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Tension and Migraine Headaches – Dr. Nathan Ng

In this blog post, we have had the opportunity for Nathan Ng from Lougheed Wellness and Tricfecta Rehab to come in to present an in-service on the practical management of varying headaches. We will be focusing on how to manage migraines and tension headaches. Please consult with a professional for medical advice or treatment.

Types of Headaches

There are several different classifications of muscles that help provide function at the shoulder girdle, including

  • Concussion Headaches
  • Sinus Headaches
  • Cervical headaches
  • Cervicogenic
  • Rebound headache –occurs with the intake of medication, where relief is first experienced, followed by worsened headache after the medication is worn off. Occurs frequently in many individuals
  • Cluster Headaches
  • Hypertension Headaches
  • Allergy Headaches
  • Exertional Headaches
  • Tension Headaches
  • Migraine Headaches

Migraine Headaches

Affects both genders equally, adulthood women greater than men


  • Onset includes throbbing or pulsating pain that occurs in the forehead and/or temple
  • Preceding a migraine, a person typically experiences a migraine aura. An individual may have a visual experience that includes symptoms of blurriness, flashing and are sensitive to both light and sound


  • Clinical Diagnosis based on subjective symptoms described by the patient
  • Currently no lab or neurological tests to diagnose a migraine, however, can be used as exclusion criteria to diagnosis a migraine
  • May be associated with myofascial dysfunction, however, predisposing factors can include genetics, family history, hormonal changes (women can have more frequent occurrences of migraines when pregnant), food intake, sleep patterns, & stress levels
  • All these factors can contribute to the severity of a migraine


  • Pharmaceutical and non-pharmaceutical treatments
  • Medication can be categorized as acute and chronic
  • Acute medications: taken at the onset of a migraine to help reduce inflammation of chemical neurotransmitters
  • Chronic medications: function to decrease severity and frequency of headaches


  • Trigger point therapies
  • Nerve blocks – greater occipital N.
  • Botox Injections
  • Heat wraps
  • Stress management – relaxation training, therapeutic imagery, medication
  • Biofeedback (using technology to monitor HR/BP and using in a real-time setting to control those variables through stressful stimuli)
  • Massage, manipulation, acupuncture
  • Rehab/Aerobic Conditioning (shown to be helpful when frequently exercising)
  • Identifying food triggers (ex: red wine, chocolate, nuts, processed meats, msg, coffee) which can vary from each individual

Tension Headaches

Affect women greater than men, 70-80% of individuals have complained of tension headaches


  • Pain starts in your neck and then moves into the head
  • ‘tight band around the head’ compressing around the forehead
  • More constant and not pulsating
  • Associated with stiffness or soreness in the neck

Episodic vs Chronic

  • Episodic = frequency of headaches is more than 15 times each month
  • Chronic = frequency is more than 15 times/month for 3 months

Differential Diagnosis

  • Pain is not worsened by activity and stays constant with the onset of a tension headache while individuals with migraine headaches will typically have worsening symptoms with activity.
  • No nausea or vomiting symptoms with tension headaches and can occasionally be sensitive to sound and light, but never both at the same time.
  • Tension headaches are more associated with referral trigger points


  • Nonprescription analgesics
  • Massage (typical)
  • Manipulation
  • Looking for dysfunction at C1-C2 thoracic cervical junctions
  • IMS needling
  • Upper cross syndrome treatment
  • Trigger point injections (however not recommended early on)

Trigger Point Referrals

A large reason for an individual having frequent tension headaches could possibly be due to changes to an individual’s posture causing changes in the resting length of certain muscles leading to hyperactivity/hypoactivity. Postural stabilizer muscles tend to become overactive and thus can cause tension headaches when we are in certain positions (such as sitting!) for prolonged periods of time. A great way to help address these issues is looking for trigger point referrals and loosening those hyperactive stabilizers while incorporating strengthening exercises. Exercises using a lacrosse ball or peanut ball for trigger point release and targeting the muscles listed below can be beneficial.

Upper trapezius:

  • The upper fibers of the upper trapezius can become overactive and cause tension referral up to the send up to the side of the neck and to the temples/side of jaws


  • Can cause referral to the side of the head & eyes


  • Overactivity/shortened muscle fibers can result in Cervical Kyphosis (lower cervical spine flexion & upper cervical spine flexion)
  • Referral behind the ear and up into the head

As previously mentioned, most headaches do have a myofascial component, and thus exercise rehab and postural training can be beneficial. Stress management is also key as high stress and anxiety can lead to hyperactivity in these regions. That is it for this blog post, I hope it was informative as headaches are very common and especially if you are someone who suffered a whiplash injury from a motor vehicle accident. That is hopefully where practitioners such as Nathan and ourselves can help in treating these headaches! We’d like to thank Nathan Ng once again for sharing his knowledge! Be sure to check him out at Lougheed Wellness & Trifecta Rehab!





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