Towards the end of the day, a few times a week, you develop a throbbing headache radiating from the back of your head to your forehead or just behind the eyes.
You have intermittent neck pain that is particularly bad when your stress levels and workload increase. Sometimes you pop an Advil or Tylenol and it kind of helps. Usually by the next morning your throbbing headache is gone… Until it comes back again. For many of my patients this non-stop loop of headaches is exhausting and frustrating and limits their ability to enjoy their lives. This blog post will provide information on the different types of throbbing headaches and provide tips on how you can find some pain relief.
Types of Throbbing Headaches
Did you know there are well over 150 diagnostic conditions of headaches? This may seem like an overwhelming number (and certainly it is!) but it just goes to show how there can be numerous reasons why you may be experiencing your headaches. From medications to nutritional deficiencies to musculoskeletal and/or neurological issues, there is always a reason behind those pesky headaches- so don’t ignore them! Make sure to seek the advice of a medical professional in order to the bottom of your specific issue. The following 3 types are the most common ones I see in clinic:
- According to the Global Burden of Disease Study 2010, 2015, migraines are the third most prevalent disorder in the world and the third-highest cause of disability worldwide in both males and females under the age of 50.
- It is a recurrent throbbing headache disorder manifesting in attacks lasting 4–72 hours.
- Typical characteristics of the headache are unilateral (one side of the head), pulsating and/or throbbing quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia (sensitivity to light) and phonophobia (sensitivity to noise).
- They can present themselves with or without a preceeding aura (changes in vision or sensory perception).
2. Frequent Tension-Type Headaches
- Tension-type headache is very common, with a life-time prevalence in the general population ranging in different studies between 30% and 78%.
- Frequent episodes of throbbing headache, typically diffuse and bilateral (both sides of the head), pressing or tightening in quality and of mild to moderate intensity, lasting minutes to days.
- The patient will sometimes report that their head feels like it’s in a vice.
- The throbbing headaches can last for days or sometimes weeks.
- The pain does not worsen with routine physical activity and is not associated with nausea, although photophobia (sensitivity to light) or phonophobia (sensitivity to noise) may be present.
3. Cervicogenic Headaches
- A unilateral throbbing headache radiating from the back of the head towards the front of the forehead and eye
- It is always experienced on the same side of the head.
- Limited upper cervical (neck) range of motion and mobility- most often difficulty rotating the head over one shoulder.
- Strength and endurance deficits of the deep neck flexor muscles.
- Often occurring after prolonged sustained postures or aggravated neck movements
- No associated nausea, photophobia (sensitivity to light) or phonophobia (sensitivity to noise)
Regardless of the type of throbbing headache, discussion with your family doctor about pharmacologic intervention is always recommended and may help you better participate in your physiotherapy treatment.
How Can Physio Help?
Physiotherapy treatment will differ depending on the type, chronicity, nature and presentation of your specific throbbing headaches. Certainly, physiotherapy has the best research and evidence in treating cervicogenic type headaches but there is evidence of benefit for both tension-type and migraines as well. Typically my treatment plans for patients with throbbing headaches will look to address the following:
- Range of motion limitations- cervical (neck), thoracic (upper back) and shoulder.
- Strength deficits- upper back, anterior neck musculature.
- Muscle tightness- chest, upper back and neck.
- Poor breathing patterns.
- Education- ergonomics, hydration, importance of regular physical activity, stress management techniques and role of other health care practitioners.
Addressing these issues is best done through a combination of hands-on manual therapy, supervised and home exercises as well as education and discussion.
Below are a few of my go-to exercises for patients suffering from throbbing headaches. Again, this is not meant to replace a session with a physiotherapist but may help you get started on your self-management plan!
1. Diaphragmatic Breathing
The diaphragm is the primary muscle designed to control our breathing however many of us (myself included) often recruit our secondary or accessory muscles of the neck and chest to control our breath. This not only creates a shallow breath but also overworks the musculature around the neck and can increase our perceptions of stress and anxiety. Taking 6-10 deep breaths every hour or two will help to ensure your diaphragm is doing its job, improve your air exchange, take stress off the neck musculature and increase your feelings of calm! Try it out!
2. Myofascial Release
One of my favourite tricks! I keep a lacrosse ball on hand at all times just incase I feel a throbbing headache coming on toward the back of my head. You can either do this laying down or standing against a wall. Essentially, find the muscle, place the ball on it and maintain the pressure for 30 seconds-1 minute before moving to the next spot. Only apply as much pressure as you can tolerate without tensing up! More pressure is not better- remember this is supposed to relax the muscles not make things worse. Pick 4-6 spots per side everyday!
3. Thoracic Spine Mobilization
Especially for those who sit at a desk and computer all day long this one is important. Keeping your upper back moving is key to reducing stress on the joints and musculature of the neck. If you don’t have access to a foam roller, roll up a large towel and it will do that trick to start. You can also try some upper back rotation as shown by my bud, Jesse below. Aim for 1-3 sets of 15 per side.
4. Anterior Neck Strengthening
Do you ever find yourself staring at your phone or laptop hunched over with your chin poking far forward. If so, you could probably use some deep neck flexor strengthening. It may not seem like it but we do have muscles that line the front of our necks! The more you allow your head to sit forward of the body, the more these muscles weaken! We have leg day, chest/back day so why not have anterior neck day almost everyday! 3 sets of 10, holding 10 seconds.
5. Upper Back and Postural Strengthening
Wow, ok classic physio move- this is getting to be a lot of homework! Lastly, you need to start thinking about strengthening through the upper back in order to decrease the load through the neck musculature and help maintain good posture throughout the day! There are many different exercises that can get this job done but below are two of my favourite moves that don’t require any equipment or tools at home (except a wall!). With these exercises always think about HOW you are executing the exercise not how many. Doing 4-6 properly is more important than completing 10-12 reps improperly- form is key! If you are looking to make strength gains try to fit them in 3-5 times per week and aim for 2-3 sets of 6-12 each.
One Last Thing…
Staying hydrated is key! In a recent study it was found that those experiencing throbbing headaches 3+ times per week had a reduction in frequency of headaches by ensuring they consumed 6 more cups of water than their average day! If drinking water improves your signs and symptoms you could simply be suffering from dehydration!
Remember, this is not to replace speaking with your trusted health care provider but I hope you find this information helpful. Please feel free to reach out with any further questions!
About Emma Jack
After graduating from McMaster University with both her Bachelor’s of Kinesiology and Master’s of Physiotherapy degrees, Emma Jack went on to complete a Master’s of Clinical Science in Manipulative Therapy at Western University. She is currently a Sport and Orthopaedic physiotherapist in private practice at ReActive Physiotherapy in London, Ontario. In addition, she works as the Team Therapist with Hockey Canada’s Women’s National Team Program. You can find out more about her at www.pressplayphysio.com or on her social media channels (Facebook, Instagram & Twitter).