? Headache and TMJ clinic using manual therapy.


I love treating headaches and here's why.  Very few fields of chronic pain treatment have such dramatic improvements as headache treatment.  There are some headaches that are gone by the end of the initial evaluation.  It is very rewarding for the patient and for me as the therapist. 

I have been treating headaches since 1997 when a physical therapist by the name of Brian Mulligan asked me “what do you do for headaches?”  Prior to that moment, I did not even consider physical therapy as an option for this group of patients. Now I welcome anyone with a headache (or migraine) to come for an evaluation because I have so much to offer headache sufferers. The treatments are relatively simple but they have to be matched to each person specifically. The reward comes when patients report no headaches or less intense headaches, not having to take so much medication or being able to reduce their own pain without reaching for the pills. Here is a list of some of the factors that may contribute to headaches:

Subcranial restrictions
This refers to the area from the back of the head and 2 inches down the neck.  A very small area but one that has a lot of relevance to headaches.  Sometimes the joints in this area do not move as freely as they could and that is a restriction.  There are many reasons why this area can become restricted but the good news is that it only takes one or two sessions to restore the motion.  The results can be dramatic.  Note: not all patients are suitable candidates for mobilization of the neck joints.  A test of blood flow in the neck is done prior to this kind of treatment for your safety.

Active trigger points in the neck
A trigger point is an area in a muscle (the trigger) that refers pain to a different place (the target).  When muscles in the neck have a buildup of tension they may refer pain to other parts of the body. Several neck muscles refer pain directly to the head and temples. These headaches respond well to trigger point releases which involve pressure directly to the offending muscles.  It usually takes 4 to 6 sessions to eliminate the trigger points and their accompanying headaches. 
See our trigger points page for more details.

Often overlooked yet a headache is a well-known symptom of dehydration.

Autonomic nervous system imbalance
The autonomic nervous system (ANS) is that part of the nervous system which balances our stress system with our relaxation system. When we are out of balance we may have more stress functions operating around the body. This means an increase in blood pressure, heart rate and sweating. In terms of muscles around the body, it is usually the muscles of the upper back, neck and jaw that get activated with the stress system (imagine you are about to fight someone and you can feel your shoulders rising and your teeth clenching). Over time this may manifest itself as chronic headaches. The treatment consists of using a special kind of monitor to graph out the balance in the autonomic nervous system. Then, using a series of breathing exercises the patient can learn to decrease the amount of stress activation in the body. The real-time graphic display of the monitor enables the patient to become an expert in balancing the autonomic nervous system.
Click here to view our page on ANS.

Temperomandibular joint (TMJ) dysfunction
The joint of the jaw may become dysfunctional due to restrictions or laxity in the joint itself or because the joints in front (the teeth) or the joints behind (the upper spine) are dysfunctional. Adding to the complexity of this area are the muscles in the face and neck that refer pain to the jaw area when the joints of the jaw may be sound. Whatever the root cause of the jaw pain, patients often report pain in the back of the head, temples or forehead that are associated with it. Treatment focuses on a careful assessment of the neck, head and jaw and, in some cases, collaboration with the dentist.

Postural ischemia
This refers to a very common phenomenon in our society.  Ischemia means choking off the blood supply and the effect of using a computer or other desk work may be cutting off the blood supply to the muscles in the back of your head.  Over a period of time a dull pain starting at the back of the head and shoulders begins to spread over the entire head.  The remedy simple to express but difficult to implement.  "Just change your posture" is correct advice but I have found that showing patients specific ways that they can modify their posture and specific exercises to increase blood flow to the back of the neck is much more helpful.

The stress response in humans is remarkably similar whether we are being chased by a bear or whether we are late for a meeting and are stuck in traffic.  The muscles of the head and neck are designed to tighten (clenched teeth, fighting posture, etc) as we prepare to face the 'threat'.  Eliminating stress from your life is not an option but teaching you how to become an expert in controling your response to threat is a realistic goal.  Using a device called a cardiac coherence monitor I can show you your body's reaction to stress and teach you how to modify your physiology so that your body does not respond in a detrimental way.  The beauty of acquiring this skill is that it is beneficial to other systems in the body such as the cardiovascular system, the immune system and mood.

Of course there are other factors which may be involved in YOUR headache which is why I do not give anyone specific advice aobut treatment or causes until I have done an evaluation.  As always, my evaluations are free and last about an hour at the end of which I can answer specific questions about your condition. 

Headache-specific training: