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[1][edit | edit source]

Secondary Headaches[1][edit | edit source]

  • Headache attributed to trauma or injury to the head and/or neck
  • Headache attributed to cranial and/or cervical 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 the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
  • Headache attributed to psychiatric disorder

Painful Cranial Neuropathies, Other Facial Pain and Other Headaches[1][edit | edit source]

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

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].

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 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia38(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.