Hey, welcome to the Stay Healthy El Paso Podcast. I'm your host Dr. David Middaugh, specialist physical therapist over at El Paso Manual Physical Therapy. I'll be talking to you today about the three big signs that you have a tension headache.
We see people here at El Paso Manual Physical Therapy for tension headaches, consistently. I wouldn't say it's the most common problem that we see here in the clinic, but we get at least one every month, or two most and they get better.
Let me just differentiate the different types of headaches and let's talk about migraines briefly for a moment, because I'm talking about specifically a tension headache. A lot of people, they have headache or migraine problems. They will start googling information and try to tease out what's a headache? What's a migraine? Do I have this type of headache or that type of headache? Because there are all kinds. But what I want to highlight here today is a tension headache.
A migraine is usually related to some sort of hormonal problem. It could be a nutritional problem or hydration problem. It's usually something that we call physiological rather than mechanical. To put the two against each other, physiological is like the cells that are inside the body, the blood flow, the fluids that are inside the body. The chemicals inside the body and how they all interact and work with each other. Versus mechanical, it’s the joints, muscles and nerves and how all those things move together.
When we are talking about a tension headache, I'm talking about a mechanical headache. The top three signs that you have a tension headache, or aka a mechanical headache:
The number one sign that everybody talks about is pain on the outside of your head.
I'm talking on the top of the head, it could be on the sides of the head, on the forehead. Some people come in saying my scalp is tender on the top of my head. Some people only have one sided head pain, you are only hurting on the right or only on the left. That's very common. Or they will say that it hurts on their forehead or right above their ear on one side. And some people just have pain on the backside of the head, kind of on the back half or back third of the head.
If you are to lie face up on a bed or a pillow, and pain anywhere around there is one of the common signs, as opposed to other headaches can create pain kind of deeper in the head, not necessarily on the on the outer surface of the head. Some headaches can cause pain behind the eye or face pain as well like around your nose and jaw. That's a different type of headache.
I'm talking about a tension headache, and we are discussing pain on the top of the head, the sides of the head above the ears, the back of the head and on the forehead as well. Another reason for this is because when you have a tension headache, there are certain nerves that can get pinched that innervate the top of your head, that on the on the outer most superficial part of your your head along the scalp pretty much. So that's where you are most likely to get all the pain sensations.
The number two most common sign is tightness at the base of your neck.
It's usually pretty strong at the base of the neck, right behind the head, on the bottom part of the head, right where the skull meets the neck, the upper most part of the neck. People usually will reach back there, and they will start digging on the muscles in the upper part of their neck. And they will say it's just tight there all the time. It just feels hard and tight and I can't turn my head all the way because it's so tight back there.
There are some muscles right there called the sub occipital muscles. And those muscles control the base of the skull against the top two vertebrae in the in the spine up there. Those muscles can spasm. They can get shortened, they can overwork or a combination of those three things and begin to not allow the joint where the skull connects to the first bone to move properly. And guess what? There are some nerves that come out right at that level that innervate the scalp, so that's why you can get pain into the scalp, and all the way to the front of the head and along the sides of the head.
But anyways, that tightness that people feel in the back of their head, or the back of the neck, right into the back of the head is the second most common sign.
The third most common sign of a tension headache is burning, achiness, stiffness and pain that can go into the neck and shoulders like lower into the neck
The pain can go into the into the neck, the middle of the neck and into the base of the neck at the bottom, and all the way into the upper part of the shoulders. The upper track region is what we call it, which is between your shoulders and neck area, and then even into the upper back and on the back of the shoulder blades and into the upper back.
The muscles that are in that region often get affected with these tension headaches. And they will feel it. They will let you know commonly that people can't turn all the way, they can turn better to one side versus the other. If they are looking to their right, it may not turn as well when they turn their head that way, but the left side is better.
Sometimes both sides are very limited. People usually just say that they feel pain, tenderness, stiffness, achiness ache Enos and oftentimes burning is a is a symptom that people tell us about whenever they've got these tension headaches.
Let's talk about treatment options for tension headaches. By far the most common treatment option that people will start on their own is over the counter pain medication. They will go to Walgreens, CVS any anywhere where they have medications, at grocery store, and they will buy the over the counter Tylenol. If it's something a little stronger that they want ibuprofen, aleeve etc. those kinds of things.
Pharmaceutical companies are so smart because they know that headaches affect so many people and that it's just so simple to go take medication, they have come out with specific medications for headaches. And usually, people will have some sort of what is it a sleeping aid along with this then they put the two medications together in one so that they can knock themselves out and also feel better. So, you can try that over the counter.
A lot of people try that over the counter and it's effective for a short term, it really is just a short-term solution that masks the pain for a bit, so that you can get through the day, or get through a few days if you need to. But I highly encourage you to use caution and be careful when taking medications because of the side effects.
Those medications, if you read the labels, you are not supposed to use them for more than a few days at a time. You need to eventually talk to your doctor. It's not a good idea to rely on an over the counter pain medication for the long term for this type of problem, for a tension headache. You have to make sure that you are careful about how you are using your medications.
Then some people will go to the doctor, if over the counter pain medications don't work, because they want a stronger prescription strength medication, and doctors of course, that's their bread and butter, they're great at handing out medications. And it's very helpful for a lot of people. But it's the same idea, you are still taking a medication, which is only going to give you short term relief.
In this case, hopefully it lasts a few days, or a week and the doctor of course is considering your overall health in the process. You have to figure that out for yourself if you want to be on prescription strength medications.
Another option that doctors will give you for tension headaches is, a lot of doctors recognize that the source of the problem is usually at the base of the skull, where it connects to that first vertebrae, so sometimes they will do injections into that area. They will do a pain injection directly in that area, and it can be pretty relieving for most people. But again, it's short lived. It only lasts for a month, sometimes a few months at most, but there's usually some underlying problem that sets up that joint to become stiff, and the muscles to become overactive and the nerves to get pinched in the area.
Injections or medications just don't fix that, they don't address stiffness and strength. They alleviate pain, they turn off the pain signals coming from that part of the body so that you can continue through your day. So it's short lived relief.
Another common treatment is chiropractic. And it's pretty effective. If you have ever visited a chiropractor, of course you know that they like to pop and snap joints so that's their bread and butter. That's what they've gone to school for it. They're usually extremely good at it. And if you have stiff joints up in your neck, they are probably going to be excellent to free it up. And they can definitely relieve the problem for the short term again.
What has to be factored in is the strength of the muscles around the neck joints, the upper neck joints so that that joint can remain free for the long term. Because it is possible to on your own, have good mobility in your neck joints, and have excellent strength in your neck bone, in your neck muscles and be able to live free of having tension headaches over and over again. It's not necessary to rely on somebody to help you out.
But chiropractic is a great place to start. Of course, it's natural, it doesn't involve any sort of medications or injections. I definitely think that it's a good place to go. But what chiropractors just usually aren't good at doing is prescribing the right kind of exercise, because that's not what they usually do. So, consider that if you've gone to a chiropractor and you've experienced the relief that they can provide for this kind of a headache problem, but if it keeps coming back then maybe you need a little bit something more.
That's when I go into this final recommendation that I make for tension headaches, and it would be physical therapy. Specifically, manual physical therapy, which is what we specialize in here at El Paso Manual Physical Therapy, of course. The reason why I highly recommend this and I'm biased of course, I'm a manual therapist myself, but seeing the results in people and seeing the long term relief that people get where they really are coming back for tension headaches over and over again, because they're taught how to self-manage.
We free up the joints here by hand. Ww do some chiropractic like maneuvers. Sometimes there's joint popping involved. It just depends on what the patient needs. In some cases, we find that the joints are actually moving okay. And it's not going to ever pop because, I don't know if you've been to the chiropractor and you've ever had the experience where they try to pop your neck and it didn't pop. Well that's usually because the joint isn't really stuck.
But you can still have that perception of stiffness in the area. And that's usually because there are muscles that are just grabbing in that area and they're not freeing up and popping the joint, or going through the technique to pop a joint can kind of free up the muscles, but it just doesn't do the same as going through some manual therapy treatment where we do specific massage techniques to free up.
But even then I tell my patients this whenever they come in for a tension headache, all the stuff that I've done by hand to you is only going to be short lived unless you do your exercises. There has to be accompanying exercises with a hands-on treatment plans so that the results can the long-term results. And you can know what to do on your own. When this comes back, if it starts to come back, there's usually some sort of maintenance program that needs to be kept up which, which most clients find easy to do. Because especially if they have an exercise routine already, it's easy to say, hey, well, you are in the gym three times a week, just let's just make sure that you are doing these exercises when you go, and you are fine, you are going to be managing your headache problems so that it's not coming back over and over again.
It's not always got to be like a physical therapy, one of those goofy looking exercises with the rubber band. We hardly ever do that here in the clinic because it needs to be something that you take home with you, that you can do at the gym, that you can do at the desk, if you have a desk job or at home, if you are at home. It needs to be something that's easily transferable and that fits into your normal routine in life.
That is how we fix tension headache problems here in the clinic naturally. Most of the time, people don't need surgery for this. I can't think of a time honestly that anybody's ever had a surgery for a tension headache specifically, if a tension headache problem continues over time, people will usually end up in pain management, or they will have an associated neck arthritis condition and they may end up having surgery for the neck arthritis.
It's usually a bunch of problems that are all stacked on each other that and then there's one that is surgical that the surgeon might operate on, but there are still problems that need to be addressed. I highly recommend clients get problems addressed right when they happen, so that they're not seeing extra healthcare professionals, and possibly having unnecessary treatments that they could have avoided.
But we help people with that all the time and they get better. They get tremendously better their clarity comes back, they can think clearly. They're not having to worry about taking pain medications every day, especially as the day goes on. It tends to get worse. They can sleep well at night. A lot of people have pain when they go to bed, they can't get comfortable. And then they get woken up at night from their a tension headache problem. And then they're just grumpy.
That's one of the, I think hidden symptoms that people don't talk about a lot. But I asked all our clients, I tell them, because I'm a big proponent of no medications, no injections and avoid surgery if you can, but there are times when it's necessary and appropriate. And whenever I get a tension headache client coming in here, the one of the things I have to ask them is, do you have any family at home that you live with? And most of the time people say yes. And then ask them when your headache symptoms are really bad. Do you think you could be nicer to them at times, and most the time people sheepishly say, yeah, I'm grumpy at times. I tell them, it's okay. That's normal, you are in pain. It happens to everybody.
They are here in the clinic usually. So I tell him, you are likely going to start working with us and this is going to get cleared up. So it's not going to be a thing here in a few months at most. But in the meantime, if you are at home with all the families and you are in pain, maybe take some medication so that you are nice to them, and your relationships can be great.
Those are times that you might consider getting some medication or talking to your doctor about an injection or medication. You have to look at the life that way because it's about quality of life. Not just avoiding surgery and injections and medication, but you need to make sure that that the people around you are happy and that you are happy around them too.
Anyways, I hope that this podcast was helpful for you. I hope that you learned about tension headaches. And if you have these signs or symptoms and you are in the El Paso region and you want to get in touch with us, the quickest way is to call us at 915-503-1314. Tell my staff that you heard this podcast and ask for a complimentary discovery visit. They will make sure to discount your discovery visit, which is a 20-minute visit to get assessed, to get checked out and learn about what's going on and get a diagnosis for the problem. You get a chance to ask questions and figure out all the details about what's involved in treating your tension headache problem with manual physical therapy.
Another option is to go on our website and look for the discovery visit option, and you can apply for a discovery visit and just mentioned that you heard about this on the podcast so that we can discount it always for you. Anyways, if you have any other questions, please reach out to us. We are happy to help, and I hope you have the best day.
