Migraines

Migraines

Does your headache stop you from working or doing routine daily activities? Do you have to lie down in a dark room with the lights off when your headache comes on? If this sounds like you, then you may suffer from migraines.

What is a migraine?

A migraine is more than just a headache. It is a complex condition that encompasses a wide variety of symptoms. For most people, the dominant feature is a painful headache that is typically one-sided, pulsating, and is of moderate to severe intensity. Although migraines can present with many different symptoms, including disturbed vision, nausea, vomiting, and light, sound or smell sensitivity (1, 2).

Migraines typically last 4-72 hours and when a migraine comes on it can have an enormous impact on a persons work, family and social lives.

What causes migraines?

Whilst migraine treatment has come a long way in the past 30 years, there is still no known cause for migraine. Most people who suffer from migraines are genetically predisposed to it; with up to 90% of migraine suffers having a positive family history. Many migraine suffers have similar migraine triggers which can include lack of sleep, lack of food, increased stress levels, alcohol and a change in environment.

Types of migraines

The two most common types of migraines are those with aura and those without aura. Migraines with aura either have nausea and/or vomiting or photophobia (light sensitivity)/phonophobia (noise sensitivity).

There are two types of migraine severity- Chronic migraine having more than 15 migraines a month for more than 3 months.- Episodic migraine less frequent than chronic.

However not everyone with the typical migraine and your migraine may present differently.

Is it a headache or is it a migraine?

Differentiating between different types of headaches can be difficult. People experience different types of headaches at different times of their lives for various reasons. For example people who suffer from cervicogenic headaches can also suffer from migraine headaches. Consulting a health care professional is the best start to finding out what type of headache you may be suffering from. Keeping a headache diary that tracks the frequency, intensity, severity and duration of your headache can be a great help when diagnosing your headache.

Migraine treatment

Due to the complex nature of a migraine, there are many different treatments available. Different people find certain treatments achieve better results when compared with others. Unfortunately, there is currently no cure for migraine.

Pharmacological treatment this can be broken down into pain-relieving and preventative medications

  • Pain-relieving medications for treatment of an acute migraine attack and are designed to stop the symptoms. This is taken when a person has a migraine or feels the migraine coming on (prodome). They include Non Steroidal Anti Inflammatory Drugs (NSAIDS) such as Aspirin or ibuprofen and paracetamol.
  • Preventative treatment these drugs are taken on a regular basis (often daily) in order to help reduce the severity and/or frequency of migraines. They include beta-blockers and certain types of anti epileptics antidepressants.
  • In cases of chronic migraine, Botox injections have been show to have mild to moderate effect. Botox is injected once every 12 weeks (3).

You should always consult your General Practitioner or Pharmacist before taking a new drug.

Chiropractic treatment

  • Migraines are often associated with upper neck and upper back dysfunctions. Joint restrictions and trigger points (knots) through the surrounding muscular can lead to the development of a migraine. Chiropractic treatment can help migraine suffers through treating these dysfunctions, which allows the neck and back to move freely and in turn has been shown to decrease migraine frequency, intensity, duration and severity (4-7).

If you have any questions on migraines or how chiropractic can help you give the clinic a call on (02) 99226116 or visit our clinic on the Ground Floor Suite 6, 157 Walker Street North Sydney for more information.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Reference:

  1. Chaibi A, Saltyte Benth J, Tuchin PJ, Russell MB. Chiropractic spinal manipulative therapy for migraine: a study protocol of a single-blinded placebo-controlled randomised clinical trial. BMJ open. 2015;5(11):e008095.
  2. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia : an international journal of headache. 2013;33(9):629-808.
  3. Khalil M, Zafar HW, Quarshie V, Ahmed F. Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, U.K. The journal of headache and pain. 2014;15:54.
  4. Tali D, Menahem I, Vered E, Kalichman L. Upper cervical mobility, posture and myofascial trigger points in subjects with episodic migraine: Case-control study. Journal of bodywork and movement therapies. 2014;18(4):569-75.
  5. Ghanbari A, Askarzadeh S, Petramfar P, Mohamadi M. Migraine responds better to a combination of medical therapy and trigger point management than routine medical therapy alone. NeuroRehabilitation. 2015;37(1):157-63.
  6. Chaibi A, Tuchin PJ, Russell MB. Manual therapies for migraine: a systematic review. The journal of headache and pain. 2011;12(2):127-33.
  7. Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000;23(2):91-5.
Headaches – Is your headache coming from your neck?

Headaches – Is your headache coming from your neck?

Headaches are a common condition that we treat at Cartwright Physicaltherapy. There are numerous different causes of headaches; one of the types of headaches we treat here regularly is cervicogenic headaches (CH).

But what are CH?

CH are headaches caused by a disorder of the neck and usually are accompanied by neck pain.

How do I know if I have a CH or another type of headache?

The typical features of a CH include unilateral (one sided) head pain that does not shift from side to side, pain is aggravated by external pressure on the same side of the upper neck, the neck may have limited range of motion and the headaches may be triggered by neck movements or sustained postures.

What is the best treatment for CH?

A recent study compared upper cervical (neck) and upper thoracic (upper back) manipulation/adjustments (high velocity low amplitude thrust techniques ) against mobilisations (slow, rhythmical, oscillating techniques). They found that the adjustment group had a greater reduction in neck pain and a larger decrease in headache intensity, frequency and duration when compared to the mobilisation group.The full article is attached at the bottom of this page.

Here at Cartwright Physical Therapy all our treatment of CH are individualised to the patient, although usually involve massage, A.R.T., rehabilitation exercises and adjustments (where appropriate).

If you have any questions on CH, headaches or neck pain or are suffering from CH or any other type of pain come in and see us or book an appointment today on (02) 9922 6116 or visit our clinic on the Ground Floor Suite 6, 157 Walker Street North Sydney for more information.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Easy to do passive neck and back remedies

Easy to do passive neck and back remedies

There are many exercises you can do to help relieve neck and back pain, but sometimes your condition is just so sore, the last thing you want to do is move about. Research suggests that returning to activity as soon as possible is advantageous for healing many musculoskeletal complaints so prolonged bed rest should be avoided.

Having said this, you will invariably require some rest time before you can engage in any restorative or therapeutic exercises. The following remedies are positions or movement patterns you can use to spare your spine further damage during this restful period.

Rolled towel exercise for neck pain:

A lot of neck pain complaints, mostly postural, can be attributed to poor sitting whilst at work. The natural curve of the neck is concave from behind and is known as the cervical lordosis. Whilst you may start off the day sitting with good posture, up straight nice and tall, invariably sitting posture will deteriorate throughout the day.

It is common to find workers sitting at their desks poking their chins forward towards the screen. Anatomically speaking, poked-chin posture involves increased flexion at the lower part of the neck, and increased extension at the upper part of the neck at the base of the skull. This disrupts the normal cervical lordosis and gives rise to stiffness and pain at the base of the skull and aching and discomfort around the shoulders. This is all because the body is now having to work extra hard to hold the head upon the shoulders.

To relieve the symptoms from sitting in this way, try using a rolled towel behind your neck when lying down. Ensure the towel is rolled thick enough such that when you are lying, your head is flush with your upper back, but not so thick that it props your head up like a pillow. Do so for 10-15 minutes. At the right thickness, you should feel well supported around the neck and able to relax the neck muscles completely thus giving them a much needed rest. Furthermore, over time this will passively restore the cervical lordosis.

 

Rolled towel exercise for upper back pain:

For the same reasons as above, desk workers in particular may suffer pain and discomfort in their upper back and shoulders region. Any posture that involves prolonged forward bending can result in pain between the shoulder blades and in turn, tightness or stiffness in the surrounding musculature.

Lying supine on a rolled towel placed vertically down the spine is an excellent way to undo the effects. A towel is preferred to a foam roller purely because of the softness of the towel versus the firmness of a roller. As you will find, this exercise is quite intense and you may only be able to tolerate a maximum of two minutes lying in this way.

When lying like this, allow your head, neck and arms to drop back as far as possible. These parts together act as a lever that helps to bend your spine back the other way. It is ideal to do this exercise on a bench so that your arms can drop further down past your body. To add further intensity to the exercise, you can perform it with arms outstretched.

 

The 90/90 position (a.k.a the astronaut position)

The 90/90 or astronaut position is an excellent rest position to try when you are suffering extremely painful lower back pain. Getting into this position decompresses your spine, taking any unwanted load off painful or injured areas so that you can at least catch your breath for a while. Whilst resting here, your body can get to work healing itself.

At home, you would try this up against your couch. Lie on the floor and bend your hips and knees both to 90 degrees so that your legs are lying on the seat of the couch. Stay here for about five minutes. It is called the astronaut position as this is the position your seat would face inside a space ship prior to blast off!

 

Hook lying

An alternative to the astronaut position is hook lying. Again, this is a rest position in which painful lower back pain should be relieved. It also reduces compressive forces through the lumbar spine but perhaps not so much as the astronaut position.

You simply lie on your back with your knees bent so that the soles of your feet rest on the floor. The exercise gets its name as the posture supposedly resembles the shape of a hook. Imagination may well be required.

 

 

Squat to sit

Painful lower back injuries make it particularly difficult to move from a standing to a sitting posture, and vice versa. You should use the squat movement pattern when trying to sit down or stand up. This gets you to bend at the hip joints as opposed to bending through your [already painful] spine, and is thus spine sparing.

 

Lunge to get to the floor

When you are suffering a painful lower back condition, it can be extremely difficult to move to the floor to pick an object up. You may also need to lie down to perform some of the above exercises and so knowing how to move safely to a lying position is vital.

Performing the lunge movement pattern allows you to protect your back at all times whilst moving to the floor. You have most likely heard people saying, bend your knees, but this really doesnt offer any help. When you think about movement patterns and how they can better assist you to perform different functions, you will have a better understanding on how to use your body safely and more efficiently.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Neck Pain Causes

Neck Pain Causes

Causes of neck pain and the things you need to know to relieve it

Common causes of neck pain include trauma from accidents, postural stresses, and working in awkward positions or cramped spaces. Unfortunately, we are limited in the things we can do to protect against unforseen accidents, hence this article focuses on what we can do to limit neck pain elsewhere in our daily lives.

When moving about, we assume a fairly upright posture with the head retracted and held directly over the vertebral column receiving maximum support. In relaxed sitting, the head and neck slowly protrude because the supporting muscles gradually tire and no longer support good posture. The pain we feel in our neck is caused by the overstretching of ligaments for prolonged periods in this protruded position. Other instances include lying or sleeping with the head in strained positions.

The cervical lordosis is the curve at the back of your neck when viewed from the side. Office workers usually sit in a slouched position, hanging their head forward of the shoulders and protruding the chin thus losing the lordosis completely. Pain from working in this position is relieved simply by correcting the posture, however, habitual poor posture will result in changes to the structure and shape of the joints of the neck, and lead to more complicated injury.

Prolonged sitting situations

The position of the low back strongly influences the posture of the neck, do not allow it to slouch or become rounded whilst sitting. Correct sitting posture is vital. You should also interrupt protruded head posture with regular intervals and postural relief exercises.

The correct head posture whilst sitting requires you to keep the head retracted. The extreme of the retracted head position is that which gives the appearance of a double chin, and is actually a position of strain. Sitting comfortably and correctly requires you to hold your head just short of the extreme retracted posture. To find this position, first retract the head as far as possible and then release the last 10% of this movement. This is the correct head posture and can be maintained for any length of time.

If you find yourself sitting for large portions of the day, your aim should be to restore correct posture and then maintain it. Pain will start to decrease as you improve your head posture, and you will have no pain once you can maintain the correct posture. Pain will reoccur in the first few weeks if you allow your head to protrude, but eventually you will be pain free even when you momentarily fall out of good posture.

During this period of posture re-training, expect to feel some new pains, possibly in different places. These pains are the result of performing the postural relief exercises and holding new head positions. They should wear off in a few days provided postural correction is continued on a regular basis.

Lying and resting

Postural stress in the lying position is another cause of neck pain. If you wake up in the morning with pain and stiffness in the neck that was not there the night before, the problem is possibly due to the sleeping surface or position in which you sleep.

Your pillow functions to support your head and neck. You might need to change the material from which it is made, the thickness, or both. The pillow should fill the curve behind your neck without tilting the head or lifting it up. Ideally, the head should be able to rest on a “dish-shaped hollow” so you need to be able to adjust the contents of the pillow easily.

Beware of pillows made of moulded foam. Many of these pillows do not allow their contents to be adjusted and always adopt the shape of their original mould. These pillows do not allow the head to rest into a “dish-shaped hollow” and rather tend to apply a recoil pressure against the natural position the head would like to adopt. You should be able to adjust your pillow such that you can make a hollow for your head to lie in whilst still being able to bunch the edge of the pillow to form a thick support for your neck.

If the lying posture itself is thought to cause neck pain, it should be investigated for each person individually. In short, it is better if you can sleep on your back or your side. Some people prefer to sleep on their stomach and frequently wake up with a headache or neck pain and stiffness.

When lying face down, the head is turned to one side to allow breathing and avoid squashing the nose. In this position however, some of the joints, particularly those in the upper neck, approach the maximum degree of rotation. This strains the surrounding soft tissues of the neck and those between the upper neck and head.

Try to avoid lying face down when sleeping if you are waking up with neck pain. In addition, there are recommended exercises to ensure you can properly retract the head, extend the neck properly and have adequate range of motion when turning the head.

 

 

Cooling down after intense exercise

After exercising, avoid sitting or lying with the head in a protruded posture. Thoroughly exercised joints in the spine easily distort if they are held in an overstretched position for too long. Commonly, the exercise is blamed for the cause of neck pain but in many cases it is attributable to the prolonged forward bending of the head and neck when relaxing afterwards.

Working related causes

Some jobs can only be performed in positions likely to cause overstretching of the joints in the neck. These jobs may require sitting and performing precision work (microscopy, watchmaking) or working in cramped spaces with the head and neck in awkward static positions.

It may not be practical to prevent the onset of neck pain by regularly assuming the correct posture. Instead you will need to interrupt positions of overstretch frequently by performing the relevant neck exercises.

The neck has a tough job – holding your head on top of your shoulders every day. Try to become more aware about the positions you find yourself in more frequently and asses yourself as to whether you are likely to be causing your neck unnecessary strain. If you can prevent neck pain from occurring, you won’t ever have to worry about how to having it treated – that’s just a pain in the neck.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Neck Pain Explained

Neck Pain Explained

Possible explanations as to why your neck hurts.

The structure of the joints in the neck allows a large degree of flexibility in this part of the spine. The neck can also move relatively more freely than the rest of the spine as there are no additional bony structures attached in this region, such as a ribcage or pelvis. Without the support and protection of other structures however, the neck is more vulnerable when subjected to strain. Its very flexibility, so helpful and necessary for everyday living, is also the cause of many of our problems.

During upright standing, the head should be carried directly above the shoulder girdle forming a cervical lordosis. This is the small inward curve, observed from the side view, just above the shoulders. Postural neglect sees people carrying the head in front of their body with the chin poking forward. This alters the cervical lordosis such that the joints of the lower neck are bent forwards, whereas those of the upper neck are bent backwards. This is called forward head carriage or protruded head posture, and if present often or long enough, neck problems may develop.

Pain may arise in a neck joint when two opposing bone surfaces are placed in a position that overstretches the surrounding ligaments and other soft tissues. This position could be one where your head is slouched all the way forward, backward, to the side or any combination. At first, there may be only minor discomfort, but as time passes, if the joint is held in a position of overstretch, pain develops. The pain warning encourages you to stop overstretching to avoid damage. If you do so, the pain ceases immediately and no damage occurs.

Failure to heed the warning system may lead to ligamentous and soft tissue tearing. This produces an aching sensation that continues even when you stop the overstretching position. The pain may reduce in intensity but continues even when the neck is at rest. The pain increases with movement in the wrong direction and ceases only when some healing has occurred. Healing should only take several days but will be prolonged if you continue to apply the same strains to the neck each day.

It is often thought that neck pain is caused by strained muscles. These structures can be overstretched, but usually heal rapidly due to their dense blood supply and seldom cause pain lasting for more than a week. It is usually the ligaments and joint capsules underlying the muscles which are injured first. These tissues provide support for spinal joints and will injure if subjected to forces of overstretch.

The real problem stems from pain in and around the affected joint. An outside force may place a sudden severe strain on the neck either due to an accident, sudden movement or sporting event. More commonly, overstretching is caused by postural stresses placing less severe strains on the neck but over a longer time period. When the tissues heal they may form scar tissue that is less elastic and shorter in length than healthy “un-injured” ligamentous tissue. With the formation of scar tissue, normal movements now become painful as they stretch the “scars” in these shortened structures.

Sometimes the ligaments are injured to the extent that the intervertebral discs are affected. The disc loses its ability to absorb shock and its outer wall weakens. This allows the inner contents of the disc to bulge or protrude outside its normal confines and may press painfully on spinal nerves. This may explain some of the pains felt further away from the source of the injury, such as in the arm or hand. Complications of a bulging disc in the neck include: misalignment of the vertebra during normal movement patterns and headaches.

When you hurt your neck, if you simply wait for the pain to pass the tissues will heal somewhat, but they will be more likely to re-injure in the future. You might also be more susceptible to the “terrible” complication of a bulging disc. To avoid this neck pain becoming an ongoing problem, there are appropriate exercises you can perform to stretch and lengthen these tissues gradually, and restore their proper function.

Always seek professional advice the moment you hurt your neck. Physical therapy is an excellent means to speed recovery and promote effective healing of the tissues. Seeing a professional early on can be the difference between fixing your neck pain in less than a week versus one to three months of chronic pain.

To aid in the prevention of neck pain, you should familiarize yourself with other causes of neck pain. Awareness of these causes should hopefully see you avoiding neck pain altogether.

*DISCLAIMER: This discussion does not provide medical advice. The information, including but not limited to, text, graphics, images and other material contained in this discussion are for informational purposes only. The purpose of this discussion is to promote broad consumer understanding and knowledge of various health topics. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read in this blog.