Physical Therapy for Headaches

Physical Therapy for Headaches

Headaches can be a painful condition for many individuals, impacting their everyday activities. There are many different types of headaches including migraines, tension-type headaches, cluster headaches, cervicogenic headaches, and many more. Determining the best treatment options for each of these can be a daunting task with options including medications, surgeries, modalities, etc.

Physical therapy could be an option for you if you are someone who suffers from headaches. Research has shown that the presence of neck pain in those with headaches is as high as 68.4%.¹ There is also a higher chance of suffering from myofascial tenderness, which is a condition treatable by Physical Therapists.¹

Headaches can be caused by many different issues some of which may need immediate medical attention. Physical Therapists are trained to determine when a headache can be managed by therapy or if it requires treatment from another healthcare provider.

Which headaches can we treat?

Cervicogenic Headaches (CGH)

Physical therapy has been shown to improve CGHs, which are classified as a condition where pain is referred to the head and/or face from the cervical spine.⁴ There are many areas of the neck that can create symptoms in the head and face, creating these headache sensations.^4,5,6 These headaches often present on one side of the head traveling from the base of the skull to the eye and worsen with neck movements or being in one position for a long period of time.^4,5 CGHs impact as high as 2.5% of the general population and can be as high as 20% in patients with chronic headache.⁶ Over half of people who have suffered from a previous neck injury also have a CGH.

How do we treat this?

Evidence-based treatments that are shown to improve this condition include but are not limited to manual therapy for the neck and upper back, exercises geared towards strengthening the often neglected deep neck flexors, and progressive resistance exercise for the shoulder blade and upper back.⁴ Symptoms have been shown to resolve within 3 months after successful treatment of the involved area.⁷

Tension-Type Headaches (TTH)

Tension-Type Headaches often present with face and neck muscle tenderness when episodes occur.⁵ TTHs occur on both sides of the head and present with a pressing or tightening sensation around the head.⁵ They often are not aggravated by routine physical activity and do not present with nausea or vomiting. It is estimated that approximately 40% of the US population suffers from Tension Type Headaches, more commonly in women younger than 40 years of age.⁸

How do we treat this?

Physical Therapy has not been shown to completely cure tension headaches, but instead can reduce the intensity, frequency, and duration of the pain associated with these headaches.⁹ Individuals also report improved quality of life and neck motion with treatment.⁹ Soft tissue mobilization, cervical manual therapy, therapeutic exercise, and dry needling are just some of the evidence-based interventions we can use to help with this condition.^9,10,11,12 Physical Therapy Plus is one of the few clinics locally that provides dry needling as an intervention choice with 3 of our clinicians certified in this area.

Disclaimer

Several conditions can cause headaches other than the conditions listed in this article. Other causes of this pain may not benefit from the advice shown above. Signs and symptoms that require immediate medical attention along with the headache include:

• Fever, muscle pain, and weight loss
• Changes in cognition, mental function, personality changes, and/or sensation or weakness in other parts of the body
• Sudden and severe headache that may or may not occur with strenuous activity
• Having new onset of headaches at an older age of greater than or equal to 50
• If this new headache is different from previous headaches such as more severe, frequent, or presents with new symptoms

Please seek medical attention immediately if you fit any of the criteria listed above. These could indicate a more serious and potentially harmful issue causing your headaches that require immediate treatment.

References

1. Ashina S, Bendtsen L, Lyngberg AC, Lipton RB, Hajiyeva N, Jensen R. Prevalence of neck pain in migraine and tension-type headache: a population study. Cephalalgia. 2015 Mar;35(3):211-9. doi: 10.1177/0333102414535110. Epub 2014 May 22. PMID: 24853166.
2. Magarey ME, Rebbeck T, Coughlan B, et al. Pre-manipulative testing of the cervical spine review, revision and new clinical guidelines. Man Ther. 2004;9:95–108.
3. Childs JD, Flynn TW, Fritz JM, et al. Screening for vertebrobasilar insufficiency in patients with neck pain: manual therapy decision-making in the presence of uncertainty. J Orthop Sports Phys Ther. 2005;35:300–306.
4. Neck Pain Guidelines: Revision 2017: Using the Evidence to Guide Physical Therapist Practice. J Orthop Sports Phys Ther. 2017 Jul;47(7):511-512. doi: 10.2519/jospt.2017.0507. PMID: 28666402.
5. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. doi: 10.1177/0333102413485658. PMID: 23771276.
6. Biondi DM. Cervicogenic headache: a review of diagnostic and treatment strategies. J Am Osteopath Assoc. 2005;105(4 Suppl 2):16S–22S.
7. Cumplido-Trasmonte C, Fernández-González P, Alguacil-Diego IM, Molina-Rueda F. Manual therapy in adults with tension-type headache: A systematic review. Neurologia. 2018 Mar 7:S0213-4853(18)30013-6. English, Spanish. doi: 10.1016/j.nrl.2017.12.004. Epub ahead of print. PMID: 29525399.
8. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998 Feb 4;279(5):381-3. doi: 10.1001/jama.279.5.381. PMID: 9459472.
9. Del Blanco Muñiz JA, Zaballos Laso A. Cefalea tensional. Revisión narrativa del tratamiento fisioterápico [Tension-type headache. Narrative review of physiotherapy treatment]. An Sist Sanit Navar. 2018 Dec 26;41(3):371-380. Spanish. doi: 10.23938/ASSN.0379. PMID: 30425380.
10. Gildir S, Tüzün EH, Eroğlu G, Eker L. A randomized trial of trigger point dry needling versus sham needling for chronic tension-type headache. Medicine (Baltimore). 2019 Feb;98(8):e14520.
11. Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Effectiveness of dry needling for headache: A systematic review. Neurologia. 2020 Jan 13:S0213-4853(19)30144-6. English, Spanish. doi: 10.1016/j.nrl.2019.09.010.
12. Van Suijlekom HA, Lame I, Stomp-van den Berg SG, et al. Quality of life of patients with cervicogenic headache: a comparision with control subjects and patients with migraine or tension-type headache. Headache. 2003;43:1034–1041.