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December 6, 2017

Chronic tension headaches and osteopathy

Hannah Parr

Headaches have become a very common complaint over the last decade, with over 10 million people in the UK suffering from them (NHS choices 2015). They cause a lot of pain and can even become a disability (Fernandez de las Penas and Courtney 2014). With these debilitating effects, they are becoming one of the most common conditions for GP appointments (NHS choices 2015).

There are different types of headache – these can be divided into primary and secondary types. Primary headaches are the most common and include tension or cluster headaches. Secondary headaches, on the other hand, are a symptom caused by a different condition e.g. concussion, brain tumours, infections, vascular disorders, etc.

However, it is fairly unlikely for your headaches to be anything nasty. Most of us suffer from tension-type headaches at some point in our lives, and these are the focus of this article.

What are tension headaches?

The cause of tension headaches is uncertain, but they are normally seen to be due to the contracture of pericraneal, suboccipital and cervical muscles (Monzani et al 2016) – in other words, tight muscles around your head and neck.

Tension headaches commonly affect both sides of the head and forehead. You can also sometimes feel them behind your eyes. They normally feel like a dull ache and will not incapacitate you (but are nevertheless uncomfortable). You can also get symptoms similar to migraines, such as sensitivity to light (photophobia) or sound (phonophobia).

Why have they become so common?

Let’s be honest, it is probably due to our lifestyle. We spend an increasing amount of time looking at computer screens or phones, which causes us to alter the way we sit and function, and this changes the mechanics of the body and overloads the neck.

In addition, stress causes us to tighten up around our shoulders and increase the amount of tension in our upper body, causing referral patterns into the head. And as we all know this is becoming part of our daily life.

Other things can include dehydration, hunger and lack of sleep.

And how can osteopathy help?

We will assess your symptoms to distinguish what kind of headache you have. We will then put together an effective treatment plan including massage, joint mobilising and home exercises.

A meta-analysis by Mesa-Jimenez et al (2015) claims that although more research is needed, manual therapy has been proven to be more effective than pharmacological use in the short term. It is also beneficial to follow the treatment up with long-term management sessions for prevention (Mesa-Jimenez et al 2015).

Can I do anything to help myself?

Yes, you can!

-Try to drink enough water during the day to remain hydrated;

– Make sure your desk is set up appropriately with correct heights for screens – you can ask for an ergonomic assessment if you don’t feel comfortable doing it yourself;

– Practice breathing techniques such as diaphragmatic breathing or pranayama techniques to reset your breathing patterns. This can help decrease the tension in your shoulders and make your breathing muscles work more effectively. Feel free to pair this with a yoga or Pilates session;

– NICE guidelines (2012) also suggests trying NSAIDs (e.g. ibuprofen), paracetamol or aspirin – but stay away from opioids (e.g. codeine, morphine, oxycodone, etc.) (BNF 2012);

– Do some neck and upper back stretches, which will also help to reduce tension in your neck, shoulders and back. Any sort of exercise also causes you to secrete endorphins which make you feel happy – so what are you waiting for?

References

Fernandez de las Penas, C. and Courtney, C. (2014) Clinical reasoning for manual therapy management of tension type and cervicogenic headache. Journal of Manual and Manipulative Therapy (22, 1: 45-51). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4062351/pdf/jmt-22-01-0044.pdf (Accessed on: 07/08/17)

Joint Formulary Committee (2012) British National Formulary. BMJ Group and Pharmaceutical Press. London, 64. Page 268. *Referred to as BNF in the text

Mesa-Jimenez, J. et al (2015) Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomised trials. International Headache Society. Sage (35, 14). Available at: http://journals.sagepub.com/doi/abs/10.1177/0333102415576226?journalCode=cepa (Accessed on: 07/08/17)

Monzani, L. et al (2016) Manual therapy for tension type headache related to quality of work life and work presenteeism: secondary analysis of a randomised controlled trial. Complementary Therapies in Medicine. El sevier. (25, 86-91). Available at: https://s3.amazonaws.com/academia.edu.documents/43866314/Monzani_et_al__2016.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1502107584&Signature=l8C63bZvNJCq44bznWUXM%2FpC4yo%3D&response-content-disposition=inline%3B%20filename%3DManual_Therapy_for_Tension-type_Headache.pdf (Accessed on: 07/08/17)

NICE guidelines (2012) Headaches in over 12s: Diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg150/chapter/Recommendations#management-2 (Accessed on: 07/08/17)

NHS Choices (2015) Tension type headaches. Available at: http://www.nhs.uk/Conditions/headaches-tension-type/Pages/Introduction.aspx (Accessed on: 07/08/17)

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