Models of headache and their implications for treatment using manual therapies.

Headaches represent symptom collections reflecting various mechanisms. True pathology causing headache is comparatively rare and therefore headache symptoms generally reflect functional disturbances. Models of headache pathogenesis may lead to therapeutic interventions, or be extrapolated from successful therapeutic interventions. These can provide a basis for research and case management. If we consider symptom expression as a manifestation of a threshold response and headache sufferers as a population with lowered threshold, therapeutic approaches may be oriented to changing the thresholds. Headache symptoms may also represent the sensitivity to other triggers, which make it easier to reach a similar symptom threshold. Treatment would then be oriented to changing the response to the triggers. This paper presents models of manual therapies related to headache treatment and discusses research directions, relation to medical models of headache and a discussion of clinical considerations for treatment. Since individuals with headaches may represent a broad spectrum of etiologies, these models may be utilized in developing and fine-tuning individual programs of treatment as well as guiding future research. Manual therapies have significant potential relative to managing headaches. There are differences in application and technique that may be considered when approaching individual presentations. Understanding the mechanisms behind different models may provide a basis for fine-tuning therapeutic algorithms for individual presentations.