Physio for Headaches: Targeted & Effective Treatment for Pain and Tension

Living with headaches can be frustrating and debilitating, impacting your daily life and productivity. Whether you suffer from tension-type headaches, migraines, or cervicogenic headaches, many people end up taking significant amounts of medication for extended periods of time. Unfortunately, many headache sufferers aren’t aware that physio treatment for headaches can be effective and provide sustained drug-free relief from symptoms. In fact, many people are surprised when they are recommended by their GP or a friend to see a physio for headaches.

Physio’s certainly don’t claim to be able to cure all headaches. However, we find that we are able to help many clients reduce the severity and frequency of their headaches. Often we can reduce their sensitivity to environmental triggers (sustained desk work at a screen, certain foods, types of light etc…), and reduce their medication use. Importantly, physiotherapy not only treats the immediate pain but also addresses the underlying causes to reduce or avoid future headaches.

Physio for headaches needs a very individualised approach. The mechanisms, triggers and symptom sensitivity for each person’s headaches will be different, so the treatment approach needed for each case will also be different. It will usually include a combination of hands-on treatment (manual therapy), targeted exercise, and advice on modifying relevant lifestyle aspects such as ergonomics and work postures and positions.

Research indicates that physiotherapy can reduce the frequency, intensity and duration of several types of headache and migraine. Understanding how and why physiotherapy works can be the key to finding the right solution for your headaches. It is important to note that as well as pain, physiotherapy has been shown to be helpful for relieving aura-type symptoms including balance problems and vertigo, nausea and aversion to light.

Understanding Headaches

Headaches can stem from various causes and manifest in different forms, each with unique characteristics and impacts. Understanding these aspects can help you better manage and treat them effectively.

What Causes Headaches?

Headaches can be caused by factors like stress, poor posture, and underlying medical conditions. Primary headaches such as migraines and tension-type headaches occur independently of other health issues. Migraines often come with intense pain, sensitivity to light, and nausea. Tension-type headaches are usually linked to muscle tension and stress, causing a band-like tightness and pain around your head. Secondary headaches are due to other conditions, like infections, medication overuse, or trauma to your head or neck. Understanding the cause is important for proper treatment.

Types of Headaches

There are several types of headaches, including migraine, tension-type headache, and cervicogenic headaches. Migraines often have severe pain, aura, and possible nausea. Tension-type headaches usually feel like a tight band around the head and are associated with stress or muscle tension. Cervicogenic headaches originate from neck problems, so they usually start at the back of your head and then spread around to the front. They are often one-sided or mostly on one side, and don’t swap sides within a single headache. Each type has distinct symptoms and requires different treatment approaches. Other less common types include cluster headaches and sinus headaches.

How Common are Headaches?

Headaches are a common condition, affecting people of all ages. Migraines impact about 12% of Australians, more often women than men. Tension-type headaches are the most common, experienced occasionally by most people. Frequent headaches can significantly affect your quality of life, causing missed work or school days and reducing productivity. The intensity and frequency of these headaches vary widely, with some individuals experiencing chronic daily headaches that require ongoing management.

Do I need an X-ray or Scans of My Neck or Head?

In most cases, X-rays or scans like MRIs are not necessary for diagnosing primary headaches, such as migraines and tension-type headaches. These imaging tests are usually reserved for secondary headaches, where there may be an underlying cause like a structural abnormality or injury. If you have sudden severe headaches, new symptoms, or a change in headache pattern, your doctor may recommend imaging to rule out other conditions.

How Can Physiotherapy Help Headaches?

Physiotherapy can effectively manage and reduce headaches’ intensity, frequency and duration. By using tailored assessment techniques and a variety of management strategies, physiotherapists can address the underlying causes of headaches, providing long term relief and reducing the need for medication.

Assessment and Examination

A thorough assessment is crucial. This usually starts with an in-depth conversation about your headache history, symptoms, and triggers. Your physio will conduct a physical examination to check for muscle tension, joint mobility (especially in the upper 3 spinal levels of your neck), posture, and overall neck and upper back movement.

There are some specific tests that your physio can use to identify issues related to tension headaches or cervicogenic headaches (cervicogenic headaches literally means headaches coming from your neck, which is your cervical spine). These include a variety of palpation and movement tests, and also some specific muscle endurance tests including your deep neck flexor muscles.

Understanding your headache history, plus completing a thorough physical examination, allows your physio to create a personalised treatment plan tailored to your unique needs. This will include relieving your current symptoms as quickly as possible, plus addressing the underlying cause to provide long-term relief.

Anatomy and Pathophysiology of Headaches

Headaches can originate from various anatomical and physiological sources. These include the upper cervical spine (i.e. your upper neck vertebra) and associated muscles, as well as nerves that carry sensation and pain signals from your head. There are many other causes of headache however, for the purposes of this post, we will focus on headaches involving the joints, discs, muscles and nerves in your upper neck.

Cervical Spine (Neck) and Muscular Connections

The cervical spine, especially the upper cervical spine, plays a crucial role in the development of headaches. The spine’s joints, ligaments, discs and muscles can all contribute to head pain. Dysfunction or irritation in these areas often leads to pain radiating towards the head.

Muscles such as the trapezius, sternocleidomastoid, and suboccipital muscles are directly connected to the cervical spine. These muscles can become tight or strained, leading to tension-type headaches. Vertebral joint dysfunction and poor posture frequently contribute to this muscle tension.

Spinal joints and ligaments, if irritated or injured, can also influence headaches. For example, inflammation in the cervical facet joints can send pain signals to the head. This can occur due to sustaining poor postures, stress, or overall lack of movement. from Maintaining good spinal strength and mobility is important in treating and preventing these types of headaches.

Nerve Involvement

Nerve involvement is another key factor in headaches. The trigeminal nerve, which is responsible for sensation in the face and head, interacts closely with the cervical spine through the trigeminocervical nucleus. Irritation of this nerve can result in significant headaches and pain.

The trigeminocervical nucleus is like the processing centre for the trigeminal nerve. It acts as a pathway for pain signals travelling up into the head. Because it is located in the brainstem, in the upper 2-3 levels of the neck, it means that dysfunction in the upper neck can affect the nucleus and refer pain up into the head. This can cause radiating pain and contribute to migraines.

Understanding the role of the trigeminocervical nucleus and nerves is crucial in designing effective headache treatment programs. Restoring correct mobility and strength to the upper cervical spine, which removes abnormal input to the trigeminocervical nucleus, is a key mechanism that allows physiotherapy treatment to relieve headaches.

Specific Physio Treatment For Headaches

Effective physiotherapy treatments for headaches incorporate a variety of specific techniques. These methods address muscle tension, pain relief, and strengthening.

Hands-On Treatment (Manual Therapy) and Mobilisation

Manual therapy techniques can provide rapid relief from headache symptoms. Manual therapy is used to target two main areas;

• Joint Mobilisations: specific joints are targeted to increase joint mobility and movement
• Soft Tissue Mobilisation and Massage: techniques, for example trigger point releases, focused on specific muscles or areas within muscles, are used to increase muscle flexibility and reduce tension

As well as treatment directed locally at the neck, often other parts of the spine, for example your upper back (thoracic spine), will also be addressed. This is because this area can impact the posture and movement pattern of your neck, for example if you are rounded in your upper back then this may cause your chin to poke forward and increase the curve/hollow in your neck, which can contribute to neck pain and headaches.

Exercise Prescription

Regular exercise is crucial for long-term headache management. Strengthening exercises are used to target weak muscles, especially in the neck and upper back, for example the deep neck flexors. These exercises enhance muscle support and reduce the strain that can lead to headaches.

Exercises to strengthen the postural muscles are often important. They increase your body’s ability to maintain postures for sustained periods, for example sitting at a desk, by improving the strength and endurance of certain muscles. Certain postures, such as a forward-head (“chin poke”) posture, are associated with headaches, so working on this can be important.

However, strengthening the postural muscles doesn’t always mean actually trying to change your posture. Rather, sometimes we focus on improving your body’s ability to maintain whatever posture you’re in. This is because there is no single “perfect posture” that is ideal for everyone. Rather, there is a range postures that are fine, but improving your muscle strength and endurance so you can stay in these postures for longer, without getting a headache, is important.

Incorporating aerobic exercises can also be effective, for example walking, cycling or gym classes. This type of exercise can lower stress and improve overall physical health. A holistic exercise program tailored to your needs can provide significant and lasting relief from headaches.

Lifestyle and Ergonomic Considerations

Managing headaches often involves addressing some aspects of your daily habits and environment. Your posture, activities, and in some cases strategies for handling stress, can make a big difference in headache prevention and relief.

Desk Work, Posture and Ergonomic Advice For Headaches

Posture can be a factor causing headaches by increasing tension and stiffness, especially in the neck and shoulders. When sitting at a desk, ensure your chair supports the natural curve of your spine. Your feet should rest flat on the ground, and your screen should be at eye level to avoid neck strain.

We also need to remember that there is no perfect posture that is right for everyone. Rather, research shows that breaking up sustained sitting is important. A good example that we recommend to many clients is using the “5 and 55 rule” This states that for each hour you are at work, you should spend 5 minutes away from your desk. It can be going to grab a water, walk around to speak to someone, go to the toilet, or just take a short walk somewhere. Basically, whatever posture you are in, you should try to break it up and move at least hourly.

Are Standing Desks Good For Headaches?

Standing desks can be helpful for headaches. It’s not that standing is any better than sitting, but what helps is the ability to vary your posture – mixing it up between sitting and standing. Postural variation, i.e. regularly changing between sitting and standing, is good for reducing sustained muscle contraction, tightness and fatigue. Reducing sustained muscle contractions and fatigue can be helpful for tension headaches as well as cervicogenic headaches.

Activity Modification

Certain activities can trigger headaches, especially if they involve repetitive movements, sustained or awkward positions. While it might not be practical or possible to completely avoid triggers, for example if you have a desk job then you will have to spend time sitting at a desk, being more aware of triggering activities and modifying or breaking them up can be effective. The 5 and 55 rule mentioned above is a good example of breaking up triggering activities.

As well as modifying your activity to reduce triggers, consistently doing exercises that strengthen your neck and shoulder muscles can help significantly. Activities like well-programmed gym routines, Pilates, swimming or yoga can improve your mobility as well as muscle strength, which can be very helpful for long-term headache management.

Stress Management and Relaxation Techniques

Stress is a common trigger for headaches. Effective stress management can be helped by including regular relaxation techniques. Many people find that enjoyable exercise, meditation or deep breathing exercises can effectively reduce stress and tension. “Mind-body” exercises like Pilates and yoga can also be very helpful.

Adequate sleep is also critical; aim for 7-9 hours per night. Having a consistent sleep schedule can help regulate your body’s natural rhythms and reduce stress-induced headaches. Being well-rested is important to help you cope with the inevitable pressures and demands of the day.

The Role Of Hydration and Nutrition In Headache Management

Staying well-hydrated is crucial since dehydration is a frequent headache trigger. Aim to drink water consistently throughout the day. Avoid excessive intake of caffeinated or alcoholic beverages as these can contribute to dehydration.

Nutrition plays a vital role too. Eating balanced meals at regular intervals helps maintain stable blood sugar levels, which can be a factor in managing some types of headaches. Also, be mindful of food sensitivities, as certain items like chocolate, cheese, or processed meats may trigger headaches.

Regular Exercise and Physical Activity

Regular exercise has been shown to help reduce the frequency and intensity of many headaches. Activities like walking, swimming, or cycling improve blood circulation and release endorphins, which act as natural painkillers. Aim for at least 30 minutes of moderate exercise most days of the week.

As discussed above, strengthening your neck, back and shoulder muscles through exercise can also help prevent tension and cervicogenic headaches. Physical activity has also been shown to be particularly effective in managing stress, which is a known trigger for many headaches. Remember to start gradually and choose activities that you enjoy to make this a sustainable habit.

Measuring Headache Treatment Outcomes

When evaluating treatments for headaches, it’s crucial to use effective and reliable methods. These can include pain scales, patient feedback, and clinical studies which provide evidence of the treatment outcomes.

Pain Scales and Patient Feedback

Pain scales are essential tools for measuring the intensity and impact of headaches. Methods like the Headache Impact Test (HIT-6) and the Migraine-Specific Quality of Life Questionnaire (MSQ v2.1) are widely used. These scales help quantify the severity and frequency of headaches, offering clear data on how treatments are working.

Patient feedback is also valuable. Direct feedback from those receiving treatment can provide insights on how much their pain has lessened and how their daily activities are impacted. Surveys and diaries are common ways to gather this feedback, allowing for a comprehensive view of treatment effectiveness.

Physio Treatment For Headaches – Clinical Studies and Research

Clinical studies play a major role in verifying the effectiveness of physiotherapy interventions on headaches. For instance, a 2014 study by Espi-Lopez et al showed that physiotherapy using combined manual therapy, stretches and massage therapy significantly improved headache outcomes. Another study by Jung et al in 2022 found that physio combining manual therapy and exercise significantly reduced headache frequency and intensity. Besides these, tracking outcomes using validated measures like the Patient Perception of Migraine Questionnaire (PPMQ-R) offers robust evidence of treatment benefits.

Sydney Headache Physio

If you’re dealing with headaches, physiotherapy offers an evidence-based, non-invasive and non-pharmaceutical treatment option. In some cases it can be used independently to provide effective relief, or in other cases it can work alongside other treatments, for example to significantly reduce the amount of medication needed on a regular basis.

Effective physio for headaches relies on a personalised approach, based on a thorough initial assessment by a physio with post-graduate education and experience in headache management. At Central Performance, one of our directors, Chris Jackson, has a Masters degree in Musculoskeletal Physiotherapy with a special focus on neck pain and headaches. Chris has also completed several post-graduate courses in the assessment and treatment of headaches and the upper cervical spine. With over 30 years experience, he has helped countless clients find effective long-term relief from headaches and neck pain.

More Information About Physiotherapy For Headaches

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Physio For Headaches – Frequently Asked Questions

Physiotherapy can help manage many types of headaches through manual therapy, targeted exercises, posture improvement, and modifications to lifestyle and ergonomics. Here, we’ll cover common questions about how physio can offer relief from headaches.

Can physiotherapy provide relief for cervicogenic headaches?

Yes, physiotherapy is effective for cervicogenic headaches, which arise from neck disorders. Treatments often include manual therapy, mobilisation, and exercises aimed at improving neck function and reducing pain.

What types of exercises are recommended for migraine management in physiotherapy?

Migraines can be managed with exercises focused on relaxation, muscle strengthening, and improving neck and shoulder mobility. Techniques like stretching and gentle aerobic exercises can also be helpful.

How does physiotherapy treat tension headaches?

Physiotherapy tackles tension headaches with manual therapy to reduce tension and increase mobility, exercises to improve muscle strength and length, ergonomic/workplace advice to reduce postural strain, and stress-reduction techniques, Treatment aims to reduce muscular tension and pain, often linked to poor posture or stress, as well as increase the strength and endurance of neck muscles to cope with sustained postures or stress.

Are there specific physiotherapy techniques used for headache relief?

Physiotherapists use various techniques for headache relief, including manual therapy, massage and trigger point release. These are matched with targeted exercise for clients to do at home to speed up their recovery and help self-manage their headaches in the future. These methods aim to reduce muscle tension, relieve pain, reduce sensitivity to other headache triggers, and provide long-term relief.

What role does posture play in headache physiotherapy?

Poor posture is a common contributing factor of headaches. Physiotherapy programs often focus on strengthening the spinal muscles involved with posture to reduce strain on the neck and shoulders. It is not necessarily about changing your posture, but about improving your ability to cope with sustained postures. Strengthening the postural muscles, in combination with ergonomic advice and modifying workplace habits, can be effective in reducing many types of headaches.

How often should I see a physio to relieve headaches?

The frequency of physiotherapy sessions for headache relief depends on the severity and type of headache. Initially, for a short period, you might need to be seen once or twice a week to settle current symptoms. However, as quickly as possible, the focus switches to be more about self-management with exercise and strengthening, which you are able to do independently. In this phase the frequency of your physio sessions reduces significantly, steadily dropping to once every 2-4 weeks as you improve. Once your strength, mobility and symptoms have improved sufficiently, you can stop seeing your physio, but you will usually have some quick and convenient maintenance exercises to continue on with, to make sure your symptoms stay well controlled.