chronic pain

My father suffered migraines as a child. In fact, they were so severe that he would lock himself in a dark room for up to 2-3 days at a time. The mere thought of bright light or loud noise would send him spiralling into another attack. Not all headaches are this debilitating. Most tend to be mild and more annoying then anything else. However, with up to three quarters of adults reporting recurrent headaches in the last year, the effects on healthcare costs, sick days and workplace productivity are an economic headache for society.

Pain is a protector. It is the brain’s way of letting us know it is worried about something and the more worried it is, the more pain it produces. We deal with headaches in much the same way we deal with many other pain issues. We take a pain killer.  We want instant solutions to the problem. The magic silver bullet to make our symptoms disappear. True, pain medication often allows us to continue performing our day to day tasks, unhindered by the ever tightening band around our head. But in taking them, we mask the protection system and dampen the noise pain creates. That headache might be saying “time for some fresh air” or “stress is making us grind our teeth again”. Whatever the case, not only do we miss these early warning signs, but the more frequently we consume pain killers, the higher the dose we require to have the same response. It’s a bit like doing Octsober and then finding that after your month of sobriety, the first two drinks at the work Christmas party go straight to your head. Like alcohol, our body builds a tolerance to pain medication.

With this in mind, why not try these 6 things before reaching for the pain medication safety net?

1. Water and electrolytes at the first sign of a headache
2. Fresh air
3. Gentle neck stretches to help reduce postural strain
4. A foam roller to help reduce tension at the back of your head and neck
5. Gentlemassage of the jaw and temples.
6. Meditation/ relaxation

Each headache is unique and appropriate treatment involves an accurate diagnosis. The first step to solving a problem is to first workout what the problem is. Here are 3 of the most common headachesI see in practice:

1. Tension– Easily the most common, often mild-moderate pain usually both sides of the head. Manual therapy tends to be effective in reducing the frequency, disability and severity of these headaches, particularly in a chronic setting (4)
2. Migraine– Can be very disabling, usually lasts between 4-72 hours and quite often has a hormonal component. It tends to affect one side and has a pulsing quality. Some migraines are proceeded by an aura, a set of sensory changes which may include visual changes, pins and needles or a heightened sensitivity to sounds, smells or light. Acute attacks are effectively treated with medication. Cognitive behavioural therapy, exercise, relaxation and manual therapy have all shown improvements in symptoms. It’s important for patients to establish what triggers the onset of symptoms and to avoid where possible (5)
3. Cervicogenic– Which means originating in the neck. Pain can be reproduced by tender points in the neck and there is usually associated restriction in neck movement (6). Manual therapy is very effective for this kind of headache.

Once the ‘what’ has been identified, the more important question is ‘why’? Yes the reason for the 101 questions I’ll ask you is to give an insight into the ‘why’. 

Here are some likely culprits:

• Stress, muscular tension and poor prolonged posture
• Injury to the head, neck or spine
• Dental or jaw problems
• Infections
• Diet
• Hormonal influences
• Medications
• Disorders of the eyes, ear, nose or throat
• High blood pressure
• Temperature – extremes of heat or cold
• Dehydration

How do you address the cause of a headache? We may need to reduce the exposure, alter habits or perhaps there is mechanical restriction affecting how well your body copes with these things. Is restriction through the neck or upper back affecting the bodies ability to remove waste products from the head, or are there postural compensations from an old shoulder injury? By examining the way the body moves, we can establish what structures aren’t functioning so well and are preventing the body from returning to health.  Treatment is directed specifically at these restricted areas encouraging normal tissue circulation, improving range of motion and decreasing pain locally. Now although osteopathic treatment is wonderful, we only see you for a minuscule portion of your week, so typically exercises and management strategies are prescribed to complement the treatment, reduce strain and minimise predisposing factors during your daily activities.

How are you managing your headaches? Pain medication is a much cheaper alternative to seeing an osteopath, but surely you can appreciate the band-aid nature of this treatment. What if you could reduce the frequency, severity or duration of your headaches. What if they could be resolved completely? Addressing the cause is the key to improving your headache and an osteopath is appropriately equipped to do so.

This advice is general in nature. If you have any concerns regarding your headache you should consult your healthcare professional.

References

1. N.p., http://www.who.int/mediacentre/factsheets/fs277/en/, 2017. Web. 16 Mar. 2017.
2. N.p.,http://thejournalofheadacheandpain.springeropen.com/articles/10.1186/s10194-015-0544 Web. 16 Mar. 2017.
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/headache
4. https://www.ncbi.nlm.nih.gov/pubmed/20647241
5. J Headache Pain. 2011 Apr; 12(2): 127–133. Published online 2011 Feb 5. doi: 10.1007/s10194-011-0296-6
6. Hall, T., Briffa,.K., Hopper, D. (2008) Clinical evaluation of cervicogenic headache: a clinical perspective. (journal of Manual Manipulative Therapy, 16(2), 73-80