Physiotherapy for Headaches – Can it Help?

Bothered by a dull ache, shooting pain or throbbing in your head – and sick of popping pills for it? You’re not alone. Headaches affect approximately 47% of people globally. But the good news is that, with headache physiotherapy, help is (literally) at hand. 

In this article, The Alignment Studio director and senior physiotherapist Pete Hunt explains the role physiotherapy can play in relieving chronic headaches and improving your quality of life.

He discusses the effectiveness of manual therapy in treating three main types of headaches: migraines, tension headaches and, especially, cervicogenic (neck-related) headaches. And he also recommends some easy lifestyle changes that can be made to ease or avoid pain (hint: it all starts with good posture).

So, to discover whether headache physiotherapy might provide the relief you need, read on.

CAN PHYSIOTHERAPY HELP HEADACHES?

Physiotherapy and manual therapy are beneficial in the management of most types of headaches – and very effective in the treatment of cervicogenic headaches. This common type of headache refers to a secondary headache that originates from the cervical spine (neck).

Cervicogenic headaches differ from primary headaches such as tension headaches and migraines which originate from the brain itself.

CERVICOGENIC, TENSION HEADACHE OR MIGRAINE – WHAT’S THE DIFFERENCE?

Source: HealthMatch

So how can you tell which type of headache you’re experiencing? Here are a few clues.

Cervicogenic headache (CGH): Originating in the cervical spine, this type of headache will usually be associated with neck pain. Accounting for 15-20% of headaches, it is most often unilateral (one-sided) and can be aggravated by sustained postures or particular neck movements. CGH is common among desk workers.

Tension headache: A tension headache, on the other hand, is typically characterised by bilateral head pain and is a generalised, pressing-type headache not associated with nausea. 

Migraine: A migraine is a unilateral, severe headache with throbbing pain sometimes accompanied by nausea/vomiting, photophobia (light sensitivity) or phonophobia (noise sensitivity). It can be triggered by factors including hormonal changes, poor sleep, certain foods or unusual smells, and usually requires bed rest or medication.

For all three types of headache, stress can be a trigger due to the sensitisation of the central nervous system which can then increase muscle tension.

Source: Physiopedia

WILL PHYSIOTHERAPY RELIEVE YOUR NECK-RELATED HEADACHE?

Absolutely. Due to the musculoskeletal source of the headache, there is Level 1 evidence to show that physiotherapy treatment is highly effective in the treatment of cervicogenic headaches.

CAN PHYSIO HELP WITH MIGRAINES AND TENSION HEADACHES?

Physiotherapy may also be beneficial for migraine sufferers and help reduce the frequency and severity of tension headaches. However, since tension headaches and migraines are primary headaches with a central source, the degree to which it will help can differ. It will depend on how much musculoskeletal impairment there is as a contributing factor to the headache.

While physiotherapy will definitely provide relief for these types of headaches and can reduce the severity, relief will be temporary. Physiotherapy can be useful as an ongoing part of managing symptoms, used in conjunction with advice from a GP or neurologist regarding pharmacological treatment.

HOW DO PHYSIOS DIAGNOSE NECK HEADACHES?

There are three key features to help assess and diagnose a cervicogenic or neck headache:

• Restricted neck movements on active testing, particularly extension and rotation.
• A detailed manual examination of the hypomobility of the cervical joints, particularly of the upper cervical spine.
• A muscle strength/endurance assessment which looks at the interaction of the deep muscle flexors with the global muscle extensors.

Additionally, poor scapula control or stability and the inability to weight bear through the arms appropriately can also be major contributing factors.

If your neck muscles and joints are in order, your physio will be able to determine if you have a tension-type headache or migraine by asking you questions about your symptoms.

WHAT PHYSIOTHERAPY TECHNIQUES ARE USED FOR HEADACHES?

Headache treatment will include muscular release, deep tissue massage, joint mobilisations and specific stretches to alleviate pain and regain range of movement. Even more importantly, strengthening exercises will be given to progressively load the muscles and build muscle strength/endurance to support the neck and shoulders and return pain-free to all tasks.

WHAT ELSE CAN HELP RELIEVE HEADACHES?

Dry needling, remedial massage, neck stretches, heat or using a massage ball can all help to manage headache symptoms. Adjusting your sleeping position or changing your pillow may also be beneficial.

However, if musculoskeletal function has been impacted, neuromuscular retraining will be important for long-term maintenance. This means ensuring an individual can control their head-on-body posture in varying positions or under differing loads. This can be achieved with rehabilitation exercises, clinical pilates and physical therapy. 

Thoracic spine stiffness (in the upper and mid back) can also be a contributing factor that can load the neck. Manual release or exercises to address this would also be helpful.

WHICH LIFESTYLE CHANGES CAN ASSIST WITH HEADACHES?

Your physiotherapist will also be able to recommend lifestyle changes to minimise headaches. For cervicogenic headaches, these will be based around identifying what is contributing to loading the structures of your neck. 

In sitting postures, we need to learn how to maintain the craniocervical neutral position. This simply means keeping a head-on-neck position rather than protracting the chin with a forward head posture – something many of us do during computer work. An ergonomic assessment of your desk set-up is therefore advised to help facilitate appropriate posture. 

Additionally, clinical pilates and exercise-based physiotherapy are also important to build the muscular endurance needed to maintain correct posture throughout the whole day.

To reduce the incidence of all types of headaches, staying active is important. General exercise has many health and wellbeing benefits including the release of ‘happy hormones’ which help to regulate pain. Moving our muscles more also helps to prevent a build-up of tension. 

However, specific exercises that build strength/endurance relative to our cervicothoracic posture or scapula control are particularly beneficial for secondary headaches stemming from the neck as they target the specific impairments directly.

Your physio also needs to ensure your exercise program is aligned with the requirements of your daily life – whether that includes retraining a tennis hit, lifting heavy washing, or repetitive computer work.

A final and major contributing factor to cervicogenic headaches and neck pain is stress, so awareness of your mental health is a priority. This may include increasing self-care tasks, taking some downtime, talking to friends/family or asking for help to manage the load – and your stress levels.

For help managing neck-related headaches with physiotherapy, book an appointment with one of our Melbourne CBD physios today.