More than "just" headaches

The International Headache Society1 lists over 100 different headache variants in its register. These differ in cause, type, severity, duration and symptoms. Over 90% of patients are affected by primary headaches, such as tension headaches or migraines.

In contrast to secondary headaches, i.e. headaches as a symptom of another disease, further diagnostics by means of EEG, MRI or CT are usually unnecessary for clarification in the case of primary headaches. An exact diagnosis is made by a detailed history interview and a physical and neurological examination. In addition, the evaluation of a headache diary can be helpful for therapy planning.

Therapy

For an effective treatment plan, it is necessary to take into account the patient's physical, psychological and social factors. Therefore, headache patients benefit from a multidisciplinary team of doctors, psychologists and therapists.

For the successful treatment of headaches, the patient's cooperation is essential. Only in this way is it possible to identify the causes of headaches in everyday life, to define individual and achievable goals and to understand the need for changes and therapy methods.

Tips for tension headache

A regular daily routine with breaks, sufficient sleep, physical exercise and relaxation exercises has a preventive effect.

For acute tension headaches, self-massage, therapeutic massage treatments or painkillers can help. For chronic tension headaches, make sure that painkillers are not taken for more than 3 days in a row and for a maximum of 10 days a month to avoid additional headaches due to medication overuse.

Tips for migraine
A consistent sleep-wake rhythm, which is also maintained at weekends, has a preventive effect. It is helpful to take regular meals and breaks in everyday life. Daily and weekly planning is recommended to avoid stress.
Stressful phases that cannot be avoided can be mastered with the help of relaxation techniques. Learning to say "no" and to delimit duties and tasks is also helpful to get through everyday life in a more relaxed way.

Chiropractic and Headache

Based on the patient's medical history and an individual examination, it is determined whether there is a connection between the existing headaches and the musculoskeletal system. The functional state of the joints, muscles, tendons and nerves is examined. Chiropractic treatment is useful and helpful if the headache is partly or completely mechanical.

Cervicogenic headache

Headache from the cervical spine (cervicogenic headache) typically starts in the neck and spreads across the top of the skull towards the forehead and eye. It is triggered or intensified by head and neck movements or by pressure on certain points at the back of the head and cervical spine (trigger points).

Blocked joints can be treated with targeted manual treatments. This is done through gentle, mobilising movements or a precisely executed impulse. The joint is moved within its anatomical limits. An audible and harmless noise (cracking) may occur.

For a noticeable and long-term improvement of headache symptoms, different changes in everyday life are necessary. An analysis of sleep patterns and various stress factors as well as dietary habits help. Physical exercise and specific exercises play an important role. Cooperation with the patient, involved doctors and other therapists is an essential part of the treatment plan.

State of the research: Chiropractic and headache

Tension headache

The review (systematic review and meta-analysis) by Kroll et al. (2021) analysed the evidence of manual joint therapy, (supervised) exercise, psychological therapy, acupuncture and patient education as treatments for tension headache.

Kroll et al. summarise that in the studies included in the review, there is no evidence regarding serious side effects of the treatment methods investigated. Furthermore, a positive tendency of the treatment methods can be observed with regard to lower frequency, quality of life, pain intensity and stress symptoms.²

Cerviocogenic headache

Fernandez et al. (2020) review the effectiveness of spinal manipulative therapy (SMT) for cervicogenic headache.

Compared to other manual therapies, SMT shows a better effect in terms of disability, pain intensity and frequency for cervicogenic headache within a short period of time.³

Both reviews point out that the level of evidence and the significance of the reports is limited due to the small number of studies, the relatively small number of study participants and the methodology (especially the risk of bias).^{2, 3}

¹ International Headache Society (IHS), 2019. IHS Classification ICHD-3. [Online] Available online at: https://ichd-3.org/de/ [Accessed 25 August 2021].
^2KrøllLS, Callesen HE, Carlsen LN, et al. Manual joint mobilisation techniques, supervised physical activity, psychological treatment, acupuncture and patient education for patients with tension-type headache. A systematic review and meta-analysis. J Headache Pain. 2021;22(1):96.
^3Fernandez, M, Moore, C, Tan, J, et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta-analysis. Eur J Pain. 2020; 24: 1687– 1702.