Attractive woman with a migraine touches her temples. Horizontal shot. Isolated on white.

Osteopathy is often well placed to help headache sufferers. In our Headache Clinic we will analyse each case individually and either be able to help ourselves or refer as appropriate. The clinic is led by ESO osteopath Helena Bridge, with support from an NHS expert advisor.  Helena is also a founder member and Director of OPHM (Osteopaths for Progress in Headaches and Migraine) – a new not-for-profit special interest group within osteopathy.

You can find more information about headache types in the Q&A section below. If you have any questions about the suitability of our Headache Clinic to your headache situation, please email clinic@eso.ac.uk. Helena Bridge can call you at a time to suit you on a Monday 9am – 7pm, or other times by arrangement. If you would like to read her article in Osteopathy Today, please email as above.

 

Headache Clinic appointments are available on Wednesday evenings only – treatment fees can be found via the following link. To book an appointment or for further information please call 01622 685989.

Do you suffer from headaches? 90% of the world’s population will have a headache at some point in their lives. Most of these are completely benign, last only 2 – 3 hours if not medicated, and do not stop us from functioning – they are generally dehydration, low blood sugar, or tension-type headaches. They should resolve with simple measures e.g. a glass of water, food, a break from the screen, or an over-the-counter painkiller respectively.

 

If they do not resolve this promptly, they may herald a virus or a sinus issue, or very rarely they may be secondary headaches due to a primary cause which needs medical attention. Most often, they will be primary headaches such as migraines, in which case we may be able to help you manage or help to prevent them. Beware of people who claim to cure migraines, as managing them is a matter of learning to balance your stresses and triggers as much as anything else e.g. treatment or medication. It is not a question of cure.

 

Other headache types exist, and each headache sufferer needs careful screening and diagnosis before a treatment plan can be formulated.

 

These other headache types include migraine with or without aura, medication overuse headaches, cervicogenic headaches (arising from trauma or mechanical issues in the neck), frequent tension-type headaches, chronic daily headache, and rarer headache types e.g. cluster headaches (excruciating and always require specialist attention), hemicranias (always on the same side) and other trigeminal autonomic cephalalgias. These are shorter-lived than migraines and accompanied by unpleasant symptoms arising around the eyes, nose and face such as drooping eyelid, tear formation, red eyes, facial flushing, one pupil constricted and stuffed up nose for no apparent reason.

 

It is a complex process diagnosing headaches properly, and research shows that many people never get a correct diagnosis.  At the ESO you will, firstly, be safety screened.

Sinister headaches are rare but be aware:  What follows is not a substitute for medical advice – seek urgent medical advice in the following situations:

 

People with severe, sudden onset headaches which may signal bleeds in the brain or other major health issues are rare but urgent, fast-unfolding scenarios and should never come to the ESO as a first port of call.

 

If this is a first, worst, or a sudden onset “thunderclap” headache, or accompanied by any sensory loss or loss of regular body functions, or changes in consciousness, CALL AN AMBULANCE.

 

Persistent headache after head injury too requires medical screening (see www.nhs.uk/Conditions/concussion/Pages/introduction.aspx)

 

Seek medical advice also in the following situations:

 

If you have a headache and have a high fever, or feel unwell

 

If you are over 50 or around this age, and this is your first headache ever

 

If your headache is different in nature from your regular ones and is accompanied by any unexplained symptoms e.g. visual disturbance, sudden loss of hearing, loss of balance, or other symptoms e.g. changes in bowel or bladder

 

If you have had a familiar headache through your life and it changes in pattern, or it becomes progressively worse

 

If you regularly suffer from headaches which you would like help with, please email or call the ESO headache clinic (see below).

Headache is more common than back pain, and some headaches are very debilitating, even tension-type headaches. It makes sense for osteopaths to become involved in reducing any pre-existing tensions in muscles and joints as these can predispose you to these headaches. In order to help prevent these often life-wrecking symptoms, we can make sure your muscles and joints are functioning optimally. We are also well-placed to give basic advice on your work station and other occupational and postural issues leading to strain on the neck and shoulders.

 

Conversely, headaches can themselves be the cause a lot of neck and shoulder pains, especially in the case of migraines and other complex headache conditions. This may be because a lot of pain is directly referred from irritated nerves in the head and face, for example, or through the sheer stress of coping with the pain levels and other debilitating symptoms of the headache or migraine.

 

Osteopathy can help reduce mechanical and stress-related tension by addressing strain throughout your musculoskeletal system using gentle hands-on manipulative techniques of all kinds (see home page). We also give you time to discuss and consider all options open to you, based on the latest scientific evidence.

The answer, very often, is a resounding yes. According to current guidelines (e.g. MIPCA – www.mipca.org.uk) and widely-held expert opinion, osteopaths are well-placed to help alleviate the suffering of patients with migraine. We can help with prevention, not acute treatment or cure. Migraine is considered by headache experts worldwide to be a type of inflammatory neurological condition, something which comes and goes. It is related to the genes in most people, so osteopaths have to work within current medical guidelines derived from current best scientific evidence and stick to migraine prevention (see above). Experience shows that this can be very helpful in reducing the severity and frequency of the attacks, whilst gold standard medical practice states that acute medication should be able to reduce the duration of your attack to a couple of hours, allowing you to resume normal activities.

As with all human beings, however, every migraine is unique to the sufferer, and it may not be possible to help everyone with osteopathy, or indeed medication. It is a case of finding a tailor-made approach which suits each individual, and this takes time and perseverance from doctors, osteopaths and other practitioners.

 

Many migraine sufferers are too sensitive to even the best medication available to them (the triptans), or they may have worked for a time and then stopped helping; they may be pregnant, not wishing or too young to take them, and so manual medicine in general and osteopathy in particular, having such refined, gentle techniques in the therapeutic toolkit, has an important part to play in helping such sensitive people.

Migraines are a special case and migraineurs, as people suffering from this headache condition are called, function differently from other people: they are generally more sensitive to sensory and other input and when it all becomes too much, the brain launches into an ‘electrical storm’ resulting in the need to lie quietly, usually in a darkened room, with no light, noise or other sensory input e.g. smells or touch, let alone conversation.

 

Such migraine headaches are generally though not always throbbing, severely painful and accompanied by nausea and vomiting, light and/or sound sensitivity until with rest, quiet and sleep, the brain has a chance to “re-boot” itself. Without medication, migraines take between 4 – 72 hours to calm down, but often people “rev up” to them for a day or two, and take a day or two to recover. This means that each migraine may take the best part of a week out of somebody’s life, which results in many consequences at work, and in their wider social and more personal relationships. Some migraines in certain circumstances may last even longer.

 

Migraineurs who have auras, are particularly unlucky. Auras are sensory disturbances which occur before the onset of the migraine headache: they are short-lived (5-60 minutes each, sometimes 2-3 together, sometimes one after the other), and often distressing, e.g. visual disturbances such as blurring or scintillating scotomas (jaggedy shapes in the visual field), fleeting inability to see (amaurosis fugax), inability to speak (aphasia), tingling in the face or limbs, and so on. It is very important that such patients have already been seen by a doctor before attending the ESO headache clinic to make sure that the symptoms are truly migraine symptoms and not due to other neurological or vascular causes requiring medical attention.

 

Migraineurs generally have other headache types as well, which they might call their normal or tension headaches, but it can be argued that they are all part of the migraine spectrum and can be helped in many ways. If you are even getting one migraine attack per week, you may be feeling “headachey” for most of that month…perhaps you have no “crystal clear” days in any given month, or you may be taking tablets either from over-the-counter or through your doctor, but they may not be working. You will need help with this situation.

If you are taking headache pills of any sort on more than 10 headache days per month and this plan is not really working, the chances are your medication is actually causing a worsening of the headache over time. You may be suffering from medication overuse headache, and will need support while you come off the pills and review your medication with your GP or headache specialist.

 

In the case of migraine medication, this medication programme to break the cycle falls into two camps: acute and prevention medication. If you suffer from 8 migraines/month, you may be put on prevention medication such as amitriptyline), for a time. We can help you use the four-question Migraine-ACT tool developed by a team of experts and researched by Dr Andrew Dowson, our clinical supervisor, to see whether you are due for a medication review (Dowson AJ et al Curr Med Res Opin. 2004).

The ESO Headache Clinic is especially suitable for those suffering from chronic headaches, i.e. more than 15 headaches per month, or 4+ per month and increasing in the case of migraines. Intermittent headache sufferers are also welcome if current treatment is not helping so far.

 

The ESO has introduced this new service as part of the World Health Organisation’s worldwide call to help headache sufferers, called “Lifting the Burden” – www.l-t-b.org. You can find more information about the prevalence and effect of headache on the world’s population here*.

 

Our Headache Clinic is headed by ESO tutor Helena Bridge, who has specialist knowledge in the field after gaining a PGCE in 2015 in Clinical Management of Headache Conditions through the School of Clinical Sciences at the University of Edinburgh. The Clinical Lead there was Dr Andrew Dowson, who still supervises her work at the ESO Headache Clinic. She is a founder member and a director of a new special interest group, Osteopaths for Progress in Headaches and Migraines, and is enrolled on a Pain Management Masters degree at University of Edinburgh in her spare time.

Together, Helena Bridge and our student practitioners are able to

  • perform rigorous safety screening,
  • diagnose the most common headache types,
  • refer appropriately for medical support, and
  • be aware of any other supporting treatments (e.g. counselling for stress management, nutritional supplements for migraine prevention etc.) for which there is reasonable evidence, particularly in treating migraine co-morbidities, which number more than 20. Comorbidities are conditions which are found to occur more in migraineurs than would be expected in the whole population.

 

Specialist Clinical Support

 

Evidence points to a multi-disciplinary approach to management being the most effective. To this end, we have the clinical support of Dr Andrew Dowson, Head of the headache department in the Neurology Department at King’s College Hospital. He also runs a large part of East Kent headache services in Margate and Ashford.

 

Dr Dowson’s role is to discuss complex cases where needed, and occasionally to deliver private medical care at the ESO or his clinic in Guildford, e.g. for prescriptions/injections where expressly needed and requested in order to break the cycle of pain of, for example, chronic migraine, whilst our students deliver their usual high-level osteopathic care.

 

In the main though, the objective is for us to work hand in hand with our patients and with local GPs to support them in their work. To this end, we also have Jacqui White, an experienced counsellor to help with associated issues which may need addressing in order for the migraine prevention programme to be successful.

In the 5 March 2007 edition of Cephalalgia, LJ Stovner et al published an arresting article: The global burden of headache prevalence and disability worldwide. “Globally, the percentage of the adult population with an active headache disorder are 46% for headache in general, 11% for migraine, 42% for tension-type headache, and 3% for chronic daily headache. Our calculations indicate that the disability attributable to tension-type headache is larger worldwide than that due to migraine. On the World Health Organisation’s ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for the two genders, and into the five most disabling for women.”  

The cost to our respective nations in days’ work lost, families blighted and relationships affected is phenomenal. There are other hidden costs, e.g. in water pollution due to ingestion/discarding of often mis- and over-prescribed analgesics. Tertiary headache clinics cannot cope with the numbers affected by chronic headaches and waiting lists are long. Meantime the population develops another chronic headache: medication overuse headache.

If you would like to read Helena Bridge’s article in Osteopathy Today ‘Unlocking Headaches’, please email clinic@eso.ac.uk.