McKenzie Method (MDT) for Headaches

Headaches are one of the most common complaints that individuals present to their general practitioner for. In fact, 2-4% of the general population report chronic daily headaches. A true headache can be defined as pain in the back, side and front of the head as well as pain in the neck and facial region. There are a variety of causes that can range from very serious to benign (non life threatening). To simplify things, headaches can be classified as either mechanically induced or non-mechanically induced. Mechanically induced headaches arise secondary to an alignment issue in the top vertebrae of the cervical spine (also know as the neck). These individuals can either present with solely headaches or in conjunction with a neck pain and/or stiffness. Non-mechanically induced headaches can arise from vascular origin (stroke), neurological origin (carbon monoxide poisoning, dehyration), infection (sinus, ear, dental), viral (meningitis, common flu), or cancer (tumor).

Headaches can be further classified as tension headaches, migraines and cluster headaches. Tension headaches are caused by spasms in the musculature which effect the mechanics of the spine. Migraines can be associated with or without an aura. An aura is the warning sign which prevails a migraine. They are typically visual but can also present as sensory, motor or verbal disturbances. Migraines can occur for no apparent reason however, many believe they're exacerbated by stress, lack of sleep, poor nutrition, hormonal changes, or poor biomechanics. Cluster headaches are the most rare and occur as a result of an irregular hypothalamus. Individuals will typically wake up in the middle of the night with pain in and around their eyes. Cluster headaches will present with remission periods ranging from months to years.

Mechanical headaches, also known as cervicogenic headaches, can be diagnosed and treated by Physical Therapists as well as Chiropractors. They will typically present as headaches that come and go dependent on the activity you're performing and position you're in. There's usually some movement loss of the neck, making it painful or difficult to look up and turn your head from side to side. Most patients will have a history of trauma or whiplash. Symptoms are typically provoked by consistent activity and sustained loading of the spine in one position. For example, these individuals may wake up with a headache after sleeping all night in one position OR gradually report increased pain and discomfort as the days goes on while they're sitting at their desks working. Most individuals will report that movement feels better and deny any symptoms while participating in activities over the weekend.

The McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) is an internationally acclaimed method of assessment and treatment for spinal and extremity pain developed by New Zealand Physiotherapist Robin McKenzie. It has been widely used all over the world for more than 30 years. MDT clinicians are trained to assess and diagnose all areas of the musculoskeletal system. That means that if a problem exists in or around the spine, joint or muscle, an MDT evaluate may be appropriate. MDT utilizes a four step process: 1) Assessment, 2) Classification, 3) Treatment, and 4) Prevention. MDT is a philosophy of active patient involvement and education that is trusted and used by clinicians and patients all over the world for back, neck and extremity problems. This approach continues to be one of the most researched physical therapy based methods available.

Three steps you can take for self-management of headache symptoms:

• Postural improvements. Attaining and maintaining alignment of the spine is essential in order to reduce your risk of developing a mechanical headache. Use of lumbar support will help maintain the proper curvature of the lower spine and decrease slouching while sitting at work or traveling in the car.
• Sleeping position can improve your condition. The number of pillows you sleep with may be causing your headaches. Headaches that occur in the morning and decrease as you get up and move are typically the result of poor sleeping posture. Sleeping with more than one pillow brings your head upward into a flexed position which places increased pressure on the cervical spine. Sleeping on your stomach requires you to turn your head towards one side which places an increased pressure on the opposite side of the cervical spine. For example, sleeping with your head turned to the right may develop left sided symptoms. The use of a cervical roll in your pillow can help reduce your risk of waking up with neck pain and cervical headaches. It supports that base of your spine when sleeping on your back and side.
• Frequent exercise to promote good posture. The McKenzie institute has found several exercises to be effective for treatment of headaches. A trained therapist can evaluate you in order to determine which exercise will help you take control of your headaches. Sustained or held positions have found to be the most effective when treating headaches. A simple exercise that can be performed at home may help you self-manage your symptoms. Lay on your back in bed and place a rolled up towel, approximately 3-4 inches in diameter, under the middle of your head (instead of a pillow) and hold for 3-8 minutes. This is a gentle exercise that will allow gravity to assist in re-aligning your spine. This exercise emphasizes the opposite position of what most humans perform daily while at work or school, which is slouching forward with a protruded head and shoulders rounded inward. If this exercise isn’t effective or only partially addresses your condition, please seek out a therapist to perform a full evaluation.

Please notify your physician if you have any of the following RED FLAGS associated with non-mechanically induced headaches: progressive worsening of intensity, recent and rapid severe onset (also known as the thunderclap headache), history of a major injury, nausea/vomiting, headache with visual changes, preceding sore throat or respiratory infection, problems with speech or swallowing, progressive muscle/body weakness, and mental changes.

If you or someone you know is suffering from headaches please notify your general practitioner and ask them for a referral to a MDT certified or trained clinician. Please refer to www.mckenzieinstituteusa.org to find a certified clinician near you.

Article written by Dr. Kaitlyn Hamel at Seacoast Spine & Sports Injuries Clinic in Portsmouth, Hampton, and Alton NH. Please email with any questions regarding this article/topic: drhamel@seacoastsportsinjuries.com.