Headaches and Physiotherapy

Treating Headaches with Physiotherapy

According to the International Headache Society there are over 150 forms of headaches, each with varying causes and symptoms.  Often people will present to physiotherapy clinics for treatment and it is important for the physiotherapist to differentiate which headache patients will or will not benefit with physiotherapy treatment.  In simple terms, physiotherapist can treat headaches that originate from the neck, otherwise known as Cervicogenic Headaches.

The first task for a physiotherapist assessing a headache patient is to screen for any sinister medical conditions. These can include (but not limited to) brain tumours and cerebral haemorrhages.  Some common symptoms of a sinister headache include (but limited to); a severe headache of sudden onset (the worst headache you have ever experienced, otherwise known as a thunderclap headache), seizures, headaches more intense in the night and early morning, headaches with signs of fever and headaches that are increasing in intensity for no particular reason.  If you experience any of these symptoms you should see a medical practitioner for an assessment. This is only a short list of symptoms indicating sinister pathology and it should be noted that these conditions are rare.  Nevertheless, it is important to exclude any of these conditions before progressing with physiotherapy treatment.

Some of the other common types of headaches seen in practices, which do not fall in the “sinister” category, include Cervicogenic Headache, Tension Headaches and Migraine.

The best way to explain the cause of a cervicogenic headache is as follows. A sore neck will produce pain signals in the nerves inside your upper neck (cervical nerves).  These signals will travel through the cervical nerves to a structure called the Trigeminocervical Nucleus (TCN), a central point that also receives information from the nerves of the face and skull (Trigeminal nerve).  The signals from the neck will then be relayed to the brain where they are processed and felt as neck pain.  However, the TCN can send signals to the brain in an unpredictable manner and can sometimes send incorrect signals.  As a result the brain perceives the pain as coming from the skull and/or face as well as the neck, resulting in a cervicogenic headache.  In this case, the source of the problem is the neck but the brain perceives it as coming from the head.


A typical feature of cervicogenic headache is that pain commences in the neck and then radiates to the head.  Figure 1 shows one of the typical pain patterns of a cervicogenic headache.  This is different to a migraine where pain will commence in the head.  It is different to a tension headache which produces more widespread pain around the neck and head and is described as a pressing or tightness pain.

Fig 1.  A typical pain pattern for a cervicogenic headache.

On physical examination a patient with cervicogenic headache will normally have restricted movement and pain on palpation of the neck, typically reproducing the headache pain.

Treatment for cervicogenic headaches include:

·         Posture correction and advice

·         Avoiding aggravating movements and postures

·         Stretching exercises

·         Therapist mobilisation techniques

·         Musculoskeletal dry needling

·         Deep cervical flexor muscle retraining

Physiotherapists cannot treat pure tension headaches or migraines because they do not originate from the neck.  However there are clients who can present with more than one form of headache, therefore some tension headache or migraine suffers may have coexisting neck pain and cervicogenic headaches.  These patients may get some symptomatic relief from physiotherapy treatment.  For this reason a detailed physiotherapy assessment is important to correctly identifying and classifying headaches, whether they are cervicogenic or not.  If a patient presents to a physiotherapist with a headache that does not have a cervicogenic origin, appropriate advice can be given and a referral to an appropriate medical practitioner can be made.

If you think you suffer from cervicogenic headaches see a physiotherapist for a detailed assessment.

Daniel Di Mauro is a McKenzie Credentialied Physiotherapist working with Advance Healthcare in St Albans. Daniel specialises in the care of spinal pain.  The St Albans clinic services nearby areas such as Sunshine, Patterson Lakes and Caroline Springs with evidence based, thorough Physiotherapy, Psychology and Pain Management services.

Daniel speaks fluent Italian. For more on Daniel, click here