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  • Rob


Headaches suck! There are many different kinds of headaches. As the name implies, they are not fun. Many people suffer from headaches. I am one of the lucky ones, I generally get 4-5 headaches per year. Most of the headaches, I get are when I am sick and coughing too much. There are many different types of headaches and we will talk about some of the different types of headaches.

If really are interested in headaches or you want to learn more about headaches, there is a place for you to go. It is the International Headache Society. I am not kidding, this is a real society. The red tape on the website is terrible (I am joking, get it headache/ red tape...) This is where I got some of the information about the different types of headaches I am going to talk about.

The different types of headaches I am going to talk about are:






Occipital neuralgia


This type of headache is caused by something in the neck. The fancy medical term for the neck is the cervical spine. So cervico = neck and genic = beginning. This is one of the types of headaches that physiotherapists can help with.

Cervicogenic headaches (CGHs) account for 15-20% of all headaches! About 2.2 - 2.5% of the population suffer from CGHs. They affect women 4x as much as men. This type of headache is caused by the upper neck, C0-3, the joints or facets, discs or muscles in this area can all be culprits. These headaches usually start at the upper part of the neck/base of the skull and go over the top/side of the head. There can even feel like some pain behind the eye. This can be one sided or two sided but predominantly one sided.

What does someone do to actually cause a cervicogenic headache? It can be a number of things, sometimes trauma to the head or neck. I think of whiplash headache, banging your head on something can cause it or simply bad posture, sitting in front of a computer all day with your chin pointing forwards and reading while looking down the entire time (we also tend to adopt this posture when driving long distances).

What can be done to help with this type of headache? In extreme cases, sometime surgery or injections into joints or disc might be needed. That extreme is definitely the exception not the rule. I have never seen someone have to use one of those interventions but I have read about them in some studies.

More typical are IMS, massage, mobilization or manipulation to help loosen up stuck joints and relax the muscles that tighten up to protect the sore area.

A lot of clients are surprised that when testing the joints of the upper neck, I can teach them what to feel, the small movements/glides. Once they know what I am testing, they can usually tell me where they feel their necks are stuck and they are usually correct!

This is very satisfying working with someone suffering from cervicogenic headaches because in a couple of sessions you can usually cut their headaches down substantially.


True migraine headaches are not much fun. About 13% of the population suffer from migraines. Women get migraines 3x as men. They can last from 4 - 72 hours. They are usually moderately to severely painful and are one sided. People usually describe the pain as intense pulsating quality. This type of headache can be aggravated by routine physical activity. People suffering usually have nausea and/or photophobia and phonophobia (fears of light and sound). This means that most people want to simply crawl into bed, no physical activity, in a room that is dark and quiet (no light and no sound). The main treatment for migraines are peace/quiet/rest and there are some special medication for the blood flow to the head. Medications are not my specialty. I would go and ask a smart pharmacist about the different types of migraine medication and how they work. Physiotherapy could be useful in simply decreasing muscle tightness in the neck area for this type of headache.


The actual cause of the tension-type headaches (TTH) is unknown. We do know that this type of headache comes on bilaterally with a squeezing/pressing sensation across the forehead. Luckily, these headaches are usually mild to moderate intensity. They can last from minutes to a few hours. TTH do not get worse with routine physical activity, this is just the opposite of what happens to people with a migraine headache. Photophobia or phonophobia may be present but nausea is not.

There are 4 subcategories of TTH; infrequent, frequent, chronic and probable.

  • Infrequent = <12 days per year (or one headache / month)

  • Frequent = between 12 – 180 days per year (1-15 headaches / month)

  • Chronic = >180 days per year (more than 15 headaches / month)

  • Probable = Tension-type-like headache missing one of the features required to fulfil all criteria for a subtype of tension-type headache coded above, and not fulfilling criteria for another headache disorder


This type of headache is almost exclusively one sided. Cluster headaches come on very sudden and last from 15 minutes to 3 hours in duration. They occur usually every other day to 8x/day (a cluster of headaches). The symptoms of cluster headaches are ipsilateral (same side) conjunctival injection (simply means having a red eye), lacrimation, nasal congestion, runny nose, forehead and facial sweating, miosis (pupil is small on affected side), ptosis (drooping eyelid) and/or eyelid oedema and /or with restlessness and agitation.

This headache type can be described as episodic or chronic.

  • Episodic = Cluster headache attacks occurring in periods lasting from 7 days to 1 year, separated by pain-free periods lasting at least 1 month

  • Chronic = Cluster headache attacks occurring for more than 1 year without remission, or with remission periods lasting less than 1 month


As the name states, this is the type of headache that people will get after they sustain a concussion. Some people will get headaches, while other people that had a concussion will not get headache. It is unclear why this occurs in some and not others. It does not seem to be related to the severity of the concussion. The headaches may be short lived, named acute, or last for weeks, persistent. The intensity of these headaches may resemble either TTH or migraine, from mild to severe intensity. If the sufferer is having severe headaches, they should make sure that they have seen their family doctor, as should anybody thinking that they have suffered a concussion. Symptoms can include fatigue, dizziness, decreased ability to concentrate, psychomotor slowing, mild memory problems, insomnia, anxiety, personality changes and irritability.

Physiotherapy may be able to help people suffering from a concussion. Making sure the upper cervical spine is not fixated and the suboccipital (upper cervical spine) muscles are relaxed and not under tension. Talking with a colleague that works at a physiotherapy that deals with almost exclusively with people that have had a concussion, stated that sometimes working in this area, suboccipital, may reproduce the client’s headache or concussion symptoms. As the suboccipital muscles relax and the joints loosen up during the treatment, the client’s state that their symptoms decrease. Interesting...

Occipital neuralgia

This type of headache can be one or two sided. The headache is thought to occur by having either the greater occipital nerve or the lesser occipital nerve being pinched. This pinching is thought to occur with the bones, atlas and axis, or as the nerves weave their way through the suboccipital muscles on the back of the head/ upper neck. The headache starts at the back of the neck and slowly works its way up, over the head or around the side of the head. Even sometimes this headache will give a pain sensation behind the eye, on the same side as the pain in the upper neck. Does this sound familiar? This is very similar description to what I gave, hopefully, to the cervicogenic headache. Occipital neuralgia is an older term and is definitely being replaced by cervicogenic headache. However, there are still some old school clinicians out there that will differentiate the two conditions.

That is a look a few of the more common type of headaches that people can suffer from. This is, by far, not an exhaustive list of headaches. If you want to know more about headaches, a great resource is the International Headache Society homepage (yes, this is a real society). You can click here to go there and take a look. If you click on ICHD/ Guidelines, scroll down a little then, in the centre of the page, then click on:

You will download a PDF of the latest headache definitions. The document is a 180 pages in length. It is great reading though! If you are suffering from insomnia! :)

If you are suffering with headaches and would like someone to take a detailed assessment, click here to book an appointment with New Leaf Physiotherapy.

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