Firstly, knowing that physiotherapy can help headaches is a good start.

With any headache a full physiotherapy assessment is required to provide an accurate diagnosis for the correct course of treatment.

Headache is a pain in any region of the head. Headaches can range from an ache, throbbing pain or sharp pain that is on one side of the head or both. It can be isolated in one area or radiate to a large vague area around the head. While there are many types of headaches, tension type headaches, migraines and cervicogenic headaches are the most common. Below we will provide some insights into these headaches.

Tension type headache

Tension type headaches are the most common type headaches (commonly known as stress headaches). These headaches are more common in females than males (3:2 ratio). They are a dull pain, tightness or pressure around the forehead or the back of your head – it is commonly described like a clamp squeezing the skull.

Common symptoms

• Mild to moderate pain/pressure in the front, top or sides of the head
• Headache that progressively gets worse throughout the day or starts later in the day
• Difficulty sleeping
• Feeling tired
• Trouble focusing
• Mild sensitivity to light or noise
• Muscle aches

Tension headaches do not have nerve symptoms such as weakness or blurred vision. They do not have sensitivity to light or noise, stomach pain, nausea or vomiting.

Causes of tension type headache

• Emotional tension, anxiety, tiredness or stress.
• Tiredness
• Physical tension in the muscles of the scalp and neck
• Eye strain - long periods of reading, typing or concentrating
• Poor posture
• Hunger / missing meals
• Physical factors such as bright sunlight, cold, heat, noise, etc.
• Drinking too much alcohol or caffeine.

Physiotherapy treatment for tension headaches

• Joint mobilisation for stiffness in the neck and thoracic spine to help postural recovery
• Addressing postural imbalances
• Strengthening programs for weaker muscles (deep cervical flexors)
• Stretches for tight muscles (levator scapulae + deep cervical extensors)
• Muscle release of tight structures (temporalis + deep cervical extensors)
• Ergonomic corrections to workstation, sleeping, driving positions etc

Physiotherapy and ongoing posture correction helps to prevent chronic problems. If you have excruciating pain in the head, or if it is your first or worst headache, you should consult your GP or attend the nearest emergency department to rule out any serious condition.

Cervicogenic headaches

Cervicogenic headaches are a referred pain arising from irritation to the neck. They are caused by problems with the nerves, bones or muscles in neck. This type pf headache affects males and females similarly (1:1 ration).

Cervicogenic headaches can be aggravated and relieved by certain neck movements. The headache presents as a steady ache or dull feeling with varying pain intensity. Usually mild to moderate and always accompanied by neck pain that moves to the head or face.

Common symptoms

• Pain on one side of the head or face, area like a ram’s horn
• Made worse with neck movements or posture
• Tenderness in the upper neck
• Restricted or stiff movement of the neck and associated neck pain
• Increased tightness in the neck muscles and upper shoulder muscles
• Pain around the eyes

Causes of cervicogenic headache

• Poor posture, unknowingly pushing chin forward,  putting your head in front of your body, such as hairdressers, carpenters, drivers, office workers
• Trauma due to sports or recreational injury or whiplash from a car accident
• Degenerative conditions such as arthritis or prolapsed disc in the neck
• Pinched nerve in or near neck

Physiotherapy treatment strategies for cervicogenic headaches

• Spinal mobilisation of aggravated structures in the neck
• Soft tissue release of irritated structures
• Offloading irritated structures
• Strengthening of deep neck stabilisers
• Dry needling
• Postural correction and ergonomic corrections to workstation, driving station etc

Migraine headache

A migraine can be episodic or a chronic headache. It is thought to be caused by an overactive nerves cell that cause sensations to be felt over the head and face. As a result of this overactivity, the body responds by releasing various chemicals causing increased swelling/inflammation leading to pain.

Prevalence of migraine

• Women have migraines 3 times more often than men
• Common between the ages of 10-40 (most women find they go away after the age of 50)
• Increased likelihood if a parent has migraines
• Often experience comorbid depression and anxiety

Common symptoms of migraine

There are many different types of migraine with varying symptoms and severity. Migraines may present either with or without aura. The headache can last between 4 hours and 3 days and have a mixture of symptoms.

Symptoms include:

• Severe pain usually on one side of the head
• Dull ache growing into a worsening throbbing headache
• Sensitivity to light and noise
• Pain increases with physical activity
• Nausea, as well as vomiting
• Pale and feeling faint

Often feel vaguely unwell for a day or two beforehand (prodromal) with symptoms including:

• Increased sensitivity to light, sound, or smell
• Fatigue
• Behaviour changes
• Difficulty in concentrating, confusion
• Neck and shoulder stiffness
• Constipation or diarrhea
• Changes in food cravings

Physiotherapy treatment for migraine headaches

The use of medicines to manage acute pain and symptoms is effective. In addition, prophylaxis is often needed to prevent recurrence and chronic migraine is often needed. Physiotherapy treatment can help in the ongoing prevention of migraines.

• Reducing muscle tension in neck shoulder and back.
• Education of relaxation of tight muscles over the head/neck - biofeedback
• Addressing muscle imbalances that stabilise the neck/head with physical therapy
• Advice on avoidance of triggers to reduce frequency/onset of the attack
• Increasing activity and exercise in everyday life