Physiotherapy for Headaches – Can it Help?

Pip Jarvis
physiotherapy for headaches - can it help?

If you’ve considered physiotherapy for headaches, you’re right in doing so. Physiotherapy can be very effective in the treatment of chronic headaches, particularly cervicogenic headaches which refer from the neck. To discover whether physiotherapy might be beneficial for your headaches, read on.

The Alignment Studio physiotherapist Naiha has provided her valuable insights into the different types of headaches that can be treated by your physio. She also recommends some easy lifestyle changes that can be made to reduce your head pain (hint: it all starts with good posture!).

Can physiotherapy help headaches?

Physiotherapy is very useful in the treatment of cervicogenic headaches. This common type of headache refers to a secondary headache that originates from the cervical spine (neck region). Cervicogenic headaches differ from primary headaches, which originate from the brain itself, i.e. tension headache and migraine.

Cervicogenic, Tension Headache or Migraine?

Since a cervicogenic headache is a referred pain from the neck, this type of headache will usually be associated with neck pain and can be aggravated by sustained postures or particular neck movements.

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. A migraine is a unilateral, throbbing, severe headache that can be associated with nausea/vomiting, photophobia (light sensitivity) or phonophobia (noise sensitivity). A migraine will usually require bed rest or medication, and can be triggered by non-mechanical factors such as hormonal changes, poor sleep, certain foods or unusual smells.

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.

Will physiotherapy relieve your headache?

Due to the musculoskeletal source of the headache, there is Level 1 evidence to show that physiotherapy is highly effective in the treatment of cervicogenic headaches. It can also play a part in the management of other types of headache.

Since tension headaches and migraines are primary headaches with a central source, the degree to which physiotherapy 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 with these headaches and can reduce 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 assess & treat headaches?

There are three key features to help assess and diagnose cervicogenic headaches:

  • 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 inability to weight bear through the arms appropriately can also be major contributing factors.

Headache treatment will include both muscular release as well as joint mobilisations to alleviate pain and regain range. Even more importantly, exercises will be given to progressively load the muscles and build muscle strength/endurance to support the neck and shoulder and return to all tasks.

What else can help relieve headaches?

Dry needling, remedial massage, neck stretches, heat or using a massage ball are all things that can help to manage headache symptoms. However, if function has been impacted neuromuscular retraining will be important for long-term maintenance. This means ensuring an individual is able to control their head on body posture in varying positions or under differing loads. This can be achieved with a clinical rehab program.

Thoracic spine stiffness can also be a contributing factor that can load the cervical spine. Manual release or exercises to address this would also be helpful.

Which lifestyle changes can assist with headaches?

Your physiotherapist will be able to recommend lifestyle changes to minimise headaches. These will be based around identifying what is contributing to loading the structures of the neck.

In sitting postures, we need to learn how to maintain the craniocervical neutral position. This simply means head on neck rather than protracting the chin forward as 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 rehab (exercise-based physiotherapy) is also important to build the muscular endurance needed to maintain posture through the whole day.

General exercise has many benefits including the release of ‘happy hormones’ which helps 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 as they target the specific impairments directly.

Your physio also needs to ensure your exercise program is specific to the loads 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 is stress, so awareness of your mental health is a major priority. This may include increasing self-care tasks, taking some downtime for yourself, talking to friends/family or asking for help to manage the load.

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