Headache & Migraine

Headache & Migraine

Which type of headache might physiotherapy be able to help with?

  • Tension type headache

  • Cervicogenic headache
  • Migraine
  • Cluster headaches
  • T4 syndrome
  • Sinusitis

Tension Type Headaches

Tension type headaches (TTH) are a the most common type of primary headache that can be caused by stress, long work hours, depression, eye strain (frowning or squinting), and are more common in females than males. Jaw clenching or grinding your teeth at night may give you (TMJ) tempero-mandibular Joint pain as well as headaches on one or both sides of the head. Neck and shoulder posture can put strain on the neck, which in turn may irritate a nerve supplying the sensory part of the head or the tight muscles can directly pull on the head / scalp. Tension headaches can be constant or intermittent and often occur at the end of the week or at end of the month.

Physiotherapy is one of the main treatments used for this type of headache, as it can be improved or even eliminated through a variety of physiotherapy treatment techniques such as soft tissue mobilisation, joint mobilisation, Trigger point release, relaxation, acupuncture, changes to posture and muscle re-training.

Cervicogenic headaches

Cervical headaches are a secondary headache where by pain is felt in the head from a source in the neck. They can occur due to tightness or postural abnormalities, and are mostly associated with the upper two vertebrae of the spine, though they may also originate from lower segments. The location of pain within the neck is often a good indicator of the location from where the headache has arisen. The sufferer may or may not have segmentally restricted movement in the upper neck, and is usually tender to touch over the upper neck.

The pain experienced from these headaches is most commonly on one side, although the pain can occur on both sides. There is not usually a pattern of frequency, severity or duration. Sufferers may have a history of neck trauma and/or poor posture, or repetitive postures in the work place, or sporting, recreational activities.

Physiotherapy treatment for these headaches has been shown to be very successful including individual postural changes, soft tissue and joint mobilisation, acupuncture, core muscle re-training and corrected movement pattern dysfunctions.


With aura (classic)

Migraines are classically preceded by an aura, a vision of specs, flashes, zigzags or similar visual changes and occur more frequently in females. An episode is usually preceded by large change in mood being either positive or negative, the day or night prior to the headache.

The ache is usually on one side on the front and/or the back of the head. A sufferer may feel sick and/or vomit, and is photosensitive and will therefore usually prefer a dark room. They may also lose part of their field of vision.

This form of headache is often treated with early medication, which is best taken when having an aura.

Without aura (common)

With common migraines there are no warning signs. The symptoms may be similar to a classic migraine, but may not include all of them making them more challenging to diagnose.

The pain often lasts until the sufferer goes to sleep, and they usually wake feeling washed out with a dull ache and experience an increased sensitivity of their vision and hearing. Their triggers can vary greatly and involve consumption such as alcohol, nitrites (such as in preserved meats), MSG, tyramines (such as in tomatoes, chocolate, orange juice, red wine, aged cheeses, chicken skins) or even a low blood sugar level. Insufficient or excess sleeping may also contribute to the onset of a common migraine. Although often difficult, it is of great benefit to find the trigger and reduce or avoid it.

60% of people with migraine have neck pain, a symptom more prevalent than nausea. There are several relationships that migraine and neck pain can occur:

  • Separate neck pain and migraine
  • Neck pain is a symptom of migraine
  • Neck dysfunction is triggering migraine

Although a physiotherapist cannot directly affect the vascular aspect of your migraine, they can reduce the associated neck and radiating head pain symptoms successfully with a combination of soft tissue and joint mobilisation, trigger point release, stretching, posture re-education, ergonomic alterations, specific muscle strengthening and lifestyle changes with awareness of aggravating factors.

 Cluster Headaches

Cluster Headaches are usually one-sided and frequently start in the eye and spreads throughout the head and neck. Often fuelled by stress, the sympathetic nervous system can also contribute to this form of headache. They can last anywhere between 10 minutes and 2 hours, and one can have several of these headaches per day. The sufferer’s eye may redden or tear-up and the eyelid may droop on the affected side. These headaches are more commonly seen in males.

These headaches can be improved through relaxation techniques, acupuncture, soft tissue techniques and addressing movement dysfunctions.

Local injection to the neck and nasal oxygen can also be helpful during the attack.

 T4 syndrome

T4 syndrome, a headache that arises in the mid to upper back often involves the entire head, or paraesthesia (tingling, pins and needles, or numbness) The headache is usually described as a fuzzy or fluffy feeling like cotton wool in the ears, or a band around the head similar to a tension headache.

Physiotherapy treatment is often very successful with the use of techniques such as mobilisations, manipulations, correction of movement dysfunction or work position, and retraining of muscles required for correct posture. Anti-inflammatory medication, if appropriate, is often helpful in conjunction with other treatment.


A sinus headache can occur when a sinus or nasal passage is inflamed. With this form of headache, sufferers often complain of pain and pressure around the eyes, across the cheeks, the forehead and possibly an ache in the upper teeth. Associated symptoms generally include facial swelling, stuffy nose with discharge, and possibly even fever and chills. Leaning forward or lying down often worsens the headache, and the headache is often worse in the morning than in the afternoon.

Treatment aims to reduce inflammation and associated swelling, as well as to enhance drainage from the sinuses and nasal passages. Your doctor can work with you to give you medication like anti histamines or work on desensitising you to your allergy. Acupuncture can be very successful to help to relieve the pain associated with this type of headache.


Treatments offered at Neurological Physiotherapy to treat headaches and migraines


  • Soft tissue mobilisation
  • Trigger point release
  • Joint mobilisation
  • Myofascial release
  • Functional stability rehabilitation
  • Biofeedback
  • Acupuncture
  • Pilates
  • Postural and ergonomic correction





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