Winnipeg Free Press - PRINT EDITION

Pinpointing your pain

Understanding your headache is crucial to treatment

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Knowing the type and cause of your headache can help you find appropriate treatment.

"I was crossing the street on my way to class, and she just hit me," one client told me. "Now my neck is still really sore, and I get headaches all the time."

While most clients don't report being hit by a car, many do complain of headache issues somewhere along their history. Clinically, head and neck pain can be a difficult puzzle to put together because of the physical and psychological aspects of both causes and symptoms.

Despite increasing research in the area, there are still many unknowns regarding headaches, which creates difficulty when organizing a treatment plan. It sometimes helps to simplify things in order to bridge these knowledge gaps, and the three-part headache model presented by Ken Niere, a physiotherapist and head-and-neck-pain specialist in Australia, has helped me better assess headaches and treat them appropriately.

The next time your head is pounding, use this system to determine the type of headache and decide on a suitable course of action.


Everything is going wrong. You forgot your wallet, your car won't start, and you've got a paper due. As your stress levels mount, so does the pounding in your head. Tension (stress, not tightness) headaches are called primary headaches because they are caused by the central nervous system. They are characterized by pressure that usually occurs on both sides of your head. You won't throw up or get nauseous, and it will typically last a few hours. Reducing your stress and anxiety levels in the long-term and short-term is the best treatment for this type of headache. While some people relax with a quiet room and a massage, others resort to medication. Because stress is psychological, most forms of treatment can result in positive effects if they are believed to do so.


While the term may be less known, cervicogenic headaches are common and largely treatable. They begin as neck pain resulting from poor/prolonged postures and single or repeated awkward neck movements (as in motor-vehicle accidents), with pain in the back of the skull that may radiate around or over top to the front of the head. Cervicogenic headaches are not considered primary headaches. Three factors often exist when cervicogenic headaches are present: restricted movement (often neck rotation), increased tension in neck extensor muscles (found just below the back of your skull) and reduced activation/endurance in the deep-neck flexors (muscles found in front of your neck that tuck in your chin). The Cochrane Collaboration, which reviews medical/health related research, concluded manual therapy and exercise interventions were effective in reducing neck tension that causes these types of headaches, with better results and fewer side-effects (including reliance/addiction) than commonly used medications.


Migraines are totally different. Another type of primary headache involving the central nervous system, migraines are often environmental in nature. Common triggers include hormonal changes, certain foods, smells and other sensations. They often result in different symptoms such as vomiting, nausea, sensitivity to light and sound and severe throbbing that can vary in location. While exercise therapy can help with neck tension associated with this type of headache, it rarely helps the cause. Prescribed medications such as certain triptans have shown varying improvements, although most research involving medication for headache treatment is less conclusive than we are often led to believe.

In the end, the most important factor in determining the cause of and treatment for your headache is you. While your doctor or therapist need to be asking the right questions, your observations are essential to provide detailed answers about your pain.

Improve your posture, reduce stress levels, and listen to your body. A better understanding of your personal symptoms will help alleviate and potentially prevent your headaches.

Tim Shantz is a certified athletic therapist and trainer.

Republished from the Winnipeg Free Press print edition July 19, 2014 D16

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