Can Physiotherapy Help My Headaches?

That’s a great question. If only there were a straightforward answer to it! Well there is, kind of?

The simplest answer to that question is if after a thorough assessment of the joints, muscles and nerves of your upper neck and head, it is concluded that your upper neck is likely to be a (or the) cause for your headache, then physiotherapy treatment is likely to help alleviate or resolve your headache, and this includes migraines, Yes Migraines.

But first let’s talk about the numerous types of headache out there.

The International Headache Society (IHS), an international professional organisation, is responsible for identifying the different types of headache that people suffer from.

The IHS has identified well over 200 different types of headache (IHS 2018)! Surely there can’t be 200 different reasons for the onset and continuation of headache and migraine?

To ‘help’ with things the IHS categorises headache into the following categories: Primary, Secondary and Cranial Neuropathies (IHS 2013).

PRIMARY HEADACHE types have been traditionally thought to largely originate within the central nervous system (CNS), this includes the brain itself. Historically, they have been thought to have no identifiable cause. Let’s just more precisely say, ‘none we’ve been able to work out, to this point’. These types of headache include all forms of migraine, as well as tension type headache (TTH) and other significantly debilitating headache like cluster headache.

SECONDARY HEADACHE types have more easily recognisable causes. There are those that are more sinister or serious, caused by things like tumours, strokes, infections and bleeds within the skull and brain. Needless to say, prompt onward referral to an emergency department is indicated when it is thought one of these is responsible for your headache(s).

Cervicogenic Headache patterns

Lumped in with these are the more benign causes of headache that have a recognisable cause. This is where the neck comes in. These are called cervicogenic headache (CGH). CERVICOGENIC HEADACHE involve neck issues causing headache and are most easily treated with manual therapy treatment, as well as other physiotherapy treatment that address issues related to muscle strength, control of muscles and rehabilitation for dizziness and postural instability that comes from issues originating from the neck.

Categorisation tries to group together headaches of a similar origin, or according to some other shared trait. However, they are ‘man made’ categories, which are imperfect, not least of which because they rely both on a correct diagnosis and that all headaches are distinct entities with no crossover or interaction between them. Here are some of the problems that have been identified by research regarding these issues.

The third type of headache, CRANIAL NEUROPATHIES, are caused by diagnosed issues with the nerves that supply sensation to the head. A typical example is trigeminal neuralgia, a nasty nerve condition caused by increased sensitivity of the trigeminal nerve, one of the cranial nerves that originate in the brainstem and which supply sensation to areas of the face, mouth and jaw.

There is significant symptom overlap between the different headache types.

One study found that 56.4% of 430 cervicogenic headache patients also experienced other types of headache, which indicates (at least) the co-existence of tension type headache and migraine +/- aura (Pfaffenrath & Kaube 1990)

In another study it was concluded that up to 50% of headache are misdiagnosed (Pfarffenrath 1990).

Furthermore, another study found that 33% of individuals who have been diagnosed with cervicogenic headache fulfil the IHS criteria for migraine (Vincent 1999).

So, that’s why I say there is a simple answer, kind of, to what types of headache can be treated by physiotherapy treatment!

How the Neck causes Headaches

The simple answer is that all benign (i.e. those without sinister or serious causes) headache should be thoroughly assessed, whatever your diagnosis (diagnoses) in order to appreciate if there is an element of your headache that is contributed in part, or whole, from your upper neck. Where a pattern of impairment (issues) with the joints, muscles and nerves of the upper neck and head is established through careful and thorough assessment, then physiotherapy treatment is more likely to alleviate your headaches and migraines.

It is my experience from treating headache for almost twenty years that those who present with headache only originating from their neck – cervicogenic headache are most amenable to manual therapy treatment and respond quickest.

For these people resolution of their headaches, and migraines, is a realistic outcome from physiotherapy treatment.

For those who have multiple reasons for their headache presentation, or who present with multiple types of headache and migraine but who have identifiable issues in the joints, muscles and nerves of their neck that contribute to their headaches are likely to be significantly helped; in terms of the frequency, intensity and duration of their headaches and migraines, with the physiotherapy treatment that I provide. 

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Written By David Saligari, MCSP, Headache Specialist