Headache patients – dream or nightmare? Top tips from my headache student clinics

This is a free preview of a paid episode. To hear more, visit mskmag.substack.com Are you ever uneasy when faced with a headache patient? Could you recognise potential trouble and respond appropriately? Headache disorders are commonly seen in our practices. Almost 10% of osteopathy appointments are solely for help with headaches and facial pain \[1]. This statistic shocked me into headache education research myself \[2,3], and ultimately into helping to create an evidence-based headache education programme for allied health professionals (EdACHe) Historically, we barely had any headache education in our undergraduate programme – did you? Most of us will experience a headache in our lifetime. About one in seven people live with migraine (increasing in women in their late 30s/early 40s). In those diagnosed with migraine, almost one in five have sought help from a physiotherapist. About 5% of us have more headache days than clear days \[4]. These are known as chronic headaches. These disorders are associated with personal and societal burdens of debilitating pain and disability, damaged quality of life and unthinkable personal and societal financial cost \[5]. We can legally put cervicogenic headache and migraine prevention on our websites, yet are we really ready for the forensic attention to detail demanded of us by our headache patients? Headache specialists do routinely refer their patients for physical intervention alongside pharmacological therapy, especially if neck pain with movement restriction is present. Physiotherapy is most used by neurologists for patients with *cervicogenic headache (CgH/CeH), chronic migraine (CM)* and *chronic tension-type headache (CTTH).* Evidence for the usefulness of physiotherapy combining manual therapy with exercise training and patient education abounds \[6,7] but is not perfect. A whole bunch of tests exist to help diagnose cervicogenic headache, plus likely cervicogenic triggers and ‘drivers’ for migraine and tension-type headaches \[8, 9]. It’s good to know that only four tests are most useful \[10].