Blog

By David Abi-Arrage

Headaches have various causes and contributing factors, some of which are out of our ability to control. According to the International Classification of Headache Disorders (2018), there are 14 different classes of headache. Of the four primary headaches, migraine and tension type headache are the two that we predominantly see in clinic.

Tension-type headache is something that we colloquially refer to as corporate headache.

Patients will often describe their symptoms as tightness and pressure in the shoulders and neck with some pain at the top of the neck and the base of the skull. Then they experience the classic ‘tight band’ wrapping around their forehead, pain at the temples with pressure either just above or behind the eyes. Then comes the brain fog! They feel slow and lethargic. 3 double espressos later and you still can’t shake that feeling.

Does this sound familiar?

So, what do we normally see during our assessment of patients who experience this?

They normally walk into the clinic speaking through their headphones while checking their emails.

They are on their fourth coffee by midday and haven’t had a lick of water all day.

Following their 10-hour workday, they will be going to the gym to lift heavy weights or smash out a spin class plus an hour of interval training.

Again, does this sound familiar?

While it is difficult to completely understand the mechanisms of tension type headaches, there are a few things to look for.

Pericranial tenderness is the first and probably the easiest to identify. It hurts when we press on your temples, above your eyes, through your jaw, neck and upper traps (Jensen et al, 1993)

The other things that I look for in the chronic tension type headache patient are two are the most important things in trying to alleviate some of the symptoms:

• Breathing patterns
• TMJ or jaw function

Breathing is essential for life. As obvious as that sounds, it’s shocking how many of us don’t know how to breathe properly. When the body is placed under stress and we activate our sympathetic nervous system – flight or fight mechanism – and we begin using our accessory muscle to breathe (Kreibig et al, 2007). These muscles include the upper traps and the cervical musculature and contribute to an increase in respiratory rate and tidal volume. Considering that the majority of the corporate world is in a semi-constant state of stress, you can see how the constant use of these neck muscles to assist breathing are going to contribute to these headaches.

The jaw is the next area that we look at when assessing someone with corporate headache. The tempomandibular joint (TMJ) is a complex joint that can often be hard to assess and treat when it is dysfunctional. Two of the things that I consider when assessing it in relation to headaches are:

• Does your jaw hinge properly bilaterally;
• Do you clench your jaw/grind your teeth?

The temporalis muscle sits at the side of your head, at your temple. One of its primary functions is to elevate and retract your jaw = chewing or clenching. Consistently having this muscle overused and overactive can be a major contributor to your tension type headaches (Schoenen et al, 1987)

How can we go about treating corporate headache?

While the treatment of headaches can be complex, there are a few things that we can do both in clinic and in our everyday lives that can help alleviate some of the symptoms of corporate headache:

• Learn how to breathe properly
  One of the best things that yoga, pilates, meditation, DNS etc have in common, is that they promote perfecting the art of abdominal breathing. Learning how to diaphragmatically breathe will help to calm your overstimulated sympathetic nervous system and give those accessory muscles a break!
• Manage stressors
  Easier said than done, right? How annoying and impractical when someone tells that if you just stressed less then things would get better! Recognising that the body reacts to stress in a similar fashion regardless of its cause can go a long way. Big day at work closing out a deal? Sit down with your family for dinner and have a glass of wine instead of running that 5kms. Worked and trained hard 6 days in a row? Put down the emails for a morning on a Sunday and catch up on a book. Active recovery will go a long way in helping manage your stressors!
• Strength work
  Identifying and correcting dysfunctions in postural weakness or strength deficit through your anterior deep neck flexors, scapular stabilisers or core stability will go a long way in de-loading over-sensitised tissues through your neck and head.
• Exercise and Movement
  One of the staples in our 4 Pillars of Human Performance, movement incorporates general movement and physical activity. Exercise has been shown to help decrease headache intensity and frequency (McDonnell et al, 2005).

As with many musculoskeletal and neuromotor conditions, treatment alone is often a band-aid solution. Used in conjunction with the above interventions, we can see good long term outcomes. I have recently been using a fair amount of dry needling of the TMJ and temporalis as well as surrounding cervical muscle to good use when treating tension type headaches.