Headaches, Migraines, and Physical Therapy: Where Does PT Fit In?
If you deal with recurring headaches, you may have wondered whether your neck, your workouts, or even the way you sit at your desk is contributing. Physical therapy can be part of the answer, but the first step is understanding what kind of headache you’re experiencing. A migraine, a tension-type headache, and a headache arising from the neck may need different approaches.
A migraine is more than a bad headache
Migraine is a neurological condition. An attack may involve head pain along with nausea, sensitivity to light or sound, and difficulty carrying on with normal activities. Neck pain can also be part of a migraine attack. Having both neck pain and migraine does not automatically mean the neck caused the migraine—an important distinction when deciding what to treat.
Other common headache patterns include:
Tension-type headache: Often experienced as pressure or tightness on both sides of the head.
Cervicogenic headache: A headache associated with a problem in the neck. A clinician looks for evidence linking neck symptoms and movement to the headache; neck pain alone is not enough to make this diagnosis.
It’s possible to experience more than one headache type. That’s why a conversation about your symptoms matters more than simply finding a tight muscle and assuming it explains everything.
How can physical therapy help?
1. Build an exercise routine you can tolerate.
Exercise may help some people manage migraine over time. A clinical practice guideline supports aerobic exercise, moderate continuous aerobic exercise, yoga, and exercise paired with lifestyle recommendations for improving migraine symptoms, disability, or quality of life. A PT can help you find a starting point and progress gradually, especially if you’ve avoided activity because you’re worried it will bring on symptoms. Exercise is one part of migraine care, alongside appropriate medical treatment.
2. Assess a possible neck contribution.
If turning your head, sustained positions, or neck symptoms appear closely linked to your headaches, a PT can examine neck movement and function. For cervicogenic headache, research suggests that exercise and some hands-on treatments may help, although the certainty of evidence for many specific treatment combinations is low. Your treatment plan should follow your assessment and response, rather than a single technique used for every headache.
3. Address tension-type headaches.
PT approaches such as exercise and manual therapy have been well studied for tension-type headache. A review of randomized trials found potential benefits, while also showing that the best approach is not firmly established. This is another reason to choose care based on your symptoms and goals.
4. Help you return to the activities that matter to you.
Headaches can make it hard to stay consistent with work, exercise, and everyday life. PT can help you adjust activity when symptoms flare and build back toward your usual routine. If you have migraines, your PT can also work alongside the clinician managing your migraine diagnosis and medications.
When should a headache be medically evaluated?
Seek urgent medical care for a sudden, severe headache that reaches peak intensity quickly, especially if it is unlike your usual headaches. New weakness, confusion, or other concerning neurological symptoms also need prompt evaluation. Arrange a medical assessment for a new or clearly changing headache pattern, a headache after an injury, or a new headache during pregnancy or after delivery. These situations call for medical evaluation before assuming the headache is a muscle or neck issue.
The takeaway
PT may be helpful for headaches associated with neck problems or tension, and it can help people with migraines build a manageable exercise routine. The goal is to understand your headache pattern, identify what PT can address, and coordinate with medical care when needed.
At Kinetix PT & Wellness, I offer mobile, individualized physical therapy to help you move with more confidence and work toward the activities you enjoy. If recurring headaches or neck symptoms are affecting your routine, book a free 15-minute discovery call to talk about whether PT could be a good fit.
Sources
Luedtke K, et al. Prescription of therapeutic exercise in migraine: An evidence-based clinical practice guideline. The Journal of Headache and Pain, 2023. Read the guideline.
Physical Therapist Interventions to Reduce Headache Intensity, Frequency, and Duration in Patients With Cervicogenic Headache: A Systematic Review and Network Meta-Analysis. Physical Therapy, 2024. Read the review.
Physical Therapy in Tension-Type Headache: A Systematic Review of Randomized Controlled Trials. International Journal of Environmental Research and Public Health, 2023. Read the review.
International Headache Society. International Classification of Headache Disorders, 3rd edition: Cervicogenic headache. Read the diagnostic criteria.
American Migraine Foundation. Neck Pain and Migraine. Read the article.
American Headache Society. Red Flags in Headache—What if it isn’t Migraine? Read the article.
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