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Woman with fingers on forehead, in pain from a headache

Headaches affect 47% of the world's population. They are described by the type and location of pain in the head. Many headaches are harmless and resolve on their own. However, frequent moderate to severe headaches can impact your ability to do daily activities and affect quality of life. 

Different types of headaches include:

  • Tension.
  • Cervicogenic or neck muscle-related.
  • Migraine.
  • Secondary headaches from an underlying condition, such as:
    • Fever
    • Infectious disease.
    • Sinus disorder.
    • In rare cases, a tumor or more serious illness.
  • Unspecified headaches.

A physical therapist will perform a full examination to diagnose the type of headache. Based on their findings, they will develop the most effective treatment plan.

Physical therapy has been proven to:

  • Decrease or resolve the intensity, frequency, and duration of headaches.
  • Decrease medication use.
  • Improve function and mobility.
  • Improve ease of motion in the neck.
  • Improve quality of life.

A physical therapist treatment plan for headaches may include:

1. Manual therapy

Proven hands-on techniques can:

  • Relieve joint and muscle stiffness.
  • Increase mobility of the head and neck.
  • Decrease muscle tension and spasms.
  • Improve muscle performance.

Some physical therapists also provide dry needling for certain types of headaches.

2. Exercise

Research has shown that various types of exercises can:

  • Decrease pain.
  • Improve endurance.
  • Decrease inflammation.
  • Promote overall healing.

In addition to prescribed exercises, customized home-exercise programs are an essential part of the treatment plan.

3. Education

Educating patients has been to be helpful in lessening the severity and/or frequency of headaches. A physical therapist can teach you how to identify your specific triggers (such as diet, sleep, movement/postural habits, stressors, hydration). They also can teach how to help alleviate symptoms through a wide variety of relaxation techniques.

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Blanpied PR, Gross AR, Elliott JM, et al. Neck pain: revision 2017. J Orthop Sports Phys Ther. 2017;47(7):A1–A83. Article Summary in PubMed.

Ferracini G, Florencio LL, Dach F, et al. Myofascial trigger points and migraine-related disability in women with episodic and chronic migraine. Clin J Pain. 2017;33(2):109–115. Article Summary in PubMed.

Bevilaqua-Grossi D, Goncalves MC, Carvalho GF, et al. Additional effects of a physical therapy protocol on headache frequency, pressure pain threshold, and improvement perception in patients with migraine and associated neck pain: a randomized clinical trial. Arch Phys Med Rehabil. 2016;97(6):866–874. Free Article.

Fernandez-de-las-Penas C, Cuadrado ML. Physical therapy for headaches. Cephalalgia. 2016;36(12):1134–1142. Article Summary in PubMed.

Irby MB, Bond DS, Lipton RB, Nicklas B, Houle TT, Penzien DB. Aerobic exercise for reducing migraine burden: mechanisms, markers, and models of change processes. Headache. 2016;56(2):357–369. Article Summary in PubMed.

Louw A, Puentedura EJ, Zimney K, Schmidt S. Know pain, know gain? A perspective on pain neuroscience education in physical therapy. J Orthop Sports Phys Ther. 2016;46(3):131–134. Article Summary in PubMed.

Fernandez-de-las-Penas C, Courtney CA. Clinical reasoning for manual therapy management of tension type and cervicogenic headache. J Man Manip Ther. 2014;22(1):45–50. Article Summary in PubMed.

Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011;6(3):254–266. Article Summary in PubMed.

Zito G, Jull G, Story I. Clinical tests of musculoskeletal dysfunction in the diagnosis of cervicogenic headache. Man Ther. 2006;11(12):118–129. Article Summary in PubMed.

Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headaches. Spine (Phila Pa 1976). 2002;27(17):1835-1843. Article Summary in PubMed.

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