How Physiotherapy can assist with headache pain and severity – Adam Shaw Musculoskeletal Physiotherapist
I recently conducted an education evening on headaches and would like to share some of the information we discussed at this evening with you.
There are constantly new headaches that are being discovered according to some researchers – recently we have added hot-bath related headache and headache attributed to space travel! There are now over 300 types of headache described in research! BUT, are there really 300 different causes of headache? In the past it was assumed that headache is caused by blood vessel changes within the brain due to their throbbing nature but there is no research to support this. In fact, it has been shown that blood vessels only change after the onset of headache and remain changed until headache has gone. Due to this, it is likely that blood vessel changes are a symptom of headache – not the cause. The same goes for the theory that muscle tension causes headache, research suggests that there is no increased activity in muscles between headache sufferers and those without.
Another more recent theory has more substantial evidence backing it up. It has been suggested that an area of the brainstem called the trigeminocervical nucleus (TCN) is responsible. This area of the brain is responsible for processing information received from the face and neck and if it is sensitised you are more likely to suffer from headache symptoms. Research has shown that those who suffer from migraines and tension type headaches have signs of increased brain stem sensitivity.
It is therefore, unlikely there are 300 different causes of headache. The variety of migraines and headache are not separate conditions with different causes but different expressions of the same condition – that condition being the sensitised brain stem.
The brainstem TCN I mentioned earlier is like the control centre for receiving information from the face and top 3 levels of your neck. If this control centre is affected and now all the messages it receives are exaggerated – kind of like turning the volume up on an amplifier. Then the rest of the brain gets an inaccurate picture of that is going on and subsequently we get overload resulting in headache or other associated symptoms such as dizziness or nausea.
One of the main reasons for this control centre (TCN) to become oversensitive is dysfunction in the upper parts of our neck. Continual information from these levels due to things such as weak neck and shoulder blade muscles, poor posture and overuse can cause onset of symptoms. Often the presence of triggers such as stress, certain foods or bright lights can lead to headache. It is thought that these only trigger headache in the presence of an already pre primed brainstem. If you settle the brainstem irritation you remove the trigger. These triggers alone are not enough to cause the severe pain of headache – it is the sensory processing of these triggers that causes symptoms.
Fortunately, there are medications that can help and you may have tried some of these. They often work by calming down the irritated brainstem, however, often they are required to be taken at the first sign of headache – miss this opportunity and the horse has bolted – the brainstem is already too wound up to settle down and you just need to wait it out.
Physiotherapy can help calm this system down in a more long-term manner by treating one of the initial causes of the brain stem sensitisation in the first place – the neck! An Adelaide based Physiotherapist Dean Watson has been treating headache for over 25 years and has developed a specific technique aimed at ascertaining which area of the neck is causing symptoms. This can be done by reproducing symptoms and subsequently reducing them with treatment to the neck. Hands on physio plus exercise has been shown to be an effective treatment strategy. It must be said this is not a panacea, however, treatment is effective in the vast majority of cases and it can be established quite early (within 4-5 treatments) whether it will help.
You may have been suffering from headaches over a long period of time or have found other treatment ineffective. I would encourage you to speak with a Physiotherapist trained in the Dean Watson Approach about whether they could assist them in their management. Physiologic is currently offering gap free initial consultations for headache sufferers to determine if they may benefit.
If you have any questions on the above information, please feel free to contact me at the clinic.
Adam Shaw
Musculoskeletal Physiotherapist
Dry needling is a broad term used to differentiate “non-injection” needling from the practice of “injection needling” which utilises a hyperdermic syringe and usually involves the injection of an agent such as saline, local anaesthetic or corticosteroid into the tissue or specific anatomical structures.
Dry needling is really a westernised form of the traditonal acupuncutre that is used so frequently in eastern medicine. It is becoming increasingly more popular as a treatment tool used by many health clinicians. Physiotherapists are a subgroup of clinicians who use dry needling as one of many treatment modalities. The question is often asked “How does this actually work?” The answer is a complex one which involves a number of physiological and biochemical repsonses. 
In short we are after specific reactions in the target tissue for a therapeutic effect. The most common tissue that is dry needled is muscle tissue. In this example the practitioner usually places the needle into a key point in the target muscle. The effect is a vast decrease in muscle tension (tone) and this usually allows better flexibility within the muscle. In addition one might see a corresponding increase in movement of adjacent joints.
These key points are called “Trigger Points” and are well documented in the literature. (see adjacent picture). They can contribute largely to a persons symptoms particularly that “muscular” type pain. The trigger point is like the “command centre” of the muscle. Dry needling can influence muscle behaviour by changing the signals that the command centre sends out to the rest of the muscle.
It should be noted that dry needling is simpy a tool used in the global management of musculo skeletal conditions. It is very effective but only when used in conjunction with an appropriate rehab program. Dry needling alone usually isnt a long term solution !
DRY NEEDLING IS AVAILABLE AT PHYSIOLOGIC – For more info contact me at josh@physiologic.com.au
Physiologic Physiotherapy
DOCTOR OR PHYSIO – WHO SHOULD I SEE ?
At Physiologic Physiotherapy we often get asked “Should I see the doctor or come straight to physio”? Traditionally doctors have been the first port of call when a person
injures themselves or requires advice and management of an injury. The field of musculoskeletal and sports type injury has become somewhat of a specialised area in recent times. In medicine we now have Sports Physicians (Specialists) and in physiotherapy we have titled sports physios and sports specialist physios. In a private practice type setting such as Physiologic physiotherapy our “bread and butter” very much is in the management of musculoskeletal injuries both in sports people and the general public. So to answer the original question – The truth is that either is acceptable. For those of us who have been to a doctor and seen a physiotherapist for a musculoskeletal injury – often the experience can be quite different. The following will help answer some common questions
DO I NEED A REFFERAL TO SEE A PHYSIO ? -You dont require a formal referral to see a physiotherapist. Physiotherapists are known as “first contact” practitioners which means that we have the necessary skills to examine, DIAGNOSE, treat and advise our patients with no previous input or referral from a doctor
WHO IS BETTER EQUIPPED TO DIAGNOSE MY INJURY ? – Both doctors and physiotherapists have the necessary skills to diagnose your injury. Interestingly the most important thing is that there is a DIAGNOSIS made ! Often we see clients who have been sent to physiotherapy from the doctor with no formal diagnosis. in my experience it is very difficult to treat a patient without a diagnosis. Can you imagine trying to make a cake without knowing that it was a cake ? it doesnt matter who you see so long as the diagnosis is made clear to you.
WHO IS BETTER EQUIPPED TO MANAGE/TREAT MY INJURY ? – In summary it depends on the injury. Often both parties have input into an injury. For example it is not uncommon for the physio to refer to the doctor to ask for a script for some anti inflammatories as these are not able to be prescribed by a physio. In general you will usually get more detail and coverage under the guidance of the physio where a musculoskeletal injury is concerned. Our range of skills in this area is extensive and we are able to correctly advise you also.
WHO IS ABLE TO PRESCRIBE EXERCISES ? – Typically this is the physiotherapy domain. Most people who see us will know that we commonly give out drills/exercises to help with your rehab. I have no problem in saying that doctors do not readily do this and probably arent great at doing it either !
WHAT IF I NEED “HANDS ON” MANUAL THERAPY ? – again this is a limited scope for doctors. Physios typically recieve the manual training needed to administer this type of treatment.
WHAT IF I REQUIRE SCANS ? – There are two options here. Both parties can send for scans although the rebates through medicare are different for some scans if a physio send you. The physiotherapist can either refer directly for a scan or send you to the doctor to get a referral for one. In summary it depends on the scan ! Interestingly a large part of our training centres on referring appropriately for scans. They can be costly and some scans have a radiation dosage associated with them. It is important that scans are adminstered correctly and the physiotherapist can direct you on this as well as most doctors.
HOW DO PHYSIOS AND DOCTORS WORK TOGETHER ? – Above all things the most important thing is the well being of our patients. We work closely with doctors for some of the following reasons. Referrral for scans, injections, to specialists, to other health professionals, for medication etc. Most good physios will recognise the need to refer to doctors and likewise most doctors will see when physiotherapy is indicated.
If you are unsure about who to see send us an email admin@physiologic.com.au or call 55787155 and chat to one of the physios. 
