Extensive clinical research has concluded that the majority of headaches are a result of dysfunction of the cervical musculature. Beyond a formal diagnosis of migraines and cluster headaches, headache symptoms-even severe ones-are often produced by trigger points and adhesions in the neck, upper back and facial regions. Well documented studies by Travell and Simons illustrate the importance of muscle in treatment of headache pain. This groundbreaking work explains previously misunderstood referral patterns of muscles. Furthermore, it clearly demonstrates how muscle adhesions in the neck produce pain in the jaw, forehead and temporal regions. By comprehensively addressing the structures in both the jaw and cervical regions, skilled TMD physical therapists can significantly reduce the intensity, frequency and duration of debilitating headaches.
The Basis of TMD Rehabilitation
In general, reducing stress on the neck and jaw regions will significantly decrease headache symptoms. This positive outcome is achieved with cessation of irritating parafunction, postural education and stress reduction. Cessation of activities which aggravate the jaw, such as gum chewing and biting of the cheeks, will result in less jaw pain and consequently neck pain. Poor posture and awkward positions of the head are contributing factors in headache manifestation. Although it is most often observed with the use of electronics; workstation, sleep and driving postures uniformly contribute to neck strain and therefore headaches.
Stress is another causative factor of headache pain. While most interventions cannot successfully eliminate stress, physical therapy treatment aims to modify the body’s response to stress. Conscious awareness and reduction of shoulder, neck and jaw tightness during periods anxiety can reduce symptoms. Additionally, education of diaphragmatic breathing techniques and relaxation can reduce headache exacerbations.
Decreasing Acute TMD Inflammation
An essential portion of physical therapy treatment is the initial reduction of headache symptoms. This can be achieved with moist heat, electrical stimulation and cold laser application, which increase blood flow to oxygen deprived tissues. While these interventions typically “feel good,” they also reduce inflammation on the cellular level. Comprehensive headache treatment addresses both cervical and facial structure with interventions designed to passively reduce pain. Modalities are not the permanent solution to headache pain, but the resulting reduced symptoms prepare problematic areas for more advance interventions.
Remodeling Soft Tissue
Soft tissue mobilization and myofascial release techniques are critical elements in the reduction of headache symptoms. Following a thorough assessment, manual treatment aims to decrease muscle strain and compression of the cervical spine. The hands-on portion of physical therapy for headaches involves stretching of the cervical vertebrae and adjacent muscles. Gentle manual traction elongates the spine and counteracts the chronic compression caused by gravity. Range of motion of the cervical spine is restored, lubricating the vertebral joints. Soft tissue structures from the upper trapezius, cervical paraspinals and suboccipital regions are manipulated to reduce adhesion and muscle knots. The muscles in the front portion of the neck are similarly addressed as they are often contacted with forward flexion postures.
A skilled TMD physical therapist is often the first healthcare provider who assesses and addresses the soft tissue in the TMJ regions in relation to headache pain. Musculoskeletal structures of the orofacial region are factors in headache pain. Often, these structures are overlooked when determining the cause of headaches. Physical therapy often eliminates this pain, without the use of pain medicine or more invasive treatment.
An Advanced Treatment
Resolving muscle knots and myofascial adhesions in the neck and facial regions may require aggressive treatment. Dry needling is a minimally invasive procedure in which a solid filament needle is inserted into the muscle directly at a persistent trigger point. While the needle used is similar to acupuncture needle, the technique and methodology varies greatly. The sole purpose of dry needling aims to decrease contraction knots, which are related to the production and maintenance of the pain cycle. These very thin needles and inserted through the skin and can affect deep layers of muscle tissue. Dry needling in the cervical and orofacial region allows TMD physical therapists to address muscles trigger points that have previously been unresponsive to other soft tissue techniques.