Headaches are a crippling problem for those who suffer them regularly,  causing pain, vomiting, blurred vision, and sensitivity to light and loud noise. They are responsible for over 25 million lost days of work in the UK (few statistics exist for Aus) per year, and effect around 50% of the population. Headache is a general term used to describe a group of disorders that can be further broken down into sub-categories of Migraine, Tension-Type Headache, Cluster headache, and Medication-overuse headache. Unfortunately, due to lack of eduction of the general public and even General Practice doctors about the different types of headache, Migraine is commonly misdiagnosed. It seems to have become synonymous with any bad headache that causes nausea or vision-disturbance, however this is simply not the case.


To understand how you should best manage your headaches, you first have to know what kind it is;

  • Migraine: This truly crippling type of headache is justifiably the type that most people think they’re having when they have a really bad headache. This type of headache shares some of the features of other headaches, namely severe pain in the head, nausea, blurred vision and sometimes vomiting, but if differs in several distinct ways
    • It has an “aura”: Almost all sufferers of true migraine will tell you that they have a warning before the headache really kicks in – commonly visual disturbances like scintillating spots in the vision that can close down to a tunnel like region of sight in the middle of the visual field. Aurae can also be things like certain smells, sounds (auditory hallucination), but tend to be very consistent and characteristic for a given person.*Disclaimer: there are variants of Migraine that behave nothing like this pattern, the neurologists will take me to task on that, but they don’t really behave like a headache so I’m not including them here.
    • It responds to medication: sandomigran, Imigran, mersyndol etc. These are each different classes of medication and work in different ways, so each individual sufferer may have to be trialed on a few (under the care of their doctor or specialist) until the best one is found, and may more or less effective due to the particular TRIGGER for that person.
    • They have a trigger: Certain foods (red wine, cheeses, chocolate – you know, all the good stuff!), smells, or fatigue conditions like sleep-deprivation or heat exhaustion.
    • Location is variable within the head, sometimes frontal, sometimes temporal (side of head) sometimes global, and can differ between episodes.
  • Tension-Type Headache: Named because of the “Tension” in the muscles of the neck, upper back, head and jaw and mostly due to stress, anxiety, or joint dysfunction in the spine or jaw. This headache can be just as severe in pain level as migraine, and it also can result in nausea, double or blurred vision and photosensitivity – leading to very common mistaken diagnosis as being a migraine type headache. The key difference with this type of headache is the location specific nature of the pain, and the lack of response to medication. 
    • Location specific pain: Because Tension headache is caused by pressure on nerves in the upper cervical spine, back of the head and often the jaw, pain from this type of headache is almost always worse on one side of the head or the other. This is because a particular joint in the upper neck will be sprained or arthritic, causing pressure on the associated nerve root, or because one side of the jaw is stiff, sore, and not opening or closing normally.
    • Medication ineffective: Since the cause of the pain is mechanical compression of a nerve due to muscle tightness, the migraine medications that involve moderating neurotransmittors like serotonin have no effect since they do nothing to reduce this compression. Some mild improvement is often reported from medications that combine an antihistamine muscle relaxant/sedative with a codeine/opiate pain killer, but the sufferer still has low grade headache and other symptoms and often has to go home from work due to the sedative nature anyway.
  • Cluster Headache: Probably the most painful and debilitating of all the headache disorders, but thankfully the rarest, “cluster” refers to headaches that occur frequently during a certain short period at the same time each year. The pain most often comes on 2-3 hours after commencing sleep, waking the sufferer. The pain is typically one sided, above or behind the eye, and peaks in intensity 5-10min after waking, lasting 30-60mins. These nocturnal attacks are worse than day time, but these can happen 3-8times during a 24hr period. Usually the “cluster” lasts for a period of days to weeks, not more than a couple of months usually. This is thought to be due to neurotransmitter changes due the changes in the circadian rhythm due to seasonal change, but it is unknown how or what triggers the, and indeed how to treat it.

As can be seen above, each major type of headache has different characteristics, and treatment options vary depending on diagnosis. Tension-type headache is the type that can be most benefited by physiotherapy intervention, as we can accurately assess the main contributor to the nerve compression (neck or TMJ) and then treat to relieve this pressure. Corrective exercise is usually necessary to strengthen the deep cervical flexor muscles that stabilise the neck joints (like Pilates for your neck) or the pterygoid muscles that support the TMJ and it’s shock absorbing disc.

If you’ve had a diagnosis of migraine, but it doesn’t fit the above pattern for true migraine – ie. doesn’t respond to medication, no aura, pain in one specific spot that doesn’t move around between episodes – it might be time to be assessed by a headache specialist and check whether some treatment and exercise might be better than those pills you’re popping for no reason.

Call your physio.

For more information, visit Headache Australia here