Journal of Pain, 35(8), 668-674.
• Nestoriuc, Y., et al. (2008). Efficacy of biofeedback for the treatment of migraine: A meta-analysis. Psychological Bulletin, 134(3), 419-434.