Physiotherapy for headaches: current situation and challenges in Brazil

Abstract

Since millennia before Christ there are records about headaches, which was once related to magic or religion, until it reached medical and scientific knowledge 1,2 . Currently, the worldwide prevalence of active headaches reaches 52%, representing a common and almost universal human complaint throughout history 3 . Headaches, according to the International Classification of Headache Disorders, correspond to a group of disorders that affect the head region, with more than 200 categorized types, which can belong to three distinct groups: primary headaches, secondary headaches and the group that includes painful cranial neuropathies, other facial pains and other headaches 4 . In ancient times, there was belief that headaches were caused by evil spirits that took over the bodies, so the treatment used initially consisted of trepanning the skulls, so that these spirits would leave the body 2 . With the advent of technology, and also human evolution, the treatments have been adapted. Nowadays, there are pharmacological and non-pharmacological treatment options for headaches 4 . There are several kinds of pharmacologic options, the choice of which depends on the type of headache, its clinical presentation, the presence or absence of comorbidities, the individual's preferences, and the expertise of the professional who is accompanying the patient. Some of the pharmacological options cited in studies are: changes in lifestyle, physical exercise, mindfulness, cognitive-behavioral therapy and/or other psychotherapeutic interventions and physical therapy modalities [5][6][7] . In general, for headache treatments, especially chronic ones, the involvement of multiprofessional teams (doctors, dentists, physical therapists, psychologists, physical education professionals, nutritionists, among others) 6 is recommended. Specifically regarding the work of physiotherapists in Brazil, there is still no common denomination of specialty recognized by the Conselho Federal de Fisioterapia e Terapia Ocupacional (Federal Council of Physiotherapy and Occupational Therapy) for physiotherapists who work in this area of head and neck disorders, as some call it. Others use the terms buccomaxillofacial, craniocervicomandibular and/or craniomandibular. Although this specialty is not yet recognized, studies have already pointed out evidence of several physiotherapeutic approaches as beneficial in specific types of headaches, especially in cases of cervicogenic headache (the most prevalent secondary headache), tension headache, and migraines (the most prevalent primary headache) [7][8][9][10] . The great objective of most individuals is to get rid of the headache. However, sometimes, and thinking mainly about primary headaches, it is not possible to guarantee that the headache will disappear, but only that periods of remission can exist. Therefore, the goal of physical therapists working in this area should be to reduce the frequency, intensity, and duration of pain, as well as to prevent crisis, reduce disability and the impact caused by headaches...