Headache Management

Physiotherapy Management of Headache in Kingston

Assessment. Treatment. Management. Discover if physiotherapy can help your headache.

Why does my head hurt and how can physiotherapy help for headaches?

Headaches are a common occurrence for many people and often have us reaching for over the counter pain medication. Migraines, also experienced by many, are typically a more severe headache, and can be extremely disruptive to daily life. What causes our headaches and what can we do about them?

The International Classification of Headache Disorders helps to categorize the causes and types of headaches that we experience. Ninety percent of headaches are classified as Primary Headaches, meaning that they are not caused by other diseases or disorders such as cancer or hypertension.

Women dizzy holding head

These Primary Headache disorders are placed into 4 categories:

Most of us are familiar with the first 2 categories, with migraine being the most well-known, perhaps due to its disabling nature. It is characterized by moderate to severe episodes of head pain, which is throbbing or pulsing, and often preceded or accompanied by disturbing neurologic symptoms known as an “aura”. An aura will commonly involve visual hallucinations or disturbance. In addition to aura, migraines can also feature severe nausea, light, sound and smell sensitivity. Migraine pain is typically only felt on one side of the head at a time. Migraine symptoms seem to be caused by changes in neurotransmitter behaviour in the brain and may have many different triggers.

In contrast to migraines, which involve the central nervous system, tension headaches are typically non pulsating and would be described as mild-moderate or less intense relative to a migraine. The head pain would more commonly be described as tightness, pressure, or sometimes a band-like sensation encircling the head. The distribution of the pain is more likely to be on both sides of the head and neck. It is not uncommon for the person to also have pain in the muscles used for chewing – the masseter and the temporalis. These muscles are involved in Temporo-Mandibular Dysfunction (TMD). This is not surprising given that our chewing muscles are well known to be “stress muscles”. Tension headaches are considered to be the most common headache disorder, and migraine headaches are the 3rd most common primary headache disorder.

The most common type of TAC is the cluster headache. It is feared due to the severity of its symptoms and is considered one of the most painful conditions that humans can experience. The pain is most commonly experienced in or around the eye and accompanied by autonomic features such as flushing and sweating. Similar to migraine, it almost always involves only one side of the face/head.

As the name implies, secondary headaches are caused by other disorders. One example would be the headache side effect from medications or from caffeine withdrawal. Another familiar form of secondary headache would be the headache associated with disease or injury to the head or neck such as that experienced from concussion or ‘whiplash’ injury in motor vehicle accidents.

Physiotherapy management of Headache

When we are experiencing recurrent or disabling pain, we commonly seek out the assistance and guidance of our family physician or nurse practitioner (NP). Physicians and NPs are well positioned to rule out headache disorders that require medical investigations and intervention. Headaches from hypertension, inflammation, infection, tumour, medications, stroke, to name just a few, require medical diagnosis and management.

Physiotherapists however have a strong role to play in the diagnosis and management of benign types of primary headache that are not associated with disease. Physiotherapists have strong musculoskeletal assessment skills and can categorize and diagnose the above classes of benign headache. Your physiotherapist knows that there are many potential contributors to your migraine or your tension headache.

These could include:

  • Spine
  • Jaw
  • Stress
  • Hormones
  • Sleep
  • Diet
  • Ergonomics
  • Weather
  • Exercise
  • Alcohol/caffeine

Given their robust knowledge of anatomy and physiology, physiotherapists can educate you about your potential musculoskeletal triggers, and coach you in the development of self-management strategies. There are also many physiotherapy treatment tools that can be used to treat your headaches between, and during the painful attacks or episodes.

Physiotherapy Assessment for Headache

An important part of your physiotherapy assessment is the “story” of your headache experience. The physio will take the time to ask detailed questions to fully understand the features of your headache such as:

  • Intensity or severity
  • History of episodes
  • Frequency of episodes
  • Distribution or location
  • Duration of “attacks”
  • Triggers
  • Effect of medication or previous forms of treatment
  • Alleviating factors

With a full understanding of the headache behaviour, your physiotherapist will physically assess your:

  • Posture
  • Spine
  • Musculature
  • Jaw

Treatment Plan

The treatment plan is very specific to each individual headache condition and will therefore vary between individuals. The cause and source of your headache will often dictate the approach. For example, if your headaches are being generated from your discs, joints and muscles of the neck, methods will be employed to address these tissues. If your headaches are migraineous or of the cluster variety, your physiotherapist is likely to use methods to address your nervous system in contrast to the musculo-skeletal system.

Management Tools

  • Manual therapy – soft tissue and spinal mobilization of the head, neck and upper back
  • Cervical traction
  • Acupuncture, Intramuscular stimulation (IMS), Functional Dry Needling
  • Education – advice and recommendation on posture, activities, sleep hygiene, exercise
  • Electrotherapy such as Ultrasound, Therapeutic LASER, TENS, NMES,
  • Cold and heat


The success of treatment for headache depends on many factors but in general physiotherapy is very successful in reducing headache frequency, intensity and duration, and can even lead to resolution of the condition.  Schedule a consultation with a physiotherapist at Best Health to learn more about your headaches, lessen your medication reliance, reduce your headache suffering, and better manage your headache condition.

Best Health Physiotherapy has physiotherapists with training and expertise specific to the management and treatment of Headaches. Contact us to find out more or see if treatment can help you.

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