What Can Physical Therapy Do For My Headaches?

Among the many conditions that physical therapy can help with, headaches are one of the worst kept secrets. Headaches (and migraines) affect nearly 12% of our population and are the 5th most common emergency room presentation. Despite how common this issue is, people are unaware of their treatment options. If you or someone you know is affected by chronic or frequent migraines/headaches, physical therapy may be helpful. In addition to physical therapy, your headache management team may consist of a primary care physician, neurologist, occupational therapist, or psychologist.

There are MANY different types of headaches. The most common types can be divided into a few categories: primary headaches, secondary headaches, and neuralgias. Primary headaches include migraines, tension type headaches, and cluster headaches. These are termed “primary” headaches, as they originate due to pathologies within in our brain and central nervous system. Secondary headaches can be due to peripheral factors such as neck pain, poor posture, trauma, etc. These include cervicogenic headaches, medication related headaches, whiplash disorders, post-traumatic (concussion) headaches, or headaches related to TMJ dysfunction. Our last category, neuralgias, involve irritation of cranial nerves or peripheral nerves and may result in head or facial pain. In more serious conditions, headaches may be related to central nervous system disorders, stroke, or more serious medical conditions which should be managed by a physician or specialist. *

Medical management is crucial in the treatment of chronic type headaches or migraines. Physical therapy is important to optimize the rest of the body. We aim to decrease stress and tension in the neck musculature, increase the strength of postural musculature, improve body mechanics catered towards your preferred recreational activities, and provide education on healthy habits in regards to sleep hygiene, work setup, and stress management. If your headaches are already being medically managed at this time, co-treatment of physical therapy may help to decrease frequency or severity of your headaches.

Common Headache Presentations**:

Migraines: Longer lasting (hours to days), more severe, aggravated with exercise, may have light or sound sensitivity

• Triggers specific to migraines: hormones, sleep, meal skipping, stress, weather change, red wine, foods, smells, lights

Tension Type Headache: may be short or long lasting, “band like tightening” or “pressure” sensations, mild-moderate severity, not aggravated with exercise

• This category is often confused with Cervicogenic Headaches as people mistakenly associate “tension” with muscular tension. If you feel your headaches are related to “tension/tightness/stiffness/stress” of your neck or jaw see below.

Cervicogenic (Neck): Headaches are related to neck pain, increased neck/shoulder pain leads to onset of headache, shorter duration, affected by posture

If any of these sound like your symptoms please feel free to schedule an appointment to see how physical therapy can help you. As mentioned above, we highly recommend co-treatment with medical management and would be happy to discuss any necessary referrals for you.  In the meantime, some tools to keep in mind while trying to manage your headache symptoms can include

• Adequate sleep

• Adequate water intake

• Diaphragmatic breathing and muscle relaxation (Lots of helpful tutorials on the web! Or feel free to contact one of our therapists)

• Regularly timed meals

• Avoiding prolonged, uninterrupted phone/computer time

* Symptoms such as “first and worst headache of your life”, headache peaks within 1 minute of onset, headache brought on with exertion, systemic issues such as fever/weight loss/chills, or upper extremity numbness/tingling should be treated by a physician, specialist, or emergency department

** These are rough guidelines and are not meant to use as the sole diagnosis for headache type, please see a medical professional to diagnose your headache

Written by Alexandra Cohen PT, DPT