Physical Therapist's Guide to
Pain of any type that occurs in any part of the head is called a headache. There are many different types of headaches, with just as many causes. The International Headache Society describes several different categories of headache:
- Migraine and cluster
- Secondary headaches from an underlying condition, such as fever, infectious disease, sinus disorder, or in rare cases, a tumor or more serious illness
- Cranial neuralgias, facial pain, and other headaches
Most headaches are harmless and resolve on their own, although severe headaches that recur frequently can affect your ability to do your daily activities and can reduce your quality of life.
There is effective treatment for almost every type of headache. The challenge lies in determining the type of headache, its cause, and in developing an appropriate treatment plan that will reduce both its frequency and intensity. Physical therapists can help determine the type of headache you have and are experts in managing pain from tension-type headaches.
What are Headaches?
Headaches, like back pain, are one of the most common of all physical complaints and can be one of the most frustrating to manage. Pain of any type that occurs in any part of the head is called a headache.
Tension-type headaches (also called muscle-spasm headaches) are the most common types of headaches in adults. They may be the result of a neck or jaw problem, poor posture, fatigue, or stress.
A problem in the neck, head, or jaw--such as an injury or arthritis--can lead to tension in the muscles at the back of the head and to increased pressure on the nerves to the face and head. Poor posture can cause these muscles to become overworked, which can trigger a headache.
How Does it Feel?
A tension-type headache typically begins at the back of the head and spreads to the top of the head and the eyes. You might feel an increase in facial pain along the cheeks near the jaw bone (temporomandibular joint dysfunction). People often describe a tightness, a sensation of someone tugging on their hair, or a feeling of wearing a tight cap. These headaches can worsen with specific positions--such as sitting at a desk--and may ease with rest.
How Can a Physical Therapist Help?
Your physical therapist will conduct a thorough examination that includes a review of your health history. Your therapist will ask you questions and will perform tests to determine the most likely cause of your headaches. For example, your therapist might:
- Ask you:
- to recall any previous injuries to your neck, head, or jaw
- the location, nature, and behavior of your pain and other symptoms
- to draw your areas of pain on a body diagram
- Perform tests of muscle strength and sensation
- Examine your posture when sitting, standing, and performing various activities
- Measure the range of motion of your neck, shoulders, and other relevant parts of your body
- Use manual therapy to evaluate the mobility of the joints and muscles in your neck
If it appears that you do have tension-type headaches, your physical therapist will work with you to design a plan of care to meet your goals. If the evaluation indicates that you may have a different type of headache--such as sinus, migraine, or cluster headache--your physical therapist likely will refer you to another health care professional for additional diagnostic tests and treatment.
Your physical therapist will work with you to correct the problems that are causing your pain and will help you learn to prevent headaches through simple changes in your posture and lifestyle:
Improve neck mobility. Physical therapists use a specialized technique called manual therapy to increase movement and relieve pain and to stretch the muscles of the back of the neck.
Improve your strength. Your physical therapist will teach you exercises to increase the strength of the muscles that help stabilize your upper back and neck to improve your posture and endurance and make it easier for you to sit or stand for longer periods of time without discomfort.
Improve your posture. Physical therapistswill teach you to ways to improve your posture. Whether it is simply pushing your chest out or pulling your shoulder blades backward and together, slight modifications to everyday living can make a vast improvement in posture.
Modify your workstation or home office. Tips may include:
- using a headset instead of a regular phone
- adjusting your computer screen so that it is no lower than the level of your eyes
- finding an appropriate desk chair
- adjusting the position of your computer mouse
Real Life Experiences
Sarah has noticed over the past 2 weeks that she has experienced a "pressure sensation" starting at the base of her head that travels to the front of her forehead when she is sitting at her computer for more than an hour. Her discomfort increases as the day goes on, but is less on weekends.
She decides to consult her physical therapist to see if physical therapy can help. Her therapist discusses her symptoms with her, examines her, and determines that her headache is a tension-type headache resulting from tightness in the muscles of the neck. The therapist works with Sarah to treat her pain, increase her flexibility and strength, and improve her posture.
The physical therapist also offers suggestions for making changes to her workspace. For instance, Sarah makes sure that her computer monitor is directly in front of her and at eye level; she buys a new desk chair; and she now uses a headset for her phone. She quickly notices that her headaches are much less severe and that she can work at the computer for longer periods of time. Soon, Sarah is headache-free.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with musculoskeletal problems. Some physical therapists have a practice with a craniofacial focus, meaning that they focus on movement disorders related to the skull and facial structures.
- A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in orthopedic physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with headaches.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
APTA has determined that the following articles provide some of the best scientific evidence on how to treat cervicogenic headache. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free access of the full article, so that you can read it or print out a copy to bring with you to your health care provider.
Becker WJ. Cervicogenic headache: evidence that the neck is a pain generator. Headache. 2010;50:699–705. Article Summary on PubMed.
Hall T, Briffa K, Hopper D, Robinson K. Reliability of manual examination and frequency of symptomatic cervical motion segment dysfunction in cervicogenic headache. Man Ther. 2010;15:542–546. Article Summary on PubMed.
Hall T, Briffa K, Hopper D. Clinical evaluation of cervicogenic headache: a clinical perspective. J Man Manip Ther. 2008;16:73–80. Free Article.
van Duijn J, van Duijn AJ, Nitsch W. Orthopaedic manual physical therapy including thrust manipulation and exercise in the management of a patient with cervicogenic headache: a case report. J Man Manip Ther. 2007;15:10–24. Free Article.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.
Authored by Eric S. Furto, PT, DPT. Reviewed by the editorial board.