What are headache “triggers”?

Different types of headaches can be caused by elements of our own environment which set off a headache. These may include, but are not limited to: sleep patterns, hormones, weather/barometric pressure, emotional stress, and food. A trigger’s effect can vary greatly from person to person and usually will not cause a problem unless one is genetically predisposed to that trigger. What may cause a significant headache in one individual may have no effect at all on another. It is important to realize that controlling these aspects of your environment may reduce headaches but not stop them completely. This is particularly important, if one of the aforementioned physical dysfunctions or conditions is present. Triggers are just one aspect of headaches, and it is most helpful to take an overall approach to treating your headaches. More information on different triggers is available upon request.

How can a physiatrist help you with your headaches?

Evaluation by a physiatrist can provide you with a working diagnosis. A detailed history and examination will uncover muscular, joint, vascular, or other causes of your pain. By pinpointing the source of pain, a specific treatment plan can be established. This may include physical therapy, biofeedback, medication, injections, cognitive therapy, or nutritional counseling. Occasionally, diagnostic tests can be of assistance in pinpointing the source of the headache.

What is the role of a physical therapist in the management of headaches?

A physical therapist can help not only to resolve headaches, but also educate you in preventing future headaches. The physical therapist’s knowledge of the muscular, articular (joint), and neurological systems allows him/her to determine the physical components which cause headache pain. He/she can assess your posture and body mechanics which may be aggravating your condition. The physical therapist can evaluate your spinal facet joints in the neck to ensure proper movement and muscle balance. The physical therapist will treat your head and neck by freeing up any bound fascia and releasing muscle and joint restrictions. He/she will educate you in proper posture, stretching, and strengthening, as well as an aerobic exercise program to assist in pain control and emotional stress reduction.

When might biofeedback be helpful?

Biofeedback is another useful tool employed by physical therapy to educate you in relaxing specific muscle groups that may be generators of pain. Biofeedback is also helpful in learning to control other symptoms that contribute to headache pain. It enables the patient to control the frequency and intensity of recurrent headaches.

When would one consider medication?

Aside from simply prescribing analgesics (pain medications), there are a number of classes of medications that can address specific components of pain. Examples include NSAIDs (non-steroidal anti-inflammatory drugs) for inflamed joints, muscle relaxants/certain anti-depressants in low dosage for muscle-based pain, vasoactive drugs for vascular headaches, etc.

How can injections help to reduce headaches?

Trigger point injections of local anesthetic may mechanically inactivate muscular pain generators. Corticosteroid injections into intervertebral joints will reduce inflammation and thereby result in improved joint movements and decreased pain.

Which patients benefit from cognitive therapy? Nutritional therapy?

Some patients have stress-related or other emotional triggers that are responsive to cognitive/relaxation therapy.

A careful assessment by a nutritionist may uncover food/beverage triggers.

In summary, a careful, precise assessment will allow the selective use of the many treatment options. The vast majority of patients experience a reduction in overall headache pain as a result of a comprehensive approach as described above.