Headache: Difference between revisions

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<div class="noeditbox">Welcome to [[PPA Pain Project]]. This page is being developed by participants of a project to populate the Pain section of Physiopedia. The project is supervised and coordinated by the [[The Physiotherapy Pain Association]].
<div class="editorbox"> '''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]]  
*Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!
*If you would like to get involved in this project and earn accreditation for your contributions, [mailto:[email protected] please get in touch]!
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*The content for this page has started to be constructed. Please review it. Are you happy that is is informed by current best evidence? Can you identify any gaps or opinions/perspectives that have not yet been covered?
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'''Original Editor '''- [[User:Rachael Lowe|Rachael Lowe]]  


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== Classification  ==
== Classification  ==


The most recognised classification for headache is from the [http://ww.ihs-headache.org/ International Headache Society]. The [http://ihs-classification.org/en/02_klassifikation/ International Classification of Headache Disorders (ICHD)] is an in-depth hierarchical classification of headaches containing explicit diagnostic criteria for headache disorders. They classify headaches into primary, secondary, cranial neuralgias and primary facial pain as outlined below:
The most recognised classification for headache is from the International Headache Society<ref name=":0">Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). ''Cephalalgia'', ''38''(1), 1–211. <nowiki>https://doi.org/10.1177/0333102417738202</nowiki></ref>. The [https://ichd-3.org/ 3rd edition of International Classification of Headache Disorders (ICHD)] is an in-depth hierarchical classification of headaches containing explicit diagnostic criteria for headache disorders. They classify headaches into primary, secondary, Painful cranial neuropathies, other facial pain and other headaches outlined below:
 
=== Primary Headaches  ===
Primary headaches are<ref name=":0" />
* [[Migraine Headache|Migraine]]
* [[Tension-type headache]]
* Trigeminal autonomic cephalalgias
* [https://www.physio-pedia.com/Other_primary_headaches Other primary headache disorders]
 
=== Secondary Headaches  ===
Secondary headaches are attributed to the following:<ref name=":0" />
* trauma or injury to the head and/or neck
* cranial and/or cervical vascular disorder
* non-vascular intracranial disorder
* substance or its withdrawal
* infection
* disorder of homoeostasis
* disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
* psychiatric disorder
 
=== Painful Cranial Neuropathies, Other Facial Pain and Other Headaches  ===
 
*Painful lesions of the cranial nerves and other facial pain<ref name=":0" /> 
*Other headache disorders<ref name=":0" /><br>


==== Primary Headaches  ====
== Physical Therapy Management ==
It is the most commonly used non-pharmacologic treatment of TTH<ref>Chowdhury D. Tension type headache. ''Ann Indian Acad Neurol''. 2012;15(Suppl 1):S83–S88. doi:10.4103/0972-2327.100023</ref>. Cervical exercises, relaxation, massage, postural exercises, cranio-cervical techniques, thermotherapy, vertebral mobilization and stretching are effective in reducing TTH symptoms such as pain frequency and intensity. In the studies that have applied joint mobilization, cervical range of motion has improved. Other parameters such as quality of life, impact and pain disability and psychological aspects have improved with MT<ref>Espí-López GV, Arnal-Gómez A, Arbós-Berenguer T, González ÁA, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. ''J Jpn Phys Ther Assoc''. 2014;17(1):31–38. doi:10.1298/jjpta.17.31</ref>.


*[[Migraine Headache|Migraine Headaches]]
Various treatment options are available for treating headaches; however, since the clinical effectiveness is unclear, a Delphi study<ref name=":1">De Pauw R, Dewitte V, de Hertogh W, Cnockaert E, Chys M, Cagnie B. [https://pubmed.ncbi.nlm.nih.gov/33548766/ Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study.] Musculoskeletal Science and Practice. 2021 Apr 1;52:102325.</ref> was conducted to obtain consensus on physiotherapy treatment for tension-type headaches, migraine, and cervicogenic headaches. The study concluded that:
*[[Tension-type headache|Tension-type headache ]]
*[[Cluster Headaches|Cluster Headaches]]
*[[Other primary headaches|Other primary headaches]]


==== Secondary Headaches  ====
* Active mobilisation exercises, upper cervical spine mobilisations, passive mobilisation with movement (MWM), work-related ergonomic training, and active MWM can be used to treat cervicogenic headaches and
* Life-style advice, manual trigger point techniques, and work-related ergonomic training for migraine and tension-type headaches<ref name=":1" />.


*Headache attributed to head and/or neck trauma - [[Cervicogenic Headache|Cervicogenic Headaches]]
**Acute post-traumatic headache
**Chronic post-traumatic headache
**Acute headache attributed to whiplash injury
**Chronic headache attributed to whiplash injury
**Headache attributed to traumatic intracranial haematoma
**Headache attributed to other head and/or neck trauma
**Post-craniotomy headache
*Headache attributed to cranial or cervical vascular disorder
**Headache attributed to ischemic stroke or transient ischemic attack
**Headache attributed to non-traumatic intracranial hemorrhage
**Headache attributed to unruptured vascular malformation
**Headache attributed to arteritis
**Carotid or vertebral artery pain
**Headache attributed to cerebral venous thrombosis (CVT)
**Headache attributed to other intracranial vascular disorder
*Headache attributed to non-vascular intracranial disorder
*Headache attributed to a substance or its withdrawal
*Headache attributed to infection
*Headache attributed to disorder of homoeostasis
*Headache or facial pain attributed to disorder of cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structures
*Headache attributed to psychiatric disorder


==== Cranial Neuralgias Central and Primary Facial Pain and Other Headaches ====
Physical therapy interventions have the largest effect on Migraines and Cervicogenic Headaches:
{| class="wikitable"
|+
!Cervicogenic - helpful
!'''Largest effect from PT treatment'''


*Cranial neuralgias and central causes of facial pain  
Spinal manipulations in Soft Tissues – C/S and T/S is beneficial. <ref name=":4">Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, Christie B, Shen I, Waldie T, Simonet D,  Bussières A . [https://pubmed.ncbi.nlm.nih.gov/32621321/ Spinal manipulation for the
*Other headache, cranial neuralgia, central or primary facial pain<br>
 
management of cervicogenic headache: A systematic review and meta‐analysis.] European Journal of Pain, 2020:24(9):1687-1702.</ref><ref name=":5">Dunning J.R, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks T.R. Cleland J.A. [https://pubmed.ncbi.nlm.nih.gov/26852024/ Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial.] BMC musculoskeletal disorders, 2016:17(1):1-12.</ref>
 
Effectively conducted mobilisations have the same effect as manipulations. <ref name=":4" />
|-
|Cervicogenic - unhelpful
|No benefit of other Manual Therapy - massage, dry needling, mobilisations.
Limited evidence of exercises – however there is good effect of combinations of manual therapy and exercise. <ref name=":5" /><ref>Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. [https://pubmed.ncbi.nlm.nih.gov/12221344/ A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache.] Spine, 2002:27(17):1835-1843.</ref>
|-
|Migraines - Helpful
|'''Physical Therapy treatment is especially effective with migraines'''
 
Low–Moderate evidence that aerobic exercises have a benefit. <ref name=":3">Krøll L.S, Hammarlund C.S, Linde M, Gard G, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/29333870/ The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain.] A randomized, controlled, clinical trial. Cephalalgia. 2018:38(12):1805–1816.</ref><ref>Touche R.L, Fernández Pérez J.J, Acosta A.P, Campodónico L.G, García S.M, Juárez D.A, García B.S, Angulo-Díaz-Parreño S, Cuenca-Martínez F, Luis Suso-Martí, Paris-Alemany A. [https://pubmed.ncbi.nlm.nih.gov/31904889/ Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis.] Scandinavian Journal of Medical Science & Sports. 2020:30:965–982. </ref><ref>Lemmens J, De Pauw J, Van Soom T, Michiels S, Versijpt J, Van Breda E, Castien R, De Hertogh W. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734345/ The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis.] The journal of headache and pain. 2019: 20(1):1-9.</ref>
 
Higher quality evidence favors exercises - type/duration/intensity unspecified. <ref name=":2">Luedtke K, Allers A, Schulte L.H, May A. [https://pubmed.ncbi.nlm.nih.gov/26229071/ Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis.] Cephalalgia. 2016:36(5):474–492. </ref>
 
'''Manual therapy''' is beneficial with migraines. <ref>Chaibi A, Tuchin P.J, Russell M.B. [https://pubmed.ncbi.nlm.nih.gov/21298314/ Manual therapies for migraine: a systematic review.] The journal of headache and pain. 2011:12(2):127-133.</ref>
|-
|Tension Type Headaches -Helpful
|Manual Therapy has a moderate effect on soft tissues, '''Manipulation has''' no benefit. '''Soft tissue therapy''' and '''dry needling''' is beneficial on pain intensity and frequency. <ref>Kamonseki D.H, Lopes E.P, van der Meer H.A, Calixtre L.B. [https://pubmed.ncbi.nlm.nih.gov/32924640/ Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis.] Disability and Rehabilitation. 2022:44(10):1780-1789.</ref><ref>Ferragut-Garcias A, Plaza-Manzano G,
 
Rodriguez-Blanco C, Velasco-Roldan O, Pecos-Martin D, Oliva-Pascual-Vaca J, Llabres-Bennasar B, Oliva-Pascual-Vaca A. [https://pubmed.ncbi.nlm.nih.gov/27623523/ Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial.] Archives of Physical Medicine and Rehabilitation. 2017:98:211-219.</ref><ref>Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes B.W, Mohseni-Bandpei M.A, Mansournia M.A, Delavari S, Keshtkar A, Bahramian M. [https://pubmed.ncbi.nlm.nih.gov/33609358/ Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis.] Physical Therapy. 2021:1-31.</ref>
 
 
'''CBT''' has some evidence on impact on headaches, not intensity or frequency| perception of headache affected by CBT. <ref>Martin P.R, Aiello R, Gilson K, Meadows G,
 
Milgrom J, Reece J. [https://pubmed.ncbi.nlm.nih.gov/26226090/ Cognitive behavior therapy for comorbid migraine and/or tension type headache and major depressive disorder: An exploratory randomized controlled trial.] Behaviour Research and Therapy. 2015:73:8-18. </ref>
 
'''Aerobic exercises''' have an impact on capacity, not pain - increased capacity, but didn’t change pain, frequency, intensity. <ref name=":3" /><ref name=":2" />
 
'''Psychological and aerobic''' – teach the patient how to live with the headache. <ref name=":3" />
|-
|Tension Type Headaches - Unhelpful
|'''Strength training had''' no benefit compared to posture correction, neither technique was beneficial either. <ref>Madsen B.K, Søgaard K, Andersen L.L, Tornøe B, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/28750588/ Efficacy of strength training on
 
tension-type headache: A randomised controlled study.] Cephalalgia. 2018:38(6):1071–1080.</ref>
|}


== Resources  ==
== Resources  ==
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[http://www.who.int/mediacentre/factsheets/fs277/en/ WHO Factsheet on Headache Disorders]  
[http://www.who.int/mediacentre/factsheets/fs277/en/ WHO Factsheet on Headache Disorders]  


[http://www.americanheadachesociety.org/assets/1/7/NAP_for_Web_-_Epidemiology___Impact_of_Headache___Migraine.pdf Epidemiology and Impact of Headache and Migraine]  
[https://americanheadachesociety.org/resources/guidelines/guidelines-position-statements-evidence-assessments-and-consensus-opinions/ AHS Guidelines and Position Statements]  
<div class="researchbox">
 
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1jiITQk_mbf9bSrJRCyDAwavekGie8J6WtrqrWkIzeqU3uxY4P</rss></div>
== References  ==
== References  ==


<references />  
<references />  


[[Category:Pain]] [[Category:PPA_Project]] [[Category:Neurology]] [[Category:Cervical Spine]] [[Category:Musculoskeletal/Orthopaedics]]
[[Category:Pain]]  
[[Category:PPA_Project]]  
[[Category:Neurology]]  
[[Category:Cervical Spine]]  
[[Category:Musculoskeletal/Orthopaedics]]
[[Category:Conditions]]
[[Category:Cervical Spine - Conditions]]

Latest revision as of 08:55, 1 August 2023

Original Editor - Rachael Lowe

Top Contributors - Admin, Kapil Narale, Kim Jackson, Fasuba Ayobami, Jo Etherton, Vidya Acharya, Evan Thomas and WikiSysop

Classification[edit | edit source]

The most recognised classification for headache is from the International Headache Society[1]. The 3rd edition of International Classification of Headache Disorders (ICHD) is an in-depth hierarchical classification of headaches containing explicit diagnostic criteria for headache disorders. They classify headaches into primary, secondary, Painful cranial neuropathies, other facial pain and other headaches outlined below:

Primary Headaches[edit | edit source]

Primary headaches are[1]

Secondary Headaches[edit | edit source]

Secondary headaches are attributed to the following:[1]

  • trauma or injury to the head and/or neck
  • cranial and/or cervical vascular disorder
  • non-vascular intracranial disorder
  • substance or its withdrawal
  • infection
  • disorder of homoeostasis
  • disorder of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
  • psychiatric disorder

Painful Cranial Neuropathies, Other Facial Pain and Other Headaches[edit | edit source]

  • Painful lesions of the cranial nerves and other facial pain[1]
  • Other headache disorders[1]

Physical Therapy Management[edit | edit source]

It is the most commonly used non-pharmacologic treatment of TTH[2]. Cervical exercises, relaxation, massage, postural exercises, cranio-cervical techniques, thermotherapy, vertebral mobilization and stretching are effective in reducing TTH symptoms such as pain frequency and intensity. In the studies that have applied joint mobilization, cervical range of motion has improved. Other parameters such as quality of life, impact and pain disability and psychological aspects have improved with MT[3].

Various treatment options are available for treating headaches; however, since the clinical effectiveness is unclear, a Delphi study[4] was conducted to obtain consensus on physiotherapy treatment for tension-type headaches, migraine, and cervicogenic headaches. The study concluded that:

  • Active mobilisation exercises, upper cervical spine mobilisations, passive mobilisation with movement (MWM), work-related ergonomic training, and active MWM can be used to treat cervicogenic headaches and
  • Life-style advice, manual trigger point techniques, and work-related ergonomic training for migraine and tension-type headaches[4].


Physical therapy interventions have the largest effect on Migraines and Cervicogenic Headaches:

Cervicogenic - helpful Largest effect from PT treatment

Spinal manipulations in Soft Tissues – C/S and T/S is beneficial. [5][6]

Effectively conducted mobilisations have the same effect as manipulations. [5]

Cervicogenic - unhelpful No benefit of other Manual Therapy - massage, dry needling, mobilisations.

Limited evidence of exercises – however there is good effect of combinations of manual therapy and exercise. [6][7]

Migraines - Helpful Physical Therapy treatment is especially effective with migraines

Low–Moderate evidence that aerobic exercises have a benefit. [8][9][10]

Higher quality evidence favors exercises - type/duration/intensity unspecified. [11]

Manual therapy is beneficial with migraines. [12]

Tension Type Headaches -Helpful Manual Therapy has a moderate effect on soft tissues, Manipulation has no benefit. Soft tissue therapy and dry needling is beneficial on pain intensity and frequency. [13][14][15]


CBT has some evidence on impact on headaches, not intensity or frequency| perception of headache affected by CBT. [16]

Aerobic exercises have an impact on capacity, not pain - increased capacity, but didn’t change pain, frequency, intensity. [8][11]

Psychological and aerobic – teach the patient how to live with the headache. [8]

Tension Type Headaches - Unhelpful Strength training had no benefit compared to posture correction, neither technique was beneficial either. [17]

Resources[edit | edit source]

The International Headache Classification (ICHD-2)

WHO Factsheet on Headache Disorders

AHS Guidelines and Position Statements

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333102417738202
  2. ↑ Chowdhury D. Tension type headache. Ann Indian Acad Neurol. 2012;15(Suppl 1):S83–S88. doi:10.4103/0972-2327.100023
  3. ↑ Espí-López GV, Arnal-Gómez A, Arbós-Berenguer T, González ÁA, Vicente-Herrero T. Effectiveness of Physical Therapy in Patients with Tension-type Headache: Literature Review. J Jpn Phys Ther Assoc. 2014;17(1):31–38. doi:10.1298/jjpta.17.31
  4. ↑ 4.0 4.1 De Pauw R, Dewitte V, de Hertogh W, Cnockaert E, Chys M, Cagnie B. Consensus among musculoskeletal experts for the management of patients with headache by physiotherapists? A delphi study. Musculoskeletal Science and Practice. 2021 Apr 1;52:102325.
  5. ↑ 5.0 5.1 Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A, Christie B, Shen I, Waldie T, Simonet D, Bussières A . [https://pubmed.ncbi.nlm.nih.gov/32621321/ Spinal manipulation for the management of cervicogenic headache: A systematic review and meta‐analysis.] European Journal of Pain, 2020:24(9):1687-1702.
  6. ↑ 6.0 6.1 Dunning J.R, Butts R, Mourad F, Young I, Fernandez-de-Las Peñas C, Hagins M, Stanislawski T, Donley J, Buck D, Hooks T.R. Cleland J.A. Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC musculoskeletal disorders, 2016:17(1):1-12.
  7. ↑ Jull G, Trott P, Potter H, Zito G, Niere K, Shirley D, Emberson J, Marschner I, Richardson C. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine, 2002:27(17):1835-1843.
  8. ↑ 8.0 8.1 8.2 Krøll L.S, Hammarlund C.S, Linde M, Gard G, Jensen R.H. The effects of aerobic exercise for persons with migraine and co-existing tension-type headache and neck pain. A randomized, controlled, clinical trial. Cephalalgia. 2018:38(12):1805–1816.
  9. ↑ Touche R.L, Fernández Pérez J.J, Acosta A.P, Campodónico L.G, García S.M, Juárez D.A, García B.S, Angulo-Díaz-Parreño S, Cuenca-Martínez F, Luis Suso-Martí, Paris-Alemany A. Is aerobic exercise helpful in patients with migraine? A systematic review and meta-analysis. Scandinavian Journal of Medical Science & Sports. 2020:30:965–982.
  10. ↑ Lemmens J, De Pauw J, Van Soom T, Michiels S, Versijpt J, Van Breda E, Castien R, De Hertogh W. The effect of aerobic exercise on the number of migraine days, duration and pain intensity in migraine: a systematic literature review and meta-analysis. The journal of headache and pain. 2019: 20(1):1-9.
  11. ↑ 11.0 11.1 Luedtke K, Allers A, Schulte L.H, May A. Efficacy of interventions used by physiotherapists for patients with headache and migraine—systematic review and meta-analysis. Cephalalgia. 2016:36(5):474–492.
  12. ↑ Chaibi A, Tuchin P.J, Russell M.B. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011:12(2):127-133.
  13. ↑ Kamonseki D.H, Lopes E.P, van der Meer H.A, Calixtre L.B. Effectiveness of manual therapy in patients with tension-type headache. A systematic review and meta-analysis. Disability and Rehabilitation. 2022:44(10):1780-1789.
  14. ↑ Ferragut-Garcias A, Plaza-Manzano G, Rodriguez-Blanco C, Velasco-Roldan O, Pecos-Martin D, Oliva-Pascual-Vaca J, Llabres-Bennasar B, Oliva-Pascual-Vaca A. Effectiveness of a Treatment Involving Soft Tissue Techniques and/or Neural Mobilization Techniques in the Management of Tension-Type Headache: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation. 2017:98:211-219.
  15. ↑ Pourahmadi M, Dommerholt J, Fernández-de-Las-Peñas C, Koes B.W, Mohseni-Bandpei M.A, Mansournia M.A, Delavari S, Keshtkar A, Bahramian M. Dry needling for the treatment of tension-type, cervicogenic, or migraine headaches: a systematic review and meta-analysis. Physical Therapy. 2021:1-31.
  16. ↑ Martin P.R, Aiello R, Gilson K, Meadows G, Milgrom J, Reece J. Cognitive behavior therapy for comorbid migraine and/or tension type headache and major depressive disorder: An exploratory randomized controlled trial. Behaviour Research and Therapy. 2015:73:8-18.
  17. ↑ Madsen B.K, Søgaard K, Andersen L.L, Tornøe B, Jensen R.H. [https://pubmed.ncbi.nlm.nih.gov/28750588/ Efficacy of strength training on tension-type headache: A randomised controlled study.] Cephalalgia. 2018:38(6):1071–1080.
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