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Headaches, Migraines & TMD

Headaches & Migraines

Pain of any type that occurs in any part of the head is called a headache. There are many different types of headaches, with just as many causes. The International Headache Society describes several different categories of headache:

  • Tension-type
  • Migraine and cluster
  • Secondary headaches from an underlying condition, such as fever, infectious disease, sinus disorder, or in rare cases, a tumor or more serious illness
  • Cranial neuralgias, facial pain, and other headaches

 

Most headaches are harmless and resolve on their own, although severe headaches that recur frequently can affect your ability to do your daily activities and can reduce your quality of life. There is effective treatment for almost every type of headache. The challenge lies in determining the type of headache, its cause, and in developing an appropriate treatment plan that will reduce both its frequency and intensity. 

Physical therapists can help determine the type of headache you have and are experts in managing pain from tension-type headaches.

Causes of headaches and migraines

Tension-type headaches (also called muscle-spasm headaches) are the most common types of headaches in adults. They may be the result of a neck or jaw problem, poor posture, fatigue, or stress. A tension-type headache typically begins at the back of the head and spreads to the top of the head and the eyes. You might feel an increase in facial pain along the cheeks near the jaw bone (temporomandibular joint dysfunction). People often describe a tightness, a sensation of someone tugging on their hair, or a feeling of wearing a tight cap. These headaches can worsen with specific positions – such as sitting at a desk – and may ease with rest.

A problem in the neck, head, or jaw – such as an injury or arthritis – can lead to tension in the muscles at the back of the head and to increased pressure on the nerves to the face and head. Poor posture can cause these muscles to become overworked, which can trigger a headache.

How Can a Physical Therapist Help?

Your physical therapist will conduct a thorough examination that includes a review of your health history. Your therapist will ask you questions and will perform tests to determine the most likely cause of your headaches. For example, your therapist might ask you:

  • To recall any previous injuries to your neck, head, or jaw
  • The location, nature, and behavior of your pain and other symptoms
  • To draw your areas of pain on a body diagram
  • Perform tests of muscle strength and sensation
  • Examine your posture when sitting, standing, and performing various activities
  • Measure the range of motion of your neck, shoulders, and other relevant parts of your body
  • Use manual therapy to evaluate the mobility of the joints and muscles in your neck

 

If it appears that you do have tension-type headaches, your physical therapist will work with you to design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache – such as sinus, migraine, or cluster headache – your physical therapist likely will refer you to another health care professional for additional diagnostic tests and treatment.

Your physical therapist will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes in your posture and lifestyle:

Improve neck mobility. Physical therapists use a specialized technique called manual therapy to increase movement and relieve pain and to stretch the muscles of the back of the neck.

Improve your strength. Your physical therapist will teach you exercises to increase the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance and make it easier for you to sit or stand for longer periods of time without discomfort.

Improve your posture. Physical therapists will teach you ways to improve your posture. Whether it is simply pushing your chest out or pulling your shoulder blades backward and together, slight modifications to everyday living can make a vast improvement in posture.

TMD (Temporomandibular disorder)

Physical therapy treatment can assist with relieving pain and discomfort associated with temporomandibular disorder (TMD).  TMD is any disorder of the jaw muscles, temporomandibular joints, and/or the nerves associated with chronic facial pain. Any problem that prevents the complex system of muscles, bones, and joints from working together in harmony may result in temporomandibular disorder.

When you come to Four Pines Physical Therapy for your physical therapy evaluation and treatment, you can expect your therapist to analyze your jaw mobility and release muscle tension in the head and neck region. Our physical therapy team will perform a comprehensive evaluation of your TMJs, neck, thoracic spine and shoulder girdle to determine the structures causing TMD symptoms. Our patients are receiving immediate relief with physical therapy.

The National Institute of Dental and Craniofacial Research, part of the National Institutes of Health (NIH), classifies the categories of TMD by the following criteria:

  • Myofascial pain, the most common form of TMD, which is discomfort or pain in the muscles that control jaw function and the neck and shoulder muscles.
  • Internal derangement of the joint. This means a dislocated jaw or displaced disc, or injury to the condyle (the rounded edges of the jaw).
  • Degenerative joint disease, such as osteoporosis or rheumatoid arthritis in the jaw joint.

 

Most oral health professionals will agree that the primary cause of this disorder is excessive strain on the muscle group that controls chewing, swallowing, and speech. This strain may be a result of bruxism (incessant clenching of the teeth), or from physical or mental stress. These factors may be the cause, in most cases, or may aggravate an existing condition of TMD.

Symptoms of TMD

The following are the most common symptoms of TMD. However, each individual may experience symptoms differently. Symptoms may include:

  • Jaw discomfort or soreness (often most prevalent in the morning or late afternoon)
  • Headaches
  • Pain radiating behind the eyes, in the face, shoulder, neck, and/or back.
  • Earaches or ringing in the ears (not caused by an infection of the inner ear canal)
  • Clicking or popping of the jaw
  • Locking of the jaw
  • Mouth motions are limited
  • Clenching or grinding of the teeth
  • Dizziness
  • Sensitivity of the teeth without the presence of an oral health disease
  • Numbness or tingling sensation in the fingers
  • A change in the way the upper and lower teeth fit together

What are the temporomandibular joints (TMJ)?

Simply stated, the temporomandibular joints (TMJ) are the two joints that connect your jaw to your skull. More specifically, they are the joints that slide and rotate in front of each ear, and consist of the mandible (the lower jaw) and the temporal bone (the side and base of the skull). According to the American Dental Association (ADA), the TMJs are among the most complex joints in the body. These joints, along with several muscles, allow the mandible to move up and down, side to side, and forward and back. When the mandible and the joints are properly aligned, smooth muscle actions, such as chewing, talking, yawning, and swallowing, can take place. When these structures (muscles, ligaments, jaw bone, mandible, TMJ) are not aligned, nor synchronized in movement, several problems may occur.