According to the National Headache Foundation, over 45 million Americans suffer from chronic, recurring headaches and of these, 28 million suffer from migraine type headaches. About 20% of children and adolescents also experience significant headaches.

While there are greater than 150 types of headache, common types are:

* Tension type or cervicogenic headache – Dull pressure wrapping around the head and sometimes the neck.

* Migraine Headache – Moderate to severe throbbing, which is usually one sided. Generally lasting 4 to 72 hours, this headache can be accompanied by nausea, vomiting, light, smell and sound sensitivity as well as increasing pain with typical daily activities.

* Cluster Headache – The least common, it is a severe headache with sharp, severe pain which develops rapidly, is one-sided, usually behind the eye, lasting 30-180 minutes and generally occurring in groups, or clusters, throughout the day.

Some headaches are dangerous and merit urgent medical attention. Immediately seek medical attention if you have:

* The worst headache of your life.

* A headache associated with trouble using, coordinating, or sensing part of the body.

* A headache with a change in consciousness, an inability to speak, stiff neck, or severe fever and chills.

If you are uncertain if your headache is being caused by something dangerous, ask your primary care physician or physical therapist. He or she will refer you to a neurologist if more specialized diagnostics and treatment are indicated.

Migraine Headache is divided into two primary sub-types:

* Classical Migraine (with aura)

* Common Migraine (without aura)

Migraine headache is a painful and debilitating headache, which can be triggered by a number of environmental as well as internal, or genetic factors. Migraine treatment can be broken into two categories: preventative and abortive. Preventative treatments can include lifestyle changes, not limited to sleep, various activities, medication and diet, while abortive measures are typically medications which would be prescribed by your Medical Doctor.

Physical Therapy can play a part in a comprehensive treatment approach as part of your preventative care. This is accomplished by treating small muscles at the base of the neck that lie close to and can affect nerves associated with migraine headache pain with functional dry needling. This is followed with specific exercises to correct dysfunction, generally building strength in postural muscles of the neck. While it is not historically utilized as an abortive approach, it can be effective in decreasing or even eliminating the pain associated with migraine headache while in progress following the aura phase.

The pain of a migraine headache is often described as an intense pulsing or throbbing pain in one area of the head. However, it is much more; the International Headache Society diagnoses a migraine by its pain and number of attacks (at least 5, lasting 4-72 hours if untreated), and additional symptoms including nausea and/or vomiting, or sensitivity to both light and sound. Migraine is three times more common in women than in men and affects more than 10 percent of people worldwide. Roughly one-third of affected individuals can predict the onset of a migraine because it is preceded by an “aura,” visual disturbances that appear as flashing lights, zig-zag lines or a temporary loss of vision.

A nice example of the visual component of migraine aura.


People with migraine tend to have recurring attacks triggered by a number of different factors, including stress, anxiety, hormonal changes, bright or flashing lights, lack of food or sleep, and dietary substances. Migraine in some women may relate to changes in hormones and hormonal levels during their menstrual cycle. For many years, scientists believed that migraines were linked to the dilation and constriction of blood vessels in the head. Current research implicates the trigeminal nerve as the primary pain modulator in migraine headache. By treating structures adjacent to the trigeminal nucleus with a close neurologic connection, physical therapy be utilized to manage migraine headache. Investigators now believe that migraine has a genetic cause.

Neck Headache

A Cervicogenic headache is pain perceived in the head but referred from a primary source in the cervical spine or neck. These headaches are common and recurring. Distinguishing criteria of headaches arising from musculoskeletal dysfunction (Zito et al, 2006) include:

* Decreased range of cervical flexion/extension

* Higher incidence of painful upper cervical joint dysfunction

* Muscle tightness

Is my headache Cervicogenic?

If your headache begins with pain in the neck or the base of the head and radiates to one side of the head more often than not, is triggered by neck movements or postures, and have at least one headache per week, you may have a headache that your physical therapist can help you with.

What does physical therapy for my headache look like?

At A. Fox Physical Therapy, PC, your first appointment will be with a Doctor of Physical Therapy, where you will discuss your history including the nature and frequency of your headache. You will be screened for other medical conditions, with a thorough head and neck examination as well as shoulder and arm screening, which will direct treatment as well as potential other providers, such as a neurologist or neurosurgeon if you have concerning clinical findings.

Treatment will include interventions specific to you and your headache. These may include spinal mobilization and/or manipulation, soft tissue mobilization, specific strengthening of the neck and upper back, postural/ergonomic education, and trigger point dry needling.

If you have further questions regarding how physical therapy can play a role in reducing or eliminating your headache and improving your function, please call or email us. A DPT level PT will return your inquiry within 48 hours!