In part 2 of the blog about Medication-Overuse Headache, we outline the treatment and the role of your GP and why a headache physio is important. Part 1 is here if you missed it.
Prevention is the key!
It is easier to prevent this condition from developing than it is to treat it. Don’t allow it to develop in the first place. If you are using any acute medications more than 1-2 times per week, you are at risk.
It is easy to see how someone who suffered from regular headaches or migraines could travel down this road of using analgesia or anti-inflammatories or triptans more regularly. In fact, I see people daily who are at risk of going down this road if they haven’t already.
This is where a skilled examination of the upper neck can help you work out why the headaches are happening, if your neck has a role in your headaches, and treating it to reduce the need for medication in the first place.
Treatment of Medication-Overuse Headache
The first step in treatment is recognising that you have this pattern of headaches, and getting some advice. Speak with your GP, and mention the term ‘Medication-Overuse Headache’.
While there is no consensus on treatment, expert opinion involves interrupting the overuse pattern by suspension of the overused medication. Even stopping simple analgesics like paracetamol can provide a significant decrease in headache frequency and severity.
This should be always be discussed and done with the guidance of your GP. Certain medications need to be reduced progressively, like opiates.
A really important factor is educating patients on the biology of headache and the idea of central sensitisation (the process where your sensitivity ‘setting’ changes and the experience of pain is more easily produced).
Education about the correct use of abortive medications like triptans and all other medications is critical.
So where does physiotherapy fit in?
It is vital that if there is an underlying reason for the headaches or migraines is present, that underlying reason is diagnosed and treated effectively.
Reading about this phemomenon makes me more even more passionate about the role that a headache physio has to play.
If there is a legitimate contribution from someone’s upper cervical spine (upper neck) it would make sense to reduce its impact. If this factor can be taken out of the equation, it can prevent the need for regular medication in the first place.
To determine if the neck has a role to play in the headache or migraine situation, a skilled examination of the upper cervical spine needs to be performed.
A general practitioner or a neurologist isn’t equipped to do this level of examination.
Diagnostic blocks have serious limitations – not the least of which not all the relevant structures can be reached and blocked.
A Watson Headache-trained physio is skilled in assessing for any relevant contribution from the upper neck, treating it and therefore preventing the course of medication-overuse headache.
How a Watson Headache Certified Practitioner can help
The best evidence is that reproduction of the exact headache pain and resolution by sustained pressure is the most reliable way of determining if the upper cervical spine is involved in headaches or migraine, regardless of the label that the headache or migraine has.
Unlike common usage, reproduction of headache pain by palpation isn’t enough to draw any conclusions – it is interesting and may make you suspicious, but the resolution of that pain is necessary to be certain that it is relevant.
Palpation of stiffness isn’t enough to draw any conclusions – asymmetry in the upper cervical spine is so common, it is normal.
Using a structured assessment protocol, it is possible to screen for any serious causes for the headaches/migraines that are non-neck related or need medical attention.
It is also possible to determine rapidly if the upper neck is likely to be contributing. The relevance of the neck can be confirmed as the headache/migraine presentation improves.
