A headache can be a sign that something very wrong is happening inside, so we must always approach them with caution.
Fortunately most headaches are benign. Here is a table with characteristics of the most common types of headaches that should help deepen our understanding.
Primary and Secondary Headaches
Headaches are defined as primary or secondary. Primary headaches are benign, recurrent headaches that are not caused by underlying disease or structural problems. For example, migraine is a type of primary headache. While primary headaches may cause significant daily pain and disability, they are not dangerous. Secondary headaches are caused by an underlying disease, like an infection, head injury, vascular disorders, brain bleed or tumors. Secondary headaches can be harmless or dangerous. Certain ‘red flags’ or warning signs indicate a secondary headache may be dangerous.
Here is a list of conditions that are known to cause a secondary headache:
• Sinus headache
• Giant cell arteritis (associated with polymyalgia rheumatica)
• Carotid artery dissection (in the neck)
• Headache associated with nonvascular intracranial disorders • Neoplasm (tumors)
• Idiopathic intracranial hypertension
• Post-traumatic headache
• Subdural hematoma
• Cervical spinal disorders (CGH)
• Temporomandibular joint (TMJ) dysfunction
• Headache caused by sleep disorders such as obstructive sleep apnea.
Overview of Common Headaches
Chronic Daily Headache (CDH) has a prevalence of 4-5% of adults. It affects males to females in a 1:2-3 ratio. These headaches often start as episodic but can ‘transform’ over time to CDH. Medication (rebound) induced headache is believed to play a role in up to 30% of CDH patients. Interestingly 50-80% of those treated in tertiary headache centers, are recorded as having ‘medication overuse’. Those with CDH often have a poorer quality of life than ‘episodic headachers’. CDH can be either primary or secondary.
Whilst many people reach for the bottle, some realize that medications can mask underlying mechanical problems such as stiff and tense muscles and look to us for long term help. For these reasons manual therapy has become ‘a popular choice’ for patients with common and benign forms of headaches, such as Cervicogenic (CGH) and Tension Type (TTH), because these two conditions are often associated with mechanical neck pain.
A headache is defined as ‘aching or pain in one or more areas of the head or neck’. Both the frequency and pain level can vary greatly. Depending on the classification between 65-90 percent of all headaches are due to Tension Type Headaches (TTH). The remaining 10-35 percent include migraines, neck based/Cervicogenic headaches (CGH), TMJ type, sinus, and cluster headaches.
In terms of trigger point therapy TTH & CGH are the most accessible and amenable to intervention, although many authorities today recognize that trigger points may have an important role to play in relieving migraines.
TTH and Trigger Points
Muscular problems and tension are commonly associated with TTH and trigger points within muscles may either be causative or may perpetuate TTH.
The most commonly affected muscles are the trapezius, sternocleidomastoid, temporalis, masseter and occipitofrontalis. There is also a strong association with postural issues such as the upper crossed pattern.
Trigger points often add to the misery of headaches because they are associated with peripheral and central sensitization.
The pain processing part of the central nervous system is almost certainly involved in TTH as it shows up abnormal in scans. many experts agree that long- term inputs from trigger points may lead to a vicious cycle that converts periodic headaches into chronic tension headaches. In such cases even if the original initiating factor is eliminated, the trigger point-central sensitization cycle can perpetuate or even worsen.
Simeon Niel Asher is a British osteopath. Simeon co-founded Niel Asher Healthcare in 1997, is widely acknowledged as one of the worlds leading authorities on trigger points and trigger point therapy. Simeon is a visiting lecturer in the UK, Scandinavia, Brasil, and Australia, and is the author of numerous publications including the best selling "Concise Book of Trigger Points" which has been in print since 2004.
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